NARINDER KAUR vs Zonal Manager, Life Insurance Corporation of India

THIS is an appeal filed against order dated 1.8.2003 passed by District Consumer Disputes Redressal Forum-II [for short hereinafter referred to as the District Forum] in Complaint Case No. 866 of 2002 vide which the complaint case of the appellant was dismissed on the finding that there was no deficiency in service on the part of the respondents.

THE deceased husband of the appellant Smt. Narinder Kaur namely Mr. Kuldeep Singh afforded to take insurance policy on his own life from the Life Insurance Corporation of India (for short hereinafter referred to as the LIC of India) and approached the O.Ps. for the same purpose. He wanted the insurance of his own life for a sum of Rs. 1 lakh w.e.f. 6.2.1998 for a period of 15 years under Term-14. While considering the matter of insurance, Mr. Kuldeep Singh had been medically examined by a doctor appointed by Senior Divisional Manager, LIC, Northern Zone Office, Sector 17-B, Chandigarh and the deceased Mr. Kuldeep Singh filled in certain information regarding his state of health which was put to him in questions and answers which have been extracted in the impugned order in Para No. 6. THE deceased Mr. Kuldeep Singh gave answers in the negative to the questions (a), (b), (c), (d) and (e) and described in question (f), regarding his usual state of health, as ''Good''. Late Mr. Kuldeep Singh died on 28.2.2000 at PGI, Chandigarh where his history of illness was recorded, inter alia, as under : "Known case of diabetes mellitus, Detected to have triopathy and chronic renal failure. Was admitted under Endochronology services from 13.1.2000 to 7.2.2000 for acute on chronic renal failure and fluid overload. Needed dialysis. Improved and discharged. On admission in emergency he came under out-patient and altered sansorin (sic) Found to have hypoglycima also had b/c broncho pneumonia. Put on isotrixs antibiotics. Expired on 28.2.2000." When the appellant/complainant filed a claim under the policy before the LIC of India/respondents, an inquiry was made while considering the question of payment of the sum insured and the respondents learnt that the insured Mr. Kuldeep Singh had been on sick leave from 3.1.1998 to 28.1.1998 and he remained on leave during this period as he was hospitalized in General Hospital, Sector 16, Chandigarh (vide Annexure R-4). Initially he was admitted from 3.1.1998 to 21.1.1998 and then his admission required further hospitalization and he applied for sick leave from 22.1.1998 to 28.1.1998. The Discharge Certificate was issued from the General Hospital, which is Annexure R-5 and which showed that he was admitted to the Hospital on 6.1.1998 and discharged on 21.1.1998 and was suffering from Bronchopneumonia and Cervical Spondylitis. He also complained of fever off and on, cough along with general weakness.

In Column No. 3 of the Certificate of the Hospital treatment of Mr. Kuldeep Singh (copy Annexure R-6), his earlier hospitalization for Endocronology Services in PGI, Chandigarh was mentioned. The cause of death as per Annexure R-6 was Septic Shock and Antecedent Causes were as ''Type II diabetes Mellitus with Triopathy''. The other significant conditions were ''Acute on Chronic Renal Failure and Bilateral Bronchopneumonia''.

IT is relevant to note that during the period of hospitalization in General Hospital, Sector 16, Chandigarh in January 1998, late Mr. Kuldeep Singh had been on sick leave from 3.1.1998 to 28.1.1998 whereas the Proposal Form was filled, in which the answers to the questions were given, on 2.2.1998 i.e. after a lapse of four days and still the answers regarding the state of health, illness, hospitalization were given in negative. The claim preferred by the complainant/appellant was repudiated by the respondents on the ground that there was deliberate suppression of the true state of health at the time when the Proposal Form taking the policy of self-life was filled by the deceased Shri Kuldeep Singh and because of this deliberate suppression, the policy was granted to him and insurance cover for Rs. 1 lakh was issued. The District Forum held that it had reason to believe that the insured had deliberately and intentionally concealed these very material facts with mala fide and fraudulent intention and after citing the citation of Hon''ble Supreme Court in the case of "Life Insurance Corporation of India and Others v. Smt. Asha Goel and Another, I (2001) SLT 89=AIR 2001 (SC) 549, the O.Ps were held justified in repudiating the claim. The judgments of the Hon''ble National Consumer Disputes Redressal Commission. New Delhi delivered in the case of "LIC of India & Ors. v. Smt. C.P. Kacheebi, Revision Petition No. 207 of 1998 decided on 4.3.2002 and Life Insurance Corporation of India v. Mansa Devi, Revision Petition No. 148 of 1998 decided on 3.9.2002.

THE notice of appeal was issued to the respondents who put in appearance through Mrs. Vandana Malhotra and Mr. Rajneesh Malhotra, Advocates. THE record of the complaint case was summoned. We have heard the learned Counsel for both the sides and carefully perused the impugned order as well as the record of the complaint case. The learned Counsel for the appellant contended that the respondents failed to lead proper and credible evidence to prove that there was any malicious and fraudulent intention on the part of the deceased Mr. Kuldeep Singh in filling the Proposal Form and particulaly when he had been examined by the own doctor of the LIC of India/respondents. He also relied on the authority of the Hon''ble Supreme Court in the case of Life Insurance Corporation of India and Others v. Smt. Asha Goel and Another (Supra). We have carefully perused the record of the case and we find that the respondents have placed on record the relevant documents showing about the illness of late Mr. Kuldeep Singh and his hospitalisation for treatment before giving answers to the questions which were submitted along with the Proposal Form. Evidence by way of affidavit of Mr. I.P. Puri, Manager (Legal and HPF), LIC of India, Sector 17, Chandigarh was filed who deposed in Para 1 that he was fully aware of the facts of the present case and was authorised by the Competent Authority to submit an affidavit on behalf of the O.Ps. He has referred to the facts relating to the illness of the insured late Mr. Kuldeep Singh and made reference to the Judgment of the Hon''ble Supreme Court in the case of Mithu Lal Naik v. LIC, AIR 1962 SC 841, wherein the life assured was examined by as many as four doctors of the Corporation and it was held that the respondent company would have had no means of knowing the serious ailment of the insured without his giving information regarding the same in the proposal form.

IN the instant case, the LIC of INdia could not have learnt about the ailments with which Mr. Kuldeep Singh suffered and which was in the exclusive knowledge of the INsured. There is no satisfactory reason mentioned in the evidence of the complainant which is in the shape of her afidavit that her husband did not suffer from the illness at the time when he filled the proposal form though it has been deposed by her in Para 3 of the affidavit that insured (deceased) fell ill on 18.1.2000 and was admitted in PGI, Chandigarh and ultimately he expired on 28.2.2000. The Death Certificate had been issued and was annexed as Annexure C-5. The appellant/complainant was also in the know of the illness with which her husband suffered and about the sick leave and hospitalization of her husband but there is no proper explanation or reason mentioned in the affidavit as to why on 2.2.1998 while filling the proposal form, the answers were given by her husband in negative regarding the true state of health with reference to Questions (a) to (e) and describing his state of health as ''Good'' in reply to Question (f). The Death Certificate is based on the information furnished by the PGI, Chandigarh. Since the admission of the deceased-insured Mr. Kuldeep Singh in PGI, Chandigarh is an admitted fact by the complainant, the record of PGI, Chandigarh becomes relevant and it did not required to be formally proved. So far as the law laid down by the Hon''ble Apex Court in the case of Life INsurance Corporation of INdia and Others v. Smt. Asha Goel and Another (supra), is concerned, the Hon''ble Apex Court has held that the burden of proving the fact that the insurer who gave wrong answers to the questions while filling up the proposal form, knew about the illness with which he suffered and for the treatment of which he had been hospitalized and also availed leave for illness but suppressed it intentionally and mala fidely.

THE respondent-LIC of India in the instant case led evidence which has been referred to above to show that immediately prior to the filling up of the proposal form and giving answers to the questions which was done on 2.2.1998, the deceased-insured was suffering from the disease aforesaid for which he had been hospitalized and received treatment in January, 1998 itself and was on leave up to 28.1.1998. It has not been rebutted by the appellant/complainant that her husband did not remain on leave for getting treatment and was not admitted in the hospital for the treatment of the disease aforesaid. It cannot thus be said that the respondent did not lead proper evidence to prove that the deceased-insured gave wrong replies to the questions while filling up the proposal form regarding his true state of health on 2.2.1998. THE District Forum has, in our considered opinion, rightly held that the deceased-insured knew fully well about his true state of health and the illness with which he suffered and for which he got treatment and remained on leave yet he gave wrong answers about his true state of health. The District Forum, in our considered opinion, rightly held that there was no deficiency on the part of the O.Ps. and has rightly dismissed the complaint. There is no merit in the appeal, which is dismissed. However, under the circumstances of the case, the costs of appeal shall be borne by the parties themselves. Copies of this order be sent to the parties free of charge. Appeal dismissed.