SHEKHAR SANGEWAR vs SR. DIVISIONAL MANAGER, L.I.C. OF INDIA

THIS appeal under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 10.7.2003 by District Consumer Disputes Redressal Forum, Durg, (hereinafter called the ''District Forum'' for short) in Complaint Case No. 108/01, dismissing the complaint of the complainant/appellant.

THE relevant undisputed facts stated in brief are that the deceased Anant Rao Sangewar had obtained a Life Insurance Policy on 28.4.1996 for the assured sum of Rs. 1,25,000/-. THE premium of Rs. 25,035/- was also paid by the deceased regarding the said policy. Anant Rao Sangewar expired on 25.5.1997. THE cause of his death was ''Mayo Cardial Infraction''. THE complainant/appellant is the nephew of the deceased and is the nominee under the policy. After the death of insured Anant Rao Sangewar the complainant/appellant laid claim with the respondent insurer for the payment of assured sum under the policy. However, the respondents/insurer repudiated the claim by their letter dated 8.10.1999 on the ground that though the deceased suffered from ''Ischaemic heart disease'' with old Mayo Cardial Infraction, however, the said material fact was not disclosed by him while filling up the proposal form for obtaining insurance policy. The complainant in his complaint averred that there was no proper justification for repudiation. It was further averred that the deceased was exanmined by the respondent''s doctor before issuance of the policy and it was found that he was not suffering from any diseases. The deceased insurer Anant Rao Sangewar died of heart failure. Accordingly the complainant prayed that the assured amount with interest and compensation be awarded in his favour.

The complaint was resisted by the respondent insurers. According to them the deceased in his proposal form for obtaining policy has declared that he was in good health and did not suffer from any disease including that of Heart, Kindey, Lungs etc. and that he had not undergone any Radiological, Cardiological, Pathological or any other test. However, on investigation after his death, it was fount that the deceased suffered from Ischaemic heart disease with old inferior Mayo Cardial Infraction and was regularly taking medicines since 11.7.1989. It was averred by the respondent that there was material suppression of facts regarding the state of his health by the deceased. The claim of the complainant/appellant was, therefore, rightly repudiated.

THE learned District Forum in the impugned order held that the respondents have established that there was material suppression of fact by the deceased in the proposal form submitted by him for obtaining insurance policy. It was, therefore, held by the District Forum that there was no deficiency in service by the respondents in repudiating the claim. THE complaint was, therefore, dismissed with liberty to the complainant/appellant to take recourse to the remedy of civil suit for vindicating his rights. The learned Counsel for the complainant/appellant reiterated the complainant''s stand in the District Forum. It was urged that there was no material suppression of fact by the complainant/appellant. It was submitted that the deceased never suffered from any heart disease and never suppressed any material fact. It was urged that the doctor appointed by the respondents also examined the deceased before issuance of the policy and he did not report that the deceased was suffering from heart disease, hence there was no reason to hold that the complainant/appellant had suppressed any material fact which was within his knowledge, at the time of filling up the proposal form.

IT may be noticed that in the proposal form submitted by the deceased, the deceased had replied in the negative to the queries as to whether he ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous system. He has also in the said proposal form replied in the negative stating that he has not consulted a medical practitioner during last 5 years requiring treatment for a period of more than a week and that he never remained absent from place of work on the ground of health during the last 5 years. However, from the medical treatment booklet relating to the deceased produced in the District Forum, it would appear that there is a entry of the year 1992, that he was a known case of I.H.D. i.e., ischaemic heart disease and he was complaining of chest pain and breathing difficulty. He was also given treatment for heart ailment as would be clear from the said booklet. IT would also appear there from that he was regularly taking Isoptin for heart ailment right from the year 1989. Sorbitrate was also prescribed which again relates to treatment for heart ailment. The medical record as above and the treatment prescribed to him as noticed above would, therefore, clearly show that the deceased was having ''ischaemic heart disease'' i.e., ailment of heart for the last many years, before he filled the proposal form on 19.12.1996 to obtain the insurance policy. The learned Counsel for the complainant/appellant also submitted that as the respondents got examined the complainant/appellant by a doctor before issuance of policy, who did not record any disease, hence the deceased cannot be held guilty of material suppression. However, even if that be so, the deceased cannot be absolved from the stigma of non-disclosure of the material facts within his knowledge, regarding his health. The learned Counsel for the complainant/appellant relied upon the decision of the Hon''ble Supreme Court in Life Insurance Corporation of India & Ors. v. Smt. Asha Goel & Anr., I (2001) SLT 89=AIR 2001 SC 549, wherein it was stated that the approach of the L.I.C. in the matter of repudiation of policy should be one of extreme care and caution and that it should not be dealt with in a mechanical and routine manner. Learned Counsel for the complainant/appellant also submitted that the appellant had no knowledge about his ailment, therefore, there was no suppression of material fact regarding his health. The learned Counsel for appellant in support of his contentions has relied upon the decision of U.P. State Commission in Life Insurance Corporation of India v. Smt. Sudha Devi, III (2001) CPJ 588=2001 Upbhokta Sanrakshan Cases 506; Life Insurance Corporation of India v. Smt. Usha Devi, 2002 Upbhokta Sanraskshan Cases 33; Senior Divisional Manager, Life Insurance Corporation of India v. Ansar Ahmed, I (2002) CPJ 419=2002 Upbhokta Sanrakshan Cases 412; abd Life Insurance Corporation of India & Ors. v. Usha Agrawal & Ors., 2001 Upbhokta Sanrakshan Cases 396. However, as has been noticed earlier since it has been established in the instant case that the deceased suffered from heart ailment and received treatment for a long period of about 10 years and that he consulted the doctor for the said ailment from time to time. Contention of the learned Counsel for the appellant, therefore, cannot be accepted that he was not aware of his ailment as above. Therefore, it appears that the deceased had chosen to falsely reply to the queries in the proposal form stating therein that he did not suffer from any disease of the heart as has been noticed earlier. Hence there being material suppression as above by the deceased insurer, regarding the state of his health and ailment, the citations as above, would not help the case of the complainant/appellant.

AS was laid down by the Supreme Court in Life Insurance Corporation v. Smt. G.M. Channabassamma, AIR 1991 SC 392, the contract of insurance is contract uberrima fides and there must be complete good faith on the part of the assured. The assured is thus under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accpeted or not.

AS noticed earlier, in the instant case, it is clear that the appellant suffered from heart disease and that he did not disclose it in the proposal form. The length of treatment and the medical record clearly indicates that the appellant was fully aware about his ailment of heart yet, in his proposal form filled by him on 19.12.1996 he stated that he did not suffer from any disease of the heart etc. and that he did not consult any medical practitioner for the treatment required for more than 7 days. The suppression as above would clearly amount to material suppression of facts within his knowledge. Thus the insured deceased having breached the obligation by giving false information in the proposal form filled by him for obtaining policy, the nominee of the deceased/appellant cannot get advantage of the Insurance Policy. Accordingly the repudiation of the claim of the complainant/appellant by the respondents appears to be justified and no deficiency in service was committed by insurer in repudiating the claim of the complainant appellant, as has been rightly held by the learned District Forum. Accordingly this appeal has no merit and is dismissed. Parties shall bear their own costs. Appeal dismissed.