Renu Sandhwar v. Life Insurance Corporation of India
2003-08-27
body2003
DigiLaw.ai
ORDER The petitioner is the wife of Shailendra Kumar Sandhwar (deceased). She is the nominee in the life insurance policy that was taken by her husband. In this writ petition she prays for a direction to the Life Insurance Corporation of India ('the Corporation', hereinafter) and its officials to pay her the sum assured under the policy and seeks quashing of the Corporation's decision to repudiate the claim as communicated to her by letters, dated 30.1.1999 (Annexure 4) and 18.10.2001 (Annexure 8). 2. The facts of the case are brief and simple and can be stated thus. Shailendra Kumar Sandhwar took a life insurance policy (bearing No. 510714603) on 24.10.1993. The insurance policy was for an assured sum of Rs.48,000/- and he had named his wife, the present petitioner, as the nominee. 3. On 31.3.1996 he became ill and was taken to the Patna Medical College Hospital where he died on the same day. It is not in dispute that at the time of his death the policy was subsisting. In the certificate of death issued by the Medical Officer, Patna Medical College Hospital on 1.5.1996 the cause of death is shown as 'CVA-ICH'. It was stated before the court that it means cardio vascular accident-intra cranial haemorrhage. 4. Following the death of her husband the petitioner made a claim for the sum assured under the policy. The Corporation appears to have subjected the case to a thorough enquiry. The deceased was an employee of the Central Government and at the material time he was posted in the Patna office of the Controller of Defence Accounts. The Corporation asked the C.D.A. for details of leave taken by him over a period of three years preceding his taking out the life insurance policy in October, 1993. In response to its query, it received from the C.D.A. the leave details of Shailendra Kumar Sandhwar vide letter dated 13.12.1996 from the Senior Accounts Officer, C.D.A. Patna to the Branch Manager, Life Insurance Corporation of India, Patna Branch. (In response to further query from the Corporation the same letter, dated 13.12.1996 was later once again forwarded by the C.DA along with letter, dated 10.3.1998). The letter, dated 13.12.1996 gave a list of leave availed of by Shailendra Kumar Sandhwar during the period October, 1990 to October, 1993. The list showed a number of E.Ls.
(In response to further query from the Corporation the same letter, dated 13.12.1996 was later once again forwarded by the C.DA along with letter, dated 10.3.1998). The letter, dated 13.12.1996 gave a list of leave availed of by Shailendra Kumar Sandhwar during the period October, 1990 to October, 1993. The list showed a number of E.Ls. (i.e. earned leave) but it also showed that on five occasions during this period he had taken leave which were post sanctioned on the basis of medical certificates. The description of the commuted leave was as follows: (i) Commuted leave: 14.1.91 to 2.2.91 - 22 days: post sanctioned on M.C. (ii) Commuted leave: 8.5.91 to 2.6.91 - 26 days: post sanctioned on M.C. (iii) Commuted leave•: 30.10.91 to 13.11.91 - 14 days: post sanctioned on M.C. (iv) Commuted leave: 30.11.91 to 4.12.91 - 5 days: post sanctioned on M.C. (v) Commuted leave: 16.3.92 to 20.3.92 - 5 days: post sanctioned on M.C. 5. From the list of leave given in the letter, dated 13.12.1996 the Corporation picked out the commuted leave said to have been taken by Shailendra Kumar Sandhwar to find and hold that in filling-up the proposal for assurance, dated 12.10.1993 he was guilty of suppression and deliberate misstatement in regard to material information. In the proposal for assurance there were two questions which, along with the replies given by the deceased are reproduced below: "(II) (c) Have you remained absent from your place of work on the ground of hearth during the last five years ... No. "(i) What have been your usual state of Health? ... Very good:' The Corporation took the view that the deceased had answered the two questions falsely. 6. In the letter, dated 30.1.1999 by which v the Corporation repudiated the claim of the petitioner, it was stated that the deceased had availed sick leave for a total of 79 days as per below: "(i) 14.01.91 to 04.02.91-21 days. "(ii) 08.05.91 to 02.07.91-25 days. "(iii) 26.06.91 to 02.07.91-7 days. "(iv) 30.10.91 to 13.11.91-14 days, and ~ "(v) 04.03.92 to 15.03.92-12 days." 7.
"(ii) 08.05.91 to 02.07.91-25 days. "(iii) 26.06.91 to 02.07.91-7 days. "(iv) 30.10.91 to 13.11.91-14 days, and ~ "(v) 04.03.92 to 15.03.92-12 days." 7. It was argued by the Corporation that the fact that he had taken commuted leave on medical certificate on five occasions clearly showed that his reply to the first question was false and from the fact that he had taken leave on medical certificates, it was further inferred that his reply that his usual state of health was very good was equally false. 8. It may be noted here that the list of "sick leave" given in the Corporation's letter, dated 30.11.1999 is not fully in accordance with the list of commuted leave as given in the letter of the C.D.A. dated 13.12.1996. The sick leave at serials (Hi) and (v) in the Corporation's letter were actually shown as earned leave in the C.D.A.'s letter, dated 13.12.1996. Further the leave at serial no. (iv) in the Corporation's letter, dated 30.11.1999 was also not sick leave as will be seen presently. 9. The matter of the petitioner's claim did' not come to close with the Corporation's letter, dated 30.11.1999. She made requests for reconsideration of the matter and it appears that her claim went up for consideration at higher levels. The Corporation made further correspondence with the C.D.A. In reply to the Corporation's letter, dated 26.6.2000 the letter of the Senior Accounts Officer, C.D.A. dated 14.7.2000 is on record at Annexure 6. This letter mentions only two commuted leave taken by Shailendra Kumar Sandhwar during the three years period before he took the policy. The letter of the Senior Accounts Officer, C.D.A., dated 4.7.2000 is quite brief and it will be useful to reproduce the contents of this letter in full: "Ref: Your letter dated 26.6.2000. In response to your letter referred to above it is stated that on verification of records held at this end it is found that the above named deceased individual has taken the following amount of leave prior to his, death: 1. Com. leave w.e.f. 14.1.91 to 2.2.91 2. - do - 8.5.91 to 2.6.91 3. Earned leave 4.3.92 to 5.3.92. Leave w.e.f. 31.10.91 to 13.11.91 as reflected in your ibid letter does not appear to have been availed of by the deceased.
Com. leave w.e.f. 14.1.91 to 2.2.91 2. - do - 8.5.91 to 2.6.91 3. Earned leave 4.3.92 to 5.3.92. Leave w.e.f. 31.10.91 to 13.11.91 as reflected in your ibid letter does not appear to have been availed of by the deceased. Leave applications grounds on which leave taken and copies of medical certificate relating to the leave for the aforesaid period are not readily available at this belated stage." (emphasis added)," 10. What follows from the foregoing can be summed up thus. The list of commuted leave on medical certificate taken by the deceased employee as given in the C.D.A.'s letter, dated 13.12.1996 was not wholly accurate and reliable because in a later letter from the C.D.A. he was shown to have taken two commuted leave only on two occasions, one from 14.1.1991 to 2.2.1991 and the other from 8.5.1991 to 2.6.1991. Further, even the letter, of the C.D.A., dated 13.12.1996 was not considered at the Corporation with proper care because the list of commuted leave shown in the Corporation's letter, dated 30.11.1999 materially differs from the list of commuted leave given in the C.D.A's letter, dated 13.12.1996. 11. As against this, it is stated on behalf of the petitioner that her deceased husband had taken leave in January, May and June, 1991 in connection with the marriage negotiation (in January, 1991), for making arrangements of the marriage (in May, 199J) and for the actual marriage of their daughter (in June, 1991). The invitation card of their daughter's wedding is on record at Annexure 7 from which it appears that the marriage ceremonies took place from 26 to 28.6.1991. 12. It is also undeniable, as appearing from the counter affidavit and the supplementary counter affidavit filed by the Corporation that apart from the C.D.A's letter dated 13.12.1996 it was not in possession of any other material showing that the deceased suffered from any illness or that he had taken leave on the basis of medical certificates. The whole matter thus boils down to this. The Corporation has tile letter from the C.D.A., dated 13.12.1996 (later corrected and modified by letter, dated 14.7.2000) that shows that over a period of three years before taking the insurance policy, the assured had taken leave on two or four occasions that were sanctioned on medical certificates. 13.
The whole matter thus boils down to this. The Corporation has tile letter from the C.D.A., dated 13.12.1996 (later corrected and modified by letter, dated 14.7.2000) that shows that over a period of three years before taking the insurance policy, the assured had taken leave on two or four occasions that were sanctioned on medical certificates. 13. The question, therefore, arises whether taking commuted leave on production of medical certificate can form a sustainable basis for a finding that the person concerned was really ill and he had given false answers to the questions in the insurance proposal form. I feel that it would be highly unsafe to record a finding having grave consequences on such tenuous and flimsy evidence. In considering the evidence of leave on medical certificate it will not be prudent to disregard certain practice widely prevalent among government servants and employees of government undertakings. It is well known that earned leave can be accumulated and encashed up to a certain limit, at the time of retirement. The medical leave, on the other hand, does not carry such advantages. The facilities of accumulation and encashment make the former very valuable and there is a strong tendency among the Government employees to preserve it as far as possible at least up to the encashable quota. The practice therefore, is quite, prevalent not to spend the e earned leave but instead to use medical leave by production of medical certificates which are often incorrect The practice is well known and it is indulged practially at all levels and it, therefore, cannot be over looked while using the medical leave taken by the deceased to hold that he had given false replies to the questions in the proposal form. 14. I would like to observe here that the practice may be undesirable and it ought to be discouraged but taking medical leave for non-medical purposes on production of certificate that is not correct may make the concerned employee liable to be proceeded against under the relevant service rules. But the mere fact that he had taken leave on production of medical certificate(s), even though he was not unwell, cannot be used as a ground to hold that the replies given by him to the questions in the proposal were false and untrue and hence, the Corporation was well within its rights to repudiate the contract. 15.
But the mere fact that he had taken leave on production of medical certificate(s), even though he was not unwell, cannot be used as a ground to hold that the replies given by him to the questions in the proposal were false and untrue and hence, the Corporation was well within its rights to repudiate the contract. 15. In this case, there are two sets of materials before this court. One is the statement that on two or four occasions, the deceased had taken leave that was sanctioned on the basis of medical certificates. The other is his replies to the questions in the proposal to the effect that he had not remained absent from his place of work on the ground of health and the usual state of his health was very good. According to the Corporation, his replies to the questions are inconsistent with the fact of his taking leave on the basis of medical certificates and, therefore, the answers must be held to be false. The Corporation seems to over-look the other possibility that his replies in the proposal form were correct and the leave was availed of on a false pretext. 16. It is noted above that the statement of leave in the letter, dated 13.12.1996 was not wholly accurate as appearing from the later, letter, dated 14.7.2000. Further, it is stated on behalf of the petitioner that her deceased husband had taken leave in January, May and June, 1991 in connection with the 'marriage of their daughter in June, 1991. Having regard to the aforesaid circumstances this court would be rather, inclined to hold that the deceased had taken leave on a false plea and not the other way round as held by the Corporation. 17. The matter can be looked at from another point of view. A suppression or misstatement of fact must be material and germane to the issue in order to form the basis for repudiation of the contract of insurance. A statement, though admittedly incorrect in any objective and abstract sense but having no relevance to or bearing upon the main issue, i.e. the cause of death .cannot be used as the basis to repudicate the contract.
A statement, though admittedly incorrect in any objective and abstract sense but having no relevance to or bearing upon the main issue, i.e. the cause of death .cannot be used as the basis to repudicate the contract. For example, if the person assured under-states his age by three or four years but dies in a road accident, the misstatement in regard to age cannot be used as the pretext to repudicate the claim. Similarly if the person assured did not disclose in the insurance proposa1 that during the past one year he had suffered from such common ailments as conjunctivitis, influenza, dysentry etc., the contract of insurance cannot be repudiated if the cause of his death is, say renal failure, hepatitis-B or a brain tumour. 18. In the case in hand it is undeniable that the leave applications, grounds on which leave taken and copies of medical certificates relating to the leave were no longer available. In that circumstance, it is impossible to connect the leave taken by him with the cause of his death being cerebral haemorrhage. One need not be an specialist to know that fatal haemorrhage resulting from rupture of cerebral blood vessel (s) can occur suddenly and without any apparent symptoms. 19. Further, the court finds it surprising that it did not occur to the concerned authorities in the Corporation that the rejection of a paltry claim of Rs.48,000/- by the widowed wife of the assured deceased on such a flimsy ground would have an adverse impact on the Corporation's image and credibility. After all the Life Insurance Corporation of India has been able to make a name for itself in the field of insurance and public service. It is not expected to act as a private profiteer anxious to reject the claim on any pretext, fair or foul. It is expected to take an objective and balanced view of the case in the totality of circumstances. 20. For the reasons discussed above, I find it impossible to sustain the decision of the Corporation to repudiate the policy and to reject the petitioner's claim. The impugned decision as communicated to the petitioner by letters, dated 30.1.1999 (Annexure 4).0 and 18.10.2001 (Annexure 8) is accordingly set aside and the matter is remitted to title Corporation to take a fresh decision on the petitioner's claim in the light of this judgment.
The impugned decision as communicated to the petitioner by letters, dated 30.1.1999 (Annexure 4).0 and 18.10.2001 (Annexure 8) is accordingly set aside and the matter is remitted to title Corporation to take a fresh decision on the petitioner's claim in the light of this judgment. It is expected that a final decision will be taken within two months from the date of receipt/production of a copy of this order in the office of the Senior Divisional Manager, Life Insurance Corporation of India, Divisional Officer, Patna. 21. In the result, this writ petition is allowed.