Life Insurance Corporation of India v. Mohinder Kaur
2006-12-18
BUDHIRAJA, JASBIR KAPOOR, R.S.MONGIA
body2006
DigiLaw.ai
JUDGMENT R.S. Mongia, President - This is an appeal by the Life Insurance Corporation of India (in short "LIC") against the judgment and order of the District Forum dated 22.9.2005 by which the complaint of the complainant was allowed in the following terms :- "7. As a result of above discussion, this complaint must succeed. As said above, the complainant being the widow and nominee of Jarnail Singh, deceased, is entitled to insurance money of Rs. 1,00,000/- under the insurance policy, copy Ex. C4, obtained by her husband Jarnail Singh since deceased, of course, with future interest @ 9% p.a. from the date of repudiation viz. from 31.7.2004 vide letter, copy Ex. C5, till payment. Besides that the complainant is also entitled to recover another sum of Rs. 2,000/- by way of costs of proceedings. We, accordingly, make an order ordering the O.P. respondents to pay a sum of Rs. 1,00,000/- to the complainant by way of insurance money under the insurance police, copy Ex. C4, obtained by Jarnail Singh deceased, of course, with future interest @ 9% p.a. from the date of repudiation viz. 31.7.2004 till payment. Besides that the O.P. respondents are also ordered to pay another sum of Rs. 2,000/- by way of costs of proceedings. The respondents are granted six weeks time to comply with the orders of the Forum from the date of receipt of certified copy of the order." 2. Brief facts may be noticed : Complainants husband, Jarnail Singh, was working as an Assistant Sub- Inspector in the Punjab Police. He had obtained a life insurance policy from the LIC on 26.3.2002 in the sum of Rs. 1 lac. Unfortunately, he died on 1.11.2003. After the death of her husband, the complainant Smt. Mohinder Kaur approached the LIC for the payment of the amount of insurance but the same was repudiated vide letter dated 31.7.2004 Ex. C5. The repudiation letter reads as under :- "Re : Repudiated death claim U/Pol No. 162054879 Fvg. Sh. Jarnail Singh (Decd.) With reference to your claim under the above policy on the life of your deceased husband, we have to inform you that we have decided to repudiate all liabilities under the above policy number on account of deceased having withheld material information regarding his health at the time of effecting the insurance on his life with us.
Jarnail Singh (Decd.) With reference to your claim under the above policy on the life of your deceased husband, we have to inform you that we have decided to repudiate all liabilities under the above policy number on account of deceased having withheld material information regarding his health at the time of effecting the insurance on his life with us. In this connection, we have to inform you that in the Proposal for Insurance dated 23.3.2002 signed by the deceased assured on 23.3.2002, the risk under the above proposal was accepted on 26.3.2002. At the time of submission of his proposal and medical examination he had answered the following questions as under noted : Questions Answer (a) During the last 5 years did you consult any medical practitioner for any ailment requiring treatment for more than a week ? No (b) Are you suffering from or have ever suffered from diabetes, tuberculosis,, high blood pressure,, low blood pressure,, cancer,, epilepsy,, hernia,, hydrocele,, leprosy or any other disease ? No (12) What has been usual state of health ? Good We may, however, state that all these answers were false as we hold indisputable proof to show that before he submitted the proposal for the above policy he had suffered from diabetes mellitus, hypertension for last 10 to 12 years. He did not, however, disclose these facts in the said personal statement. Instead he gave false answers therein as stated above. It is, therefore, evident that he had made deliberate mis-statement and withheld material information from us regarding his health at the time of effecting the insurance and hence in terms of the policy contract and the declaration contained in the form of proposal for insurance and personal statement, we hereby repudiate the claim and accordingly we are not liable for any payment under the above policy and all money that have been paid in consequence thereof belongs to us. In case, you are not satisfied with our above decision and feel that we have not considered any particular fact and circumstances in support of your claim, you may send your representation within a month for reconsideration of your claim to our Zonal Office at the following address." 3. This led the complainant to file the complaint before the District Forum, which has been allowed as aforesaid. Hence the present appeal. 4.
This led the complainant to file the complaint before the District Forum, which has been allowed as aforesaid. Hence the present appeal. 4. Learned counsel for the appellant argued that while taking the insurance policy the deceased had intentionally given false answers which were to his knowledge which led the Insurance Company to issue the insurance policy. The questionnaire, which was given in the proposal from to the insured and the answers given by him, are as follows :- Personal History, Answer Yes or No If Yes Please give full details (a) During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week ? No (b) Have you ever been admitted to any Hospital or nursing home for general check-up, observation, treatment or operation ? No. (c) Have you remained absent from place of work on grounds of health during the last 5 years ? No (d) Are you suffering from or have you ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System ? No (e) Are you suffering from or have you ever suffered from Diabetes, tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease ? No (f) Do you ever have any bodily defect or deformity ? No (g) Do you ever have any accident or injury ? No (h) Do you use or have you ever used : (1) Alcoholic Drinks No (2) Narcotics No (3) Any other Drugs No (4) Tabacco in any form No (i) What has been your usual state of health ? Good (j) Have you ever received or at present availing/undergoing medical advice, treatment or tests in connection with Hepatitis B or an AIDS related condition ? N/A 5. Learned counsel for the appellant further argued that in the claim form the claimants statement regarding the place of death of the life assured was given as Talwandi Mange Khan and the cause of death had been mentioned sudden heart failure whereas in fact as per the investigation by the LIC it was found that the insured had died in PGI, Chandigarh.
It was argued that intentionally in the claim form the claimant complainant had mentioned that the deceased had died at the village to keep the LIC in dark regarding the admission of the insured in the hospital as also the disease from which he was suffering and the cause of death. It was further argued that from Form No. 3816 regarding the certificate of the hospital treatment it was mentioned that the deceased had been admitted in the PGI, Chandigarh on 1.11.2003 and he died the same day. In the column Nature of the complaint of the patient it was mentioned as under :- "(a) Headache 3-4 hours (b) Left sided hemporem 3-4 hours." Under the column What was the diagnosis arrived at in the Hospital ? It was mentioned as under :- "Diabetes Mellitus-2 Hypertension Cerebro Vascular accident ? IC bleed." In other words, how cerebro vascular accident occurred was because of intra cranial bleed. In the column History of illness it was mentioned that known case of diabetes mellitus-2 for 10-12 years, sudden onset headache left sided weakness unconsciousness for the last three to four years. In the death certificate issued by the PGI the immediate cause of death was mentioned as raised ICT (intra cranial tension). According to the counsel, this has to do something with the scalp. Intra cranial tension also means hypertension. Under the column Antecedent Cause (Morbid conditions, if any, giving rise to the above cause stating the underlying condition last) and other significant conditions contributing to the death but not related to disease or condition causing it, it was mentioned diabetes mellitus-II essential hypertension and C.V.A. and the I.C. Bleed. Meaning thereby cerebro-vascular accident and how it occurred it was case of intra cranial bleed. This history etc. is stated to have been recorded by some Junior Resident of the PGI. The certificate was given by one Rajiv Gupta, Senior Resident of the PGI but what was the name of Junior Resident who recorded the history was not mentioned and the column who recorded the history is still in the service of the PGI is left blank. 6-7. Learned counsel for the appellant LIC emphasized that as per the history recorded in the PGI, the patient was suffering from diabetes Mellitus-2 for last 12 years but while answering question No. 11(d) in the proposal form "whether the insured was suffering from diabetes etc.
6-7. Learned counsel for the appellant LIC emphasized that as per the history recorded in the PGI, the patient was suffering from diabetes Mellitus-2 for last 12 years but while answering question No. 11(d) in the proposal form "whether the insured was suffering from diabetes etc. ?" he had mentioned No. According to the counsel, diabetes mellitus-2 has a direct connection and nexus with the heart failure. Had the assured given correct answer to question No. 11(d) supra and also whether he was enjoying good health to which he had given answer No whereas he was not enjoying good health, the Company might not have insured the complainants husband. Added to this fact was further fact that in the claim form the cause of death had been given as heart failure by the complainant and further that the insured had died in the village and not in the PGI. 8. On the other hand, the learned counsel for the respondent-complainant argued that the claimant complainant is an illiterate lady and did not understand the true import when she mentioned that her husband had died in the village. Since, according to the counsel, the body had been brought to the village she might have mentioned that her husband had died in the village. So far as the cause of death is concerned the complainant may not be knowing as to in fact how had her husband died and for this the PGI, Chandigarh mentioning the cause of death can be the only cause of death. In case, thre is a conflict between statement of a witness and the record of a hospital, the record of the hospital has to be preferred. In the hospital record, the cause of death mentioned was raised ICT i.e. intra cranial tension. According to the counsel, firstly, there is no medical literature that diabetes mellitus-2 has any connection or nexus with intra cranial tension. There is no evidence to support this. Even there is no evidence that diabetes mellitus has any connection or nexus with the heart failure. Further it was argued that the diabetes mellitus which is stated to be of 12 years the complainants husband may not be taking that seriously and there is nothing on the record to show that complainants husband was getting any treatment for diabetes mellitus.
Further it was argued that the diabetes mellitus which is stated to be of 12 years the complainants husband may not be taking that seriously and there is nothing on the record to show that complainants husband was getting any treatment for diabetes mellitus. It is also not clear from the form as also the death certificate as to who had recorded the history as the name of the Junior Resident is also not mentioned and there is no affidavit of any such person. Further it is not clear as to who gave the history to the doctor whether the same was given by the patient or any of his relatives. 9. After hearing the learned counsel for the parties, we are of the view that there is no force in the arguments of the learned counsel for the appellant LIC. Even if the insured was suffering from diabetes mellitus-2 whether he knew about the disease is not coming forth on the record. There is nothing on the record that he was getting any treatment for this alleged disease. The insured might not be thinking it to be disease and might not be knowing that he was suffering from diabetes mellitus and, therefore, he answered question No. 11(d) in the negative. Further that the deceased was suffering from diabetes mellitus is only recorded in the history of the patient when he was admitted in the PGI, Chandigarh. Who gave that history i.e. the patient himself or any of his relatives is not forthcoming. Who recorded that history i.e. who was that Junior Resident is also not forthcoming. No affidavit of any such Junior Resident has come forth. Whether the Junior Resident was still working in the PGI is also not forthcoming. In these circumstances, the mere alleged history recorded in the PGI cannot be relied upon. Further there is no evidence on the record in the shape of any expert evidence that the diabetes mellitus has directly to do anything with the cause of death which has been mentioned in the death certificate as raised ICT (intra cranial tension), which is some type of hypertension. Merely mentioning by the complainant that her husband had died of heart failure does not mean anything. She being an illiterate woman would not know what the actual cause of death was which is mentioned in the PGI record.
Merely mentioning by the complainant that her husband had died of heart failure does not mean anything. She being an illiterate woman would not know what the actual cause of death was which is mentioned in the PGI record. Further we cannot lose sight of the fact that the complainants husband had died after about 20 months of taking the insurance. The insurance was also not of a very big amount. In other words, it was not taken by the insured thinking that he was going to die soon and, therefore, by withholding the facts of his good health he had got the insurance done. 10. For the foregoing reasons, we do not find any infirmity in the approach of the District forum. Appeal is dismissed. No order as to costs. Judgment was reserved on 14.12.2006. Be communicated to the parties. Appeal dismissed.