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2005 DIGILAW 411 (HP)

LIFE INSURANCE CORPORATION OF INDIA LTD v. KAMLA DEVI

2005-11-08

A.K.GOEL, ONKAR CHAND THAKUR, PREM CHAUHAN

body2005
ORDER Arun Kumar Goel, J. (Retd.) President: - Sole ground urged in this case on behalf of the appellant was that Policy of insurance was obtained by deceased Kishori Lal, husband of the respondent by practicing fraud inasmuch as in the Proposal Form material facts were purposely as well as intentionally withheld by him. As such the appellant was not liable to indemnify the respondent in terms of the Policy. Deceased Kishori Lal having been insured in terms of the Policy, Annexure R.1, in the sum of Rs. 50,000/- and the date of commencement whereof being 284.2001 and the annual premium being Rs. 6488/-, are the other facts which were not disputed on behalf of the appellant. However, great emphasis was laid on Cols. 10 and 11 of the Proposal Form for insurance, Annexure R.III while challenging the impugned order. 2. According to the learned Counsel for the appellant, deceased had been taking alcohol for a duration of about 30 years. In this behalf reliance was placed on Annexure R.II. In the context of Annexure R.III, it may be noted that the deceased had answered in the negative so far information required in Col. 10 (ka) to (ja) thereof is concerned. Thus, according to the learned Counsel, withholding of this information was sufficient for allowing this appeal and consequently dismissing the complaint of the respondent. All these pleas have been controverted on behalf of the respondent by Shri Rathore. As according to him, impugned order of the Forum below calls for no interference in this appeal which is based on proper appreciation of facts as well as correct application of law. Thus, he prayed for its dismissal. Kishori Lal, husband of the respondent i.e. the insured died on 31.10.2001 as is evident from photostat copy of the death certificate issued by Local Registrar, Births and Deaths, M.C. Ludhiana. 3. In view of the aforesaid facts, core question involved in this appeal is whether the Policy, Annexure R.I, was obtained by either withholding or by suppressing true facts fraudulently. In case this is established, then we have no escape but for allowing this appeal. Reason being that once fraud is established it vitiates the entire transaction. 3. In view of the aforesaid facts, core question involved in this appeal is whether the Policy, Annexure R.I, was obtained by either withholding or by suppressing true facts fraudulently. In case this is established, then we have no escape but for allowing this appeal. Reason being that once fraud is established it vitiates the entire transaction. Learned Counsel for the respondent conceded and in our view rightly that it fraud is established, then the order of the Forum below cannot stand the test of scrutiny by this Commission and consequences have to follow in such a situation. But added that there was no fraud committed by the husband of his client. 4. It is by now well settled under the law by authoritative judicial pronouncements of the Supreme Court of India, High Court as well as of National Commission, that contract of insurance is based on utmost good faith being uberrima fides. 5. Therefore, we are now turning to the Proposal Form, Annexure R.III in this case. Its perusal shows that its Col. 10(ja)(1) requires the proposal to give information whether he uses or had ever used Alcoholic drinks, answer given by the deceased was in the negative. In our considered view and for the reasons to be recorded hereinafter, no benefit can be derived by the appellant from Annexure R.III, Proposal Form, as well as from the Certificate of Hospital treatment, Annexure R.II also relied upon by Mrs. Sharma. Clauses 5(a) to 6(e) and Clause 11 being relevant for this appeal are extracted herein below:- "5(a) What was the exact history reported by the patient at the time of admission? (Dates, Duration of the ailments, the symptoms narrated etc. to be given) 5.(a)(1) Loss of appetite (2) Irrelevant talks. (b) Was the history reported by the patient himself, or by some one else. Relationship of the person who reported. Was the patient present at that time and was he conscious ? (b) By the attendant. Semi conscious. (c) If the history was not reported by the patient himself, the name and relationship of the person who reported, was the patient present at that time and was he conscious ? (c) Not ascertained. (d) To whom was the history reported and by whom was it recorded ? (d) Dr. Naresh Gupta. (b) By the attendant. Semi conscious. (c) If the history was not reported by the patient himself, the name and relationship of the person who reported, was the patient present at that time and was he conscious ? (c) Not ascertained. (d) To whom was the history reported and by whom was it recorded ? (d) Dr. Naresh Gupta. (e) Is the doctor, whom the history was reported who has recorded the history, still with Hospital and if not what is the present address (e) Still with the hospital. 11. (History of illness as per records: (Case summary). The pt. reported with C/O loss of appetite and irrelevant talk for 4 days. Pt. has been taking alcohol for a duration of about 30 years." 6. A perusal of the above extracted portion of Annexure R.II clearly shows that the Medical Officer, Zonal Hospital, Dharamshala, who has signed the Certificate of Hospital treatment, Annexure R.II, was not the one to whom the history was reported. Further, the Doctor who recorded the history was still with the Hospital. The history of the patient was reported by an attendant, the patient being semi conscious. In these circumstances, no advantage can be obtained by the appellant from Annexure R.II. Even the Medical Officer, Zonal Hospital, Dharmashala, who has signed Annexure R.II has not sworn affidavit. There is no other evidence either in the shape of affidavit of Dr. Naresh Gupta who was still in the Hospital when Annexure R.II was issued, nor any record of the Hospital whether deceased - Kishori Lal was being treated has been produced. In addition to this, there is nothing on record to suggest that the immediate cause of death of the person insured i.e. Kishori Lal was his being alcoholic for a duration of 30 years. Similarly, neither the basis as to how the deceased was taking alcohol was recorded nor it was disclosed that at whose instance this fact has been noted, there is nothing on record to support the same. 7. In this behalf, it may also be appropriate to observe that while obtaining certificate of hospital treatment, R.II, nothing prevented the appellant to have ensured that requisite information was also placed on record from the Hospital. 7. In this behalf, it may also be appropriate to observe that while obtaining certificate of hospital treatment, R.II, nothing prevented the appellant to have ensured that requisite information was also placed on record from the Hospital. Why this was not done, learned Counsel for the appellant could not satisfy this Commission, except for persisting that R.II clearly established withholding of relevant information with a fraudulent purpose to obtain the Insurance Policy. We are not at all impressed by this arguments. Where there is no evidence, as in the present case, how the matter has to be dealt with, is now squarely covered by a decision of the National Commission in the case of L/C. of India v. Mohinder Kaur, 2003(11) CPJ 30 (NC). 8. To be fair to Mrs. Meenakshi Sharma, learned Counsel for the appellant, we may notice that she placed reliance on a decision of the National Commission in the case of Life Insurance Corporation of India v. Mansa Devi, 2003(11) CPJ 135 (NC). This decision is of 3rd September, 2002 wherein while allowing the revision petition, order of the District Forum was upheld and that of the State Commission was set aside. However, looking to the later decision of the National Commission in the case of L.I.C. of India v. Mohinder Kaur (supra), it is of 18.2.2003, we feel that not only in law but even on facts this decision is applicable to the present appeal. It being Jater in point of time, therefore, needs to be followed and will hold the field. As such, no benefit can be derived by the appellant from the decision dated 3.9.2002 of the National Commission. 9. Under the doctrine of onus probandi, it is the duty of the party who alleges fraud to establish the same. It being Jater in point of time, therefore, needs to be followed and will hold the field. As such, no benefit can be derived by the appellant from the decision dated 3.9.2002 of the National Commission. 9. Under the doctrine of onus probandi, it is the duty of the party who alleges fraud to establish the same. At the risk of repetition, we may observe that in the proof affidavit filed on behalf of the appellant of Shri Yengjor, Branch Manager of the appellant at Dharamshala, there is no mention as to on what basis it has been stated by the deponent that the deceased was taking alcohol in large quantity for the last 30 years, and this fact having been disclosed by the life insured to the Doctor in Zonal Hospital, Dharamshala, particularly regarding life assured having disclosed to doctor that he was taking alcohol in large quantity for last 30 years is even controverted by R.II, the document relied upon by the appellant. When deceased was in a semi conscious state and the history having been reported by the attendant to the attending doctor, it is not understood as to on what basis the affidavit has been filed and strangely enough, its contents have been verified being true and correct to the best of his knowledge and belief. In the face of these facts, there is prima facie no evidence to accept the submission of learned Counsel of the appellant regarding policy having been obtained by fraud. 10. We will go a step further in this behalf by observing that even if it is assumed for the sake of argument that there was suppression of material facts, then the next question that arises is whether the suppression was material which had directed nexus with the cause of death of the deceased. Again there is nothing on record to suggest any such thing. Therefore, on this ground also, pleas urged on behalf of the appellant for allowing this appeal have no substance. What is the effect of non-disclosure, came up for consideration before the Maharashtra State Commission, Delhi State Commission as well as before Rajasthan State Commission in the case of LIC of India v. Smt. Shanti Devi Thakur, 2005(3) CPR 189, Oriental Insurance Co. Ltd. V. Hemant Bhandari, 2005(3) CPR 231 and Life Insurance Corporation of India and another v. Shravan Kumar, 2005(3) CPR 243 respectively. Ltd. V. Hemant Bhandari, 2005(3) CPR 231 and Life Insurance Corporation of India and another v. Shravan Kumar, 2005(3) CPR 243 respectively. We reiterate that appellant has reasonably failed to discharge the onus to prove fraud as was urged by its learned Counsel and there is nothing on the record of the Forum below to uphold this plea. 11. To be fair to the learned Counsel for the appellant, we will now make reference to the decisions relied upon by her for allowing this appeal. These decisions are:- (i) Life Insurance Corporation of India v. Mansa Devi, 2003(II) CPJ 135 (NC). (ii) Shanta Bai v. Life Insurance Corporation Ltd. and others, 2004(3) T.A.C. 865 (All.). (iii) P. Sarojam v. L.I.C. of India, AIR 1986 Kerala 201. 12. Since we have held that there is no legally acceptable evidence for coming to the conclusion that deceased had withheld any material fact and or practiced fraud, therefore, these decisions are not being gone into. It is reiterated that fraud vitiates everything and no claim can be based on it. 13. No other point was urged. In view of the aforesaid discussion, there is no merit in this appeal, which is accordingly dismissed. All interim orders passed from time to time shall stand vacated forthwith.