RAMRATTI vs Life Insurance Corporation of India And Ors.

REVISION Petition No. 409 of 2013 has been filed by the petitioner/complainant against the order dated 18.10.2012, passed by Haryana State Consumer Disputes Redressal Commission, Panchkula (short, "State Commission") in First Appeal No. 1476 of 2006. Brief facts of the case as per petitioner/complainant are that Shri Chander Hass Yadav, husband of the petitioner was serving in Air India as ASO and took a LIC policy on 28.2.2001 for Rs. 1 lakh. Unfortunately, the life insured died on 19.1.2004 of Septic Shock, as per death summary issued by Pushpawati Singhania Research Institute for Liver, Renal and Digestive Diseases, New Delhi. The petitioner submitted a claim with the respondent but the same was repudiated on the ground that before taking of the policy, the life assured was chronic alcoholic as well as a chronic smoker for the last 30 years and had been diagnosed as a patient of severe upper G1 Hemorrhage and Grade IV Desophageal Varices for which he was taking medical treatment from Pushpawati Singhania Research Institute for Liver, Renal and Digestive Diseases, New Delhi. This fact, however, was not disclosed by him in the proposal form while giving his personal statement. Hence, the petitioner challenged the repudiation of her claim by filing a complaint.

RESPONDENT Nos. 1 and 2/opposite party Nos. 1 and 2 in their reply before the District Consumer Disputes Redressal Forum, Jhajjar (short, ''District Forum'') has stated that; "The deceased life assured was suffering from Septic Shock and as the duration of the policy was less than three years and this being the early claim, it was subjected to death claim investigation as per death claim settlement procedure in vogue. During investigation, it was revealed that life assured was a chronic alcoholic and smoker for the last 30 years as is evident from question No. 11 of Form 3784 furnished by Dr. (Col.) Arun Kumar VSM, MD (Med.) DM (Gastro) AIIMS, New Delhi. The immediate cause of death was decompensated chronic liver disease as per death summary and form 3816 issued by Pushpawati Singhania Research Institution, New Delhi. The cause of death is directly related to his being chronic alcoholic and smoker for the last 30 years at the time of his admission in the Pushpawati Singhania Research Institution, New Delhi. Hence, the deceased life assured did not disclose correctly regarding his health and habits at the time of proposal and had given false answers to question Nos. 11(h) and 11(i) of the proposal form dated 18.3.2001."

District Forum vide order dated 12.5.2006 while allowing the complaint observed that: "Further the OPs have not placed any cogent or convincing evidence to prove his allegations. Hence, we observe that the OPs have wrongly and illegally repudiated the claim of the complainant.

In view of the above discussion, we have no option except to allow the present complaint. Accordingly, present complaint is hereby allowed by giving direction to pay Rs. 1 lakh including all benefits comes under the policy as insured sum to the complainant within a period of one month. Accordingly, present complaint is hereby disposed of."

AGGRIEVED by the order of the District Forum, the respondent Nos. 1 and 2 filed an appeal before the State Commission. The State Commission in its impugned order dated 18.10.2012 held as under: "Undisputedly the life assured had obtained the insurance policy bearing No. 172432591 dated 18.3.2001 for Rs. 1 lakh and died on 19.1.2004. It has also come on the record that life assured was chronic alcoholic as well as chronic smoker for the last 30 years prior to the obtaining of insurance policy. The life assured was suffering from chronic disease prior to the date of purchasing the insurance policy as is evident from the death summary issued by Pushpawati Singhania Research Institution for Liver, Renal and Digestive Disease which reveals that the life assured was having history of alcoholic and a chronic smoker for the last 30 years. But this fact was not disclosed by the life assured in the proposal form.

By now, it is well settled law that a contract of insurance is based on the doctrine of uberrima fides, i.e., ''utmost good faith'', in the conduct of the insured. The life assured is under an obligation to disclose each and every aspect with respect to his/her health at the time of submitting the proposal form giving personal statement.

In view of our aforesaid discussions, it has been established on the record that the life assured had concealed the true and material facts with respect to his state of health before purchasing the insurance policy and for that reason the appellant -opposite parties cannot be held liable to pay any insurable benefits as per terms and conditions of the insurance policy. District Consumer Forum has failed to appreciate the above stated evidence. Hence, the impugned order cannot be allowed to sustain.

For the reasons recorded above, this appeal is accepted, the impugned order is set aside and the complaint is dismissed."

HENCE , the revision petition. We have heard the son who is the Authorized Representative of the petitioner and the Counsel for respondents and carefully gone through the record.

SHRI Shashi Bhushan, Authorized Representative of the petitioner argued that Shri Chander Hass his father worked in Air India and was perfectly healthy before his death except that he has some liver complaint. He argued that the doctors had concocted and prepared a fictitious record in the death summary.

COUNSEL for respondents drew our attention to the death summary in the Pushpawati Singhania Research Institution, where it is clearly recorded that Mr. Chander Hass, a 51 years old male patient was admitted in Pushpawati Singhania Research Institution on 13.12.2003 with severe upper G1 Hemorrhage. He was a known alcoholic for 30 years and also a chronic smoker for 30 years. On admission, the patient was conscious and alert, Upper G1 Endoscopy was done which revealed Grade IV esophageal varices, EST was done. Further, treatment record was establishes; that the patient was being treated for chronic liver failure secondary to decompensated cirrhosis of liver with sepsis with hepatic encephalopathy. He also drew our attention to the proposal form submitted by Shri Chander Hass, where there is a specific query in point No. 10(h) which reads as "Do you use or have you ever used alcoholic drinks, narcotics or any other drugs? (i) Alcoholic drinks,

(ii) Narcotics,

(iii) Any other drugs,

(iv) Tobacco in any form."

Against this he has written categorical ''No'' against all columns.

Undisputedly, the life assured had obtained the insurance policy. We do not agree the facts recorded in the death summary are concocted by the doctors as alleged by Shri Shashi Bhushan. There is no reason for the doctors to do the same. The earlier history of the patient is invariably given by the patient or the attendants who accompany him. The facts of the patient history has to be given and recorded factually and truthfully as depending upon them the diagnosis is made and treatment is given. The treatment given also fully supports the facts recorded on admission. These are also supported by the affidavit of the Assistant Admn., Legal and HPF Department, LIC which reads as under: "AFFIDAVIT

Mrs. Sushma Jalali, aged about 53 years Assistant Admn. Officer, Legal and HPF Department, LIC of India, Divisional Office Sector -1, SCO, Rohtak do hereby solemnly affirm and state as under - -

That I am working as Asst. Admn. Officer, Legal and HPF Department, LIC of India, Divisional Office Sector -1, SCO, Rohtak, as such conversant with the facts of the case, borne out from the official records, authorized and competent to swear this affidavit.

After receipt of order dated 17.1.2014, I approached to the Pushpawati Singhania Institute for Liver and Renal Digestive diseases, Sheikh Sarai, New Delhi and contacted the concerned official and shown the copy of the said order issued by this Hon''ble Commission and requested the hospital authority to issue true copy of the history and findings on admission of the deceased life assured. The attested true copy of the history and findings on admission which shows that the deceased was chronic, alcoholic (drinking since 30 years) and chronic smoker since 30 years. The said copy is annexed hereto as Annexure -Y.

DEPONENT

Verification:

Verified at on this day of March 2014 that the contents of the above affidavit are true to my knowledge and believed to be true and nothing material has been concealed therefrom.

DEPONENT"

THE true attested copy of the history and findings shows that Shri Hass was a chronic alcoholic and chronic smoker since 30 years. Hence, the State Commission has correctly accepted the appeal of the respondents and set aside the complaint of the petitioner/complainant. We do not find any error in the order passed by the State Commission.

HON ''ble Supreme Court in Mrs. Rubi Chandra Dutta v. M/s. United India Insurance Co. Ltd., : IV (2011) SLT 303 : II (2011) CPJ 19 (SC) : 2011 (3) Scale 654, has observed: "Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21(b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view than what was taken by the two Forums. The decision of the National Commission rests not on the basis of some legal principle that was ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts. This is not the manner in which revisional powers should be invoked. In this view of the matter, we are of the considered opinion that the jurisdiction conferred on the National Commission under Section 21(b) of the Act has been transgressed. It was not a case where such a view could have been taken by setting aside the concurrent findings of two Fora."

Thus, no jurisdictional or legal error has been shown to us to call for interference in the exercise of powers under Section 21(b) of Act. Since, the State Commission has given detailed and reasoned order which does not call for any interference nor it suffer from any infirmity or erroneous exercise of jurisdiction or material irregularity. Thus, the present revision petition is hereby dismissed. No order as to cost.