Research › Search › Judgment

Uttarakhand High Court · body

2001 DIGILAW 199 (UTT)

L. I. C. of India v. Kaloo Begum

2001-10-11

D.D.BAHUGUNA, K.C.BHARGAVA, RACHNA

body2001
JUDGMENT Rachna, Member: This is an appeal against the judgment and order dated 23.4.2001 passed by District Consumer Forum, Bulandshahar in Complaint Case No. 494/1998. 2. The facts of the case stated in brief are that the complainant's husband took a life insurance policy of Rs. 50,000/- on 27.4.1995. At the time when insurance was done the complainant's husband was in good health and after medical examination which was done by the doctor appointed by the opposite party, Life Insurance Corporation of India, the policy was issued. 3. After four months of the policy being taken, the complainant's husband was admitted in G.T.B. Hospital, Shahdara, Delhi due to stomach pain. The complainant's husband was diagnosed for intestinal cancer and a minor operation was performed and was discharged on 6.9.1995. After one year two months he was again admitted in same hospital on 29.11.1996 and was discharged on 25.12.1996 and died on 4.1.1997 at his village Thora. The complainant, the wife and nominee of the policy holder submitted a claim on 14.1.1997 but same has been repudiated by the Insurance Company vide letter dated 7.11.1997 on the ground that the policy holder did not disclose true facts about his health. Hence complainant filed a complaint before the District Forum for getting insured amount, compensation and expenses etc. .(as per her complaint). 4. The opposite party in its written version has taken following pleas : (1) The opposite party admitted that the complainant is nominee of the policy holder. (2) The policy holder has concealed the facts of his illness at the time of policy taken by him. (3) The Medical Officer of the Insurance Company had made general checkup of the policy holder and if the policy holder could disclose the true facts about his ailment then the Insurance Company's doctor could have made a thorough check-up of the policy holder. (4) According to the Insurance Company, policy holder was already suffering from illness according to the admission on 25.8.1995 in Guru Teg Bahadur Hospital, Shahdara, Delhi. He had already complained of the pain in his stomach since the last eight months. Therefore, the Insurance Company rejected his claim on the ground of concealment of his ailment. 5. (4) According to the Insurance Company, policy holder was already suffering from illness according to the admission on 25.8.1995 in Guru Teg Bahadur Hospital, Shahdara, Delhi. He had already complained of the pain in his stomach since the last eight months. Therefore, the Insurance Company rejected his claim on the ground of concealment of his ailment. 5. The learned District Forum, after considering the case of the parties, came to the conclusion that there is a deficiency of service on the part of the opposite party, hence it decreed the claim of the complainant for Rs. 50,000/- along with interest at the rate of 12% per annum with effect from 7.11.1997 till the date of payment alongwith cost of Rs. 500/- failing which interest will be payable at the rate of 15% per annum. 6. Aggrieved against this order, the opposite party, Life Insurance Corporation of India has come in appeal and has challenged the correctness of the order passed by the learned District Consumer Forum. 7. We have heard the learned counsel for the appellant in absence of the opposite party/respondent without issuing the notice to the opposite party. 8. The learned counsel for the appellant has argued that the complainant's husband was suffering from the stomach intestinal ailment and this fact was concealed by him at the time of policy proposal made specially with reference to (Column Nos. xxx and xxx). But the perusal of this Column No. (xxx) reveals that there is no mention of the paining stomach or intestinal and, therefore, the declaration made by the complainant in this column appears to be correct and there is no concealment of any facts relating to the deceased mentioned in that column, secondly in column (jha) regarding his usual state of health, the complainant has mentioned it to be good. From the report of the G.T.B. Hospital, it appears that there has been a complaint of pain due to gas ball formation in his lower abdomen which used to be settled itself. From the report of the G.T.B. Hospital, it appears that there has been a complaint of pain due to gas ball formation in his lower abdomen which used to be settled itself. The District Forum in its order has discussed these points in the light of the arguments of the learned Counsel of the Insurance Company, opposite party and has rightly come to the conclusion that there was no concealment of the material facts of stomach ailment and it was the duty of the Medical Officer of the Insurance Company on whose behalf the medical examination was done and has given a clearance certificate that complainant's husband was not suffering from any disease. 9. Now at this stage the plea taken by the Insurance Company that the Medical Officer has given the medical fitness certificate to the policy holder believing on the version of the insured is not acceptable because it is the duty of the Insurance Company and its Medical Officer to make thorough check-up of stool, urine, blood and other things to arrive at the real position of the health of the proposer i.e. complainant's husband. 10. Besides the Insurance Company has relied on the medical report dated 24.5.2000 while the policy was taken in April, 1995. Therefore, this certificate (which is five years late) is not worth reliance as to how this certificate was given by some doctor whose seal is in the name of Dr. S. N. Giri Moreover this certificate does not indicate on what basis this certificate was given after a long period of more than five years. There is no mention of any document about registration number of the patient in Kasturi Devilal Jain Charitable Hospital, G. B. Nagar, hence this certificate cannot be relied upon and District Forum was right in not accepting this certificate. Moreover, if for the sake of argument it is to be taken that the complainant's husband (policy holder) was suffering from subacute obstruction for which he was admitted in hospital on 26.3.1995 and discharged on 27.3.1995, even then from this it appears that he was discharged next day as he was allright and this certificate does not indicate that what treatment was given to him and discharged after one day. This further strengthens the case of the complainant's husband that the pain used to settle itself and there was no serious thing like cancer which could not be detected before 25.8.1995 and, therefore, there is no case of concealment of any disease by the policy holder, Ali Mohammad at the time of proposal of the policy. 11. In view of the above discussions, we find that the repudiation of claim made by the Insurance Company is unjustified and it is proved that the Insurance Company has committed deficiency in service by wrongly repudiating the claim of the complainant. We, therefore, do not find any force in this appeal. The judgment and order of the District Forum are liable to be upheld, the stay order issued is vacated and District Forum may proceed according to the law to enforce in its own order against the Insurance Company. ORDER The appeal is dismissed. The judgment and order of the learned District Forum are confirmed. There will be no order as to cost. Let copy of this order be made available to the parties as per rules.