Life Insurance Corporation of India Ltd. vs NARSINGH PRASAD THAKUR

THIS appeal under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 21.1.2003 in Case No. 519/2002, by District Consumer Disputes Redressal Forum, Raipur (hereinafter called as ''District Forum'' for short) whereby the complaint of the complainant/respondent was allowed, and the opposite party/appellant was directed to pay him the sum assured under two policies taken by the deceased Veer Singh.

FACTS no longer in dispute are : that the deceased Veer Singh was the brother of complainant/respondent. Veer Singh obtained two policies on his life : first on 9.8.2001 for assured sum of Rs. 1,00,000/- and the other on 21.8.2001 for the assured sum of Rs. 60,000/-. The said policies were effective on 15.8.2002, the date of death of the policy holder. The cause of death of Veer Singh was Cerebral Malaria. The complainant/respondent laid claim with the appellant/insurer for payment of the sum, assured under two policies, obtained by his brother - deceased Veer Singh. The claims as above were repudiated by the appellant by letters dated 26.2.2002 and 3.6.2002, on the ground that Veer Singh did not disclose that he was suffering from diabetes for a period of 3 years, prior to obtaining policies of insurance on his life.

The learned District Forum held that it has not been proved that the deceased Veer Singh suffered from diabetes as alleged by the appellant/insurer. It was further observed by the learned District Forum that there was no connection between diabetes and cerebral malaria which was the cause of death of Veer Singh. It was, therefore, held that the claims of appellant could not justifiably be repudiated. Accordingly, complaint was allowed and the appellant was directed to pay the sum assured.

LEARNED Counsel for the appellant/insurer submitted that the complainant''s brother Veer Singh deliberately misrepresented and suppressed the fact of his ailment. It has been submitted that the certificate of Dr. Chandrakar who treated Veer Singh clearly shows that Veer Singh was suffering from diabetes before and prior to his filling up the proposal forms. However, Veer Singh in the proposal forms filled up by him did not disclose the ailment as above. Had he done so, the appellant would have considered as to whether the policy should be issued on his life, and if so, on what terms? It is, therefore, submitted that there was material suppression of fact by Veer Singh which vitiated the agreement of life insurance between the parties. Learned Counsel for the respondent however, supported the impugned order. It was submitted that the burden of proving that Veer Singh suffered from diabetes was on the insurer/appellant. It was further submitted that the death of Veer Singh occurred on account of cerebral malaria which had no connection with the ailment of diabetes. There was, therefore, no justification for the appellant/insurer to repudiate the claim of the complainant/respondent.

IN view of the contentions as above, it has to be considered as to whether there was material suppression of fact by Veer Singh as a result of which the agreement of his life insurance stands vitiated. As laid down by National Commission in the New India Assurance Co. Ltd. v. P.P. Khanna, II (1997) CPJ 1 (NC)=1997 (2) CPR 21 (NC), that the insurer could not avoid consequence of insurance contract by simply showing inaccuracy or falsity of statement. Burden is cast on the insurer to show that the material matter or facts have been suppressed which it was material for the policy holder to disclose and that the statement was fraudulently made by the policy holder with the knowledge of the falsity of the statement. The appellant''s learned Counsel laid great emphasis on the certificate dated 11.2.2002 issued by Dr. Chandrakar. As per certificate dated 11.2.2002 of Dr. Chandrakar, Veer Singh was suffering from Sugar (Diabetes) for the last about three years. However, it may be noticed that in the said certificate, question No. 2 was to the effect as to what was the nature of the disease ? The answer was malaria fever. Question No. 3 of the said certificate was, how long he has been suffering from the disease ? Answer was Sugar for the last three years. Question No. 5 was, when was they first observed by the deceased ? The answer was last three years before his death. Question No. 8 was, what other disease or other illness proceeded or co-existed with disease mentioned under question No. 2. The answer was malaria fever. Obviously, the answers to the above questions were incorrect. It is nobody''s case that the deceased was suffering from malaria for last 3 years, as appears to be the purport of the said certificate dated 11.2.2002.

IT may further be noticed that Dr. Chandrakar himself issued another certificate dated 13.10.2001 earlier, which is also on the record of the District Forum. IT is not stated therein that the deceased Veer Singh suffered from diabetes for the last three years. IT is also clear from the said certificate dated 13.10.2001, that the deceased suffered from malaria from 17 days prior to his death on 30.8.2001. This earlier certificate dated 13.10.2001 nowhere mentioned that the deceased suffered from Blood Sugar or diabetes as has been stated in the certificate dated 11.2.2002 issued later by Dr. Chandrakar. What was the basis for issuing the certificate dated 11.2.2002 is not disclosed. IT would, therefore, be clear that subsequent certificate dated 11.2.2002 by Dr. Chandrakar issued after about six months after death of deceased is inconsistent with his earlier certificate. IT may be noticed that appellant has not furnished any prescription or diagnosis by Dr. Chandrakar or any other material to show that the deceased was suffering from diabetes for the last three years.

IN view of the above, it is clear that the appellant insurer failed to establish that the deceased was suffering from diabetes for the last three years. That being so, it cannot be inferred that there was material suppression of fact by the deceased. Further, it may be noticed that the deceased died due to cerebral malaria. The said disease has no connection and was not caused due to diabetes. For this reason also, it cannot be held that there was suppression of any material fact by the deceased. The findings of the learned District Forum are wholly justified and do not call for any interference. This appeal has no substance and is accordingly dismissed. The cost of this appeal shall be borne by the appellant. It shall also pay cost of the respondent which is quantified at Rs. 500/- (Rupees Five hundred only). Appeal dismissed.