SNEH LATA AGGARWAL vs Life Insurance Corporation of India

WHETHER there has been a patent deficiency in the services undertaken to be rendered herein by the Life Insurance Corporation is inevitably the primal question in this complaint. Since we are inclined to hold that this is not plainly so, it seems unnecessary to delve too deeply in the facts and the merits of the case.

IT suffices to mention that way back on the 5th of January, 1985, Shri Ram Kishan son of Shri Geneshi Lal (hereinafter referred to as the deceased) got himself insured for a sum of Rs. One lac with the Life Insurance Corporation of India through its branch Office at Hisar vide Policy No. 76093188. IT is his widow-complainant''s case that all necessary formalities including the medical check up had been got done before the issuance of the said policy. According to her, the deceased was taken seriously ill far away at Darjeeling and was admitted to the Sadar Hospital on the 12th of August, 1985 and died therein on the 16th of August, 1985 because of liver Hepatic failure at the age of about 32 years. The express stand was that before his death, he was hale and hearty. Inevitably after the husband''s death the complainant lodged a claim with the opposite party on the policy and the latter demanded a number of documents like the death certificate, admission and death record of her husband with the hospital, the birth certificate and other relevant documents. IT is the grievance that the opposite party raised many objections to the claim and she had to make repeated requests and visits to their office, the last one being in the month of June, 1991. However, unable to get redress, the present complaint was filed to seek relief for the insured amount of Rs. One lac with interest and costs thereon. On notice being issued the opposite party raised a number of preliminary objections and the primal one was with regard to the bar of limitation. On merits, the issuance of the life insurance policy in favour of the deceased was admitted. But the plea taken was that this was done on the basis of statements made by the deceased in his proposal form and personal statement which later on turned out to be false. The firm stand taken is that even at the time of taking out of the Policy, the deceased was a case of Pulmonary Tuberculosis and Cirhosis of the liver and his death occurred due to this after a prolonged illness. It was pointed out that the same had taken place within seven months of the issue of the Policy and a few days of the commencement of the same. It is alleged that the deceased did not disclose the chronic diseases from which he was suffering at that time and in case he had done so; the opposite party would not have accepted the risk.

The defence raised was that the complainant had been most un-cooperative and had deliberately delayed the submission of the requisite papers with ulterior motives in order to suppress the facts. On the basis of Annexures R.1 to R.3, it was pointed out that despite repeated demands the relevant documents ere withheld and the opposite party had to secure them with considerable difficulty. The allegation of in assurance having been held out by the opposite party to finalise the claim in the complaint has been expressly denied and it is reiterated that in fact the policy had been obtained by suppression of information about the deceased''s health and consequently nothing was payable thereunder.

IT deserves pointed notice that the preliminary objection on the issue of limitation was disposed of by a comprehensive order dated the 29th June, 1992 rejecting the same. The complaint consequently proceeded for disposal on merits. The complainant herein has rested herself content by putting in her own affidavit and that of Shri Sehdev Arya, the real brother-in-law of the deceased. Both of them were cross-examined at considerable length by the learned Counsel for the opposite party and therein they admitted the execution and authenticity of the documents Annexures OP1/1 to OP1/9. As regards the documentary evidence, the primary reliance was on the receipt of the solitary premium instalment paid by the deceased.

IN rebuttal, the opposite party adduced the testimony of Shri C.R. Dang, Assistant Administrative Officer, L.I.C. at Karnal and Shri D.S. Khosa, Branch Manager of the L.I.C. Divisional Office at New Delhi. Shri C.R. Dang in his affidavit stated that because of the death of the deceased within seven months of the taking out of the policy an investigation was got conducted which revealed that the policy holder was an old case of Pulmonary Tuberculosis and Cirhosis of the liver and reliance was placed on Annexures R.5 and R.6 therefor. It was expressly averred that had this been revealed at the time of the proposing of the Policy, the L.I.C. would not have undertaken the risk. It was also averred that despite repeated demands, the necessary documents and complete papers were not made available. Both the witnesses were cross-examined on behalf of the complainant without eliciting anything meaningful in her favour. Apart from oral testimony, reliance was placed on Annexures R.1 to R.8 and the admitted documents some of which were confronted to the complainant''s witnesses and admitted vide Annexures OP/I to OP/1/9. What is of great significance is the fact that the authenticity of these documents was in terms admitted by the learned Counsel for the complainant. Mr. G.C. Verma, the learned Counsel for the complainant unavoidably had to fall back on the somewhat interested testimony of the complainant herself and the brother-in-law of the deceased Shri Sehdev Arya. It was submitted that both these witnesses should be accepted at their words. Somewhat couriously particular reliance was place on Section 45 of the Insurance Act, 1938 and it was contended that the insurance policy could not be called in question on the ground of mis-statement after two years from the date on which it was effected. We are afraid that the learned Counsel''s reliance on Section 45 aforesaid is patently misplaced. In the present case, there is no dispute that the deceased died hardly after seven months from the date of the Policy. Consequently the said policy did not continue to remain in force for a duration of two years or more. That appears to be a precondition for the applicability of Section 45. Herein, that primal condition having not been satisfied Section 45 can obviously be of no aid or assistance to the complainant. Even otherwise, it is plain that the said Section is not in absolute terms. If the insurer can show that the false and inaccurate statement was on a material matter which was incumbent upon the insured to disclose, or was fradulently made by the policy holder, the bar cannot operate. Herein that is the specific and particular stand of the opposite party. Therefore, viewed from any angle, the said Section is wholly off the mark of the facts of the present case.

ONCE the aforesaid legal issue is out of the way on merits, the learned Counsel for the complainant was on a somewhat unsure foundation to sustain his claim against the vehemently contested stand taken on behalf of the opposite party. It bears repetition that the evidence of the complainant herself is inevitably interested and seems to be considerably shaken by the cross-examination. The testimony of Shri Sehdev Arya does not cover the issue directly involved and is in the nature of hearsay and with regard to matters which are purely peripheral to the core question herein. His testimony even if accepted, does not materially advance the complainant''s claim. As already noticed, there is virtually no documentary evidence worth the name to buttress the complainant''s case.

AS against this there is the categoric testimony on affidavit of Shri C.R. Dang, a responsible Officer of the L.I.C. He has emphatically stated that because of the early claim following the execution of the Policy the matter was deeply investigated by the authorities. This investigation revealed that the deceased was a very old case of Pulmonary Tuberculosis and Cirhosis of the liver and particular reliance was placed on documents Annexures R.4 R.5and R.6. It was further the case that because of the suspicious circumstances, the claimant did not complete the requisite papers and the authorities deputed Shri D.S. Khosa, the then ASsistant Branch Manager at Delhi to finalise the claim but the evasive attitude of the claimant led to the dropping of the same. Mr. D.S. Khosa in his affidavit has fully supported and corroborated the basic stand of the opposite party and it bears repetition that Shri D.S. Khosa was not seriously challenged by way of cross-examination and nothing worthwhile could be elicited from Shri C.R. Dang either on behalf of the complainant. Apart from the above, what seems to clinch the issue is the unchallenged documentary evidence in Annexures R.4 and R.6, the authenticity of which was very fairly admitted by the learned Counsel for the complainant. Document R.6 is a communication of Dr. R.N Adhya, a highly qualified professional and apparently a retired Civil Surgeon at Darjeeling who in terms had recorded as under in his letter:- "This is to inform you that Shri Ram Kishan Aggarwal was under my treatment in their residence, as I am the family physician of theirs. He was suffering from Cirhosis of liver for about six months or so, with manifestations and ultimately died due to coma on 16.8.85. xx"

Again Annexure R.5 is the hospital record of the Sadar Hospital at Darjeeling where the deceased was admitted on the 12th of August, and died on the 16th of August, 1985. Therein, it is in terms recorded that the diagnosis arrived at the hospital was that the deceased was a case of old Pulmonary tuberculosis and Cirhosis of the liver. He was admitted in a semi-conscious and drowsy condition and being a case of old T.B. and Cirhosis of the liver, died thereof due Hepatic failure. It bears recalling that this document is again not assiled on behalf of the complainant.

Once it is found as above what merits pointed notice is the well-established medico-legal fact that Pulmonary Tuberculosis and Cirhosis of the liver are not maladies which strike suddenly or accidentally. These are indeed the effects of long and chronic disease and somewhat patent results of a prolonged pre-existing malady. One has only to recall the fact that the deceased had made the proposal form sometime in January, 1985 and died nearly seven months thereafter. It is not in dispute that in the said proposal form, he had not disclosed the incidence of the above diseases at all. This has to be viewed in the context of Dr. R.N. Adhya''s certificate that for six months or more prior to his death, he had already remained under his treatment for this fatal ailment. The case set up on behalf of the complainant that the deceased was hale and hearty at the time of the execution of the policy and thereafter thus stands patently belied.

IT is against the aforesaid virtually established facts that one has to remined oneself that the scope of enquiry in the present consumer dispute is somewhat limited. Inveitably, it has to turn on the question whether there has been any deficiency in the Insurance service undertaken to be rendered by the L.I.C, IT is their firm stand that because of the patently early death of the deceased from the execution of the policy a detailed investigative enquiry was conducted by them. From the material collected therein, the competent authority of the L.I.C. had came to the conclusion that the deceased in his proposal form had made material suppressions which vitiated the contract of insurance which is admittedly one of the utmost good faith. That view was arrived at on the basis of material to which a reference has been made earlier and it cannot be said that the same was either wholly arbitrary or not bonafide, Mr. Brij Jit Singh, the learned Counsel for the Opposite Party was on a plausible stand when he contended that the delay and procrastination on the part of the complainant to furnish the damaging evidence of the hospital record at Darjeeling or the bed-head ticket and the cause of death etc. was a motivated one. Equally, it bears notice that no allegation of mala fides against the concerned officials of the L.I.C. has been raised and in doing what they did they were apparently performing their duty according to their lights. In such a situation, it cannot possibly be said that there was any patent deficiency in the service hired by the complainant which can merit relief in the consumer jurisdiction. The view we are inclined to take buttressed by the recent enunciation of the law by the National Commission in First Appeal 156 of 1991 ''Jagadish Prasad Dagar, Bangalore v. Senior Divisional Manager, Life Insurance Corporation of India, Bangalore''. decided on February 26, 1992 II (1992) CPJ 493 (NC). Therein it was concluded as under:- "Since, in the present case we have found that the decision communicated by the Life Insurance Corporation as per its letter dated February 6,1990 had been taken by the respondent in good faith after due application of its mind after taking relevant factors into account, it is not possible to say that there has been any ''deficiency in service'' on the part of the insurer. The appeal is liable to fail on this ground."

IN view of the aforesaid binding precedent and the findings of facts recorded earlier, it is somewhat manifest that herein no patent deficiency in the services undertaken to be rendered by the L.I.C. has been established which can be laid at their door. Consequently, no relief can possibly be granted on that score within the consumer jurisdiction. The complaint therefore, must fail and is hereby dismissed without any order as to costs. As a matter of abundant caution, it may | however, be recorded that the dismissal of the complaint would obviously not preclude the complainant if so advised to resort to any civil remedies under the contract in a Court of law. Complaint dismissed.