BHARTIYA JEEVAN BIMA NIGAM v. THAKUR RAM CHANDRAKAR
2004-04-28
R.S.AWASTHI, V.K.AGRAWAL, VEENA MISRA
body2004
DigiLaw.ai
ORDER V.K. Agrawal, President : 1. This appeal, under section 15 of the Consumer Protection Act. 1986, is directed against the order dated 8-7-02 in complaint No. 35/2002 by District Consumer Disputes Redressal Forum, Rajnandgaon, (hereinafter called the 'District Forum' for short) directing the appellant insurer to pay Rs. 50,000/- under the Life Insurance Policy obtained by the insured Smt. Lokeshwari Chandrakar. 2. Undisputedly. Smt. Lokeshwari Chandrakar was wife of respondent No. 1 Dr. Thakur Ram Chandrakar and mother of remaining respondent. The deceased insured Lokeshwari Chandrakar in the month of March, 1999 submitted proposal form and obtained Life Insurance Policy for an assured sum of Rs. 50,000/- from the appellant insurer. The deceased died after about 2 months thereafter on 17-5-99. The complainant/respondents who are the legal representatives of deceased insured, claimed the assured amount payable under the said policy from appellant/insurer. The claim was however, repudiated by the appellant insurer by letter dated 20-9-2002 on the ground of suppression of material facts about the disease by the insured. 3. The complainants/respondents filed the complaint before the District Forum. According to them the repudiation of their claim by the appellant insurer was without any justification and thus the appellant insurer committed deficiency in service by repudiating the claim of the complainants and by not paying the assured sum under the Life Insurance Policy obtained by Smt. Lokeshwari Chandrakar. 4. The complaint was resisted by the appellant insurer. It was averred that though in her proposal form the insured stated that she was not suffering from any disease and had not taken any treatment and that her general health was good. Yet, it was discovered on investigation after her death that she suffered from the disease of Sickle Cell for the last 5 years prior to her death. It was therefore, averred that since the insured obtained life insurance policy by suppression of material facts as above, the complainants are not entitled to any benefit under the said policy. Appellant insurer therefore, repudiated the claim of the complainants by letter dated 20-9-2002. It v. as averred that repudiation as above was justified. 5. Learned District Forum did not feel convinced with the defence as above of the appellant insurer and held that there was no material to conclude that deceased insured knowingly suppressed any material facts about her health.
Appellant insurer therefore, repudiated the claim of the complainants by letter dated 20-9-2002. It v. as averred that repudiation as above was justified. 5. Learned District Forum did not feel convinced with the defence as above of the appellant insurer and held that there was no material to conclude that deceased insured knowingly suppressed any material facts about her health. In view of the above, it was held that the complainants were entitled to get the assured sum under the said policy. Accordingly, appellant insurer was directed to pay Rs. 50,000/- with interest etc. thereon. 6. Learned counsel for the appellant insurer submitted that the medical certificates and documents placed on record by the appellant, go to show that the deceased was suffering from many diseases including Sickle Cell for the last 5 years. However, she did not disclose these diseases in the proposal from submitted by her. Therefore, it was a case of suppression of material facts by the insured and the repudiation therefore, by the appellant insurer was justified. No interference in such a case deserved to be made. 7. However, learned counsel for complainants/respondents supported the impugned order. It was submitted that the documents filed by the appellant insurer do not in any manner show that the deceased insured was aware of any of her ailments. Therefore, there was no question of any suppression of material facts by her. It was therefore, submitted that the District Forum was justified in directing the appellant insurer to pay the assured amount to the complainants/respondents. 8. As noticed earlier, it is undisputed that the complainants are the legal representatives of the deceased insured Smt. Lokeshwari Chandrakar. Copy of the proposal form submitted by Smt. Lokeshwari Chandrakar on 20-3-99 is placed on record. According to the declaration made by the insured, she did not suffer from any disease and did not take any treatment within 5 years or nor was admitted in any hospital for treatment. It was also stated that her general condition was good. 9. The question that arises for consideration is : as to whether there was any suppression of material facts regarding the health by the deceased insured ? 10. In the above context, learned counsel for appellant insurer referred to the certificate of hospital treatment issued by J.N. Memorial Hospital and Research Centre, Sector-9, Bhilai.
9. The question that arises for consideration is : as to whether there was any suppression of material facts regarding the health by the deceased insured ? 10. In the above context, learned counsel for appellant insurer referred to the certificate of hospital treatment issued by J.N. Memorial Hospital and Research Centre, Sector-9, Bhilai. It appears from the said certificate that the insured was admitted in the hospital on 16-5-99 and expired on 17-5-99. It was mentioned in the certificate in the column the nature of the complaint that the insured complained of breathing difficulty, there was lesser amount of Urine since 3 days prior to her admission. The diagnosis as mentioned in column 6 of the certificate is S C D c C L De Liver disease and Hospital. The date of death is mentioned as 17-5-99. It would further appear from column 7 of the said certificate that history of any other disease was not reported. Thus from the said certificate of hospital treatment dated 31-8-99 issued after the death of the deceased insured, it cannot be inferred that the deceased suffered from any ailment for a long period before her death. 11. There is yet another medical certificate dated 14-8-99 issued Dr. Sujata of J .N. Memorial Hospital and Research Centre. The said certificate also indicates that it was not known as to from what time the deceased was suffering from the ailment, as would be clear from column 4 (c) of the said certificate. The cause of death which occurred is mentioned as 'G.I.C.H .B.P. & Chronic liver disease. The said certificate was issued on 14-8-99 i.e. much after the death of the deceased insured. The said certificate does not disclose that the deceased insured know about her ailment or had taken any treatment for any disease prior to obtaining the insurance policy. 12. It may be noticed that there is also a copy of document purporting to be medical certificate dated 22-2-2000 issued by some medical officer C.H.C. of some place which is also not legible. The said document does not appear to be on a letter pad of any Doctor or the prescribed form of any hospital. The name and designation of the Doctor in the said document is also not decipherable. In fact, the said document purporting to be the certificate is not clearly legible.
The said document does not appear to be on a letter pad of any Doctor or the prescribed form of any hospital. The name and designation of the Doctor in the said document is also not decipherable. In fact, the said document purporting to be the certificate is not clearly legible. However, it appears from whatever can be read from the said certificate that Smt. Lokeshwari Chandrakar was a chronic patient of Sickle Cell and Aneamia for the last 5 years and required frequent blood transfusion. However neither the said certificate is legible nor appears to be authenticated by any competent authority. Such a document in our opinion, cannot be of any assistance to the insurer and does not deserve to be relied upon. Moreover, it does not disclose that any treatment was given to the deceased or that she was told about her disease. The document as above dated 22-2-2000 would thus be of no consequence as there is no material such as medical prescription, hospital record or affidavit of the concerned doctor, in support of the said document. 13. Besides the above documents, there is no other material to show that the deceased suffered from any disease for the last many years and much less that she knew about it and thus knowingly suppressed the same. Needless to say that it was the burden and obligation of the appellant/insurer to have proved its defence version and justification for repudiating the claim of the complainants under the policy. The material placed on record by appellant insurer does not go to show that the deceased knowingly suppressed any facts regarding her ill health. 14. Learned counsel for appellant insurer has cited a decision of National Commission in Divisional Manager. LIC of India & Ors. Vs. Sunita Sharma. In that case the insured was suffering from the disease for the last about 17 years and was also operated upon for appendicitis and had remained on medical leave. These facts were suppressed by the complainant' in the proposal form. The insurer in that case repudiated the claim under the policy obtained by the deceased. The District Forum and State Commission in their orders held that there was no deficiency in service by the appellant insurer.
These facts were suppressed by the complainant' in the proposal form. The insurer in that case repudiated the claim under the policy obtained by the deceased. The District Forum and State Commission in their orders held that there was no deficiency in service by the appellant insurer. The National Commission in that case allowed the revision in the facts and circumstances of the case as it held that there was concealment of material fact by the insured and the repudiation by the insurer was bonafide and made in good faith. However in the facts of the present case, the decision as above would not render any assistance because, as the deceased insured does not appear to have knowingly concealed or suppressed any facts, regarding her health. 15. In view of the above, it is clear that the appellant insurer committed deficiency in service by repudiating the claim of the complainants. The findings as above of the learned District Forum is therefore, justified and calls for no interference. In view of the above, this appeal has no substance. It is accordingly dismissed. The appellant insurer shall bear its own cost and shall pay that of the complainants/respondents which is quantified at Rs. 500/- (Rupees five hundred) only. Appeal Dismissed.