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2003 DIGILAW 17 (UTT)

Life Insurance Corporation of India v. Rajbala Walia

2003-03-05

K.D.SHAHI, LUXMI SINGH, SURENDER KUMAR

body2003
JUDGMENT 1. This is an appeal against the judgment and order dated 21.12.2000 passed by the District Forum, Dehradun whereby the appellant, Life Insurance Corporation, was directed to pay a sum of Rs. 50,000/- along with bonus, if any, and interest at the rate of 18% per annum from 1.4.94 till the date of payment. The complaint was also allowed a cost of Rs, 1000/-. 2. The brief facts of the case are that Shri Pritam Kumar Walia, since deceased, son of the complainant, had got a life insurance policy. It is not disputed that the policy was in force. It is also not disputed that the complainant is a successor of the deceased, in the night of 19/20.8.1992 Shri Pritam Singh died out of heart attack. The information of the death was given to the appellant. All the papers were submitted but after great delay on 19.7.95 a letter was received by the complainant that his claim has been repudiated. The claimant filed the complaint before the District Forum where in besides other plea, the main plea was taken which alone has been agitated here, that before the death the victim has suffered an accident on 20.4.92. He was hospitalised in Nahan, Himachal Pradesh. It is alleged that in the proposal and claim form, this accident was suppressed. Therefore, the claim was repudiated because under the terms of the policy, this was to be disclosed. 3. After hearing the parties in detail, the learned Forum has passed a very detailed order. We have gone through this order. Each and every detail of the case has been discussed in the judgment and we do not get anything for which we should differ from the finding of the learned Forum. While confirming the entire finding, we only confine on the fact of suppression of the accident. 4. The injury report shows that this was a very minor accident. The victim, since deceased, suffered only a few contusions and abrasions. There was one suspicion of fracture in the leg. It is not clear whether the leg was xrayed or not. Whether this was a grievous or simple injury could have been decided only on the perusal of the xray report. The victim, since deceased, suffered only a few contusions and abrasions. There was one suspicion of fracture in the leg. It is not clear whether the leg was xrayed or not. Whether this was a grievous or simple injury could have been decided only on the perusal of the xray report. It is true that this fact should have been within the special knowledge of the complainant but it is also true that inquiry was made by the appellant and if they can get the details 3bout the accident, the injury report. the prescriptions of medicines, why they could not get the report of x-ray, if there was any. To the worst, even if there was x-ray and there was fracture in the leg, that could not have added anything to a heart attack which the complainant was to meet after 3 or 4 months. The fact of accident was neither material nor has got any nexus with the heart attack. So much so the matter was referred by the Insurance Company itself to CRC (Chief Review Committee) for expert opinion whether the accident could have contributed anything in the death of the deceased. This CRC did not submit any report regarding this querry but only preferred to say that the claim has rightly been repudiated. 5. The policy was taken on 28.7.92. The victim met with an accident on 20.4.92. His death took place on 20.8.92. It is alleged that at the time of taking of the policy as well as in the claim nothing was said about the accident. We have already said that this accident was very minor and could have contributed nothing towards the cause of death. The learned counsel for the appellant referred the ruling reported in AIR 1966 Allahabad 474 Brahm Dutt Sharma v. Life Insurance Corporation of India and argued that about the hospitalisation and accident, false declaration has been given. It is true that information might have been with-held but since it was immaterial, therefore, it will not affect the claim of the petitioner. The ruling is very old and mere non-disclosure is not sufficient if it had got no nexus with the cause of death. Similarly the position with the ruling reported in AIR 1975, Delhi, Smt. Krishna Wanti Puri v. Life Insurance Corporation of India. The ruling is very old and mere non-disclosure is not sufficient if it had got no nexus with the cause of death. Similarly the position with the ruling reported in AIR 1975, Delhi, Smt. Krishna Wanti Puri v. Life Insurance Corporation of India. It is alleged in the present complaint that on •the declaration form, Shri A. K. Yadav, the agent being on visiting term with deceased Pritam Kumar had taken signatures on blank form, he did not make any inquiry and in view of the earlier friendship, Shri Pritam Kumar had signed it. The Insurance Company has merely denied this allegation but a judicial view of the fact can be taken that the LIC people do not make any inquiry at the time of making proposals for taking insurance policies, fill up the form themselves, get the signatures and issue policies and when there is a death, they start digging the grave and make inquiry about every minutest detail. The affidavit of Shri Yadav does not appear to have been filed to deny this allegation. Consequently, this allegation shall be taken to have been admitted and proved~ and therefore, it cannot be said that anything was suppressed by the complainant or the deceased at the time of taking the policy. 6. This Commission can only propose that instead of making inquiries about minutest details after the death, the Insurance Company should make provisions to make these inquiries before accepting the proposal for insurance and should not issue policies to such persons who with-held material facts. It is very unfortunate that after the death of a young son, the unfortunate mothers are given other extra blows by the Insurance Company by making these allegations. The ruling of 1975 also shows that fraudulent statement and suppression of material facts entitles the insurer to avoid the policy. What fraudulent intention could have been on the part of the insured to have suppressed about a minor accident which could have never added anything to the cause of death. Everybody knows that on such minor accidents which every individual meets daily, the Insurance Company could not have refused the issuance of insurance policy and therefore, it cannot be said that there was any fraudulent mind with the insured to have suppressed the factum of accident. Everybody knows that on such minor accidents which every individual meets daily, the Insurance Company could not have refused the issuance of insurance policy and therefore, it cannot be said that there was any fraudulent mind with the insured to have suppressed the factum of accident. This can be only an accidentally slip and in the opinion of both i.e., the agent as well as insured, it would have been immaterial fact to be disclosed in the proposal form. 7. The appellant further referred the ruling reported in 1994 (1) CPR Page 31, Life Insurance Corporation v. S. Sharma where it has been held that when the claim has been repudiated by speaking order, a claim before the Forum will not lie. 8. The claimant have been held guilty by the LIC for having submitted the claim after a year but the repudiation of the claim is after about more than 3 years. Such a repudiation after 3 years on flimsy grounds will not disentitle the claimant from lodging the claim before the Forum. The repudiation of the claim after such a long delay is in itself deficiency of service and the forum will have jurisdiction where there is any deficiency of service. 9. So is the case with the other rulings referred by the appellant. 10. The learned counsel for the respondent also referred rulings reported in 2002 (1) CPR 163, Senior Divisional Manager, LIC v. Smt. Satya Devi. The deceased has got many serious illnesses. It was not disclosed. The Insurance Company could not show that there was any nexus of the illness with the cause of death. It was held that claim was rightly allowed. Similar is the position with the ruling reported in 2002 CPR 211, LIC v. Krishna Devi. The deceased has suffered with a temporary decease of Typhoid. It was held that it is only when person seeking insurance suffer from such decease which affect the life span adversely, he was under obligation to disclose the same. We have already held alone that this minor accident could never have contributed anything after 3 or 4 months with any heart attack. In the ruling reported in 1997 (III) CPR 7 of National Commission certain information regarding previous illness and about trivial ailment was not disclosed. We have already held alone that this minor accident could never have contributed anything after 3 or 4 months with any heart attack. In the ruling reported in 1997 (III) CPR 7 of National Commission certain information regarding previous illness and about trivial ailment was not disclosed. The National Commission held that this could not be said to be fraudulent suppression of material fact and the claim must be allowed. In AIR 2001 Supreme Court Page 594, LIC v. A. Goyal, the Hon'ble Supreme Court has held that merely on the grounds that deceased• has with-held certain information regarding his health at the time of taking the policy, that should not be made a ground to repudiate the claim in a mechanical and routine manner. 11. We do not find anything material in this appeal for which the judgment passed by the learned Forum may be interfered. This appeal has got no force and while confirming the entire judgment as passed by the learned Forum and while adding only a few words to that judgment, we hereby dismiss the appeal. However, in the sircumstances of the case, the cost of the appeal shall be easy. 0ORDER The appeal is hereby dismissed, cost easy.