The Life Insurance Corporation of India, Rep by its Branch Manager, Vellore & Another v. S. Anusuya Bai
2009-12-07
R.BANUMATHI
body2009
DigiLaw.ai
Judgment :- Being aggrieved by concurrent findings of facts recorded by Courts below and decreeing plaintiffs suit for recovery of money under LIC policy No.711192328, LIC has preferred this appeal. Plaintiffs husband G.Sivasankaran was working as Tahsildar in Revenue Department of Government of Tamil Nadu. 2. The plaintiffs husband G.Sivasankaran, while he was alive, took two policies each for a sum of Rs.25,000/- under Policy Nos.711192328 and 89838465. The plaintiff was nominated as nominee for the above said policies. The plaintiffs husband died on 2. 1992 and thereby she became entitled to the above said insurance amount from the defendant. The defendant though settled the amount under Policy No.89838465 failed to pay the amount due under policy No.711192328. The defendant refused to pay the amount alleging that plaintiffs late husband withheld material information regarding his health at the time of effecting insurance. According to the plaintiff, her husband did not suppress any fact regarding his health and the insurance premium was being paid regularly. The defendant has no right to repudiate the contact and hence the suit for recovery of the policy amount, together with future interest at 12% p.a. 3. Appellant / defendant corporation resisted the suit contending that Life Assured was suffering from Diabetes and Hypertension prior to the date of proposal under policy No.711192328 and Life Assured has deliberately suppressed material information from the knowledge of defendant corporation, with a fraudulent intention of enriching himself. Defendant corporation further averred that from the discharge summary brought from C.M.C hospital and Government General Hospital, Madras submitted by the claimant, it was found that Life Assured was a known diabetic and hypertensive and was also suffering from Diabetic Nephropathy, Diabetic Retinopathy and Chronic Renal Failure. According to defendant Corporation, under the terms of the above said policy, premium paid by the Life Assured towards the suit policy is vitiated and is liable to be forfeited by the defendant. 4. On the above pleadings four issues were framed. Plaintiff/claimant examined herself as PW1 and relied upon LIC policy of deceased Sivasankaran (Ex.A1) and Exs.A2 to Ex.A15. Defendant Corporation examined its Senior Assistant as DW1 and Doctor of C.M.C Hospital was examined as DW2. Defendant Corporation relied upon Exs.B1 to B7. 5.
4. On the above pleadings four issues were framed. Plaintiff/claimant examined herself as PW1 and relied upon LIC policy of deceased Sivasankaran (Ex.A1) and Exs.A2 to Ex.A15. Defendant Corporation examined its Senior Assistant as DW1 and Doctor of C.M.C Hospital was examined as DW2. Defendant Corporation relied upon Exs.B1 to B7. 5. Upon consideration of oral and documentary evidence, trial Court held that burden lies heavily upon LIC to avoid its statutory obligation and LIC failed to prove that Life Assured fraudulently suppressed the ailments and thereby rendering the contract null and void. Trial Court further held that claim being within time, plaintiff is entitled for the suit amount and decreed the suit together with interest at the rate of 6% p.a and cost. 6. Being aggrieved by decreeing of suit, LIC preferred appeal in A.S.No.35 of 2007. Holding that Sick Leave taken by the deceased by itself cannot give raise presumption that he was suffering from renal failure, lower Appellate Court confirmed findings of trial Court and dismissed the appeal. 7. Challenging concurrent findings of Courts below, unsuccessful defendant Corporation has filed this Second Appeal. With the consent of both, counsel for the appellant corporation and respondent, even at the time of admission, final hearing of Second Appeal was taken up and arguments were heard at length. 8. Arguments were advanced on the following substantial questions of law:- "1. In view of Sec.45 of the Insurance Act whether the appellants are right in rejecting the policy claim when the insured /proposer has misrepresented or suppressed the material particulars about his health condition in as much as the death happened within two years from the date of the policy. 2. Whether the Courts below are right in holding that the respondent has come with in the exception clause of Sec.45 of the Insurance Act to substantiate the policy claim when Ex.B6 and Ex.B7 medical certificate and discharge summary reveals chronic illness of the insured. 3. Whether the Courts below are right in decreeing the suit when the burden is on the claimant to prove the non application of Sec.45 of the Insurance Act to the case." 9. Application of Section 45 of Insurance Act is in question. Admittedly, plaintiffs husband Sivasankaran took Jeevanmithra Insurance Policies each for a sum of Rs.25,000/- under policy Nos.711192328 and 89838465. Sivasankaran submitted proposal dated 29.03.1990 (Ex.B2) and took policy No.711192328.
Application of Section 45 of Insurance Act is in question. Admittedly, plaintiffs husband Sivasankaran took Jeevanmithra Insurance Policies each for a sum of Rs.25,000/- under policy Nos.711192328 and 89838465. Sivasankaran submitted proposal dated 29.03.1990 (Ex.B2) and took policy No.711192328. In Column No.17 of the proposal, Life Assured has stated that he was of good health and in column 18, stated as "No disease". Life Assured lastly attended duty on 012. 1991 and died on 07.03.1992. Defendant Corporation settled claim under Policy No.89838465 but not settled the amount due under disputed Policy No.711192328. According to defendant Corporation they have got unimpeachable evidence to show that Life Assured was suffering from Diabetes and hypertension prior to the date of proposal under suit policy (Ex.A1) and Life Assured deliberately suppressed the material information. 10. Application of Section 45 of Insurance Act was in question in (2008) 1 SCC 321 [P.C.Chacko and Another Vs. Chairman, Life Insurance Corporation of India and Others]. Scope of Section 45 was considered by the Supreme Court and held as under: "13. Section 45 postulates repudiation of such policy within a period of two years. By reason of the aforementioned provision, a period of limitation of two years had, thus, been specified and on the expiry thereof the policy was not capable of being called in question, inter alia, on the ground that certain facts have been suppressed which were material to disclose or that it was fradulently been made by the policy-holder or that the policy-holder knew at the time of making it that the statement was false. Statute, therefore, itself provides for the limitation for valid repudiation of an insurance policy. It takes into account the social security aspect of the matter." 11. According to Defendant Corporation as per Ex.B3 certificate (dt.28.07.1992) issued by employer, Life Assured lastly attended his duty on 012. 1991 and died on 07.03.1992 and that while in service, he was on Sick leave on medical certificate for various spells of time. Considering this plea, Courts below held that policy holder Sivasankaran was a Government Employee eligible to take leave on medical grounds and sick leave taken by deceased Sivasankaran by itself cannot give raise to presumption that he was suffering from chronic renal failure which caused his death in 1992. 12.
Considering this plea, Courts below held that policy holder Sivasankaran was a Government Employee eligible to take leave on medical grounds and sick leave taken by deceased Sivasankaran by itself cannot give raise to presumption that he was suffering from chronic renal failure which caused his death in 1992. 12. There are three conditions for application of second part of Section 45 of the Insurance Act, which are: 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. As held by Courts below, LIC being an established corporation, the burden is heavy upon the Corporation to escape from its statutory obligation. LIC failed to examine either the agent, who filled up Ex.B2 proposal or the panel Doctor of LIC. There is no evidence to show that the insured was aware of the consequences of making a statement of good health in Columns 17 and 18 of Ex.B2. .13. Contending that a duty is cast upon the insured to disclose material facts, the learned counsel for appellant Corporation placed reliance upon AIR 1959 Pat 413 [Rataj Lal V. Metropolitan Insurance Co. Ltd.,] wherein as regards to disclosure of facts Supreme Court opined as under:- ."The well-settled law in the field of insurance is that contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission. And this duty to disclose continues upto the conclusion of the contract and covers any material alteration in the character of the risk which may take place between proposal and acceptance. .14. Reliance was also placed upon (2001) 2 SCC 160 [LIC of India V. Asha Goel] wherein the Supreme Court has held as under: ."12. ... The contracts of insurance including the contract of life assurance are contracts uberrima fides and every fact of material (sic material fact) must be disclosed, otherwise, there is good ground for rescission of the contract.
Reliance was also placed upon (2001) 2 SCC 160 [LIC of India V. Asha Goel] wherein the Supreme Court has held as under: ."12. ... The contracts of insurance including the contract of life assurance are contracts uberrima fides and every fact of material (sic material fact) 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 its acceptance. If there are any misstatements or suppression of material facts, the policy can be called into 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" 15. It is no doubt true that a duty is cast upon the insured to disclose material facts. As held by the Supreme Court, misstatement by itself was not material for repudiation of the policy unless the same is material in nature. In para 17 of P.C. Chacko Vs.Chairman, LIC of India [ (2008) 1 SCC 321 ] , Supreme Court has held as under: "17. The purpose of taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can eb repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the fact of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policyholder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose.
In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policyholder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law." As held by the Supreme Court it is only a wrong answer which has a greater bearing on the contract of insurance may lead to repudiation of the policy. Even though from Ex.B6, the Medical Attendants Certificate issued by the Medical Attendant of the deceased, in his last illness had stated in Clause.4.(a) that the exact cause of death primary: Chronic Renal Failure and Secondary Hepatitis and Tuberculosis. Thus Chronic Renal Failure alone was not the cause of death. Further Clause 6 in Ex.B6 would reveal that Hepatitis which caused the death was first observed only on the month of January 1992, and for the last illness he was treated only from March 1992 very much later from the date of Ex.A1 Policy dated 7. 1990. 16. As held by Courts below there is no evidence to show that the deceased took treatment even prior to Ex.A1 policy or otherwise had knowledge of seriousness of his ailments and that there was deliberate suppression of such ailments. 17. Since LIC is an established Corporation, it cannot be said that the Courts below committed error in placing the burden of proof upon defendant Corporation. It is not the case of the appellant Corporation had further enquired into the matter in regard to the question as to whether the proposer was suffering from any serious ailments. Non-examination of its agent who filled up Ex.B2 proposal seriously affects the defence plea of Corporation. Courts below rightly drew adverse inference against the defendant Corporation in view of non-examination of its agent. 18. As held by Supreme Court, it is only a deliberate wrong which has greater bearing on the contract of insurance may lead to policy being vitiated in law. In the instant case, it cannot be said that there was deliberate wrong answer which has a greater bearing on the contract of insurance.
18. As held by Supreme Court, it is only a deliberate wrong which has greater bearing on the contract of insurance may lead to policy being vitiated in law. In the instant case, it cannot be said that there was deliberate wrong answer which has a greater bearing on the contract of insurance. Concurrent findings of fact that there was no suppression of material facts is based upon analysis of evidence and materials on record. No substantial question of law is involved warranting interference exercising jurisdiction under Sec.100 of C.P.C. 19. In the result, the judgment in A.S.No.35 of 2007 dt. 29.06.2007 on the file of the Principal District Judge, Vellore confirming the Judgment and Decree dated.310. 2006 passed in O.S.No.442 of 2004 on the file of the Additional District Munsif, Vellore is confirmed and the Second Appeal is dismissed with cost. Consequently, M.P.No.1 of 2009 is closed.