DURGAWATI DEVI v. LIFE INSURANCE CORPORATION OF INDIA, BOMBAY
1996-11-19
R.S.DHAVAN, V.P.GOEL
body1996
DigiLaw.ai
( 1 ) THIS is a writ petition by a widow who is awaiting the payment of certain insurance policies subscribed and taken from the Life Insurance Corporation of India (LIC) by her husband. Her husband Ram Munakka Pathak died on 2 1- 11992 at the age of 50 years. ( 2 ) THESE were not the only three policies which the petitioners husband had taken out from the LIC. The total number of policies taken by the petitioners husband were six. Three were discharged after payment. The other three are pending. These are policy Nos. 2801376, 280410670 and 290317011. ( 3 ) THE defence by the LIC to resist payment to the widow on these three policies, as submitted in the counter-affidavit of the Administrative Officer, LIC, Divisional Office, Allahabad is explained thus:-"the enquiries reveal that at least since l987 he had been suffering from the following ailments:-1. Hypertension for last four years before death. 2. Demantia (a chronic persistent disorder of disease) for one year before death. 3. A diltent sensortum (failure of nerves) for one week before death. 4. Hemiporasis of right side for four years. " ( paragraph 4 of counter-affidavit ) ( 4 ) THE Court had adjourned the matter on the last occasion as it did not want to express nor make any observation on merits. This matter was adjourned on 12-8-1996 and then again on 2-9-1996. To-day there is a request on behalf of the learned counsel for LIC that the matter be adjourned further. The Court would have granted the adjournment but regard being had to the circumstances of the ailments which are attributed to the husband of the widow, the Court feels that the pendency of this case may itself become the cause of hypertension to the widow, the petitioner. If the record of the LIC is such that the husband of the petitioner was harbouring or labouring under a disease which disease was of such a nature, that if disclosed the risk of insurance could not be covered, by all means the policy could be rejected for deliberate non-disclosure. It is not unknown for a person to carry a disease and yet not know of it nor for a Doctor to detect it. Harbouring a disease without knowing of it and its origins is one aspect.
It is not unknown for a person to carry a disease and yet not know of it nor for a Doctor to detect it. Harbouring a disease without knowing of it and its origins is one aspect. Symptoms follow which symptoms make a person conscious that he is carrying a disease and that there is something wrong. Symptoms reveal to the Doctor investigating what may actually be wrong. ( 5 ) THE diseases being attributed to the petitioners husband have been identified in the counter-affidavit as (a) Hypertension (b) Demantia which has been explained as a chronic persistent disorder of mental processes due to organic brain disease for one year before death; (c) a diltent sensorium which has been explained as failure of nerves for one week before death and (d) Hemiporasis of right side for four years. ( 6 ) THE petitioners husband was examined nevertheless on all the four so-called ailments by the LIC doctor. On ailments the Court is taking up the matter in the reverse order. Hemiporasis of the right side is attributed to have afflicted the husband of the petitioner. It is stated in the counteraffidavit that the petitioners husband had hemiporasis for last four years before death. Whatever may be the disease which may have caused the hemiporasis the disease is described with physical condition as on right side for four years as may have been observed and seen by the Doctor. The insurance policy should have been rejected on the threshold when it was taken out. The issue will arise every time, whether the petitioners husband was actually afflicted by this disease, not observed by the doctor of the LIC or whether he colluded in keeping quite on observing his physical condition. Or is it that the disease was not there as is being made out now? The Court would not know the answer. But hemiporasis as being referred to a disease, subject to correction by medical experts, is not to be found as a term in the medical dictionary. Butterworths Medical Dictionary is one of them. Three terms having phonetic affinity with this word are recorded. These are hemiparesis, hemipyonephrosis and hemisporosis. The Court does not want to sit in judgment over the doctor of the LIC.
Butterworths Medical Dictionary is one of them. Three terms having phonetic affinity with this word are recorded. These are hemiparesis, hemipyonephrosis and hemisporosis. The Court does not want to sit in judgment over the doctor of the LIC. But, if a claim was being rejected on technicalities, then there must be precision and the ailment attributed must be described accurately and the ailment must be deduced reasonably. ( 7 ) THE next ailment attributed as "a diltent sensorium (failure of nerves) for one week before death. "how would a person a year or so before his death at the time when the policy was being taken have a premonition that one week before his death he would have a failure of nerves? ( 8 ) ANOTHER disease attributed to the insured is "dementia (a chronic persistent disorder of mental processes due to organic brain disease) for one year before death. " Of an organic brain disease one year before death, the question would arise of the insured being conscious of this one year before death. Within one year of death is one aspect, but whether this existed prior, if so how long beyond and was the insured conscious of it and hid it, is a serious inquiry. ( 9 ) THE last ailment mentioned in the counteraffidavit is "hypertension for last four years before death. " Hypertension is the generality. The technics of medicine bifurcate this into distinct symptoms from benign to malignant and yet more specific divisions. Which one had caught the petitioner when the doctor of LIC had checked on him? Is hypertension a disease which rules out, a insurance policy? Was the insured indicated of this? ( 10 ) SUMMING up on the ailments of the hemiporasis which is attributed to the insured on the right side for four years, the policy taken out three years later or little before one year of death, the physical condition ought to have been taken into account by the doctor of the LIC. Today no person will know that one year later and week before his death, he will suffer failure of nerves. Organic brain disease may exist even one year before death, but the means to discover this, requires high technology beyond the old style radiology. It is possible that a person may suffer from this and yet may not know of it.
Organic brain disease may exist even one year before death, but the means to discover this, requires high technology beyond the old style radiology. It is possible that a person may suffer from this and yet may not know of it. But if the disease is concealed, it would need strict standards of allegations on concealment. Hypertension is too much of a generality unless it is specified on the seriousness of it. ( 11 ) THE petitioner the widow of the insured, desires the Court to issue a certiorari to quash the communication dt. 22-1-1994 ( Annexure 2 to the writ petition) by which the insurance claim has been denied. She seeks mandamus that be made on the policies. The issue of insurance policy is truely a matter of enquiry. Thus, Court cannot issue a certiorari nor a mandamus for quashing the decision of the LIC not to makepayments on the policies nor can give a rule of mandamus to deliver payments. ( 12 ) BUT the reasons given by the LIC, in the counter-affidavit to deny the claim do not meet with stringent standards so as to inspire public confidence to justify the allegation that there was material suppression of facts by the person who took out the insurance that he was at every given time, when the insurance policies were sought and signed was consciousness of the fact and knew that he was harbouring and labouring under a disease or ailments, the sort of which are mentioned in the counter-affidavit. ( 13 ) THE Court is of the opinion that each one of the four ailments, mentioned in the counteraffidavit, will need to be scrutinised and enquired scrupulously. It is possible that a person may suffer from this and yet may not know of it. But if the disease is concealed, it would need strict standards of allegations on concealment. Hypertension is too much of a generality unless it is specified on the seriousness of it. The petitioner, the widow of the insured, desires the Court to issue a certiorari to quash the communication dt. 22- 1- 1994 (Annexure-2 to the writ petition) by which the insurance claim has been denied. She seeks mandamus that payment be made on the policies. The issue of insurance policy is truely a matter of enquiry.
The petitioner, the widow of the insured, desires the Court to issue a certiorari to quash the communication dt. 22- 1- 1994 (Annexure-2 to the writ petition) by which the insurance claim has been denied. She seeks mandamus that payment be made on the policies. The issue of insurance policy is truely a matter of enquiry. Thus, the Court cannot issue a certiorari nor a mandamus for quashing the decision of the LIC not to make payments on the policies nor can given a rule of mandamus to deliver payments. But the reasons given by the LIC, in the counteraffidavit to deny the claim do not meet with stringent standards so as to inspire public confidence to justify the allegation that there was material suppression of facts by the person who took out the insurance that he was at every given time, when the insurance policies were sought and signed was consciousness of the fact and knew that he was harbouring and labouring under a disease or ailments, the sort of which are mentioned in the counter-affidavit. The Court is of the opinion that each one of the four ailments, mentioned in the counter-affidavit, will need to be scrutinised and enquired scrupulously by the LIC and the claims should not be rejected so easily as they have been done at present. If indeed there has been suppression, then the reasons given must inspire public confidence with a prudent man that the circumstances of the contract of the insurance are such that the claims have to be negatived. But, should the enquiry reveal that the person, who took out the insurance, was not conscious nor aware of the fact that he was harbouring a disease or ailments then the claims must be accepted. That the insured may have had a premonition of his death, as the LIC suggests in the present case, is not a plausible explanation to reject the claims. ( 14 ) THE Court is not impressed with the defence taken by the LIC that the petitioner, the widow of the insured, should file a suit to lay claims for payments on the three policies. Litigations should be discouraged. Filing a suit means another enquiry though in a Court of law, of claims and counter-claims, evidence, cross-examination, documents etc. The LIC must first make an enquiry within.
Litigations should be discouraged. Filing a suit means another enquiry though in a Court of law, of claims and counter-claims, evidence, cross-examination, documents etc. The LIC must first make an enquiry within. But to reject the claims must meet with standards of public accountability, fairness, reasonableness and plausibility. At present these factors are lacking. ( 15 ) THE Court is of the opinion that the matter does need re-examination. This should be done now but thoroughly. Whatever be the decision, the exercise should be carried out during two months next from to-day and indicated to the claimant, that is the widow of the insured, the petitioner. If the claim is to be granted then the decision should also be indicated within this period. If there be material which is against her interests, her attention should be drawn to it. ( 16 ) THE petition succeeds in part, but without the directions as prayed. ( 17 ) THERE will be no order on costs. Petition allowed in part.