SUSHILA BAI SHUKLA vs L.I.C. of India

SINCE both these appeals are directed against the order dated 20.2.2002 n Complaint No.465/01 by District Consumer Disputes Redressal Forum, Raipur, (herein after called ''District forum'' for short) whereby the complaint of (complainant/appellant of Appeal No. 624/03 and respondent of Appeal No. 740/03) was allowed and a total amount of Rs. 2,00,000/- with interest was awarded in her favour, they are being disposed of by this common order.

UNDISPUTABLY A.K. Shukla, the husband of the complainant obtained three Life Insurance Policies one for the assured sum of Rs. 50,000/- covering the risk from 15.4.1997, another policy for the assured sum of Rs. 50,000/- covering the risk from 15.10.1997 and the third policy for the assured sum of Rs. 1,00,000/- covering risk from 23.9.1998, from the Life Insurance Corporation. It is also not in dispute that the deceased paid the premium, etc. of the said policies as stipulated. The complainant Smt. Sushila Bai is the wife and nominee of the said policies obtained by A.K. Shukla. It is also not in dispute the deceased died of ''Mayo Cardial Infarction'' on 5.4.1999. The complainant Sushila Bai Shukla in her complaint laid claim for the payment of assured sums under the said policies, after the death of her husband. However, her claim was repudiated by the insurer L.I.C. by their letter dated 31.3.2000, wherein it was stated that the claim could not be honoured as there was material suppression of fact by the deceased insured. The complainant thereafter filed the complaint before the District Forum.

The Insurer Life Insurance Corporation, resisted the complaint. It was averred by the insurer that there was material suppression of facts by the deceased insured. It was averred in the above context, that in the declaration forms filled up by the deceased for obtaining the said policies he had stated that he was not suffering from any disease requiring treatment of more than a week or that he did not remain absent from his duties during the last 5 years on account of illness and that he did not suffer from any disease of kidney, heart, lungs, liver, etc. However, on investigation by the insurer it was observed that the deceased suffered from tuberculosis and jaundice and remained absent from duties from 14.10.1996 to 29.11.1996 for treatment. It was averred that the deceased had suppressed material facts as above and the claim was , therefore, rightly repudiated.

THE learned District Forum held that there was no nexus between the ailment of jaundice and tuberculosis and the cause of death namely ''Mayo cardial Infarction''. Hence there was no justification for repudiation of claim of the nominee. THE contention as above of the insurer was accordingly repelled and it was held guilty of deficiency in service. THE complaint of the complainant was allowed and total assured sum of Rs. 2,00,000/- under the aforesaid three policies, with interest @ 12% per annum payable from 31.3.2000 till payment, was awarded, in favour of complainant Sushila Bai Shukla. In Appeal No. 624/03 the complainant/appellant has prayed that the interest be awarded from 6.6.1999 instead of from 30.3.1999, as order by the learned Distt. Forum. While in Appeal No. 740/03 preferred by the insurer, it has been prayed that the complaint be dismissed.

LEARNED Counsel for the insurer as well as the complainant reiterated their stand in the District Forum. LEARNED Counsel for the insurer L.I.C. mainly contended that the documents placed by it on the record of the District Forum unimpeachably show that the deceased suffered from serious ailments of jaundice and tuberculosis. It was contended that the copy of leave application submitted by the deceased insured A.K. Shukla as well as the certificate of Dr. K.S. Mishra clearly indicate that the deceased A.K. Shukla suffered from tuberculosis and jaundice and was on medical leave from 14.10.1996 to 29.11.1996. It was further contended that the deceased had thus deliberately made false statement in his proposal form, that he did not suffer from any disease for which he had to remain absent from duty for more than 7 days during the last 5 years prior to submitting the proposal form and that he does not suffer from any disease of lungs, kidney, heart and liver. It was submitted that such being the suppression and false statement by the deceased, the insurer corporation was justified in repudiating the claim of nominee Smt. Sushila Bai Shukla. It was, therefore, contended that the complaint should not have been allowed, by the learned District Forum. Learned Counsel for the complainant, nominee of the insured, however, submitted that deceased died on account of ''Mayo Cardial Infarction''. It was submitted that there was no co-relation between the ailments of tuberculosis and jaundice with ''Mayo cardial infarction'' which was the cause of the death of the insured. Hence there was no suppression of material fact on the part of the deceased. Undisputably the deceased had filled up the proposal form stating that he did not suffer from any ailment relating to liver, lungs, kidney and heart and that he did not receive treatment which required absence from duty for more than 7 days during the preceding five years. However, the medical certificate and the copy of his leave application clearly indicate that he suffered from tuberculosis and jaundice and was on medical leave from 14.10.1996 to 24.11.1996 for the treatment thereof. It is also not in dispute that the deceased insured died of heart failure (Mayo cardial infarction). It is clear that the ailments of jaundice and tuberculosis have no apparent connection or nexus with heart ailment. Therefore, the death was not as a consequence of the said diseases with which the deceased was afflicted. Hence, even though deceased has not mentioned the diseases as above in the proposal form, it would not constitute suppression of material facts.

IT may be noticed in the above context that every suppression is not material suppression of facts. The National Commission in New India Assurance Co. Ltd. v. P.P. Khanna, II (1997) CPJ 1 (NC), has held that the insurer could not avoid consequence of insurance contract by simply showing inaccuracy or falsity of statement. IT is the burden of the insurer to show that the material facts have been suppressed. In Smt. B. Chinnamma v. Divisional Officer, L.I.C. of India and Another; III (1996) CPJ 136 (NC)=1996(3) CPR 229 (NC), the deceased suffered from Peptic Ulcer and died of heart stroke. IT was observed by the National Commission in that case that the ailment for which the deceased was admitted in the hospital had no nexus with the heart stroke. Therefore, the finding of the learned District Forum that the repudiation by the insurer was arbitrary and was not based on proper application of mind, was upheld by the National Commission in the said case. Reference may also be made in the above connection to decision of M.P. State Commission in Life Insurance Corporation of India v. Jagat Kumar, IV (2003) CPJ 424. Similar facts and circumstances exist in the present case. As has been noticed above the deceased suffered from jaundice and tuberculosis which had no nexus with the cause of death which was on account of ''Mayo Cardial infarction''.

ACCORDINGLY, the finding of the learned District Forum that there was no justification for repudiating the claim of the complainant, appears to be justified and is affirmed. So far as the appeal of the complainant is concerned, he has claimed interest from an earlier period than from 30.3.1999 as awarded by the District Forum. After considering the facts and circumstances of the case, we do not consider that the prayer as above deserves to be allowed. Since, both the appeals are without substance, they are dismissed. Parties shall however, bear their own costs of these appeals. Appeals dismissed.