LIFE INSURANCE CORPORATION OF INDIA v. ARVIND PAL SINGH
2006-04-12
NARINDER SINGH THAKUR, SAROJ SHARMA
body2006
DigiLaw.ai
ORDER Justice Arun Kumar Goel (Retd.), President (Oral):- At the time or" hearing of this appeal, two grounds were alleged by Mr. Sharma while assailing the order of the District Forum below in Complaint No. 66/2002 dated 9.7.2003. Issuance of two Insurance policies on 28.3.1992 and 28.1.2001 by the appellant is r 3t disputed. These were 15 years money back policies with profits (with accident b benefit) each being in the sum of Rs.50, 000/-. According to Mr. Sharma, both these policies were obtained by suppression of material facts regarding state of health by the deceased, predecessor-in-interest of the respondents. By placing reliance on facts detailed in Forum No 3816 purported to have been issued by Senior Resident, Nehru Hospital, Postgraduate Institute of Medical Education and research (PGI MFR), Chandigarh, he pointed out that deceased had undergone surgery for bladder stone in 1990 and Choleystectomy in 1999. Both these material facts vitiated the policies in question, as according to him, contract of insurance is based on umost, bonafide and good faith and principle of uberrima fides. Second ground urged in support of this appeal was that even if it is assumed for the sake of argument without admitting, that his client was liable to pay the amount in terms of both the policies, respondents were not entitled to anything beyond the sum assured plus bonus earned till the date of death form the respective dates of both the policies. 2. So far first submission of Mr. Sharma is concerned, it was seriously contested and resisted by Mr. Kanwar Per him there is no suppression of any fact muchless material fact by predecessor-in-interest of his clients when he obtained the policies in question. While questioning and challenging Forum No. 3816 relied upon by the learned Counsel for the appellant, he submitted that on the face of it, it cannot be looked into for any purpose. He referred to its different clauses and pointed out that there is no legal basis to accept what is contained in it Regarding the amount awarded by the Forum below, he pointed out that it calls for no interference us it has been awarded in terms of the policies. Thus, he prayed for dismissal of the appeal. 2 We will take up the second submission first.
Thus, he prayed for dismissal of the appeal. 2 We will take up the second submission first. As admitted on behalf of the parties, both policies were in the sum of Rs.50,00.0/- each obtained on different dates In terms of clause 10(b) of Conditions and Privileges with reference to accident ) benefit, we find that additional sum equal to the Sum Assured is payable under the policy, if the life-assured (like deceased Narinder Pal Singh, father of the respondents in the present case) shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 90 days of its occurrence solely, directly and independently of all other causes result in the death of the Life Assured. Admittedly, it is not the case of the respondents that their father had died due to bodily injury resulting solely and directly from the accident cased by factors envisaged under Clause 10 (b) of the Terms and Privileges. For ready reference, this clause is extracted herein below: "Death of Life Assured:- To pay an additional sum equal to the Sum Assured under this Policy, if the Life Assured shall sustain any bodily injury resulting solely an directly from the accident caused by outward, violent and visible means and such injury shall within 90 days of its occurrence solely, directly and independently of all other causes result in the death of the Life Assured. However, such additional sum payable in respect of this policy, together with any such additional sums payable under other Policies on the Life Assured shall not exceed Rs.5,00,000/-". 4. Faced with this situation, Shri Kanwar was not in a position to stretch his submission any further to uphold the amount as ordered payable by the Forum below. Accordingly, it is held that the appellant is liable to pay Rs.1,00,000/- only qua both the policies with interest and litigation cost as directed by the Forum below. Ordered accordingly. 5. So far submission of Mr. Sharma that the policy was obtained by suppression of material facts by the deceased Life Assured having undergone i surgery etc. as noted herein above is concerned, we are of the view that there is no material worth the name to uphold such a plea. A perusal of Form No. 3816 relied upon by Mr.
So far submission of Mr. Sharma that the policy was obtained by suppression of material facts by the deceased Life Assured having undergone i surgery etc. as noted herein above is concerned, we are of the view that there is no material worth the name to uphold such a plea. A perusal of Form No. 3816 relied upon by Mr. Sharma shows that it has been issued by Senior Resident in Surgery, PGIMER, Chandigarh whereas when a reference is made to Col. 5(d) and (e) as well as to Col.(c), it completely belies the stand of the appellant For ready reference these columns are extracted herein below: - “5(d) To whom was the history reported and by who was it recorded? (d) JUNIOR RESIDENT. reported and by who was it recorded? "5 (d) To whom was the reported arid by whom was it recorded? (d) Junior Resident (e) Is the doctor, to whom the history was reported who has the history still with Hospital and if not what is the present Address (d) Yes, Dr. Vikraman Junior Resident deptt. of Gen. Surgery, Chandigarh.. xxx xxx xxx xxx 7 (c) By whom treated? (c) Not Reported, xxx xxx xxx xxx 7(e) By whom the history was noted and recorded? (if the doctor is not with the hospital at present, please give his present address). (Wrongly repeated as (c) in the form (e) Senior Resident Endocrinology senior Resident hepatology (names not mentioned in the case file)" Admittedly as per this form, history was reported and recorded by Junior Resident and was given by the patient himself as per Col.5(b), whereas in Col.l7(a) supra, it is mentioned that the history was noted by Senior Resident, Endocrinology and Senior Resident, Hematology (names not mentioned in the case file). Both these columns of this form cannot be reconciled because history was reported to DR. Vikraman and he was still in Hospital in the Department of General Surgery, PGIMER, Chandigarh. It may further to appropriate to observe in this behalf that there is nothing on the record to suggest that Senior Resident who has filled-in the form was one of the Senior Residents who had noted the history and recorded it. Reason for taking view is that if was the same person, then in Col.7(e) it would not have been mentioned in response to Col.7(e) of Form No. 3816 that "names not mentioned in case file".
Reason for taking view is that if was the same person, then in Col.7(e) it would not have been mentioned in response to Col.7(e) of Form No. 3816 that "names not mentioned in case file". Suffice it to say in this behalf that it would have been totally different situation if the Junior Resident Dr. Vikraman had either left the Hospital and/or his whereabouts could not be known after undue delay. That is admittedly not the case of the appellant. In these circumstances, for want of any material, no benefit can be derived by the appellant from the contents of Form No.3816. Accordingly, the submission based on it is without substance and merits rejection. Ordered accordingly. 6. No other point was urged. In view of the aforesaid discussion, while partly allowing this appeal, it is held that the appellant is liable to pay only a sum of Rs.1,00,000/- instead of Rs.2,00,000/- as ordered by the District Forum below in complaint No.66/2002 alongwith interest from the date of as awarded by the Forum below besides litigation cost awarded in the impugned order. The impugned order is modified accordingly. No costs. All interim orders passed from time to time in this appeal shall stand vacated forthwith Office is directed to supply copy of this order free of cost to the parties as per rules.