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2008 DIGILAW 1251 (MP)

S. B. I. Life Insurance Company Ltd. v. Sheela Yadav

2008-10-23

NEERJA SINGH, PRAMILA S.KUMAR, S.K.KULSHRESTHA

body2008
JUDGMENT : Asper S.K. Kulshrestha , J . : - Heardparties and record perused. 2.This appeal is directed against the order dated 12-3-2007 passed by theDistrict Forum, Indore in Case No. 568/2005 wherebythe District Forum has saddled the appellant-Insurance Company with theliability of making payment under the insurance policy on account of the deathof the policy holder. 3.The facts which are not disputed are that the husband of the complainant namely Basantilal Yadav hadobtained insurance cover for safeguarding the loan advanced by the State Bankof Indore in relation to the construction of house ofthe estimated value of Rs . 10,00,000/-. While takingthe loan, the husband of the complainant filed a declaration in Column 21 ofthe application to the effect that he had undergone an operation on 27th July, 1991 for enucleation of the right eye. It is stated that he hadexplained that he sustained injury in the right eye while playing gulli danda and that is why theoperation was performed. The fact that it was on account of cancer that therewas growth of malignancy behind the orbit that was removed, was not disclosed. Learned Counsel has also invited attention to Annexure C-16in which the Histopathology Report gave an impression that the features favour metastasis of adenocarcinoma .This was therefore, a positive indication about the disease suffering fromcancer although subsequent to the policy. In the discharge ticket it was dulymentioned that the person had undergone several surgery in the past 17 yearssince 1992. 4.The facts which strike at the inception are that the operation undergone by thedeceased in the year 1991-92 was though disclosed, it was not stated that itwas malignant tumour . In fact, there was no treatmentfor malignancy as the reports indicated that it was benign. It was onlysubsequently that the insured member of the scheme suffered from metastasis of adenocarcinoma and ultimately succumbed. Learned Counselfor the respondent has submitted that the description of not suffering from anycritical illness is cancer, heart and irreversible liver operation. LearnedCounsel therefore, submits that it was not a critical illness that the insuredwas suffering from which necessitated the disclosure to the Insurance Company.Under these circumstances, it cannot be said that there was any suppression on the part of the insured in so far as his operation in theyear 1991 was concerned. LearnedCounsel therefore, submits that it was not a critical illness that the insuredwas suffering from which necessitated the disclosure to the Insurance Company.Under these circumstances, it cannot be said that there was any suppression on the part of the insured in so far as his operation in theyear 1991 was concerned. There is no evidence to suggest that at the time whenthe policy was taken on 4-12-2003 to cover risk of the Bank in respect of the housing loan of Rs .10 lakhs , there was any additional illness whichwould have disentitled the insured from the insurance cover. We may also point out, in the year 1991 he had undergone surgery and died on 3-5-2005 several years after. Thus, itcannot be said that the insured was in the knowledge of the fact that he wassuffering from cancer on 4-12-2003 and in so far as his disclosure about the previous operation is concerned, hehad duly disclosed. It was only latter that thereoccurred cervical lymph-node metastasis that his condition became critical andto which he succumbed. 5.From the submissions made by the learned Counsel it is explicit that whilelearned Counsel for the appellant submits that the suppression of the operation13 years ago vitiates the policy and no claim can be made on the basis thereof,the learned Counsel for the complainant submits that such a remote course doesnot vitiate the policy specially when subsequent events were also disclosed. Itis clear that in Clause 21 the illness was disclosed, but still the InsuranceCompany did not probe into the matter to find out whether he suffering from anymalignant carcinoma. We are therefore, of the view that in the facts andcircumstances of the present case, liability of the Insurance Company is nottotally vitiated. 6.Learned Counsel for the appellant-Insurance Company has invited attention tothe decision of the Supreme Court in P.C. Chacko andanother Vs. Chairman, Life Insurance Corporation of India and others, 2007 (1)CCC 634 (NS) and to the decision of this Commission, dated 4-4-2007 in Appeal No.2586/06 ( Arvind Naik Vs.S.B.I. Life Insurance Co. Ltd.), to buttress his argument that if there issuppression of material the person is divested from making any claim from theInsurance Company. Chairman, Life Insurance Corporation of India and others, 2007 (1)CCC 634 (NS) and to the decision of this Commission, dated 4-4-2007 in Appeal No.2586/06 ( Arvind Naik Vs.S.B.I. Life Insurance Co. Ltd.), to buttress his argument that if there issuppression of material the person is divested from making any claim from theInsurance Company. In the present case, the deceased had given full informationwith regard to the eye operation and it has not been stated that at that timeit was known that the part taken-out from behind the orbit was cancerous.Indeed the record shows that it was benign. We are, therefore, of the view thatit was not a case of suppression of the information which was in possession ofthe policy holder at the time of filing of the application for insurance. 7.We may refer to the decision of the National Commission in Santosh Kanwar Vs. Life Insurance Corporation of India, IV(2008) CPJ 19 (NC), in which it has beenexpressed that suppression should be of material disease. In the case in hand,as we have already observed, there is no suppression as the operation of theyear 1991-92 has duly been accounted for in the application form itself, sincethe piece removed from behind the orbit was benign and not malignant,non-disclosure would not be fatal though the operation was duly disclosed. 8.In P.C. Chacko (supra), the facts were totallydifferent from the facts of the case in hand. It was on the premise that theinsured suppressed material facts, the policy wasrepudiated by the respondent on 10-2-1989 .It was stated that non-disclosure and mis -statementin the proposal form for the various questions to which answers were given bythe insured is said to be the reason for the aforementioned repudiation of thecontract of insurance. It has been observed by the Supreme Court that there wasdirect nexus with the health of the insured which the insured has suppressed. Inthe present case, the insured had not suppressed any material fact. In so faras his ailment was concerned, he had duly stated that in 1991 he had undergonesurgical treatment and he recovered and the piece was removed from behind orbitof right eye. In this view of the matter we are of the view that the relianceplaced by the learned Counsel on the said decision is misconceived. LearnedCounsel has also referred to the decision of this Commission in Mis . In this view of the matter we are of the view that the relianceplaced by the learned Counsel on the said decision is misconceived. LearnedCounsel has also referred to the decision of this Commission in Mis . S.B.I. Life Insurance Company Ltd. Vs .Rajesh Kadam , decided on 19th May, 2008 . In the said case on account ofleave obtained, it was held that the insured was suffering from throat cancerwhich he has not disclosed in the appropriate column. In the present case, wedo not find that any such information was suppressed. Even the operation of1991 was disclosed thus, removing any doubt about concealment. 9.In view of the above factual position, we are of the view that his appeal doesnot have any merit or substance. However, we make it clear that during theperiod the matter was under litigation, if the complainant or anyone on hisbehalf has deposited any amount, she would not become entitled to recover itback from the Bank. The Bank shall deposit only the amount which is outstandingas on date together with interest. There shall be no order as to costs.