LIFE INSURANCE CORPORATION OF INDIA v. LAXMI KARNATKA
2004-04-06
K.D.SHAHI, LUXMI SINGH, SURENDRA KUMAR
body2004
DigiLaw.ai
ORDER Mr. Justice K.D. Shahi, President—This is an appeal against the order dated 11.9.2003 passed by the District Forum, Nainital whereby the complaint of the complainant was allowed for recovery of the insured amount from the L.I.C. (hereinafter called the appellant). 2. The facts of the case are very limited. Sh. Ganesh Chandra Karnatka had taken two policies of Rs. 50,000/- (Rupees fifty thousand) each in 1993. He could not pay premium, these were lapsed in 1996. These were renewed in 1999 and thereafter he paid the premium regularly. In an accident, he died on 19.6.1999. After his death Smt. Laxmi Karnatka his widow lodged the claim before the Insurance Company, which was repudiated on the ground that the insured had taken medical leave from 21.5.1998 to 20.6.1998 and 24.11.1998 to 12.12.1998. He was ill from Appendicitis and he has taken treatment from Dr. A.K. Srivastava. It is alleged that before two months of the renewal, the insured was suffering from appendicitis. 3. After taking the evidence of the parties, the learned Forum allowed the complaint. Against which order the present has been filed. 4. We have heard the learned Counsels for the parties and gone through the records. Mere taking of medical leave is no ground to presume that the insured was actually ill, this we have held in a number of cases. There are judgments of other Commissions as well that often an employee takes leave on medical ground, when no other leave is available to him. Even otherwise, an employee gets one full year’s medical leave througout his service and also for the purpose to consume this leave, employees often take leave on medical ground off and on. There is no statement of Dr. A.K. Srivastava that he actually examined the insured and had given any treatment to him. There is nothing on the record to show that the insured had got any prescription, treatment, medicine, etc. from any doctor of this alleged disease. There is also no evidence that he charged any amount of his treatement from his department of this illness. Therefore, mere taking of medical ground is no ground to presume that the insured was actually suffering from appendicitis. 5. Even otherwise it is admitted fact that the insured died out of accident.
from any doctor of this alleged disease. There is also no evidence that he charged any amount of his treatement from his department of this illness. Therefore, mere taking of medical ground is no ground to presume that the insured was actually suffering from appendicitis. 5. Even otherwise it is admitted fact that the insured died out of accident. The disease was not such a material disesase, therefore, this was not a material fact, which was to be disclosed in the proposal form. Ordinarily illness or pain, fever, cold, cough, which a person ordinarily suffers, is not such a disease, which should be mentioned in the proposal form or renewal form. Only those facts, which are very material, for that only, the insured can be held guilty, if he has suppressed it. Even otherwise there is no nexus of the death of the victim with the alleged disease and, therefore, aslo the claim could not have been repudiated on that ground. The learned Counsel for the appellant referred the judgment of Revision Petition No. 3507 of 2003, Fateh Chand Kalra v. L.I.C. of India, wherein the victim was actually suffering from SLE and which has not been disclosed in the proposal form. This was held to be a material fact. The judgment of National Commission is on the basis of the judgment given by this Commission in Appeal No. 261/2002, L.I.C. of India v. Sh. Fateh Chand Kalra, wherein the insured was suffering from SLE. She was admitted in BHEL Hospital where she was treated. SLE is a disease of a form of cancer and is a serious disease. The deceased was also treated in AIIMS, Delhi but in this particular case, no evidence of any admission in the hospital and treatment and acutally suffering of the insured has been given. To the contrary the learned Forum in its order has referred the judgment reported in =2001 (1) CON.LT 89, L.I.C. v. Asha Goyal, wherein the Hon’ble Supreme Court has held that the claim cannot be rejected merely on the ground that the victim has not disclosed true facts in the proposal form. The learned Forum further referred the ruling reported in II (1997) CPJ 1 (NC)=1997 (2) CPR 21, New India Assurance Co.
The learned Forum further referred the ruling reported in II (1997) CPJ 1 (NC)=1997 (2) CPR 21, New India Assurance Co. Ltd. v. D.P. Khanna, wherein it has been specifically held that it is the duty of ther Insurance Company to prove the fact of actual illness and after the revival of the policy, the Insurance Company cannot escape from the liability merely by saying that the insured has not disclosed the true facts. 6. The order given by the learned Forum is a detailed order. We find nothing for which we may interfere with that order. This appeal has got no force and is liable to be dismissed. ORDER The appeal is hereby dismissed. Cost of the appeal shall be easy. Appeal dismissed. –