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2011 DIGILAW 578 (UTT)

LIFE INSURANCE CORPORATION OF INDIA v. SITA DEVI BANGWAL

2011-09-13

B.C.KANDPAL, C.C.PANT, KUSUM LATA SHARMA

body2011
ORDER Hon'ble C.C. Pant, Member. This is Insurance Company's appeal against the order dated 22.08.2008 passed by the District Consumer Forum, Haridwar allowing the Consumer Complaint No. 285/2007 and directing the Insurance company- opposite party in the complaint, to pay to the complainant the amount insured under the insurance policies together with interest @ 9% per annum pendentelite and future, as compensation, and Rs. 2,000/- towards the litigation expenses within a month from the date of the order. 2. The facts of the case in brief are that the complainant Smt. Sita Devi Bangwal had submitted two claims for the insurance amounts to the Life Insurance Corporation of India- opposite party. These two insurance policies were taken by her husband Late Shri Jagdamba Prasad Bangwal, who expired on 10.05.2005, from the opposite party for a risk of Rs. 1,00,000/- each on his own life. The opposite party, however, repudiated the complainant's claims on the ground that the deceased had concealed material information regarding his health at the time of submitting the proposal forms for the said policies. This led the complainant to file a consumer complaint, alleging deficiency in service made by the opposite party, before the District Forum, Haridwar. The District Forum, after an appreciation of the facts of the case, allowed the complaint vide its order dated 22.08.2008 and directed the opposite party to pay to the complainant the insured amounts under the policies alongwith interest and litigation expenses as stated above. Aggrieved by the order the Insurance Company has filed this appeal. 3. We have heard the learned counsel for the parties and perused the material placed on record in the light of the legal aspect of the case. 4. The deceased husband of the complainant had taken two insurance policies on 21.03.2001 and 15.02.2002 numbered as 270896827 and 271044464 respectively for a risk of Rs. 1,00,000/- each on his own life. These policies had lapsed due to default in payment of premiums and were revived on 05.10.2004 (policy no. 271044464) and 08.02.2005 (policy no. 270896827). The insured expired on 10.05.2005, just after there months from the date of the revival of the policy no. 270896827. The certificate issued in form no. 3784 (paper no. 49) by the treating doctors of the L.R.S. Institute of T.B. and Respiratory Diseases, New Delhi states that the primary cause of insured's death was "Pulmonary Tuberculosis". 270896827). The insured expired on 10.05.2005, just after there months from the date of the revival of the policy no. 270896827. The certificate issued in form no. 3784 (paper no. 49) by the treating doctors of the L.R.S. Institute of T.B. and Respiratory Diseases, New Delhi states that the primary cause of insured's death was "Pulmonary Tuberculosis". The record also reveals that the insured used to take leave on medical ground most frequently. As per the record before us, from 16.05.1996 till 10.05.2005, the date of his death, he had taken leave on 56 occasions for different periods totaling to 1264 days. There are some medical certificates issued by the treating doctors available on record in support thereto. A medical certificate dated 31.03.1999 (paper no. 42 on record) issued for the period from 31.03.1999 to 28.04.1999, reveals that the insured was a patient of viral fever, chronic bronchitis and Anaemia. Similarly, a certificate dated 30.06.1999 (paper no. 46 on record) reveals that he was treated for viral hepatitis during the period from 30.06.1999 to 31.07.1999. Inspite of these facts, the insured had answered to the questions related to his health in the proposal forms (paper nos. 21 to 25 no record) in negative. The question in the proposal forms and the answers given thereto by the insured are as follows:- 11.(a) During the last five year did you consult a medical Practitioner for any ailment requiring treatment for more than a week? No. (b) Have you remained absent from place of work on grounds of health during the last 5 years? No. (c) are you suffering from or have you ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System? No. (i) What has been your usual state of health? Good (ii) Have you ever received or at present availing/undergoing medical advise, treatment or tests in connection with Hepatitis-B or an AIDS related condition? No. 5. The plea taken by the learned counsel for the respondent complainant that the insured was not aware of the fact that he was suffering from the diseases like chronic bronchitis and hepatitis and was leading a healthy life is not tenable in the light of the medical certiticates issued by the treating doctors for various periods. No. 5. The plea taken by the learned counsel for the respondent complainant that the insured was not aware of the fact that he was suffering from the diseases like chronic bronchitis and hepatitis and was leading a healthy life is not tenable in the light of the medical certiticates issued by the treating doctors for various periods. The learned counsel for the respondent, in support of his contention, pressed into service the following judgments of the Hon'ble National Consumer Disputes Redressal Commission, New Delhi- (1) Life Insurance Corporation of India and Anr. Versus Smt. Chandrakanta Lohande, 2008 (2) CPR 246 (NC). (2) Life Insurance Corporation of India and Ors. Versus smt. Kunari Devi, 2008 (4) CPR 8 (NC). 6. We went through these judgments and found that these cannot be applied to the instant case. In the case of "Smt. Chandrakanta Lohande" Hon'ble National Commission has observed that the problems like acidity, indigestion, back pain, headache etc. may occur from time to time with different levels of intensity and these may be sometimes chronic in nature but these cannot be considered as diseases. With specific reference to dyspepsia, the Hon'ble National Commission has held that dyspepsia is not a disease and its non-mentioning in proposal form would not entitle the insurance company to repudiate claim under life policy. The respondent's case is not that of back pain, headache or even dyspepsia but there are evidences that he was treated for chronic bronchitis during the period for 31.03.1999 to 28.04.1999 i.e., prior to taking the life policies. He was also treated for hepatitis during the period from 30.06.1999 to 31.07.1999. In our view, these ailments are certainly under the category of "disease" and the insured knew it very well because these are clearly mentioned in the medical certificates obtained by him from the treating doctors. Not only these ailments but he was also treated for typhoid, dysentery, urinal infection, and anaemia. A person, who was suffering from multiple diseases and had taken 1264 days leave for his treatment, died ultimately due to pulmonary tuberculosis. The pulmonary tuberculosis, thus, appears to be a cumulative effect of the diseases like hepatitis, chronic bronchitis etc. Not only these ailments but he was also treated for typhoid, dysentery, urinal infection, and anaemia. A person, who was suffering from multiple diseases and had taken 1264 days leave for his treatment, died ultimately due to pulmonary tuberculosis. The pulmonary tuberculosis, thus, appears to be a cumulative effect of the diseases like hepatitis, chronic bronchitis etc. and, therefore, the case of "Smt. Kunari Devi" (supra), in which the Hon'ble National Commission has held that where there is nothing on record to prove that life assured was suffering from tuberculosis prior to revival of policy, repudiation of claim was unjustified is also not applicable to the instant case. In the instant case, the policy no. 270896827 was revived on 08.02.2005 and the insured died just after three months from the date of the revival of the policy. It also creates suspicion that the insured had taken two policies within a period of 12 months. The death of the insured just after 3 months from the date of revival of the policy confirms the suspicion. Further, the answer to question no. 11 (j) of the proposal form that his state of health was good is certainly a "big lie." Similarly, answers to question nos. 11(a) and 11(c) as mentioned above are apparently false. Therefore, it is well proved that the insured had given false information and had concealed material facts about his health. The appellant has, therefore, rightly repudiated the claim of the respondent. The Hon'ble National Consumer Commission, in the case of Sabnam Devi & Ors. Vs LIC of India & Ors., I (2008) CPJ 133 (NC) has also held that suppression of material facts about the insured's heath is a valid ground for the repudiation of the claim. The District Forum, without appreciating the aforesaid facts of the case, has erred by allowing the complaint and directing the Insurance Company to pay to the complainant not only the insured amount but also compensation in the form of interest @ 9% per annum. Such an order certainly deserves to be set aside and this appeal deserves to be allowed. 7. Appeal is allowed. The impugned order dated 22.08.2008 passed by the District Forum, Haridwar is set aside and the consumer complaint no. 285/2007 is dismissed. No order as to cost.