Divisional Manager, LIC of India v. Roshan Khatoon
2009-07-03
G.D.Sharma, Rifat Aijaz
body2009
DigiLaw.ai
G.D. Sharma, J. 1. Through the medium of this appeal, order dated 15.4.2008, passed by the learned Divisional Consumer Protection Commission, Srinagar (hereinafter to be referred as the Forum), has been challenged. The learned Forum has directed the appellant to pay to the respondent the assured amount under the insurance policy under consideration to the extent of Rs. 2.00 lacs alongwith interest @ 6% P.A. after three months from the date of the deceased (insured) till its realization in favour of the nominee under the said policy, namely Abasha Anjum, minor daughter of the deceased. The complainant being her mother is the natural guardian and nominated under the policy. For undergoing mental pain and agony compensation in the amount of Rs. 10,000/- has been awarded and litigation charges in the sum of Rs. 5000/-. 2. Brief facts of the case are that the husband of the complainant, Zaheer Ahmed Sheikh, had taken insurance policy from the respondent bearing No. 141099824 in the sum of Rs. 2.00 lack w.e.f. 28.12.2001. He had been paying regular premium of the policy for its revival which was revived in the year 2004 and during its currency he died on 21.11.2004. After a period of more than one year, letter dated 21.12.2005 was sent to the complainant whereby she was informed that the claim had been repudiated on the ground that the insured had suppressed the material fact regarding his ailment as he had been suffering from kidney problem since December 2003. It is noteworthy that the deceased filled up the revival form of the said policy on 4.12.2003, which had been attested on the same day by the panel doctor of the respondent certifying the fact that the insured was not suffering from any ailment. After considering the certificate of the expert doctor, the policy was revised upto 12.2.2005. It is an admitted fact that the deceased remained admitted in Sher-e-Kashmir Institute of Medical Sciences from 7.6.2004 to 7.7.2004, from 24.7.2004 to 31.8.2004 and from 9.9.2004 to 1.10.2004. The cause of his death was certified by the doctors as cardio respiratory arrest. Learned Forum, after appraisal of evidence brought on record, has held that there was no suppression of the ailment even at the time of taking the initial policy on 28.12.2001 or from its final revival from 13.2.2004 to 12.2.2005.
The cause of his death was certified by the doctors as cardio respiratory arrest. Learned Forum, after appraisal of evidence brought on record, has held that there was no suppression of the ailment even at the time of taking the initial policy on 28.12.2001 or from its final revival from 13.2.2004 to 12.2.2005. The Forum has also dealt with the provision of Sec. 45 of the Insurance Act and held that it is not hit by any disabling clause. 3. In the memo of appeal the order has been challenged, inter alia, on the ground that there was suppression as to the material fact as the insured had been suffering from kidney trouble from December 2003. That in view of the law laid down by the National Consumer Disputes Redressal Commission in revision petition no. 1534/2002, titled Sarama Verghese vs. L.I.C. reported in Legal Digest Vol. II April 2008, it was the bounden duty of the insured to inform the appellant about his ailment and as such he had suppressed material fact, so rightly the policy has been repudiated. He has also cited the law laid down by the Allahbad High Court in case of Shanta Bai vs. LIC, (Vol. II Consumer Cases page 36) as well as the law laid down by High Court of Bombay in appeal No. 99 of 1999 decided on 6.5.04 titled LIC of India vs. Smt. Maya. 4. Mr. Shalla has rebutted contention of the appellant's counsel by urging that the impugned order does not suffer from any legal infirmity because there was no suppression of any material fact regarding any ailment. There is no proof that the deceased was suffering from kidney problem in the year 2003. On the contrary, the cause of his death has been certified by the doctors of SKIM Institute where he remained admitted for the above said three occasions as cardio respiratory arrest. That when the form of revival of the policy was filled on 4.12.2003 he was examined by the panel doctor of the appellant, namely, Dr. Syed Shabir Ahmed, who had certified that he was in good health.
That when the form of revival of the policy was filled on 4.12.2003 he was examined by the panel doctor of the appellant, namely, Dr. Syed Shabir Ahmed, who had certified that he was in good health. Concluding his arguments, he has stated that heavy burden was cast upon the appellant to prove that the deceased had been suffering from such ailment was proximate with the cause of his death, and he willfully suppressed it but there is not even an iota of evidence even to suggest that the alleged kidney problem was the cause of cardio respiratory arrest. 5. After considering the respective contentions of counsel for the parties and going through the contents of the impugned order we are of the view that there is not even an iota of evidence to hold the view that the insure-deceased, Zahoor Ahmed Sheikh, had suppressed any material fact with regard to the risk covered under the insurance policy in question. When the policy in question was revived the panel doctor, namely, Dr. Syed Shabir Ahmed, had thoroughly examined him and found that he was in good health. Moreover, the cause of death of the insured is cardio respiratory arrest and it is not proved that the alleged kidney problem had any proximity or even remote effect on the cause of cardio respiratory arrest. Such a death can happen to any hale and hearty person at any time due to many unknown causes. No disabling clause of sec. 45 of the Insurance Act is attracted to the facts of the case. The order under appeal is factually and legally correct and the law cited by the learned counsel of the appellant has no bearing on the facts of the present case. It is an admitted legal proposition that willful concealment of a material fact in the insurance policy disentitles the insured to be indemnified by the insured. 6. On the facts and in the circumstances of the case, we find that a meritless appeal has been filed to prolong the agony of the respondent, who is an unfortunate widow of the insured, Zaheer Ahmed Sheikh, and mother of the nominee of the insurance policy. While dismissing the appeal with costs of Rs. 4000/- the order of the Forum is upheld. The appeal be consigned to records and record of the D.F. be returned forthwith.