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2015 DIGILAW 289 (CAL)

Life Insurance Corporation of India v. Jyotsna Dawn

2015-03-27

JYOTIRMAY BHATTACHARYA, SAMAPTI CHATTERJEE

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JUDGMENT:- Jyotirmay Bhattacharya, J. This First Appeal is directed against the judgment and decree passed by the learned Civil Judge Senior Division, 1st Additional Court at Burdwan in Money Suit No.25 of 2001- 4 of 1997 at the instance of the defendant/appellant. The plaintiff filed a suit for recovery of money being the sum assured payable to her by the defendant Corporation on the death of her husband in terms of the policy being No.460587173 dated 24th August, 1993 amongst other incidental reliefs including damages, allotment of bonus etc. The cause of action pleaded in the plaint is as follows:- The plaintiff’s husband, namely, Nirmalendu Dawn during his life time had two insurance policies issued by the Life Insurance Corporation of India. One of such policies being No.460444710 dated 15th March, 1990 was held by him on his life, appointing his wife, namely, Jyotsna Dawn (plaintiff/respondent) herein as his nominee under the said policy. He also obtained another policy along with his wife Jyotsna Dawn under Jivan Sarathi (Double Accident Benefit) Scheme in the year of 1993. In terms of the said policy, sum assured under the said policy was payable to the survivor on the death of anyone of them. The said policy was issued on 24th August, 1993 under policy No.4605587173. The husband of the plaintiff/respondent died due to cardiac respiratory failure on 7th April, 1994. Thereafter the plaintiff/respondent submitted claims along with necessary documents in respect of both the aforesaid policies. The plaintiff’s claim in respect of the first policy which was issued by the Insurance Company in the year 1990 was duly satisfied by the Insurance Company. Problems started regarding payment of the money payable under the other policy issued by the Insurance Company in 1993 under Jivan Sarathi (Double Accident Benefit) Scheme, as the Insurance Company repudiated the claim of the plaintiff/respondent on the plea that such policy was obtained by the husband/plaintiff/respondent by suppressing material facts regarding rheumatic fever which he suffered at the age of 8 years and subsequently again at the age of 15 years. Hence the instant suit was filed. The appellant/defendant Corporation contested the said suit by filing written statement denying the material allegations of the plaint. Hence the instant suit was filed. The appellant/defendant Corporation contested the said suit by filing written statement denying the material allegations of the plaint. It was stated therein that the defendant repudiated its liability under the policy in question being No.460587173 as the deceased Nirmalendu Dawn withheld material information regarding his health and age at the time of obtaining insurance policy from the defendant Corporation. It was stated therein that though the said Nirmalendu Dawn suffered from rheumatic fever twice, once at the age of 8 years and subsequently again at the age of 15 years but he did not disclose those facts in his proposal form submitted on 17th August, 1993. It was further stated therein that immediately after receiving the claim from the plaintiff/respondent, the defendant Corporation conducted an enquiry to ascertain the justifiability of the plaintiff’s claim when it was revealed that the said Nirmalendu Dawn obtained the said insurance policy by giving wrong information about the state of his health and as such the plaintiff’s claim was repudiated by the appellant/respondent. The plaintiff was accordingly informed, by the letter issued by the appellant/defendant on 4th April, 1996. The defendant/appellant thus, denied its liability to pay any amount under the aforesaid policy in question. The defendant/appellant thus, prayed for dismissal of the said suit. The parties led their respective evidence in support of their claims in the said suit. The learned Trial Judge after considering the materials on record including the evidence of the parties, decreed the said suit in part on contest with costs against the defendant Corporation by holding, inter alia, that the defendant Corporation was not justified in repudiating the claim of the plaintiff, as Nirmalendu Dawn did not deliberately suppress any known fact with an intent to illegally gain anything after obtaining the impugned insurance policy. The learned Trial Judge held that even there is no iota of evidence showing that Nirmalendu had been suffering from such rheumatic fever just before obtaining the impugned insurance policy or he had suffered from such rheumatic fever twice i.e., once at the age of 8 years and subsequently again at the age of 15 years. The learned Trial Judge further held that even there was no iota of evidence as to whether the heart disease developed in him due to his sufferance from rheumatic fever when he was a boy of 8 years and 15 years. The learned Trial Judge further held that even there was no iota of evidence as to whether the heart disease developed in him due to his sufferance from rheumatic fever when he was a boy of 8 years and 15 years. It was also held that it is not possible for a man of ordinary prudence to feel it necessary to mention in the proposal form about his sufferance from rheumatic fever at the age of 8 years and 15 years. The learned Trial Judge, thus, held that the defendant/appellant is liable to pay the claim amount of the plaintiff as she is legally entitled to the sum assured under the said policy on the death of her husband Nirmalendu Dawn. The defendant Corporation was directed to pay a sum of Rs.1,50,000.00 to the plaintiff/respondent within one month from the date of the order, failing which, the plaintiff/respondent was given liberty to put the decree into execution. The learned Trial Judge found that the damages which the plaintiff allegedly suffered due to non payment of the sum assured to her under the policy has not been proved by the plaintiff/respondent and as such, the relief for damages claimed in the suit, was turned down. Thus, the suit was decreed in part. The legality of the said judgment and decree is under challenge before us. Let us now consider the merit of the instant appeal in the facts of the instant case. It is well-settled that contracts of insurance including contract of life assurance are contracts uberrima fides and as such every fact of material must be disclosed, otherwise there is good ground for rescission of the contract. The Hon’ble Supreme Court in the case of Life Insurance Corporation of India & Ors. –Vs Asha Goel & Anr. reported in (2001) SCC 160, held that the duty to disclose material facts continues right up to the conclusion of the contract and it also implies that any material alteration in the character of the risk which may take place between the proposal and its acceptance should also be disclosed. If there are any misstatements or suppression of material facts, the policy can be called into question. 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 knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person. The Hon’ble Supreme Court in a subsequent case reported in AIR 2008 SC 424 P.J. Chacko & Anr. –Vs Chairman, Life Insurance Corporation of India & Ors. also held that 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. The purpose for taking a policy of insurance is not 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. It was thus held that proposal can be repudiated if a fraudulent act is discovered. Keeping in mind that aforesaid principle laid down by the Hon’ble Supreme Court in the aforesaid decisions, let us now examine the facts of the present case to ascertain as to whether any deliberate wrong answer was given by the insured person while obtaining the insurance policy and the suppression of material facts are of such nature and/or magnitude which may ultimately lead to repudiation of the contract. Here is the case where the insured person obtained two insurance policies from the Life Insurance Corporation of India. One of such policies was obtained on 15th March, 1990 on his life and the other was obtained along with his wife Jyotsna Dawn under Jivan Sarathi (Double Accident Benefit) scheme on 24th August, 1993. The husband of the plaintiff/respondent died due to cardiac respiratory failure on 7th April, 1994. Thereafter the plaintiff/respondent submitted claims along with necessary documents in respect of both the life insurance policies which were obtained by her husband in the year 1990 and 1993 respectively. The husband of the plaintiff/respondent died due to cardiac respiratory failure on 7th April, 1994. Thereafter the plaintiff/respondent submitted claims along with necessary documents in respect of both the life insurance policies which were obtained by her husband in the year 1990 and 1993 respectively. Problems started regarding payment of money payable to the plaintiff/respondent under the policy issued by the Insurance Company in 1993 under Jivan Sarathi (Double Accident Benefits) scheme as the Insurance Company repudiated the claim of the plaintiff/appellant on the plea that such policy was obtained by her husband by suppressing material facts regarding rheumatic fever which he suffered twice; once at the age of 8 years and subsequently at the age of 15 years. Thus, we find that legality of repudiation of the insurance policy is the sole and primary issue in the suit. If it is found that the repudiation was justified then the plaintiff’s suit will be dismissed. On the contrary, if it is found that such repudiation was not justified or legal then the plaintiff’s claim will be allowed. Let us now examine as to how far the Life Insurance Corporation was justified in repudiating the insurance policy in the facts of the instant case. We have already mentioned above that the Life Insurance Corporation repudiated the plaintiff’s claim on the ground that her husband while submitting the application form for obtaining the policy in 1993 deliberately suppressed the disease, i.e., rheumatic fever which he suffered twice during his life time i.e., once at the age of 8 years and subsequently again at the age of 15 years. The Insurance Company claimed that since the insured person ultimately died due to cardiac respiratory failure and his heart disease developed due to the rheumatic fever which he suffered at the age of 8 and 15 years, the plaintiff is not entitled to get any benefit under the said insurance policy which was vitiated due to suppression of material facts regarding sufferance of the rheumatic fever twice during the life time of the plaintiff’s husband. To justify the legality of such repudiation of the insurance policy, the Insurance Company has proved two basic documents, i.e., the proposal for Insurance of Life Insurance Corporation issued in the name of Nirmalendu Dawn dated 17th August, 1993 being Ext. A and the certificate of hospital treatment of Nirmalendu Dawn dated 1st August, 1994 being Ext. To justify the legality of such repudiation of the insurance policy, the Insurance Company has proved two basic documents, i.e., the proposal for Insurance of Life Insurance Corporation issued in the name of Nirmalendu Dawn dated 17th August, 1993 being Ext. A and the certificate of hospital treatment of Nirmalendu Dawn dated 1st August, 1994 being Ext. H. In fact, the Insurance Company placed strong reliance on these two documents to substantiate its contention that repudiation of the insurance policy was justified as the plaintiff’s husband deliberately suppressed the rheumatic fever which he suffered during his life time, i.e., at the age of 8 years and thereafter at the age of 15 years. Let us now consider the evidential value of these two documents in the context of the present case. This certificate of hospital treatment was produced by the witness of the defendant/appellant, namely, Susovan Patra, D.W. 1. He stated that he was not present at the time of writing of the said certificate. He admitted in his evidence that some of the columns of the said format, i.e., column Nos. 1, 2, 3 and 6 were prepared in black ink and the other columns thereof, i.e., column Nos. 4 and 5 were written in blue ink. He also stated that since he is not a handwriting expert, he cannot say by looking at the document as to whether the entire document was prepared by one person or not. He further stated that excepting the said document that is Ext. H, the Life Insurance Corporation has got no other paper to show that Nirmalendu Dawn had suffered from rheumatic fever once at age of 8 years and subsequently again at the age of 15 years. In fact, Ext. H is the sheet anchor of the Life Insurance Company to justify their action for repudiation of the insurance policy. We have very carefully inspected the said document with great anxiety. We have seen that the said document was prepared on a prescribed format of Life Insurance Corporation of India. There are as many as 10 columns in the prescribed format. Column No. 5 thereof is relevant for our present purpose. In column No.5, the exact history reported by the patient at the time of admission in the hospital was mentioned. We have seen that the said document was prepared on a prescribed format of Life Insurance Corporation of India. There are as many as 10 columns in the prescribed format. Column No. 5 thereof is relevant for our present purpose. In column No.5, the exact history reported by the patient at the time of admission in the hospital was mentioned. It was mentioned above that the plaintiff’s husband suffered from rheumatic fever at the age of 8 years and subsequently again at the age of 15 years. We have already mentioned here that the said document was not prepared in one uniform process. Column Nos. 4 and 5 which are relevant for the present purpose were written in blue ink while the other columns were filled up by black ink. On mere visual inspection of the document it appears to us that the entire document was not prepared by one person in one handwriting. All the columns of the said format certificate were filled up by handwriting. Handwriting used in filling up column Nos. 1, 2,3 & 6 differs from the handwriting of the person who filled up column No.4 and 5. Though the deponent said that he was not present when the said certificate was prepared still then no attempt was made by the appellant Corporation to bring the author of the said certificate in the box for giving evidence to prove the said document in accordance with law. Though the said certificate was signed by doctor of the Insurance Company and was also counter signed by the doctor of the hospital but neither the doctor of the Insurance Company and nor the doctor of the hospital was examined in this case. Whether these entries in column Nos. 4 and 5 were prepared in conformity with the entries made in the hospital records cannot be ascertained in the absence of the hospital records where the case history of the patient was recorded in usual course of business. The hospital record is the best and primary piece of evidence to show the actual case history of the patient which was recorded therein. Hospital records have not been proved in this suit. No effort was made by the Insurance Company to bring those documents on record. The hospital record is the best and primary piece of evidence to show the actual case history of the patient which was recorded therein. Hospital records have not been proved in this suit. No effort was made by the Insurance Company to bring those documents on record. On examination of the said document as a whole we have no hesitation to hold that the said document is a very suspicious document and the same was not proved in accordance with law and as such the entries made in the said document cannot be relied upon. Even assuming that the entries in column Nos. 4 and 5 were correctly recorded in conformity with the hospital records of the patient concerned, still then can it be held that for non disclosure of the said disease which the plaintiff’s husband allegedly suffered at the age of 8 years and subsequently again at the age of 15 in the proposal form submitted by the plaintiff’s husband for obtaining the insurance policy in the year 1993, vitiated the insurance contract on account of suppression and/or deliberate concealment of the fact of sufferance of such rheumatic fever at an early age of the plaintiff’s husband? In this regard we are required to examine Ext. A. Though the said document contains various columns but presently we are concerned with some of the columns of the said proposal form which we indicate hereunder. (d) 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 Let us now consider the questionnaire in column No. (d) and the answer given by the insured person thereto first. On reading this questionnaire, we find that the Insurance Company wanted to know as to whether the proposer was suffering from and/or had suffered from any ailments pertaining to : 1. Liver 2. Stomach 3. Heart 4. Lungs 5. Kidney 6. Brain 7. Nervous system To the said questionnaire the proposer answer “No”. Let us now scan as to how far the Insurance Company succeeded in proving that the answer given by the proposer was erroneous, misleading and incorrect. Liver 2. Stomach 3. Heart 4. Lungs 5. Kidney 6. Brain 7. Nervous system To the said questionnaire the proposer answer “No”. Let us now scan as to how far the Insurance Company succeeded in proving that the answer given by the proposer was erroneous, misleading and incorrect. The Insurance Company has not proved that the proposer at the time of submission of the proposal form or prior thereto, has been suffering or had suffered from any ailment pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain and Nervous System. The Insurance Company contended that the proposer suppressed the disease i.e., rheumatic fever which he suffered once at the age of 8 years and subsequently again at the age of 15 years. We have recorded the questionnaire in column (d) in verbatim. On reading the said questionnaire, we do not find that any answer was sought from the proposer at the time of submission of the proposal form as to whether he was suffering and/or earlier he ever suffered from any ailment pertaining to rheumatic fever. When no answer was sought for from the proposer regarding his sufferance from rheumatic fever, the Insurance Company cannot accuse the proposer for non-disclosure of said disease which he allegedly suffered at the age of 8 years and again at the age of 15 years. Had it been a case that such an information was necessary for issuance of such a policy in his favour, a specific query ought to have been made by the Insurance Company in this regard and if in spite of a query being made by the Insurance Company, the proposer avoided in giving that answer or made any incorrect statement or misstatement to the said query, then one can conclude that there was suppression of material facts and/or concealment on the part the proposer. Since such a query was not made by the Insurance Company, the proposer had no obligation to disclose the said disease which he allegedly suffered at the age of 8 years and subsequently again at the age of 15 years. The plaintiff as P.W 1 in her evidence categorically stated that her husband did not suffer from any such disease, i.e., rheumatic fever at the age of 8 years and subsequently again at the age of 15 years. She maintained her said stand in her cross-examination also. The plaintiff as P.W 1 in her evidence categorically stated that her husband did not suffer from any such disease, i.e., rheumatic fever at the age of 8 years and subsequently again at the age of 15 years. She maintained her said stand in her cross-examination also. No further evidence could be brought by the Insurance Company to prove that the plaintiff’s husband ever suffered from rheumatic fever at the age of 8 years and subsequently again at the age of 15 years. In the absence of any credible evidence regarding sufferance of such a disease by the plaintiff’s husband at the time of 8 years and again at the age of 15 years, we cannot hold that the plaintiff’s husband ever suffered from such disease either at the age of 8 years or at the age of 15 years. He remained alive up to the age of 36 years. Of course he died due to cardiac respiratory failure but there was no iota of evidence that his heart disease developed due to his sufferance from rheumatic fever at the early age of 8 years and subsequently again at the age of 15 years. There is also no iota of evidence that the general condition of health of the plaintiff’s husband was not good and sound at the time when he submitted the proposal form. He was clinically examined by the doctor of the Insurance Company and after the doctor certified the condition of his health as good and sound, the Insurance Company issued the said insurance policy under Jivan Sarathi (Double Accident Benefit) scheme. The corporation’s doctor certified that the plaintiff’s husband had no cardiac problem. At least the said certificate indicates that he had no cardiac problem at the time of submission of the proposal form in the year of 1993. The witness of the defendant/appellant being D.W.1 stated in his evidence that no policy is issued in favour of any proposer unless the corporation’s doctor certifies his health as good and sound after conducting clinical test of him. He has not stated in his evidence that there was any departure from this normal practice while issuing the insurance policy to the plaintiff and her husband in Jivan Sarathi (Double Accident Benefit) scheme 1993. He has not stated in his evidence that there was any departure from this normal practice while issuing the insurance policy to the plaintiff and her husband in Jivan Sarathi (Double Accident Benefit) scheme 1993. As such we do not find any justification to hold that the plaintiff’s husband gave any incorrect answer to the query of the Insurance Company in the proposal form in column No.(d) or in column No.(i) If that be so, then where is the suppression of any material fact relating to the condition of the health and/or ailments of the plaintiff’s husband. That apart, for proving that he was guilty of suppression of material facts, the corporation was required to prove that the fever which he suffered at the age of 8 years and again at the age of 15 years was diagonized by the doctor as rheumatic fever and he had the knowledge of the classification of the said disease as rheumatic fever and despite he having such knowledge, suppressed the same willfully for some unlawful gain. On examination of the materials on record, we have no hesitation to hold that the appellant corporation has miserably failed to prove that his fever was diagonized by the doctor as rheumatic fever earlier and he having knowledge of the nature of the said disease suppressed the same at the time of submission of the proposal form. Before parting with, we like to mention here that though the plaintiff’s husband while obtaining the insurance policy on his life in the year 1990 was called upon by the Insurance Company to answer as to whether he suffered and/or was suffering from any ailments relating to rheumatic fever and the proposer answered the said question in the negative but still then no such query was made by the Insurance Company while issuing the subsequent policy in the year 1993 presumably for the reason that such a query was immaterial for issuance of such a policy under double benefit scheme. In this regard, a confusion has arisen as to whether he suppressed sufferance of the said disease while submitting the proposal form in the year 1990 or not. In this regard, a confusion has arisen as to whether he suppressed sufferance of the said disease while submitting the proposal form in the year 1990 or not. Be it mentioned here that the said policy has been duly satisfied by the Insurance Company and as such that is not the subject matter of the present suit but still then to dispel the cloud as to whether any suppression was made by him while submitting the proposal form in the year 1990, we feel that our discussion in this regard may be necessary. Accordingly, we do it. Is there any human being who does not suffer any ailment in his lifetime? Everybody has some or the other disease. But is it possible for anybody to specify the clinical name of the disease which he suffered from? What is the after effect of the disease which he suffered from? What treatment is required if somebody suffers from any special form of disease. These are the business of the doctors and not of the patients. As such it is impossible for the patient to identify that the fever which he allegedly suffered at his early age can be clinically identified as rheumatic fever. Thus even assuming that the proposer suffered from fever at the age of 8 years and 15 years, still then there was nothing unusual if he failed to identify his disease as rheumatic fever resulting in non disclosure of the same while submitting the proposal form in 1990. In our experience we have seen that while consulting a doctor, the patient informs the doctor about his immediate sufferance and/or the sufferance which he earlier had in different parts of his body. On receipt of such information from the patient, the doctor identifies the disease which the patient is suffering or has suffered earlier and then prescribes medicine. Patient does not identify the clinical name of the disease which he is suffering from and on the basis of such identification, the doctor does not treat him. On receipt of such information from the patient, the doctor identifies the disease which the patient is suffering or has suffered earlier and then prescribes medicine. Patient does not identify the clinical name of the disease which he is suffering from and on the basis of such identification, the doctor does not treat him. As such, even if we find that the doctor who attended the plaintiff’s husband at the time of his admission in the hospital, recorded that he suffered from rheumatic fever at the age of 8 years and subsequently again at the age of 15 years, still then we cannot conclude by holding that sufferance from such a disease, i.e., rheumatic fever at his age of 8 years and 15 years was known to him when he allegedly suffered the said illness and as such for non-disclosure of the same in the proposal from which he submitted in the year 1990, we cannot hold that he deliberately and willfully suppressed the sufferance of such disease by him at the age of 8 years and 15 years while submitting the proposal from in the year 1990. Doctor’s detection of sufferance from such a disease by the husband of the plaintiff at the time of admitting him in the hospital cannot lead us to conclude that the husband of the plaintiff was aware of the clinical name of the disease which he allegedly suffered at the age of 8 years and subsequently at the age of 15 years and he suppressed the said disease by not disclosing the same in the proposal form submitted in 1990 for making any unlawful gain from the Insurance Company. Thus, we hold that the learned Trial Judge did not commit any mistake and/or illegality in arriving at the conclusion that there was no material suppression on the part of the plaintiff’s husband while submitting the proposal form for obtaining the insurance policy under Jivan Sarathi (Doubled Accident Benefit) Scheme in the year 1993. We thus, hold that the learned Trial Judge was absolutely justified in holding that the repudiation of the plaintiff’s policy was illegal. Thus, we approve the findings of the learned Trial Judge in this regard. We thus, hold that the learned Trial Judge was absolutely justified in holding that the repudiation of the plaintiff’s policy was illegal. Thus, we approve the findings of the learned Trial Judge in this regard. Though we agree with the learned Trial Judge that in the absence of proof of any special damages due to non payment of the sum assured to the plaintiff on the death of her husband, the plaintiff is not entitled to get any decree for special damage, but we hold that for depriving the plaintiff from enjoying the benefit of the sum assured payable to her by withholding the payment thereof by the Insurance Company, the Insurance Company is liable to compensate such loss of the plaintiff by payment of interest on delayed payment of sum assured @ 10% per annum from the date when such payment became due and payable to her till realization thereof. The judgment and decree appealed against is, thus, modified to the above extent. The Insurance Company is thus, directed to pay the sum assured under the said policy, i.e., a sum of Rs.1,50,000.00 (Rupees one lakh fifty thousand) and the bonus admissible thereon together with interest @ 10% thereon from the date when such payment became due and payable to her up to the date of realization therein. Such payment should be made by the Insurance Company to the plaintiff/respondent herein within two months from date, failing which, the plaintiff/respondent will be at liberty to realize the same by executing the decree in accordance with law. We are informed by the learned Counsel appearing for the appellant that the decreetal amount has already been deposited by the appellant before this Hon’ble Court in connection with this appeal and the said amount has already been invested in short term fixed deposit with a nationalized bank. Under such circumstances, we permit the appellant corporation to withdraw the deposited amount together with interest from this Court. The learned Registrar General of this Court is, thus, directed to pay the said deposited amount together with accumulated interest to the appellant, subject to compliance with necessary formalities by the appellant in this regard, after the decree is satisfied by the appellant.