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2003 DIGILAW 111 (UTT)

Life Insurance Corporation of India v. Uma Sati

2003-07-29

K.D.SHAHI, LUXMI SINGH

body2003
JUDGMENT 1. These are two cross appeals against the judgment and order dated 04.07.97 passed by District Forum, Almora. 2. Appeal No. 168/2003 (1329/1997 of Lucknow) was filed by Life Insurance Corporation of India on 06.08.97 against the grant of Rs. 50,000/- along with interest @ 9% as policy value and compensation of Rs. 2,000/- and Rs. 250/- as cost of the proceedings payable to the complainant Smt. Uma Sati. 3. Appeal No. 283/2002 (1353/1998 of Lucknow) was filed by the complainant Smt. Uma Sati on 26.05.98 for the enhancement of the amount payable under the policy and rate of interest. 4. Since, both the appeals arise out of one judgment and in both the appeals, common question of law and facts are involved, therefore, both the appeals are taken together for disposal. 5. The brief facts of the case are that the deceased Dr. Mukesh Chandra Sati has taken the policy in dispute for a sum of Rs. 50,000/- on 30.6.92. He has also paid premium for accidental benefits as well, therefore, the policy was for Rs. 50,000/- for life + Rs. 50,000/- for accidental benefits. The instalments were paid regularly, but on 08th May 1993, while the deceased was travelling by a bus, which met with an accident, the deceased died on the spot. The complainant, after his death, being the beneficiary, gave the information to the Insurance Company but the claim was repudiated. However, it is alleged that the deceased has taken two policies in 1987 and 1988 for Rs. 10,000/- and Rs. 15,000/- each which were subsequently paid. Since, the claim was repudiated, she filed the complaint. 6. The Insurance Company filed objections and alleged that since the two policies were old policies, the claim was found correct, the payment was made but as regards the disputed policy, the deceased has suppressed certain facts, which disentitles the beneficiary from claim. It is alleged that from 16.01.92 to 26.01.92 the deceased was on medical leave on the ground of Bronchitis, which was not disclosed in the proposal form etc. This is suppression of material fact and therefore, the claim was liable to be rejected. 7. After hearing the parties, the learned Forum found the claimant was entitled to a sum of Rs. 50,000/- and allowed the claim for the said period. In the judgment, it is specifically written that the complainant was entitled to the. This is suppression of material fact and therefore, the claim was liable to be rejected. 7. After hearing the parties, the learned Forum found the claimant was entitled to a sum of Rs. 50,000/- and allowed the claim for the said period. In the judgment, it is specifically written that the complainant was entitled to the. full amount of the policy and the rejection of the claim is mala fide, however, the benefit of accident was not given to the complainant. 8. Being aggrieved by the order, the Insurance Company (hereinafter called the appellant) filed its appeal within time alleging that the claim was rightly repudiated because material facts Were not disclosed at the time of taking the policy. 9. The complaint was decided on 04.07.97. It is alleged that there is some clerical and apparent mistake in the order passed by the learned Forum. The complainant applied for the correction of the order, which was rejected on 04.05.98. Copy was received on 12.05.98, then on 26.05.98 the appeal was filed. It was alleged by the counsel for the LIC that since the complainant filed the appeal after about 10 months, therefore, her appeal is barred by time. 10. We shall take both the appeals separately. We will first take the appeal of Life Insurance Corporation of India. 11. The proposal for policy was given on 30.06.92 and the proposal was accepted on 31.07.92. The copy of the proposal form has been filed wherein reply to every question have been written in negative. In the proposal form, there is a column, whether the insured has been absent from duty on the ground of health in the last 5 years. There is also a column, whether the insured has been suffering from any disease within last 5 years. The reply to every question is in the negative "No". It was argued that on 18.01.92, the insured has applied that he has gone to Haldwani, but all of a sudden, he got ill and therefore, he was unable to discharge his duties. Doctor has advised him rest till 26.1.92. He, therefore, applied for leave from 16.01.92 to 26.01.92. The application was supported with a Medical Certificate of Prashant Clinic showing that Shri Mukesh Chandra Sati was ill from 16.01.92 to 26.01.92 and Bronchitis has been written therein. Doctor has advised him rest till 26.1.92. He, therefore, applied for leave from 16.01.92 to 26.01.92. The application was supported with a Medical Certificate of Prashant Clinic showing that Shri Mukesh Chandra Sati was ill from 16.01.92 to 26.01.92 and Bronchitis has been written therein. This appears to be on printed certificate form and it appears that the doctor is only a doctor for issuing medical certificates for leave purposes etc. Otherwise, having a printed form for issuing medical certificates does not appear to be reasonable for any qualified and good doctor. This is not clear who is the doctor, what was his qualification, however, it is written that this is Prashant Clinic, Rajendra Nagar, Haldwani. It was argued that there may be illness or not, but, at least the insured should have written that he has been on leave for 10 days on medical grounds in the proposal form. 12. The learned counsel for the Insurance Company referred rulings that suppression of material facts is in, itself, a ground for rejection of the claim as the contract, itself, is vitiated. He referred the rulings reported in 2002 (3) CPJ 56 (NC) Sr. DiV/sional Manager, LIC of India V/s Smt. Gangama and 1995 (1) CPJ 122 (NC) Marketing Manager, LIC of India V/s Smt. S. Vijaya. To the contrary, the learned counsel for the complainant referred the ruling reported in 2000(2) CPR 429 Senior Branch Manager, LIC of India V/s Ms. Leelawati Gupta which was decided on the basis of the ruling reported in Smt. Alia Begum Vs LIC of India, 1997(3) CPJ 106 decided by the National Commission that unless the fact is material, that will not effect the policy and also that the death must have some nexus with the disease. To support this argument, the complainant also filed the ruling reported in 2001 (1) CPJ 475 Life Insurance Corporation of India V/s Smt: Kavita Vinayak. In this ruling the ruling of Hon'ble Supreme Court reported in AIR 1991 Supreme Court 392 Life Insurance Corporation of India V/s Smt. G.M. Channabasemma was referred. The complainant also referred the ruling reported in 1999 (2) CPJ 27 LIC of India V/s Usha Rani Bansal, which too was decided on the basis of National Commission's ruling Life Insurance Corporation of India V/s Smt. Lila Rani Roy and New India Assurance Co. The complainant also referred the ruling reported in 1999 (2) CPJ 27 LIC of India V/s Usha Rani Bansal, which too was decided on the basis of National Commission's ruling Life Insurance Corporation of India V/s Smt. Lila Rani Roy and New India Assurance Co. Ltd. Vs P.P. Khanna reported in 1997(2) CPR 21 =II(1997)CPJ 1 (NC). On the basis of these rulings, the complainant argued that unless some nexus is proved unless deliberate suppression of fact is proved, the claim cannot be repudiated. In the last ruling of the complainant, it has been held that applications for leave on medical grounds are of no importance in the absence of evidence of medical treatment taken. We have already discussed above that the doctor and his clinic appears as such, which is a professional certificate giver and not a regular doctor to treat any patient and there is absolutely no evidence of any treatment of any Bronchitis. There is no other evidence except this solitary paper of medical leave. 13. The deceased died out of accident. There is no nexus of his death with any disease. He died on the spot. Therefore, the policy could not have been repudiated merely on this false certificate of illness. 14. As regards the appeal of the complainant Smt. Uma Sati the complaint was decided by the Forum on 04.07.97. The appeal has been filed on 26.05.98 after about 10 months. This is definitely barred by time. It is alleged that after the decision, the copy has been issued on 08.07.97. Since, the complainant got the copy of the order on 08.07.97. it shall be deemed that she has full knowledge about what the order is, but, it is said that the mistake in the judgment came to the knowledge of the complainant in the first week of January 1998 i.e., after about five months. Why it did not come in the knowledge of the complainant for five months, could not be explained. It is on 15.01.1998 that she moved application for the correction of the order, which did not lie at all because there is no provision of review. Only clerical mistake can be corrected. There is no clerical mistake, the Forum did not allow the accident benefit. Nowhere in the body of the order passed by the learned Forum it is written about Accident Claim benefit. Only clerical mistake can be corrected. There is no clerical mistake, the Forum did not allow the accident benefit. Nowhere in the body of the order passed by the learned Forum it is written about Accident Claim benefit. In fact, the learned Forum did not consider about this claim and the matter shall be deemed not to have been decided or a relief not given shall be deemed to have been refused by the learned-Forum. The Forum or the Commission has got no jurisdiction to review its order. Therefore, there was no Option for the Forum, but to reject the application. The application was rejected on 04.05.98 and then, this appeal is said to have been filed on 26.05.98. Even if an application for correction was given, then also, the appeal could have been very easily filed had the complainant been desirous of getting additional relief from the appellate authority. She filed an application which did not lie. Even a layman knows. atleast a lawyer is presumed to know that there is no provision for review. At any rate, even the application for review was highly belated and that cannot afford a ground for condonation of delay in filing the appeal. It has also been held in the ruling reported in 1998(16) LCD 610 Supreme Court P.K. Ramchandran V/s State of Kerala that law of limitation may harshly affect a particular party, but it has to -be applied with all its rigour when the statute so prescribe. Courts have no power to extend the period of limitation on equitable grounds. The order in appeal may be incorrect to some extent, but when the complainant, herself, is to be blamed for that, there is no question for condonation of delay. Her appeal is to be dismissed merely on this ground. 15. The net result is that both the appeals are to be dismissed. ORDER Both the appeals No. 168/2003 and 283/2002 are, hereby, dismissed. However, cost of both these appeals shall be easy. Copy of the judgment shall be placed in the records of both the files separately.