Saroj Agrawal v. Life Insurance Corporation Of India
2004-06-23
TAPEN SEN
body2004
DigiLaw.ai
ORDER Tapen Sen, J. 1. Heard the parties. 2. The Petitioner in the instant case prays for issuance of an appropriate writ for quashing the communication dated 31-3-2000 as contained in Annexure-1 whereby and whereunder the Respondent No. 2. informed the decision taken in respect of the death claim filed by her with regard to the policy of the life of her deceased husband. In the said communication, it was informed that it had been decided to repudiate all liabilities under the said policy and that the Corporation was not liable to make any payment and further, any money that may have been paid under the same, would be deemed to belong to the Corporation. 3. The Petitioner further prays for issuance of an appropriate writ commanding upon the Respondents to admit the claim of the Petitioner under Policy No. 550444818 taken in respect of the life of her deceased husband Jagnnath Agrawal. 4. The short facts which are necessary to be taken note of are that on 30-6-1995, the deceased husband of the Petitioner submitted a proposal being Proposal No. 36100560. being a Life Insurance Policy to the extent of Rs. 2 lacs. Upon submission of the said proposal, the Life Insurance Corporation of India (hereinafter referred to for sake of brevity as the Corporation) accepted the same and accordingly issued a Policy vide Annexure-2 on 9-11 -1995 being Policy No.550444818. 5. The deceased husband of the Petitioner paid annual premium of Rs. 7618/- to the Corporation for the years 1995 and 1996. The premium for the year 1997, however could not be paid by him as he suffered a serious ailment and had to go to the Apollo Hospital at Chennai, where he ultimately died on 10-12-1997. 6. The Petitioner being the nominee under the said Policy, was aged about 42 years at the time of death of her husband and after recovering from the shock and trauma, she informed the Divisional Manager of the said Corporation at Ranchi about the death and also filed claim vide Annexures-3 and 3/A along with necessary documents praying for payment of the sum assured and also gave reasons for non payment of premium which had fallen due in November, 1997. 7.
7. It is stated that the Divisional Manager of the Corporation at Ranchi gave an assurance that her claim would be expeditiously settled but she was made to wait till July, 1999. Thereafter, she met the Divisional Manager sometime in September, 1999 when she was asked to send original policy papers to the Regional Office at Jamshedpur. She complied and sent all relevant documents to the said Regional Office on 15-9-1999. Thereafter in February, 2000. she received a letter dated 28-1 -2000 (Annexure-4) from the Jamshedpur Divisional Office wherein the Senior Divisional Manager informed her that during the course of investigation, the Investigating Officer had found that her husband had a heart problem and that he was under continuous treatment in the Apollo Hospital at Chennai since 1992-93 and that, he was a regular visitor to the said Hospital for check-up since 1995 but all these facts had not been disclosed by him at the time of submitting the proposal. According to the Senior Divisional Manager, had such disclosure been made at the time of submission of the proposal, the Corporation may not have accepted the same at all. The Petitioner was therefore asked to explain the reasons for non disclosure of the illness with a further advice that she should submit photocopies of documents showing treatment at the Apollo Hospital. Chennai. 8. The Petitioner states that having received the aforementioned letter dated 28-1-2000, she immediately sent all documents but the Respondents maintained silence whereafter she sent a reminder on 18-3-2000 vide Annexure-5 which was addressed to the Senior Divisional Manager of the Corporation at Jamshedpur. 9. In reply to the aforementioned reminder dated 18-3-2000, the Respondents issued the impugned communication on 31-3-2000 vide Annexure-1 repudiating the claim of the Petitioner. Being aggrieved the Petitioner protested and sent a letter vide Annnexure-6 addressed to the Zonal Manager of the Corporation at Kolkata submitting that the decision of the Senior Divisional Manager was arbitrary and that there was no intention on the part of her husband to cheat the Corporation. She further stated that all requisite information had been furnished by him and it was not expected that a minor ailment would prove to be fatal. 10.
She further stated that all requisite information had been furnished by him and it was not expected that a minor ailment would prove to be fatal. 10. The Respondents did not attend to these objections and made the Petitioner wait and thereafter finding no other alternative, a legal notice dated 3-8-2001 (Annexure-7) was sent to the Manager of the said Corporation at Kolkata (Respondent No.5). The Petitioner has further stated that there was no material suppression of the condition of health of her husband at the time of submitting the proposal. It is her further case that at the relevant time, her husband had some minor ailment which required occasional treatment and as per Rules of the Corporation, he had to undergo medical check-up by the doctor of the Corporation at the time of submitting and/or acceptance of the proposal. The doctor of the Corporation did not find any serious ailment. According to her, had her husband been a patient of some serious and/or fatal disease, the same would have been detected by the doctor but there was evidently no such finding recorded. After a thorough scrutiny and medical check-up, the Respondents had accepted the proposal and had also accepted annual premiums for two years amounting to Rs. 15.236/-. They had also issued the Policy and therefore it was not at all proper on their part to repudiate the same on the death of her husband on grounds which are neither tenable nor reasonable. 11. A counter-affidavit has been filed on behalf of the Respondents wherein they have taken various objections. One of the objections is that in terms of the Judgment, of the Honble Supreme Court of India in the case of Mithoolal Nayak v. Life Insurance Corporation of India Limited reported in AIR 1962 Supreme Court 814, the Policy itself was vitiated on account of fraudulent suppression of material facts to the effect that, the policy holder had been treated for serious ailment a few months before taking the Policy. In that view of the matter, the insurer/proposer, namely the Corporation. had the right to repudiate the claim. According to these Respondents, the deceased Jagannath Agrawal had obtained the relevant Policy which commenced with effect from 9" 11-1995 and about two years and one month thereafter, he died. The primary cause for death as mentioned by Dr.
In that view of the matter, the insurer/proposer, namely the Corporation. had the right to repudiate the claim. According to these Respondents, the deceased Jagannath Agrawal had obtained the relevant Policy which commenced with effect from 9" 11-1995 and about two years and one month thereafter, he died. The primary cause for death as mentioned by Dr. K. C. Prakash, Consultant Nephrologists, Apollo Hospital, Chennai was Coronary Artery Disease. The secondary cause was described as Triple Vessel Disease and Diabetic Nephrology. The said Certificate brought on record by these Respondents vide Annexures-A and B appended to the counter affidavit mentions that the deceased was suffering from at least these two diseases under the secondary cause since 1994 and was put on Dialysis on 1-10-1994. Column No. 9 of Annexure-A, mentions the fact that the deceased was under treatment for Nephropathy and Chronic Renal Failure since 1-10-1994. 12. These Respondents therefore contend that the deceased husband had nowhere declared nor disclosed the fact that he was under treatment for Triple Vessel Disease and Diabetic Nephropathy and that on account of Renal Failure, he was put on dialysis. All these happened since the year 1994 (1-10-1994) and these were material facts which should have been disclosed at the time of submitting the proposal. According to the learned counsel appearing for the Respondents, if these facts had been disclosed, the Corporation may not have accepted the proposal at all. Additionally, the Respondents have relied on the Proposal Form which was duly filled up and submitted by the deceased husband of the Petitioner on 30-6-1995. This has been brought on record vide Annexure- C appended to the counter-affidavit and the last page thereof has been brought on record through the supplementary affidavit filed by them stating that "earlier a counter affidavit has already been tiled on behalf of the respondents. It however appears that the last page of the proposal form submitted by the life assured which is Annexure C to the counter affidavit could not be enclosed inadvertently. In that view of the matter the deponent is filing the last page of the proposal form which should be treated as part and parcel of AnnexureC to the counter affidavit". 13.
In that view of the matter the deponent is filing the last page of the proposal form which should be treated as part and parcel of AnnexureC to the counter affidavit". 13. The Petitioner, in reply to the counter-affidavit has stated that the ratio as laid down in the case of "Life Insurance Corporation of India v. Smt. Asha Goel reported in "2001 AIR SCW 161 : (2001) 2 SCC 160 : ( AIR 2001 SC 549 )" will be fully applicable in the facts and circumstances of this case and that the deceased husband of the Petitioner, at the time of taking the Policy, had some minor ailments for which he had undergone treatment in the Apollo Hospital at Chennai but the ailments were not so serious that it was necessary for him to disclose about them in detail in the proposal for insurance. According to the Petitioner, non-disclosure of minor ailments at the time of taking the Policy was not a sufficient ground for repudiating the claim of the Petitioner. 14. This Court is unable to accept the arguments put forward by the learned counsel for the Petitioner. In this context it is necessary to bear in mind that the deceased husband of the Petitioner submitted the proposal on 30-6-1995 and in that proposal (as is evident from the last page thereof brought on record by the supplementary affidavit filed by the Respondents), a set of questions in column No. 11 have all been answered in a manner that conveys an impression that he was absolutely hale and hearty on the date of submitting the proposal i.e. 30-6-1995. It would therefore be necessary to reproduce the said question and their answers given under Column No. 11. The same reads as follows :-- (1) Personal History Answer If Yes --------------------------------------------------------------------- Yes or please no give full details --------------------------------------------------------------------- (a) During the last five years No. did you consult a medical practitioner for any ailment requiring treatment for more than a week ? (b) Have you ever been ad- No mitted to any Hospital or Nursing Home for general check-up, observation, treatment or operation? (c) Have you remained absent No from place of work on ground of health during the last 5 years? (d) Are you suffering from or No have you suffered from ail- ment pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System ?
(c) Have you remained absent No from place of work on ground of health during the last 5 years? (d) Are you suffering from or No have you suffered from ail- ment pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System ? (e) Are you suffering from or No have you ever suffered from Diabetes. Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease? (f) Do you have any bodily No defect or deformity? (g) Did you ever have any No accident or injury? (h) Do you use or have you No ever used alcoholic drinks, narcotics or any other drugs? (i) What has been your usual Good state of health? --------------------------------------------------------------------- 15. Upon perusal of the aforementioned Proposal Form filled up in the manner stated by the creceased husband of the Petitioner, as is evident from the supplementary-affidavit filed by the Respondents, it is clear that these sets of questions are pertinent and material for purposes of enabling the Corporation to either accept or reject the proposal. The most important questions in so far as this case is concerned are question Nos. (b) and (d). These are questions which point to the fact as to whether the proposer has ever been admitted to a Hospital or a Nursing Home for either general check-up or for observation or for treatment and as to whether he has suffered or suffering from ailments pertaining to, amongst others, the Kidney and the Heart. The third question which is equally important is question No. (i) which asks the proposer to mention about his usual state of health. This proposal was submitted on 30-6-1995. Annexure-A to the counter-affidavit, which is the Medical Attendance Certificate signed by Dr. K. C. Prakash, Consultant Nephrologist, Apollo Hospital, Chennai shows that on 1-10-1994 (i.e. 8 months prior to this date. i.e. 30-6-1995), the deceased husband had suffered a Renal Failure (which is directly connected with question No. (d)) above and was under treatment since 1 10-1994 for Nephropathy and Chronic Renal Failure (again, directly connected with question Nos. (b) and (d) above.) 16. It was therefore expected of the deceased husband of the Petitioner to have correctly answered the questions by using the word yes against question numbers (b) and (d) and then to have given details as required in the fourth column quoted above.
(b) and (d) above.) 16. It was therefore expected of the deceased husband of the Petitioner to have correctly answered the questions by using the word yes against question numbers (b) and (d) and then to have given details as required in the fourth column quoted above. Instead, he answered all these questions by using the word No. The fourth column was left totally blank and in answer to question No. (i), he made a statement that his usual state of health had been good without realizing that since eight months from the date he signed this document he had become a chronic patient of Renal Failure as certified by the doctor himself vide Annexures-a and B to the counter-affidavit. These therefore are material suppression of facts. 17. The submissions of the learned counsel for the Petitioner to the effect that repudiation other claim by Annexure-1 has been done in a routine manner and is therefore arbitrary, cannot be accepted because the letter of repudiation also mentions and draws the attention of the Petitioner to the question numbers (a) to (d) of the Proposal Form and the answers given against each of them as has been stated earlier. The Judgment cited by the learned counsel for the Petitioner in the case of "Life Insurance Corporation of India v. Smt. Asha Goel reported in 2001 AIR SCW 161 : (2001)2 SCC 160 : ( AIR 2001 SC 549 ) does not come to the rescue of the Petitioner at all. On the contrary, paragraphs 12and 13 of the said Judgment goes in favour of the Respondents and against the Petitioner.
On the contrary, paragraphs 12and 13 of the said Judgment goes in favour of the Respondents and against the Petitioner. In paragraph 12, their Lordships of the Supreme Court have observed as follows :- "No Policy of Insurance, after expiry of two years from the date on which it was effected, can be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a Medical Officer, or referee, or friend of the insured, or in any other document leading to the misuse of the Policy was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the Policy Holder and that the Policy Holder knew at the time of making it that the statement was false or that is suppressed fact which it was material to disclose." (Emphasis and Italics supplied). Their Lordships have further observed that the burden of proof is on the insurer to establish that the circumstances mentioned in Section 45 are fully attracted before it is in a position to repudiate a claim/policy. In the instant case, after having read and perused the documents brought on record by the Respondents in their counter-affidavit and which have been considered in the foregoing paragraphs, this Court is satisfied that the Corporation has been able to establish that there was non disclosure of material facts and such non disclosure was made in such a manner that it amounted to suppressing the true state of health of the deceased proposer. While relying upon the case of Mithoolal Nayak v. Life Insurance Corporation of India reported in 1962 Supreme Court 814. their Lordships, in the case of Asha Goel (supra) ( (2001) 2 SCC 160 ) : ( AIR 2001 SC 549 ) have stated in paragraph 13 as follows ;-- "...........
While relying upon the case of Mithoolal Nayak v. Life Insurance Corporation of India reported in 1962 Supreme Court 814. their Lordships, in the case of Asha Goel (supra) ( (2001) 2 SCC 160 ) : ( AIR 2001 SC 549 ) have stated in paragraph 13 as follows ;-- "........... Where the policy holder, who had been treated, a few months before he submitted a proposal for the insurance of his life with the insurance company by a physician of repute for certain serious ailments as anaemia, shortness of breath and asthma, not only failed to disclose in his answers to the questions put to him by the insurance company that he suffered from those ailments but he made a false statement to the effect that he had not been treated by any doctor for any such serious ailment. Held (i) that, judged by the standard laid down in S. 17, Contract Act. the policy holder was clearly guilty of a fraudulent suppression of material facts when he made his statements, which he must have known were deliberately false and hence, the policy issued to him relying on those statements was vitiate. (ii) The principle underlying the Explanation to S. 19 of the Contract Act is that a false representation, whether fraudulent or innocent, is irrelevant if it has not, induced the party to whom it is made to act upon it by entering into a contract. That principle did not apply in the instant case. The terms of the policy made it clear that the averments made as to the state of heath of the insured in the proposal form and the personal statement were the basis of the contract between the parties and the circumstance between the parties and the circumstance that the policy holder had taken pains to falsify or conceal that he had been treated for a serious ailment by a physician only a few months before the policy was taken showed that the falsification or concealment had an important bearing in obtaining the other partys consent. A man who has so acted cannot afterwards turn round and say "It could have made no difference if you had known the truth." In the circumstances no advantage could be taken of the Explanation to S. 19 of the Contract Act." 19.
A man who has so acted cannot afterwards turn round and say "It could have made no difference if you had known the truth." In the circumstances no advantage could be taken of the Explanation to S. 19 of the Contract Act." 19. Taking all these facts and circumstances into consideration, this Court is of the opinion that there was deliberate suppression and/or withholding of information which was necessary to be disclosed. It is well settled that contracts of insurance as also Contracts of Life Assurance are contracts Uberrima fides and every, material fact must be disclosed, otherwise there is a good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract. If there are any misstatements or suppression of material facts, the insurer certainly has the right to repudiate the claim made under a Policy which was obtained on the basis of suppression of truth. For the foregoing reasons, this Court does not find any irregularity or arbitrariness nor any illegality with the impugned communication dated 31-3-2000 as contained in Annexure-1. On the country, this Court holds that the action on the part of the Respondents in issuing the said communication was justified, in accordance with law and consequently, they were also justified in saying that they were not liable to make any payment under the said Policy and that all money paid in consequence thereof belonged to them. As a result, this Court holds that there is no merit in this writ petition. It is accordingly dismissed. There shall however be no order as to costs.