PARUMAL CHOUDHARY vs Life Insurance Corporation of India

THIS appeal under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 10.1.2002 in Complaint No. 251/2000 by District Consumer Disputes Redressal Forum , Bilaspur (hereinafter called the ''District Forum'' for short) dismissing the complaint.

THE complainant''s wife Injana Bai obtained a life insurance policy for the assured sum of Rs. 50,000/- from the respondent Life Insurance Corporation. THE proposal form was submitted by the insured on 30.12.1993 wherein she stated that her health was good and she also stated that she was never required to take any treatment etc. during the last 5 years. THE said policy covered the risk of the life of Injana Bai from 28.12.1993 to 28.12.2008. Undisputably insured Injana Bai expired on 27.6.1995. The complainant, husband of Injana Bai and nominee under the policy, laid claim with the respondent insurer for payment of the assured amount. The claim was however, repudiated by the respondent insurer by their letter dated 3.9.1996 on the ground of material suppression of facts by the insured, in her proposal form. The complainant, therefore, filed the complaint before the District Forum praying that the respondent/insurer be directed to pay him the assured sum of Rs. 50,000/- with compensation etc.

Respondent insurer resisted the claim. According to respondent insurer, the insured Injana Bai died of Acute Haemorrhagic Pancreatitis with respiratory failure with septicemia. It was averred that the insured suffered from the said disease much earlier prior to the submission of the proposal form. It was, therefore, averred that there was material suppression of facts, on the part of the insured regarding the state of her health and ailment suffered by her. The repudiation was, therefore, justified.

THE District Forum in the impugned order relied upon the certificate of the hospital treatment dated 30.8.1995 and held that the deceased insured suffered from similar attack 3 years back i.e., prior to the submission of proposal form and died of the said ailment. It was, therefore, held that she suppressed the said material facts in her proposal form. THErefore, repudiation of complainant''s claim by the respondent insurer was held to be bona fide. THE District Forum accordingly dismissed the complaint. Learned Counsel for the appellant submitted that there was no justification for repudiating his claim. It was submitted that it was the burden of the respondent insurer to have proved their defence of material suppression by the deceased. It was submitted in the above context that no reliable material has been placed by the respondent insurer to substantiate their contentions as above and that they have failed to show that the insured suppressed any material facts.

THE respondent''s learned Counsel however, reiterated its stand in the complaint and urged that medical certificate issued by Dr. Arun Balani as well as Sr. Consultant of J.L.N. Hospital, Bhilai clearly indicate that the deceased died of Acute Haemorrahgic Pancreatitis etc. and the certificate of hospital treatment of J.L.N. Hospital further discloses that she suffered from similar attack 3 years back, prior to her death. It has, therefore, to be considered as to whether there was any suppression of material facts by the insured in her proposal form? As noticed above the deceased was treated for Acute Haemorrhagic Pancreatitis as was certified by Dr. Arun Balani in his certificate dated 6.12.1995. Copy of certificate of hospital treatment by Sr. Consultant Surgeon, J.L.N. Hospital, Bhilai has also been filed which discloses that the deceased insured was admitted in the hospital on 15.6.1995 and died on 27.6.1995 during treatment. It also states that the insured was operated for pain in abdomen on 9.6.1995 at Bilaspur. In Column 7 of the said certificate, it has been stated that history of similar attack 3 years before, history of jaundice 6 months back and the patient was a known case of Ischaemic heart disease and hypertension. It appears from Column 5(b) of the certificate that son of the patient was present in ICU and that the patient was conscious. It is also stated that history was given by the son of the patient. The name of the doctor who issued the certificate is not mentioned in the certificate of hospital treatment. Neither any affidavit of the said doctor or the son of the deceased has been filed. It would also appear from the certificate of hospital treatment that the history was recorded by Dr. Mahaural. However the said doctor issued any certificate on 13.8.1995, is not clear from the said document. No record of the previous treatment of the deceased which allegedly took place 3 years back, has been produced. There is no material on record to show as to what was the actual ailment suffered at that point of time by the deceased.

IT may be noted in the above context that the deceased was operated at Bilaspur hospital for pain in abdomen and in view of the above, it is quite possible that the son of the deceased might have told the doctor on duty that she had history of similar attack 3 years back but that by itself would not establish that the deceased knew that she suffered from Hypertension, Jaundice and Haemorrhagic Pancreatitis. Therefore, certificate of medical treatment does not prove that the deceased suffered from diseases from 3 years prior to her death or that she knew that she was suffering from the said ailments. In the absence of any such material, it cannot be said that the deceased insured suppressed material facts at the time of submission of proposal form dated 30.12.1993. The District Forum was not justified in holding that the deceased insured suppressed material facts about her health or previous ailment. The complainant/appellant, therefore, deserves the amount under the policy as claimed by him.

ACCORDINGLY the complaint and appeal are allowed. The impugned order is set aside. The respondent/insurer shall pay to the complainant/appellant the assured sum of Rs. 50,000/- with interest @ 10% per annum from the date of complaint. The cost of this appeal quantified at Rs. 1,000.00 (one thousand) only shall also be payable by the respondent/insurer to the complainant/appellant. Appeal allowed.