DIVISIONAL MANAGER, LIFE INSURANCE CORPORATION OF INDIA v. DAI RANI
2010-05-13
IRSHAD HUSSAIN, KUSUM LATA SHARMA
body2010
DigiLaw.ai
ORDER [Per : Justice Irshad Hussain, President] This is insurer’s appeal against the order dated 31.08.2006 passed by the District Forum, Haridwar, allowing consumer complaint No. 130 of 2003 with costs amounting to Rs. 1,000/- and further directing the insurer to pay to the complainant the sum assured with benefits accrued under the life insurance policy Nos. 270548673 and 270548674, each for sum of Rs. 50,000/-, purchased by late Sh. Amar Singh, the husband of the complainant together with interest @ 9% p.a. w.e.f. 16.09.2002, the date on which the claim was repudiated within the stipulated period. In allowing the consumer complaint the District Forum rejected the contention of the insurer that the claim has rightly been repudiated on account of the fact that the insured made deliberate misstatement and withheld material information regarding his health at the time of affecting the assurance. 2. Contentions raised by the learned counsel for the parties give rise to the following points for determination of this appeal on merit : (i) Whether the insured had made deliberate misstatement and withheld material information regarding his health at the time of purchasing the insurance policies and that the finding to the contrary recorded by the District Forum, is incorrect? (ii) Whether the insurance company was justified in repudiating the claim on the aforesaid ground and made no deficiency in service? 3. Point Nos. (i) and (ii) – The above-mentioned two policies were purchased on 01.04.1999 and 15.04.1999 respectively by the insured late Sh. Amar Singh and it is not in dispute that in the proposal forms, while giving answer to the queries vide question No. 11, the insured gave out that he has not suffered from any disease etc. and his usual state of health has been good. It is not in dispute that late Sh. Amar Singh died a normal death, although he had suffered with Pulmonary Koch’s and had taken treatment for the same subsequent to the purchase of the insurance policies. In other words, the insured had not died on account of any disease or ailment.
and his usual state of health has been good. It is not in dispute that late Sh. Amar Singh died a normal death, although he had suffered with Pulmonary Koch’s and had taken treatment for the same subsequent to the purchase of the insurance policies. In other words, the insured had not died on account of any disease or ailment. Learned counsel for the insurance company, however, urged that the life assured had remained on medical leave from 17.05.1995 to 16.09.1995 and from 17.09.1995 to 05.11.1995 for and in connection with fracture of neck of femur bone in the year 1995 and has made concealment of this material fact while giving answer to the queries vide question No. 11 of the proposal forms and since the insurance contracts are based on the principle of uberrima fides, i.e., founded on utmost good faith, the contract got vitiated, that too under the terms and conditions of the policies of insurance and on that ground, the claim has been validly repudiated by the insurance company vide communication dated 16.09.2002 issued to the complainant. On the other hand, learned counsel for the complainant – respondent persuasively urged that at the time of purchasing the policies of insurance, the life assured was not suffering from any disease or ailment and, therefore, answer to the queries vide question No. 11 of the proposal forms, has been bonafidely given by the life assured and, as such, there was no material concealment of facts as regards the health of the life assured. According to the learned counsel, the District Forum was, therefore, justified in accepting the contention of the complainant while observing that the insurance company made deficiency in service by repudiating the claim. 4. Having considered the respective submissions in the light of the peculiar facts and circumstances of the case, we see no merit in the submissions of the learned counsel for the insurance company except to the extent that the interest awarded by the District Forum is on the higher side and that too from the date of repudiation of the claim instead from the date of filing of the consumer complaint. 5. The reasons for the above decision are that the life assured suffered fracture of neck of his femur bone in the year 1995 and had then taken medical leave for surgical treatment etc.
5. The reasons for the above decision are that the life assured suffered fracture of neck of his femur bone in the year 1995 and had then taken medical leave for surgical treatment etc. from Shivalik Medical Centre and Mahant Poly Clinic of the town of Haridwar. After complete recovery, the life assured had been leading normal life, as is apparent from the material on record and in other words, was not suffering from any pre-existing ailment or disease at the time of purchasing the insurance policies in question. Considering this aspect of the matter, we don’t think that the life assured made deliberate misstatement and withheld material information regarding his health at the time of making proposal for purchasing the insurance policies and in our view, the insurance company was not justified in repudiating the claim on the ground of suppression of material fact fraudulently, in view of the fact that the life assured died a normal death on 04.04.2002, after more than two years of the purchase of policies. In the case of the facts of the case, we may advantageously refer to a reported decision of Rajasthan State Consumer Disputes Redressal Commission in the matter of L.I.C. of India vs. Savita Rathoria; I (2010) CPJ 286. In that case, life assured died after two years of taking policy. Claim was repudiated on the grounds that the deceased was suffering from hypertension and met with an accident five years prior to taking the policy. The said facts were not disclosed in the declaration form. Fracture of bones suffered by the deceased four and half years back, same not a reason for death of assured. Suppression of facts was held not proved and repudiation of claim was held unjustified. Considering this aspect of the matter, the following reported decisions based on facts varying from the case in hand, pressed into service by the learned counsel for the appellant, would not help the cause of the appellant: (i) Life Insurance Corporation of India vs. Smt. Purna Devi; 2009 (2) UAD 390.
Considering this aspect of the matter, the following reported decisions based on facts varying from the case in hand, pressed into service by the learned counsel for the appellant, would not help the cause of the appellant: (i) Life Insurance Corporation of India vs. Smt. Purna Devi; 2009 (2) UAD 390. (ii) Life Insurance Corporation of India vs. Krishan Chander Sharma; 2007 (1) CPC 590 (iii) Life Insurance Corporation of India vs. Mansa Devi; II (2003) CPJ 135 (NC) (iv) Angoori Devi vs. LIC of India and others; IV (2008) CPJ 187 (NC) (v) Life Insurance Corporation of India and another vs. Sunita Hemnani; II (2009) CPJ 172 (NC) (vi) LIC of India and others vs. K.A. Chandrakala; II (2009) CPJ 167 (NC) (vii) LIC of India and another vs. M. Gowri and others; X-1994(3) CPR 398 (viii) Smt. Kailasho Devi vs. Life Insurance Corporation of India; 2006 UAD 166 (ix) Panni Devi vs. LIC and others; III (2003) CPJ 15 (NC) (x) Brahm Dutt Sharma vs. Life Insurance Corporation of India; AIR 1966 Allahabad 474. (xi) M/s Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd.; I (2000) CPJ 1 (SC) (xii) Budhiben Pababhai vs. LIC of India and others; I (2010) CPJ 92 (NC). 6. In view of above, we are convinced that the District Forum made no error in recording a finding that the insurance company made deficiency in service by repudiating the claim on the above ground. The consumer complaint was rightly allowed. Both the points are answered accordingly. 7. However, interest awarded by the District Forum @ 9% p.a. is on the higher side, as we have been awarding interest @ 7% p.a. in most of the cases and that too from the date of filing of the consumer complaint. To that extent, the contention raised by the learned counsel for the insurance company is sustainable. 8. For the reasons aforesaid, appeal is partly allowed. Order impugned dated 31.08.2006 of the District Forum is modified to the extent that the rate of interest is reduced from 9% p.a. to 7% p.a. and the interest shall be payable from the date of filing of the consumer complaint till payment. Rest of the order of the District Forum is maintained. Costs of the appeal made easy.