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2007 DIGILAW 402 (HP)

LIFE INSURANCE CORPORATION OF INDIA v. SHASHI SETHI

2007-09-28

DEV DARSHAN SUD

body2007
JUDGMENT Dev Darshan Sud, J.—This is defendants appeal against the judgment of the learned District Judge allowing claim of the plaintiffs claiming the benefit of life insurance of the deceased Shri N.K. Seth. 2. The undisputed facts are that the deceased Shri N.K. Seth had two policies of life insurance for the total value of Rs. three lacs including accident insurance. Mr. N.K. Seth, husband of plaintiff No. 1 and father of plaintiffs No. 2 and 3, met with an accident while driving his scooter on 24.4.1985 and as a result of the injuries sustained by him he died on 28.4.1985. He was employed as an Accountant in the State Bank of India. He was driving his scooter to his place of work on the ill fated day when he suffered serious head injuries. He was treated at Indira Gandhi Medical College, Shimla and lateron shifted to the PGI, Chandigarh, where he breathed his last on 28.4.1985. The plaintiffs claim that the appellants- defendants have wrongfully denied the insurance claim and, therefore, they were entitled to the suit amount. 3. Defendants refuted the claim alleging that the deceased was guilty of withholding material facts. In particular, it was alleged that in the proposal for insurance submitted on 14.3.1985, he had stated that his state of health was good, he had not suffered from cough, asthma and bronchitis high or low blood pressure etc. The defendants submit that the medical evidence on the record shows that the plaintiff had suffered from jaundice, cough, asthma etc. which was proved by the medical record in the nature of certificates furnished by the deceased stating that he was justified in claiming medical leave. There was a non-disclosure and suppression of material facts necessary for consideration as to whether life insurance could be taken out for the deceased or not. In these circumstances, the contract of insurance which is one of uberrima fides was discharged and no liability could be fastened on the defendant. Non disclosure of necessary and essential facts would vitiate the entire contract and the mis-statements made by the insured were of material nature which vitiated the entire contract. 4. I have heard Learned Counsel for the parties and have gone through the record. 5. Non disclosure of necessary and essential facts would vitiate the entire contract and the mis-statements made by the insured were of material nature which vitiated the entire contract. 4. I have heard Learned Counsel for the parties and have gone through the record. 5. It is undisputed that the death of the policy holder occurred because I- of fatal injuries suffered in a road accident and not because of any of I disease. 6. PW-1 Dr. R.L. Gupta, is the Professor and Head of the Department for Surgery in Indira Gandhi Medical College, Shimla. He testified that the deceased Shri N.K. Seth was admitted in the hospital on 24th April, 1985 where he remained under treatment and was thereafter referred to the PGI, Chandigarh as he required specialized treatment for his injuries. He has proved in evidence Ex.PW-1/A, which is the bed head ticket showing the treatment given to him and the state of his health including the nature of injuries sustained by the deceased. PW-2 Dr. Inderjit Dewan, who was Professor in the PGI, Chandigarh, conducted the post-mortem. He testified that on 29th April, 1985 at the request of the police, Medico Legal postmortem examination was conducted by him on the body of Shri N.K. Seth. He deposed that the body was received from the Intensive Care Unit of the Neurosurgery Department for conducting the autopsy. He found that there were multiple abrasions on the body of the deceased and a lacerated wound deep to the bone on right parietal region; a craniotomy operation had already been performed. There were two fractures on the left side of the frontal bone; multiple contusions on the brain which were edematous tonsils and unci were groove. The upper lobe of the right side and the lower lobe of the left side of the lungs were consolidated. He opines that the cause of death was odema of the brain following multiple brain contusions due to fracture of skull. Ex.PW-2/A is the postmortem report which has been proved by him. He has not been cross-examined with reference to any material fact as to whether the cause of death was the result of disease or infirmity caused therefrom. The post-mortem report shows that all the organs of the deceased were healthy and not diseased or in a condition which would have accelerated his death in case of an injury having been sustained. The post-mortem report shows that all the organs of the deceased were healthy and not diseased or in a condition which would have accelerated his death in case of an injury having been sustained. The medical record of the treatment given to the deceased at the PGI, Chandigarh is Ex.PW-2/B. On admission at the PGI, Chandigarh, he was examined by Professor Kak, as is apparent from the evidence on record. There is no abnormality detected on physical examination of the deceased in the detailed medical history which has been taken after examination of the patient. Notably, his abdomen, cardiovascular system and respiratory system were examined where it has been noted, "NAD", meaning "No Abnormality Detected". In the column, General Physical Examination, again it has been noted that there is no abnormality. The medical summary only records the injury sustained because of accident and no any other organic abnormality. 7. PW-6, Smt. Kanta Saddar, was posted alongwith deceased at Kullu and was living as his neighbour. She states that the deceased was in good health. To similar effect is the statement of PW-7 Shri P.S. Thakur. PW- 8 is the father of deceased who also states that his son was not suffering from any disease. 8. DW-1 is Shri K.S. Mainee, retired Senior Manager of the Life Insurance Corporation. He is the author of the report Ex.D-1 which is the purported inquiry conducted by him. This is the entire evidence on the record. 9. In Life Insurance Corporation of India v. Smt. G.M. Channabasemma, AIR 1991 SC 392, the Honble Supreme Court has held : "7. The principle as to when an insurer can validly repudiate a contract of insurance on the ground of misrepresentation or suppression of material facts is not in controversy in the present appeal. Mr. Vasudev, the learned Counsel for the appellant has, however, placed a number of decisions both English and Indian dealing with this aspect, but we do not consider it necessary to discuss them here. It is well settled that a contract of insurance is contract uberrima fides and there must be complete good faith on the part of the assured. The assured is thus under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding, whether the proposal should be accepted or not. The assured is thus under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding, whether the proposal should be accepted or not. While making a disclosure of the relevant facts, the duty of the insured to state them correctly cannot be diluted. Section 45 of the Act has made special provisions for a life insurance policy if it is called in question by the insurer after the expiry of two years from the date on which it was effected. Having regard to the facts of the present case, learned Counsel for the parties have rightly stated that this distinction is not material in the present appeal. If the allegations of fact made on behalf of the appellant Company are found to be correct all the three conditions mentioned in the Section and discussed in Mithoolal Nayak v. Life Insurance Corporation of India, (1962) Supp 2 SCR 571: (AIR 1962 SC 814), must be held to have been satisfied 8. The burden of proving that the insured had made false representations and suppressed material facts is undoubtedly on the Corporation " 10. Subsequently, in Life Insurance Corporation of India and others v. Smt. Asha Goel and another, AIR 2001 SC 549, it has been held : "12. Coming to the question of scope of repudiation of claim of the insured or nominee by the Corporation, the provisions of Section 45 of the Insurance Act is of relevance in the matter. The Section provides, inter alia, that no policy of life insurance effected after the coming into force of this Act shall, after expiry of two years from the date on which it was effected, 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 issue 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 facts which it was material to disclose. The proviso which deals with proof of age of the insured is not relevant for the purpose of the present proceeding. On a fair reading of the Section it is clear that it is restrictive in nature. It lays down three conditions for applicability of the second part of the Section namely:- (a) the statement must be on a material matter or must suppress facts which it was material to disclose; (b) the suppression must be fraudulently made by the policy holder; and (c) the policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose. Mere inaccuracy of (or) falsity in respect of some recitals or items in the proposal is not sufficient. The burden of proof is on the insurer to establish these circumstances and unless the insurer is able to do so there is no question of the policy being avoided on ground of mis-statement of facts. The contracts of insurance including the contract of life assurance are contracts uberrima fides and every fact of material must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and is acceptance. If there are any mis-statements or suppression of material facts, the policy can be called in question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person. 16. In course of time the Corporation has grown in size and at present it is one of the largest public sector financial undertakings. The public in general and crores of policy-holders in particulars look forward to prompt and efficient service from the Corporation. Therefore the authorities in-charge of management of the affairs of the Corporation should bear in mind that its credibility and reputation depend on its prompt and efficient service. The public in general and crores of policy-holders in particulars look forward to prompt and efficient service from the Corporation. Therefore the authorities in-charge of management of the affairs of the Corporation should bear in mind that its credibility and reputation depend on its prompt and efficient service. Therefore, the approach of the Corporation in the matter of repudiation of a policy admittedly issued by it should be one of extreme care and caution. It should not be dealt with in a mechanical and routine manner." 11. The Court holds that the repudiation of the claim should not be a matter of routine. It is, of-course, by now well settled that the insurer cannot avoid the consequences of the contract of insurance by simply alleging inaccuracy of the statements made in the proposal. What is necessary to be established is that the statement was made fraudulently by the insured with the knowledge that such statement is false and proof of deliberate fraud is necessary. 12. In Life Insurance Corporation of India, Machilipatnam v. Vankadaru Koteswaramma, AIR 2003 AP 153, the High Court of Andhra Pradesh held that where the policy holder had been examined by the doctor who had found him fit, the Life Insurance Corporation was not right in rejecting the claim on the ground that the deceased was suffering from diabetes at the time when the proposal form was submitted. 13. In Life Insurance Corporation v. Swarnalata Sahu, 1996 ACJ 134, the High Court of Orissa, while considering the provisions of Section 45 of the Insurance Act (4 of 1938), held that suppression must be fraudulently made by the policy-holder, statement must be of a material nature, the policy-holder must know at the time when the statement is made that it was false. 14. Turning to the facts of the present case, the record does not establish that the defendant has been able to discharge the onus as required by law. The post-mortem report Ex.PW-2/A is a vital piece of evidence. It has not disclosed any abnormality in the internal organs of the deceased policy-holder which may have been caused by the diseases which according to the Insurance Company, the deceased had not disclosed and purportedly suffered. The report shows that all the organs are normal except for the injuries received in the accident and which resulted in the death of the policy-holder. The report shows that all the organs are normal except for the injuries received in the accident and which resulted in the death of the policy-holder. There is nothing in the evidence to suggest to this witness (PW-2 Dr. Inderjit Dewan) that the death was caused either because of any disease suffered by the policy-holder or that the injuries caused in the accident acted as catalyst in aggravating any abnormality caused by any disease and consequently causing the death of the policy-holder. Similarly, Ex.PW-2/B does not record any abnormality in the cardio-vascular system, abdomen and other internal organs of the deceased, save and except, injuries received in the accident. The evidence of the defendant is also relevant. DW-1 K.S. Mainee, retired Senior Manager of Life Insurance Corporation, has simply tendered in evidence Ex.D-1, copy of the report regarding the authenticity of the claim submitted by the plaintiff. In his cross-examination, he admits that the policy-holder had died because of injuries sustained in accident and not by natural causes or on account of any illness. He also admits that when the proposal form is filled, the doctor of the Insurance Corporation examined the insured and furnished certificate regarding the state of health of the insured. Relevant portion of his cross-examination may be referred to:— "I did not see Shri N.K. Seth ever before his death. It is correct that Shri N.K. Seth had died in scooter accident and not by natural death or on account of any illness. It is correct that when the proposal form is filled in the doctor of the Insurance Company also examines the insured and furnishes a certificate regarding the state of health of the insured. It is correct that in this case also the LIC doctor has examined Shri N.K. Seth about the state of health as per the procedure". This is a clear admission on the part of the defendant that the insured was in good health on the day when the proposal was accepted. 15. Learned Counsel appearing for the appellants has laid emphasis on the fact that deceased had not made full and complete disclosure of facts and that he had taken medical leave which facts were not disclosed by him. 15. Learned Counsel appearing for the appellants has laid emphasis on the fact that deceased had not made full and complete disclosure of facts and that he had taken medical leave which facts were not disclosed by him. The learned District Judge, while dealing with this submission, has rightly held that it is common knowledge that employees of Government and public sector undertakings etc., feign sickness to avail leave and furnish certificates which are not worth the paper they are written on. This aspect cannot be ignored. Further, there is nothing on the record to suggest or show that the deceased had obtained reimbursement for any of the illness purportedly afflicting him for which purpose he produced the medical certificates for obtaining leave viz. Ex. D-2 to D-7. Another fact which needs to be noticed and which has been rightly accepted by the learned District Judge is that the family of the deceased was staying at a place different from that of his posting and in the circumstances, he was obtaining leave to visit his family members. From the totality of the evidence on record the learned Court below concluded and rightly so that the deceased was enjoying good health. In the totality of the circumstances, the learned District Judge holds and rightly so that there has been no material suppression of facts and the death of the policy-holder cannot be attributed to any of the purported illness which according to the Insurance Company has been concealed. 16. I am not persuaded to take a different view and cannot accept the contention of the appellants that the contract of insurance was discharged because of deliberate suppression of material facts. On reaching this conclusion, I am supported by the medical evidence in the nature of the post-mortem report Ex. PW-2/A, the evidence of PW-2 Dr. Inderjit Dewan, who conducted the post-mortem report, the evidence of PW-1 Dr. R.L. Gupta, Professor of Surgery, Indira Gandhi Medical College, Shimla, who treated the deceased and the evidence of DW-1 Shri K.S. Mainee who admits that the deceased policy-holder was examined by the doctor of the defendant at the time he had submitted the proposal. Inderjit Dewan, who conducted the post-mortem report, the evidence of PW-1 Dr. R.L. Gupta, Professor of Surgery, Indira Gandhi Medical College, Shimla, who treated the deceased and the evidence of DW-1 Shri K.S. Mainee who admits that the deceased policy-holder was examined by the doctor of the defendant at the time he had submitted the proposal. Surely, in the circumstances, if there was any organic or metabolic abnormality afflicting the deceased policy-holder, the doctor would have detected at the time when the policy holder was examined when the proposal was submitted or at the time of treatment after accident and in any event when the post-mortem was conducted. The evidence clearly establishes that the death of the policy-holder was caused of the injuries sustained in the accident and not because of any disease or illness for which he may have suffered or which he may have required to disclose. 17. In the circumstances of the case, this appeal is dismissed. There shall be no order as to costs. Appeal dismissed.