SHEELA DEVI MANGLA vs Life Insurance Corpn. of India

THIS appeal under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 10.3.1999 by District Consumer Disputes Redressal Forum, Durg (hereinafter called as ''District Forum'' for short) in Case No. 143/98 dismissing the complaint of the complainant/appellant.

RELEVANT facts no longer in dispute are; that the deceased Vedprakash Mangla husband of the complainant/appellant, obtained a Life Insurance Policy on 28.3.1994 on his life. The policy was for the term of 20 years. Complainant/appellant is the nominee of the said policy. The insured Vedprakash died on 24.10.1995. As stated in the death certificate, cause of death was bronchial Asthma and CIHDC Left ventricular failure. Thus, the death of the insured Vedprakash Mangla occurred about one year and seven months after obtaining the policy. The complainant laid claim for the sum assured with the respondent/insurer. The respondent, however, repudiated the claim of the complainant/appellant on the ground that the husband of the complainant was suffering from serious disease much before he obtained the policy and had suppressed material facts regarding the state of his health.

The complainant/appellant in her complaint averred that her husband whose life was insured by the respondent died a natural death. Therefore, the complainant/appellant is entitled to receive the assured sum under the policy.

THE respondent in his reply denied the averments as above. According to the respondent, the deceased in his proposal form answered queries by replying that he did not suffer from serious disease of heart, lungs, etc. and also stated in his declaration that he was keeping good health. However, on investigation, it was discovered that the deceased was suffering from bronchial Asthma for the last about 20 years and had been receiving regular treatment therefor. In view of the above, the respondent repudiated the claim of payment of sum assured under the insurance policy of deceased Vedprakash Mangla. The learned District Forum held that the deceased died due to bronchial Asthma, heart disease and ventricular failure. It was also observed by the learned District Forum that the deceased suffered from bronchial Asthma and acid peptic disease for the last about 20 years, as reported to the doctor by the deceased Vedprakash himself, which was so recorded in the certificate issued by Pt. Jawaharlal Nehru Hospital, Sector-9, Bhilai. In view of above, the learned District Forum recorded its finding that there was material suppression of facts regarding his ailment by the deceased. It was thus held that the repudiation by the respondent of the claim of the complainant was justified and there was no deficiency in service on the part of the respondent/insurer. The complaint was accordingly dismissed.

THE learned Counsel for the appellant submitted that the deceased had not suppressed any material fact. He died natural death because death was due to IHD and Ventricular failure, which could not be associated with bronchial Asthma. It was, therefore, submitted that the learned District Forum erred in holding that the deceased was guilty of suppression of material facts regarding his health and, therefore, in dismissing the complaint. THE learned Counsel, therefore, submitted that the complainant/appellant the widow of the deceased was entitled to receive the sum assured under the policy. As against this, the learned Counsel for the respondent urged that the death of deceased was due to combined result of bronchial Asthma, IHD and ventricular failure. It was further submitted that deceased suffered from bronchial Asthama for the last many years. However, he failed to disclose the serious ailment as above which ultimately proved fatal. It was, therefore, submitted that in the face of material suppression as above on the part of deceased, the respondent was fully justified in repudiating the claim under the policy. Thus, it was submitted by the learned Counsel for the respondent, that the District Forum was justified in dismissing the complaint of the complainant/appellant. In view of the rival contentions as above, the main question that arises for consideration is : as to whether there was material suppression of facts by deceased Vedprakash Mangla regarding the state of his health?

AS noticed earlier, undisputedly, ''the appellant''s husband Vedprakash Mangla had obtained policy on his life on 28.3.1994 for a term of 20 years. The assured sum was Rs. 25,000/- with accident benefit. It is also not in dispute that Vedprakash Mangla died on 24.10.1995. According to complainant, her husband died natural death. However, it also appears that the deceased Vedprakash Mangla in his proposal form had answered the queries made by the respondent/insurer that he was not suffering from any disease relating to his heart, lungs, stomach, liver, etc. and that general condition of his health was good.

IT may be noticed in the above context that the documents produced on behalf of the respondent clearly show that the deceased suffered from asthmatic bronchitis for a long period of about 20 years as would be clear from the certificate of discharge issued by J.L.N. Hospital and Research Centre, Bhilai, copy of which is placed on the record of the District Forum. IT also appears that he received continuous treatment for the said disease as an indoor patient from 19.10.1995 onwards till his death. His death certificate indicates that the cause of death was bronchial Asthma, IHD and left ventricular failure. The certificate of Hospital treatment issued by the D.M.O. indicates that he was a known case of bronchial Asthma since last about 20 years and that he had received treatment for ailment of chest at Bhilai hospital. In view of the material documents as above, there appears to be no doubt that the deceased suffered from bronchial Asthma and chest disease for a long period and from much prior to his filling up the proposal form. Therefore, declaration that he did not suffer from any disease of heart, lungs, etc. and that he was in a good health, was not correct. It appears that the policy of insurance was issued on the representation regarding his health by the deceased. It would thus appear that there was material suppression of facts. The misrepresentation as above vitiates the agreement of insurance between the deceased and the respondent.

It may be mentioned that contract of insurance is based on mutual trust and confidence of the parties. Contract of insurance is ''Uberrimae Fidie''. The insurer accepts to cover the risk of the proposer in good faith and belief that the insurer has disclosed all material facts as filled up in the proposal form. A false answer or non-disclosure of any material fact would be a good ground for the insurer to avoid the policy. Since insurer has been led to believe that the deceased was in good health and did not suffer from any major disease as mentioned by the insured, the insurer was entitled to avoid the policy in case the representation as above is found to be false. Had the insurer known about the correct facts regarding the ailments suffered by the deceased, it would not have agreed to issue policy of insurance in his favour. Thus, by suppression of material facts, the insured had gained an advantage which he was not otherwise entitled to. In view of above, it is clear that the doctrine that no one should be allowed to take advantage of his own wrong; especially while entering into contract of insurance which is based on utmost good faith, would apply. In the circumstances, the complainant cannot get advantage under the policy of life insurance issued by the respondent.

CONSEQUENTLY, the finding of the learned District Forum that there was no deficiency of service on the part of the respondent and that the appelant is not entitled to any relief and to get amount of insurance appears to be fully justified. There is no reason for interference therein. This appeal has no substance and is dismissed. However, in the circumstances of the case, parties are left to bear their own costs. Appeal dismissed.