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1996 DIGILAW 978 (MP)

Life Insurance Corporation Of . . . v. Smt. Neelam Ramprakash Vijjan And . . .

1996-11-28

A.S.TRIPATHI, T.S.DOABIA

body1996
JUDGMENT T.S. Doabia, J. 1. The appellant-Life Insurance Corporation of India (hereinafter referred to as the Corporation) repudiated the insurance claim of one Ram Prakash Vijjan. The respondents are his legal heirs. Ram Prakash Vijjan also referred as deceased got number of insurance policies on his life. Information regarding such policies is available on the record of this appeal. The dispute is with regard to two policies. The first one was issued on 10th December, 1983. The sum assured was Rs. 40,000/-. The second policy was issued on 30-12-1985. The sum assured was Rs. 1,30,000/-. The numbers of policies are 57705983 and 81745427 respectively. Ram Prakash Vijjan died on 29th July, 1986. The claims were lodged by the heirs with regard to these policies. While lodging these claims the cause of death of Ram Prakash Vijjan was indicated as "Cirrhosis of liver". These policies were repudiated. This led to a filing of a civil suit. It was pleaded inter alia that the policies have been wrongly repudiated. The main plea taken was that there was nothing abnormal in the manner in which death of the deceased took place. The main thrust of the pleadings was that medical experts of the Corporation had medically examined the deceased. They found nothing wrong with. him. It was accordingly pleaded that if medical experts duly appointed by the Corporation were unable to detect any bodily infirmity in the person of Ram Prakash Vijjan then his legal heirs cannot be deprived of the amount. The allegations made in the plaint were denied. It was pleaded that the deceased had died on account of excessive consumption of alcohol. It was also pleaded that the doctors of the Corporation do not check the internal disorders. It is for the person concerned to answer questionnaire regarding his health and if any answer is wrongly given then the claim can be validly repudiated. 2. When the matter was put to trial, the trial Court came to the conclusion that the deceased was not suffering from 'collitis peptic ulcer'. It was also held that the deceased did not die due to "cirrhosis of liver". The fact that the medical experts of the Corporation had examined the deceased was highlighted. The trial Court accordingly decreed the suit. It is against the above judgment the present appeal has been filed. 3. It was also held that the deceased did not die due to "cirrhosis of liver". The fact that the medical experts of the Corporation had examined the deceased was highlighted. The trial Court accordingly decreed the suit. It is against the above judgment the present appeal has been filed. 3. The argument advanced by the learned counsel for the appellants is that the general principles governing issuing of insurance covers is that the person whose life is assured should possess sound health. If some information regarding this is concealed then the Corporation which had issued the insurance cover would not be liable. Some documents by way of additional evidence were sought to be placed on the record. By these documents it is sought to be proved that one person by the name of Ram Prakash Vijjan, aged about 30 years, was having "alcoholic cirrhosis of liver with portal hypertension". He was discharged from a Hospital by the name of 'Jaslok Hospital' on 29th June, 1985. 4. This Court while issuing notice to the respondents also directed the appellants/Corporation to give information regarding other earlier policies also and also file an application with the affidavit in support of application preferred under Order 41, Rule 27 of the Civil Procedure Code. This order is dated 14th November, 1995. The relevant observations are as under :- "Learned counsel for the appellants has filed certain documents along with the memorandum of appeal, but there was no application under Order 41, Rule 27 of Civil Procedure Code. After the arguments were heard and the matter was reserved for orders, then an application under Order 41, Rule 27 of Civil Procedure Code was filed. The office has also made an endorsement that the said application has been filed after the case was closed for orders. We wanted to examine the propriety of this application but it is not supported by an affidavit. However, in the interest of justice, we direct that an affidavit of the Highest Officer of the Main Office of Life Insurance Corporation of India of Bombay, be filed explaining the circumstances and the reasons as to why this application under Order 41, Rule 27, Civil Procedure Code was not filed earlier. We also direct that all the policies Nos. However, in the interest of justice, we direct that an affidavit of the Highest Officer of the Main Office of Life Insurance Corporation of India of Bombay, be filed explaining the circumstances and the reasons as to why this application under Order 41, Rule 27, Civil Procedure Code was not filed earlier. We also direct that all the policies Nos. 28229693, 8697330, 28626204, 57579884 and 57705983 under which the deceased was earlier insured be produced along with the affidavits of the persons proposing/accepting insurance as well as the affidavits of the doctors, who had examined Ram Prakash (deceased) in those years at the time of insurance. We also direct that the Chairman of the LIC, either himself or through any suitable officer of the Head Office to get the matter examined within two months and submit the report in that regard to this Court thereafter." An affidavit of one Jagdish Sadashiv duly notorised on 11-1-1996 has been placed on record. However, there is nothing on record to indicate as to what was the state of affairs when earlier policies were issued. 5. It be seen that the dispute is regarding the two policies. One was issued on 10-12-1983 and the other is dated 30-12-1985. 6. If policy dated 10-12-1983 is taken into consideration then it becomes apparent that this was issued two years before the death of the deceased. Therefore, the logic adopted by the Corporation in not honouring this policy is not understandable. The stand of the Corporation is that if death takes place within two years of the issuance of the policy then some enquiry is held by the Corporation with a view to find out as to whether the deceased was not suffering the same disease which was not disclosed. If this be the position then the policy issued on 10-12-1983 would be outside the purview of that scrutiny. 7. So far as the second policy is concerned, this was issued on 30-12-1985. The deceased had given information that he was not suffering from any ailment. The deceased was examined by the medical experts of the Corporation. If this be the position then can it be said that the Corporation is not bound to honour the policy in question. Learned counsel for the Corporation contends that the deceased was suffering from "cirrhosis of liver" and was alcoholic. This was concealed. The deceased was examined by the medical experts of the Corporation. If this be the position then can it be said that the Corporation is not bound to honour the policy in question. Learned counsel for the Corporation contends that the deceased was suffering from "cirrhosis of liver" and was alcoholic. This was concealed. It is also stated that the deceased died of jaundice. His urine was yellow and so was the colour of his eyes. The other argument raised is that when information was given for proposal of policy No. 81745427 on 30-12-1985, the deceased had indicated that he was not suffering from any of the diseases mentioned in column No. 18. He had also indicated that he had not been admitted in any hospital for more than one week. He also indicated that he was not taking liquor or any other intoxicants or drugs. The information given would not be correct if the certificate issued by the Jaslok Hospital, Bombay, is examined. It does indicate that one Ram Prakash Vijjan was admitted in Jaslok Hospital, Bombay, on 19th June, 1985. The address given in this certificate is of Gwalior. It is also indicated that he was discharged on 29th June, 1985. It further indicates that his condition had improved. It has been stated there that he was suffering from 'alcoholic cirrhosis of liver and portal hypertension'. As to what would be the effect of this concealment? Learned counsel for the Corporation placed reliance on a decision given by the Supreme Court of India in Mithoolal Nayak v. Life Insurance Corporation of India, AIR 1962 SC 814 . He submits that the Corporation is absolved of its liability to make payment under insurance cover when there is material concealment. Reliance is also being placed on the decision given in the case reported as Krishwati Puri v. Life Insurance Corporation of India, AIR 1975 Delhi 191. In this case it was held that because the person who was insured was examined by the doctors of the Insurance Corporation and they found him fit would not affect the right of the Corporation to repudiate the claim liability on the ground of fraud under section 45 of the Insurance Act. In this case it was held that because the person who was insured was examined by the doctors of the Insurance Corporation and they found him fit would not affect the right of the Corporation to repudiate the claim liability on the ground of fraud under section 45 of the Insurance Act. Again in P. Sarojam v. Life Insurance Corporation of India, AIR 1986 Ker 201 (DB), it has held that if false answers are given to the questions in the proposal form, this fact would be sufficient to disentitle the heirs to claim benefit of the policy. The decision reported in A.V. Venkatesh v. Life Insurance Corporation of India, 1986 ACJ 656 Mad and B.I.G. Insurance Co. v. Ramnath, 1962 MPLJ 559 , 1962 JLJ 1128 also support the aforementioned position of law. 8. We are of the opinion that so far as the first policy is concerned, this was issued on 10th December, 1983. There is nothing on record to indicate that on that point of time Shri Ram Prakash Vijjan was suffering from any ailment. It has also not been established that any wrong answers were given to the questionnaire formulated by the Insurance Corporation. There is also no evidence on the record that earlier to 10-12-1983 Ram Prakash Vijjan was ever admitted in any hospital. Therefore, the Corporation is bound to make the payment which is payable on account of the insurance cover issued on 10th December, 1983. However, with regard to the latter policy issued on 30th December, 1985 the Corporation has been successful in prima facie proving that the deceased was admitted in the Jaslok Hospital. This prima facie conclusion is apparent from the record appended with the application under Order 41, Rule 27 of the Civil Procedure Code. It again prima facie becomes apparent that the deceased was suffering from 'cirrhosis of liver'. He ultimately died of jaundice. Jaundice is a disease directly connected with the liver problem. When the deceased was asked to give information as to whether he had any problem regarding liver, he answered in the negative. He prima facie concealed that he was admitted in the Jaslok Hospital. Thus, so far as the latter policy is concerned, the appellants/Corporation's application under Order 41, Rule 27 of the Civil Procedure Code is allowed. When the deceased was asked to give information as to whether he had any problem regarding liver, he answered in the negative. He prima facie concealed that he was admitted in the Jaslok Hospital. Thus, so far as the latter policy is concerned, the appellants/Corporation's application under Order 41, Rule 27 of the Civil Procedure Code is allowed. The Corporation has placed on record medical reports which indicate (i) that one Ram Prakash Vijjan was admitted in Jaslok Hospital, (ii) this person was suffering from 'cirrhosis of liver' and (iii) that he remained in Jaslok Hospital, Bombay, as an indoor patient from 19-6-1985 to 29-6-1985. If above is the position then it can be said that there was some concealment on the part of the deceased. The question however, remains to be proved as to whether certificate pertain to the same person, who had got the insurance cover. This is to be proved as a fact. 9. We are accordingly of the opinion that the appeal of the Corporation vis-a-vis the policy dated 10-12-1983 for a sum of Rs. 40,000/- bearing No. 57705983 is liable to be dismissed. It is dismissed accordingly. This is because the proposal was signed on 10-12-1983. The death took place after two years of the taking of the policy. Nothing has come on record that the deceased was ever admitted earlier in the Hospital. 10. However, with regard to the second policy dated 30-12-1985 for a sum of Rs. 1,30,000/- bearing No. 81745427 the matter is remanded to the trial Court who would permit the parties to lead such evidence as they may wish to lead. Application under Order 41, Rule 27 of the Civil Procedure Code is allowed. It be seen that this Court on 5th August, 1996 allowed disbursement of 50% of the amount to the respondents. This amount would remain with them. They would, however, give an undertaking that in the event of dismissal of suit qua policies dated 30-12-1985 they would refund the amount. The appeal is dismissed qua policy dated 10-12-1983 but regarding policy dated 30-12-1985 the judgment is set aside and the matter is remanded for fresh decision. The trial Court to make an effort to dispose of the suit within six months. The parties to appear before the trial Court on 16-1-1997.