SUSHIL KAUR v. LIFE INSURANCE CORPORATION OF INDIA
2011-08-02
B.C.KANDPAL, C.C.PANT
body2011
DigiLaw.ai
ORDER Hon'ble Justice B.C. Kandpal, President This is complainant's appeal against the order dated 06.10.2007 passed by the District Forum, Dehradun, dismissing consumer complaint No. 176 of 2003. 2. In brief the facts of the case are that Km. Jaswant Kaur (life assured), the sister of the complainant, was a teacher in Hindu National Inter College. During her lifetime, Km. Jaswant Kaur had purchased four life insurance policies. At the time of purchasing the policies, the life assured was medically examined and her status of health was found good. The life assured took medical leave from the school from 21.12.1989 to 29.12.1989 and 02.07.1998 to 10.07.1998. The life assured was also on leave from 28.09.2011 to 14.11.2001 and during the said period, she expired on 14.11.2001. The complainant lodged claim with the insurance company for the assured sum. The insurance company settled the claim of the first two policies and paid the amount to the complainant. The insurance company, however, repudiated the claim in respect of the remaining two policies on the ground that the insured had made deliberate misstatement and withheld correct information with regard to her health at the time of effecting the assurance. It was also mentioned by the insurance company that the life assured was suffering from Nephritis, Insomnia and Hypertension from before submitting the proposal form and in connection with the said diseases, she had consulted a medical practitioner and remained on medical leave for 26 days, which fact was concealed by her in the proposal form. Alleging deficiency in service on the part of the opposite parties, the complainant filed a consumer complaint before the District Forum, Dehradun. 3. The insurance company filed written statement and pleaded that the life assured had concealed material fact at the time of submitting the proposal form and gave false answers to the questions regarding her health and withheld correct information and, therefore, the claim was rightly repudiated and no deficiency in service was made. 4. The District Forum, on an appreciation of the material on record, dismissed the consumer complaint vide order dated 06.10.2007. Aggrieved by the said order, the complainant has filed this appeal. 5. None appeared on behalf of respondent No. 3. We have heard learned counsel for the appellant and respondent Nos. 1 and 2 and perused the record. 6.
4. The District Forum, on an appreciation of the material on record, dismissed the consumer complaint vide order dated 06.10.2007. Aggrieved by the said order, the complainant has filed this appeal. 5. None appeared on behalf of respondent No. 3. We have heard learned counsel for the appellant and respondent Nos. 1 and 2 and perused the record. 6. Learned counsel for the insurance company has submitted before us that the insured, at the time of submitting the proposal form, concealed the material facts with regard to her ailment and, therefore, the claim has been repudiated by the insurance company in a justified manner. However, learned counsel for the complainant- appellant has submitted that the death of the deceased- insured had no nexus with the ailment with which she was suffering. Therefore, the repudiation of the claim can not be said to be justified. The cause of death of the insured was Fibroid. The documents available on record show that the insured remained on medical leave from her place of work from 21.12.1989 to 29.12.1989, from 02.07.1998 to 10.07.1998 and thereafter from 28.09.2001 to 14.11.2001. Learned counsel for the appellant has submitted that there is no material available on record which may suggest that the insured remained on leave for 26 days on account of any ailment, as has been pointed out by the counsel for the insurance company. According to the submission raised by the learned counsel for the appellant, the documents on record suggest that the insured was no leave only for 9 days on account of another disease, which has got no nexus with the disease with which she ultimately died. 7. In order to assess this aspect whether the insured, in fact, made concealment while submitting the proposal form or not, it is relevant to mention question No. 11 of the proposal form which pertains to the personal history of the life assured. It contains 10 questions.
7. In order to assess this aspect whether the insured, in fact, made concealment while submitting the proposal form or not, it is relevant to mention question No. 11 of the proposal form which pertains to the personal history of the life assured. It contains 10 questions. Question No. 11 (a) is to the effect, "during the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week?" Question No. 11 (c) states, "have you remained absent from place of work on grounds of health during the last 5 years?" Question No. 11 (d) states, "are you suffering from or have you ever suffered from ailments pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system?" Question No. 11 (e) reads, "are you suffering from or have you ever suffered from diabetes, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia, hydrocele, leprosy or any other disease?" The insured has replied all the aforesaid question in negative. Learned counsel for the insurance company pointed out to the medical certificate issued by Dr. Khalid Mahmood on 20.03.2002 which indicates that the insured was admitted in the hospital on 05.04.1999 and at that time, she was suffering from Nephritis, Insomnia and hypertension. Our attention has also been invited towards Form 11-C wherein it is mentioned that the insured remained on medical leave w.e.f. 02.07.1998 to 10.07.1998 and while in the proposal form, the insured has replied in negative to the question as to whether she remained absent from place of work on grounds of health during the last 5 years. Therefore, it is a case where the insured concealed the material facts with regard to her ailment while filing the proposal form. 8. The Hon'ble National Commission is the case of Life Insurance Corporation of India Vs. Krishan Chander Sharma; II (2007) CPJ 51 (NC), has held that ultimate cause of death of the deceased has no relevance whatsoever to the disclosing of information regarding health as required by aforementioned sub-clauses of Question No. 11 of the proposal form. In case the answers to the questions put in the proposal form were false, then the insurance company was justified in repudiating the claim. The Hon'ble National Commission in the case of Sr. Divisional Manger, LIC of India Vs.
In case the answers to the questions put in the proposal form were false, then the insurance company was justified in repudiating the claim. The Hon'ble National Commission in the case of Sr. Divisional Manger, LIC of India Vs. Smt. Gangama and another III (2002) CPJ 56 (NC), has held that the suppression of information itself violates the terms of the contract. The Hon'ble National Commission in the case of Maya Devi Vs. Life Insurance Corporation of India; III (2011) CPJ 43 (NC), has held that an insurance policy is an agreement in utmost good faith between the insurer and the insured and any breach of this agreement by suppressing material facts on the part of the insured, would result in repudiation of the claim by the insurer. 9. In the light of the observations made by the Hon'ble National Commission in different cases as well as after going through the material before us, we are of the definite view that it is a case where life insured has violated the condition of the policy by suppressing the material facts with regard to her ailment. The District Forum has rightly dismissed the consumer complaint filed by the complainant- appellant and we do not find any ground for interference in the impugned judgment and order passed by the District Forum. The appeal lacks merit and is liable to be dismissed. 10. For the reasons aforesaid, appeal is dismissed. No order as to costs.