Senior Divisional Manager, Life Insurance Corporation of India vs KRISHNA DEVI

THE present appeal, filed by the appellants, under Section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as ''the Act''), is directed against order dated 12.1.2001, passed by District Forum (New Delhi), in Complaint Case No. TC/1070/98-entitled Smt. Krishna Devi v. THE Senior Divisional Manager, Divisional Office-II, Life Insurance Corporation of India & Anr.

THE facts, relevant for the disposal of the present appeal, briefly stated, are that the respondent, Smt. Krishna Devi had filed a complaint under Section 12 of the Act, before the District Forum, averring that her husband late Shri Desh Ram Yadav had taken a Life Insurance Policy bearing No. 120293896 for Rs. 1,00,000/-, which was issued by the appellants. It was stated that the complainant, being the wife of the deceased, was appointed as a nominee to receive the amount in respect of the abovesaid policy in case of death of the person, whose life was assured. It was stated that said Shri Desh Ram Yadav, whose life was assured under the abovesaid policy, unfortunately, expired on 23.7.1994. THE respondent, being the nominee, preferred claim in respect of the policy amount but the same was repudiated by the appellants vide letter dated 30.3.1996. It was stated, in the complaint, filed by the respondent, that the repudiation of the claim by appellant No. 1, was illegal and unjust. It was prayed, in the complaint, filed by the respondent, said Smt. Krishna Devi, that the appellants be directed to release the claim of the respondent without any delay together with interest @ 24% per annum. The claim of the respondent, in the District Forum, was resisted by the appellants who had filed a joint reply/written version. In the reply/written version, filed on behalf of the appellants, before the District Forum, certain preliminary objections were taken to the effect that the respondent had not approached the Forum with clean hands; that the complaint filed by the respondent, did not disclose any cause of action; that the complaint filed by the respondent, was an abuse of the process of law and the machinery set up under the Act and that the complaint, filed by the respondent, was against the principles of ''Uberima Fides''. On merits, it was stated that the claim of the respondent was repudiated after due application of mind and that the repudiation was absolutely valid, legal and justified. It was stated that the claim of the respondent had been repudiated bonafidely on the ground of mis-representation and withholding of material information of vital facts with regard to the state of health of the assured at the time of taking out the policy in question. It was stated that there was no deficiency in service on the part of the appellants and the complaint filed by the respondent, be dismissed with heavy costs.

The parties led evidence by filing documents and by affidavits, in the District Forum. On behalf of respondent, affidavit of the respondent, Smt. Krishna Devi was filed, whereas on behalf of the appellants an affidavit of Shri S.K. Gubrele, Senior Divisional Manager of the appellants had been filed.

THE learned District Forum, vide impugned order, has allowed the complaint filed by the respondent, and has held the appellants guilty of deficiency in service and on the basis of the above findings, has passed the order, being impugned in the present proceedings. Feeling aggrieved, the appellants have preferred the present appeal before this Commission under Section 15 of the Act.

WE have heard the learned Counsel for the appellants at length on the question of admission of the present appeal and have also carefully gone through the documents/material on record. On the basis of material on record, it is an admitted fact that late Shri Desh Ram Yadav, husband of the respondent, took a Life Insurance Policy for Rs. 1,00,000/- on 15.3.1994, issued by the appellants and the respondent, Smt. Krishna Devi, being the wife of the assured, was appointed as nominee to receive the amount in case of death of said Shri Desh Ram Yadav. It is also not in dispute that the person, whose life was assured, namely Shri Desh Ram Yadav, expired on 23.7.1994 and after his death, the respondent preferred a claim in respect of the policy amount. The only question requiring consideration is, as to whether the repudiation of the claim by the appellants, in the facts and circumstances of the case, was justified or not. The appellants, vide their letter dated 30.3.1996 (copy at pages 40 and 41 of the paper book) have repudiated the claim of the respondent on the ground that the deceased, Shri Desh Ram Yadav, had made deliberate mis-statement and withheld material information from the appellants regarding his health at the time of effecting assurance with the appellants. During the course of arguments, it is stated by the learned Counsel for the appellants, that before taking the policy in question, said Shri Desh Ram Yadav was suffering from Puo-Typhoid-UTE, for which, he received treatment in Raj Hospital, Nazafgarh. On record at page 34 of the paper book, there is a photocopy of Medical Certificate issued by Dr. R.S. Sharma of Raj Hospital dated 4.7.1993, in which, the nature of illness has been stated as Typhoid. Thereafter, there is copy of another document, issued by the abovesaid hospital at page 35 of the paper book, which is dated 5.7.1993, wherein, the abovesaid hospital has certified the fitness of said Shri Desh Ram Yadav. On record, at page 37 of the paper book, there is a copy of ''Sickness Certificate'', issued by ''Vishwakarma Medicare Centre'', in which, the description of the disease is mentioned as UTD. In respect of the above illness also, there is a Fitness Certificate dated 17.9.1993, issued by the abovesaid Institute declaring said Shri Desh Ram Yadav, as fit. Similarly, on record, at page 38 of the paper book, there is a photocopy of certificate issued by Dr. R.S. Sharma of Raj Hospital dated 9.5.1993 stating the nature of disease as PUO followed by Fitness Certificate dated 10.5.1993, issued by the same hospital in respect of said Shri Desh Ram Yadav. All the above mentioned certificates are prior to 15.3.1994, last being 17.9.1993, declaring said Shri Desh Ram Yadav, as fit to resume his duties. In our opinion, in the peculiar facts and circumstances of the case, it cannot be stated that said Shri Desh Ram Yadav had made any deliberate mis-statement of facts in respect of his health. Moreover, the nature of disease, suffered by said Shri Desh Ram Yadav, was temporary. There are certain diseases such as hypertension, diabetes, diseases relating to kidney, heart, which effect the life span of a person and if any mis-statement is made in respect of such type of diseases by the person seeking insurance, in that event, it can be believed that knowingly the person taking out the insurance has made mis-statement. If anyone suffers from temporary illness, such as fever, cough, cold etc. and the same is not mentioned at the time of taking insurance, it cannot be stated in true sense that a mis-statement in respect of the state of health has been made by the person seeking insurance. The intention is that in case the person, seeking insurance, suffers from such a disease which effects his life span adversely, in that event, he is under an obligation to disclose the same and in the event of failure on his part to do so, the Insurance Company would be fully justified in repudiating the claim but in case if a person suffers from occasional/minor ailments such as common cold, fever and the same are not disclosed, it cannot be stated that mis-statement has been made by him in respect of his health at the time of taking out insurance policy. In view of the position explained above, in our opinion, the order being impugned in the present proceedings suffers from no infirmity so as to call for any interference by this Commission in exercise of its appellate powers. The present appeal, filed by the appellant is, therefore, devoid of substance. The same merits dismissal. Accordingly, the same is dismissed in limine with no order as to costs. Appeal dismissed.