Research › Search › Judgment

Chhattisgarh High Court · body

2009 DIGILAW 4 (CHH)

BRANCH MANAGER, LIC OF INDIA v. ARUNA DEVI

2009-01-05

S.C.VYAS, V.K.PATIL

body2009
ORDER Hon'ble Shri S.C. Vyas, President: 1. This is an appeal preferred by Life Insurance Corporation of India (hereinafter called "LIC' for short), challenging the award passed by District Consumer Disputes Redressal Forum, Durg (hereinafter called "District Forum" for short) in complaint case No.213/07 on 26.02.08, whereby the complaint of the respondent was allowed and award of sum assured by way of 13 policies amounting to Rs.5.90.000/- was passed in favour of the respondent.1n addition to it Rs.5.000/- were also awarded for mental harassment as well as for cost of litigation. 2. The only ground for challenge of the award contended before this Commission in this case is that it was proved by the LIC that material fact was deliberately suppressed by the deceased Ram Khilawan at the time of making proposal for insurance in respect of his previous illness. namely Hypertension, which was a cause of death also. so learned District Forum should have dismissed the complaint but it has committed mistake in awarding the sum assured. 3. The case of the appellants, who were OP before District Forum was this that deceased in all obtained 13 insurance policies from the LIC for a huge amount of Rs.5,90,000/-. At the time of making proposal for such insurance the question in respect of disease of Hypertension and other similar diseases were answered in negative by him and it has been specifically stated that he is not suffering from high or low blood pressure, epilepsy. hernia or other similar diseases and has never suffered from these diseases. It has been contended by the appellant that these answers in the proposal form, to the relevant questions, were false and in fact deceased was suffering from Hypertension from much prior i.e. from atleast 14.03.1996, which is clear from his treatment papers of Bhilai Steel Plant Hospital. On these treatment papers on 14.03.96 it has been written that he is a known case of Hypertension and on that day his blood pressure was 180-100. He was even not able to talk on that day. It has also been contended that ultimately he died and the cause of death was determined by the doctor inter allia along with other diseases Hypertension also. It has also been submitted that in this circumstance, if LIC has repudiated the claim then has not committed any mistake. 4. He was even not able to talk on that day. It has also been contended that ultimately he died and the cause of death was determined by the doctor inter allia along with other diseases Hypertension also. It has also been submitted that in this circumstance, if LIC has repudiated the claim then has not committed any mistake. 4. Case of the complainant before District Forum was simply that the deceased husband of complainant, entered into contract for 13 insurance policies, later on he died and thereafter when claim was preferred then the same was repudiated without any valid ground. 5. We have heard the arguments of both the counsels appearing for the parties and perused the record of the District Forum. 6. Learned District Forum in the impugned order has not accepted the defence of the insurance company mainly on the ground that proposal forms have not been placed on record, so there is no material to show that wrong information was given deliberately by the deceased while making proposal for insurance. Learned counsel for the appellant submitted that this is a misrepresentation of facts recorded by the District Form and he has drawn attention of this Commission towards documents filed before District Forum. List of documents shows that Ex.D2, 05,08,011 etc. are such proposal forms which are containing the information given by the deceased himself regarding the previous illness at the time of making proposal for insurance, which bears his signature as well as declaration to the effect that if any information provided by him is found false then the contract of insurance may be cancelled by the insurance company. So we are satisfied that the proposal forms have been filed before District Forum and learned District Forum has failed to go through these proposal forms and to properly appreciate them and then to draw conclusions. Learned counsel for the respondent submitted that there is nothing to show that deceased was suffering from Hypertension previously. He submitted that when deceased was lastly examined by medical officers then either in the medical certificate or in his postmortem examination report this has not been mentioned that he was suffering from Hypertension from before. It has also been contended that there is nothing to show that Hypertension was only cause of death. He submitted that when deceased was lastly examined by medical officers then either in the medical certificate or in his postmortem examination report this has not been mentioned that he was suffering from Hypertension from before. It has also been contended that there is nothing to show that Hypertension was only cause of death. Whereas learned counsel for the appellant has put much stress on OPD Book of the deceased maintained by Bhilar Steel Plant Hospital and submitted that in this Book it has been mentioned in clear words that the deceased was a known case of Hypertension and he was taking treatment for the same at least from 1996. He submitted that when he started taking treatment for this disease and this fact was within his knowledge, then it was the duty of the deceased to mention correct facts in the proposal form of insurance, so that insurance company may decide whether to issue insurance policy or not, to a person who is a known case of Hypertension. 7. We have gone through OPD Book of the deceased. It can very well be seen from contents of the Book, which is EX.D58 that the deceased was taking treatment for Hypertension from at least March, 1996 and he was referred as known case of Hypertension, when ultimately decease died then at that time also it was found that he was making complaints of weakness of one portion of the body, which was symptom of paralysis and cause of which might be Hypertension. Therefore, there is material to show that the diseases from which the deceased was suffering from before was one of the cause of his death. He was admitted in Hospital on 23.10.04 and was making complaints of weakness of 50% of the body and he was unable to speak properly. On diagnosis, it was found that he was suffering from Bilateral Aspiration Pneumonia CVA, Right Hemiplegia, Hypertension, after 7 days he died and in the death certificate also one of the cause of death was mentioned Hypertension. These all material shows that the deceased was suffering Hypertension and it was such disease which was required to be mentioned in the proposal form, even then this material information was suppressed by the deceased insured and in a short duration many insurance policies were obtained for a huge sum and ultimately, within a Short span of time he died. These all material shows that the deceased was suffering Hypertension and it was such disease which was required to be mentioned in the proposal form, even then this material information was suppressed by the deceased insured and in a short duration many insurance policies were obtained for a huge sum and ultimately, within a Short span of time he died. On the basis of all these facts we find that a material fact was suppressed by the deceased at the time of making proposal for insurance and therefore if the LIC has repudiated the claim for sum assured then it has not committed any deficiency in service. 8. We find that the claim of amount of insurance is not payable because of suppression of material facts. So, we allow this appeal. The order passed by the District Forum is set aside and the complaint of the respondent is dismissed. Appeal Allowed.