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2018 DIGILAW 299 (CAL)

Divisional Manager, Life Insurance Corporation of India v. Somenath Karmakar

2018-03-22

SHYAMAL GUPTA, UTPAL KUMAR BHATTACHARYA

body2018
ORDER : SHYAMAL GUPTA, J. 1. This Appeal is directed against the Order dated 19.07.2016 passed by the learned District Forum, Siliguri in CC/40/2015, where of the complaint has been allowed. In short, case of the Complainant is that his wife, since deceased, took a life insurance policy from the OPs. While the policy was in vogue, his wife unfortunately died on 19.10.2014 in a case of 'Septic shock Pneumonia". Following such death of his wife, a claim was lodged with the OPs which, however, was repudiated by them. Accordingly, the complaint. 2. Per contra case of the OPs is that the DLA, suppressing her previous ailments, took the said policy. Accordingly, the instant claim was repudiated by them. Decision with reasons 3. We heard the learned Advocates of the parties and perused the material on record. 4. The appellant from the Medical Certificate of Cause of Death, issued by the Medical Officer, Govt. of West Bengal dated 19.10.2014 that the proximate cause of death of the DLA was Septic Shock with Pneumonia with ARF with ILD with Pul. Koch's with HTN with Hypothyroidism. 5. In this regard, it is claimed by the learned Advocate of the Appellants that the patient was suffering from various ailments before inception of the policy, but she did not make any whisper while applying for the subject insurance policy. The learned Advocate also claimed, that the DLA died of her pre-existing diseases. In support of such contention, the learned Advocate draws our attention to host of treatment sheets pertaining to the DLA. 6. On a reference to the treatment sheet of Manipal Hospital, Bangalore dated 04.02.2014 we find that the patient was suffering from HTN for the last 6-7 years; from Hypothyroidism for the last 3 years; from RA for the last 17 years and was on medication. Other medical papers on record also corroborate such fact. 7. In this regard, it bears mentioning that, in terms of Section 19 of the Indian Contract Act, a contract is not voidable merely because consent to contract was obtained through misrepresentation or fraud, if the party whose consent was so caused had the means of discovering the truth with ordinary diligence. 8. The Hon'ble Supreme Court in Life Insurance Corporation of India & Ors. 8. The Hon'ble Supreme Court in Life Insurance Corporation of India & Ors. v. Asha Goel (Smt.) & Anr., (2001) 2 SCC 160 observed thus, '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. 9. It appears from the photocopy of proposal form that the DLA was examined by the panel doctor of the Appellants. It is indeed surprising that the poor state of health of the DLA completely escaped the watchful eyes of the panel doctor. Given that the DLA was 50 years (approx.) old at the time of opting for the policy, the panel doctor ought to be extremely vigilant while clinically examining her and obtain at least some routine pathological test reports to corroborate his clinical findings. Apparently, there was laches on the part of the panel doctor. Be that as it may, since the past ailments of the DLA could be detected with ordinary diligence, in our considered opinion, the Appellants cannot shrug off their responsibility in the matter. 10. That apart, it is noteworthy that the proposal form was not filled up by the DLA. Being a literate person, the DLA was very much capable of filling up the proposal form herself. Question arises, despite this, why the proposal form was not filled up by the DLA concerned. Had the proposal form been filled up by her, at least she could have the opportunity of having a glimpse of the particulars of the proposal form. 11. Also, it is an open secret that procuring insurance business is the be all and end all of insurance agents. Therefore, in order to achieve their business target, in most of the cases, agents of the Insurance Companies do not explain the grey areas of the insurance policies and obtain signature of prospective clients literally on the blank form and thereafter, fill up the same behind the back of the prospective clients as per their whims and fancies. 12. Therefore, in order to achieve their business target, in most of the cases, agents of the Insurance Companies do not explain the grey areas of the insurance policies and obtain signature of prospective clients literally on the blank form and thereafter, fill up the same behind the back of the prospective clients as per their whims and fancies. 12. Since the proposal form was not filled up by the DLA, there always remains an element of suspicion as to the (1) filling up of the proposal form properly as per the direction of the DLA and (2) filling up of the same in presence of Respondent's wife, since deceased. 13. In such a scenario, without examining the agent concerned, it is virtually impossible to ascertain if the proposal form was filled up in presence of the DLA and further, whether the columns were filled up strictly as per her direction. Given that the Respondent's wife is no more in this world to articulate what actually transpired behind the scene, without adequate material proof, merely because the proposal form contains the signature of the DLA, we feel that, it would not be just and proper for us to squarely blame a dead person and accuse her of acting mala fide. 14. For all these reasons, without examining the concerned agent, it cannot be stated with certainty that the DLA purposely withheld material information about her past ailments. For the reasons best known to the Appellants, no affidavit was filed from the side of the concerned agent to prove that the proposal form was filled up strictly in accordance with the direction of the DLA and the same was shown to her before obtaining her signature on the proposal form and most importantly, pros and cons of the policy concerned was duly explained to her by the agent concerned. 15. In our considered opinion, therefore, by according benefit of doubt in favour of the Respondent, the learned District Forum committed no illegality. Accordingly, we see no good reason to interfere with the impugned order in any manner whatsoever. The Appeal, thus, fails. Hence. ORDERED The Appeal stands dismissed on contest against the Respondent but without any cost. The impugned order is hereby affirmed.