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2024 DIGILAW 67 (JHR)

Zonal Manager, Life Insurance Corporation of India v. Sita Devi, W/o. Late Girdhar Pandey

2024-01-16

ANIL KUMAR CHOUDHARY

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JUDGMENT : ANIL KUMAR CHOUDHARY, J. Heard learned counsel for the petitioner but no one turns up on behalf of the sole respondent, in spite of repeated calls. 2. This writ petition has been filed invoking the jurisdiction of this court under Article 226 of the Constitution of India, with a prayer for issuance of a writ of certiorari to quash and cancel the award dated 06.05.2017 (Annexure 6) passed by learned Permanent Lok Adalat, Ranchi in PLA case no. 241 of 2013 whereby and where under, claim petition filed by the claimant has been allowed and the repudiation letter at Exhibit A has been set aside with further direction to the Life Insurance Corporation of India to pay a sum of Rs. 2,00,000/-to the claimant with Simple Interest @ 6% per annum from the date of filing of the case i.e. 15.05.2013 till payment, the copy of which has been kept at Annexure 6 of this writ petition. 3. The brief facts of the case is that the deceased Girdhar Pandey took a policy from the Life Insurance Corporation of India bearing policy no. 537424569 wherein the sum assured was Rs. 2,00,000/-. Girdhar Pandey was working as Constable in Jharkhand State police service, during his life time. The policy name was Jeevan Anand with profits, (with accident benefit). The policy was taken from Hazipur branch of LIC of India and the only first and last premium of the policy was made on 17.05.2008. On 04.01.2009, the insured was admitted in Sadar Hospital in Dumka from where, he was referred to RIMS, Ranchi and he was admitted there on 06.01.2009 and he died on 09.01.2009 in course of medical treatment. The claimant being his wife submitted a claim annexing therewith the certificate of the hospital treatment of Girdhar Pandey, the copy of which has been kept at page 3033 of this writ petition, which is the certificate issued by the Assistant Professor, Department of Medicine, RIMS Ranchi dated 17.07.2010, in para 5 of which, it has been mentioned by the doctor, in response to the question “What was the exact history reported by the patient at the time of his admission?” -Weakness and inability to walk – 3 to 4 days, dribbling of urine since one year and diabetic for five years, and same was also mentioned in para 7 of the said certificate of the hospital treatment. In the declaration from for obtaining the policy, the said Girdhar Pandey suppressed the materials facts of his ailment, even though he was very much aware that he was suffering from the diabetes since five years and dribbling of urine from one year and he made false statement in the declaration in the proposal form of the policy about his health in the policy in question and on the basis of the same, the LIC of India repudiated the claim of the claimant. The claimant approached the permanent Lok Adalat at Ranchi and the same was contested by the writ petitioner, who were officers of the LIC of India mentioning that in Column No. 11 of the proposal form, for obtaining the said policy of the life assured, the life assured answered in negative with regard to the consultation of the to the medical practitioners, since last five years, in respect of the ailments pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system and about suffering from diabetes, T.B., high B.P, low B.P., cancer, Epilepsy Hernia, Hydrocele or any other disease. The conciliation proceeding before the Permanent Lok Adalat failed and the Permanent Lok Adalat, went on for adjudicating the dispute between the parties. The Permanent Lok Adalat on the basis of the pleadings of the parties, formulated the following six points for determination: (I) Is the instant case as framed maintainable? (II) Whether the claimant has a valid cause of action for the case? (III) Whether P.L.A. Ranchi has jurisdiction to decide the instant claim case? (IV) Whether there was suppression of material facts by the life assured relating to his health as alleged by O.Ps? (V) Whether Ext. A, i.e; the repudiation of claim vide reference no. PDO/REPD.CLAIM/AKP dated 27/02/2012 of Policy no. 537424569 favoring Late Girdhar Pandey, sum assured Rs. 200000/-is justified? VI) Is the claimant entitled to get the relief or reliefs as prayed for? 4. In support of their claim, the claimants examined two witnesses and filed the documents while from the side of the LIC of India, one witness was examined. The claimants besides the oral testimony, and other documents, also produced the photocopies of the hospital treatment issued by the RIMS, Ranchi marked as Ext. 3, the copy of which is kept at page 30-33 of this writ petition. 5. The claimants besides the oral testimony, and other documents, also produced the photocopies of the hospital treatment issued by the RIMS, Ranchi marked as Ext. 3, the copy of which is kept at page 30-33 of this writ petition. 5. The Permanent Lok Adalat first took up the point for determination no. III for consideration and relying upon the judgment of the Hon’ble Supreme Court of India in the case of Bar council of India vs. Union of India reported in 2012 (117) AIC13 (S.C.) and Section 22 C-(8) of Chapter VIA of Legal Services Authority Act, 1987, came to the conclusion that even without the consent of the Opposite Parties, it can adjudicate the dispute upon failure of the conciliation. 6. Then, the Permanent Lok Adalat took up point for determination no. IV and came to the conclusion that as the certificate of employer issued by the S.P., Dumka and the details of the leave availed by Girdhar Pandey, was issued by S.P., Dumka which has been marked exhibit 4 and 5, respectively, goes to show that Girdhar Pandey did not take any leave for his ailment for a considerable period of time hence, the same overrides the fact that of his earlier ailments, as mentioned in the Ext. 03, which is the certificate of the hospital issued by the RIMS, Ranchi and also considered the Exhibit 2, which is the medical certificate, issued by RIMS Ranchi, wherein the cause of death has been mentioned as ‘Cardio Vascular Failure’ which has no bearing on the diabetic, and dribbling of urine and came to the conclusion that the deceased life assured had not suppressed any material facts relating to his health at the time of obtaining policy in question and the LIC of India erred by repudiation of the policy when they made payment of Rs. 57,000/-to the claimant in connection with other policy no. 554402374 in the name of Girdhar Pandey and decided the point for determination no. IV in the negative. 7. Permanent Lok Adalat next took up point for determination no. V and came to the conclusion that the repudiation of the claim is not justified and lastly, took up point for determination no. 554402374 in the name of Girdhar Pandey and decided the point for determination no. IV in the negative. 7. Permanent Lok Adalat next took up point for determination no. V and came to the conclusion that the repudiation of the claim is not justified and lastly, took up point for determination no. I, II and VI together and on the basis of the findings of the other points for determination, held that the case as framed is maintainable, and the claimants have valid cause of action for the case and they are entitled for the relief as prayed for, and directed for payment of Rs. 2,00,000/-to the claimants, along with the interest, as already indicated above. 8. It is submitted by learned counsel for the petitioner that the contract of insurance is based on the Principle of Uberrima fides i.e. Utmost Good Faith hence, the life proposed is required to disclose true and correct facts in the Proposal Form, which is the sole basis of the contract of Insurance. It is then submitted that in the instant case also, the LIC of India believed the statements made by the life proposed in the proposal form and the declaration signed by him and issued the policy bearing no. 537424569 in the name of the life proposed. It is next submitted that the undisputed fact remains that the life assured was suffering from diabetes mellitus for five years and urine dribbling from one year before his death and the history was reported by the patient himself, to the doctor, RIMS, Ranchi at the time of admission there, as is evident from the Ext. 3, which is the certificate of hospital treatment issued by the Assistant Professor, Dept. of Medicine, RIMS, Ranchi and even after these overwhelming facts, the Permanent Lok Adalat, committed an illegality by passing an order arbitrarily, which is not sustainable in law. 9. Relying upon the judgment of the Hon’ble Supreme Court of India in the case of the Branch Manager, Bajaj Allianz Life Insurance Company Limited and Others vs. Dalbir Kaur Reported in (2021) 13 SCC 553 , para 7 and 12 of which reads as under:- “7. A contract of insurance is one of utmost good faith. 9. Relying upon the judgment of the Hon’ble Supreme Court of India in the case of the Branch Manager, Bajaj Allianz Life Insurance Company Limited and Others vs. Dalbir Kaur Reported in (2021) 13 SCC 553 , para 7 and 12 of which reads as under:- “7. A contract of insurance is one of utmost good faith. A proposer who seeks to obtain a policy of life insurance is duty-bound to disclose all material facts bearing upon the issue as to whether the insurer would consider it appropriate to assume the risk which is proposed. It is with this principle in view that the proposal form requires a specific disclosure of pre-existing ailments, so as to enable the insurer to arrive at a considered decision based on the actuarial risk. In the present case, as we have indicated, the proposer failed to disclose the vomiting of blood which had taken place barely a month prior to the issuance of the policy of insurance and of the hospitalisation which had been occasioned as a consequence. The investigation by the insurer indicated that the assured was suffering from a pre-existing ailment, consequent upon alcohol abuse and that the facts which were in the knowledge of the proposer had not been disclosed. This brings the ground for repudiation squarely within the principles which have been formulated by this Court in the decisions to which a reference has been made earlier. 12. The medical records which have been obtained during the course of the investigation clearly indicate that the deceased was suffering from a serious pre-existing medical condition which was not disclosed to the insurer. In fact, the deceased was hospitalised to undergo treatment for such condition in proximity to the date of his death, which was also not disclosed in spite of the specific queries relating to any ailment, hospitalisation or treatment undergone by the proposer in Column 22 of the policy proposal form. We are, therefore, of the view that the judgment [Bajaj Allianz Life Insurance Co. Ltd. v. Dalbir Kaur, 2020 SCC OnLine NCDRC 463] of Ncdrc in the present case does not lay down the correct principle of law and would have to be set aside. We order accordingly.” it is submitted by learned counsel for the petitioner that in case of non-disclosure of full material information, sought in proposal form, insurance claim can be repudiated. 10. We order accordingly.” it is submitted by learned counsel for the petitioner that in case of non-disclosure of full material information, sought in proposal form, insurance claim can be repudiated. 10. Learned counsel for the petitioner next relies upon the judgment of the Hon’ble Supreme Court of India in the case of the Mithoolal Nayak vs. Life Insurance Corporation of India reported in AIR 1962 SC 814 , para 8 and 9 of which reads as under:- “8. The three conditions for the application of the second part of S. 45 are- (a) the statement must be on a material matter or must suppress facts which it was material to disclose; (b) the suppression must be fraudulently made by the policy-holder; and (c) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose. XXX XXX XX ………….. In other words, there was a deliberate suppression fraudulently made by Mahajan Deolal. Fraud, according to S. 17 of the Indian Contract Act, 1872 (IX of 1872), means and includes inter alia any of the following acts committed by a party to a contract with intent to deceive another party or to induce him to enter into a contract- (1) the suggestion, as to a fact, of that which is not true by one who does not believe it to be true; and (2) the active concealment of a fact by one having knowledge or belief of the fact. Judged by the standard laid down in S. 17, Mahajan Deolal was clearly guilty of a fraudulent suppression of material facts when he made his statements on July 16, 1944, statements which he must have known were deliberately false. Therefore, we are in agreement with the High Court in answering the first question against the appellant. 9. We may here dispose of the third question. Learned counsel for the appellant has argued before us that Mahajan Deolal was examined under the direction of the respondent company by as many as four doctors, namely, Dr. Desai, Dr. Kapadia, Dr. Belapurkar and Dr. Clarke. It is further pointed out that Mahajan Deolal had correctly disclosed that he had suffered previously from malaria, pneumonia and cholera. Dr. Kapadia, it is pointed out, was specifically asked to examine Mahajan Deolal in view of the conflicting reports which Dr. Desai, Dr. Kapadia, Dr. Belapurkar and Dr. Clarke. It is further pointed out that Mahajan Deolal had correctly disclosed that he had suffered previously from malaria, pneumonia and cholera. Dr. Kapadia, it is pointed out, was specifically asked to examine Mahajan Deolal in view of the conflicting reports which Dr. Desai had earlier submitted. On these facts, the argument has been that the respondent company had full knowledge of all facts relevant to the state of health of Mahajan Deolal and having knowledge of the full facts, it was not open to the respondent company to call the policy in question on the basis of the answers given by Mahajan Deolal in the proposal form and the personal statement, even though those answers were inaccurate. Learned counsel for the appellant has referred us to the Explanation to S. 19 of the Indian Contract Act in support of his argument. We are unable to accept this argument as correct. It is indeed true that Mahajan Deolal was examined by as many as four doctors. It is also true that the respondent company had before it the conflicting reports of Dr. Desai and it specially asked Dr. Kapadia to examine Mahajan Deolal in view of the reports submitted by Dr. Desai. Yet, it must be pointed out that the respondent company had no means of knowing that Mahajan Deolal had been treated for the serious ailment of secondary anaemia followed by dilatation of heart, etc., in September-October, 1943 by Dr. Lakshmanan. Nor can it be said that if the respondent company had knowledge of those facts, they would not have made any difference. The principle underlying the Explanation to S. 19 of the Contract Act is that a false representation, whether fraudulent or innocent, is irrelevant if it has not induced the party to whom it is made to act upon it by entering into a contract. We do not think that that principle applies in the present case. The terms of the policy make it clear that the averments made as to the state of health of the insured in the proposal form and the personal statement were the basis of the contract between the parties, and the circumstance that Mahajan Deolal had taken pains to falsify or conceal that he had been treated for a serious ailment by Dr. Lakshmanan only a few months before the policy was taken shows that the falsification or concealment had an important bearing in obtaining the other party's consent. A man who has so acted cannot afterwards turn round and say : "It could have made no difference if you had known the truth." In our opinion, no question of waiver arises in the circumstances of this case, nor can the appellant take advantage of the Explanation to S. 19 of the Indian Contract Act.” and submits that in view of Section 45 of the Insurance Act, 1938 as it stood before its amendment, deliberate concealment of fact that the proposer had been treated by the doctor before the policy was taken for serious ailment, such policy is vitiated. 11. Learned counsel for the petitioner also relied upon the judgment of the Hon’ble Supreme Court of India in the case of Reliance Life Insurance Co. Ltd. And Anr. vs. Rekhaben Nareshbhai Rathod reported in (2019) 6 SCC 175 , para 36 of which reads as under:- 36. Finally, the argument of the respondent that the signatures of the assured on the form were taken without explaining the details cannot be accepted. A similar argument was correctly rejected in a decision of a Division Bench of the Mysore High Court in V.K. Srinivasa Setty v. Premier Life and General Insurance Co. Ltd., 1957 SCC OnLine Kar 27 : AIR 1958 Mys 53] where it was held : (SCC OnLine Kar paras 8081) “80. Now it is clear that a person who affixes his signature to a proposal which contains a statement which is not true, cannot ordinarily escape from the consequence arising therefrom by pleading that he chose to sign the proposal containing such statement without either reading or understanding it. That is because, in filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from the insurer to write the answers in the proposal form. 81. If an agent nevertheless does that, he becomes merely the amanuensis of the insured, and his knowledge of the untruth or inaccuracy of any statement contained in the form of proposal does not become the knowledge of the insurer. 81. If an agent nevertheless does that, he becomes merely the amanuensis of the insured, and his knowledge of the untruth or inaccuracy of any statement contained in the form of proposal does not become the knowledge of the insurer. Further, apart from any question of imputed knowledge, the insured by signing that proposal adopts those answers and makes them his own and that would clearly be so, whether the insured signed the proposal without reading or understanding it, it being irrelevant to consider how the inaccuracy arose if he has contracted, as the plaintiff has done in this case that his written answers shall be accurate.” and submits that a person who affixes his signature to a proposal which contains a statement which is not true, cannot ordinarily escape from the consequence arising therefrom by pleading that he chose to sign the proposal containing such statement without either reading or understanding it and it is submitted that Permanent Lok Adalat committed grave illegality in passing the said award and hence, the same be quashed and set aside. 12. Having heard the submissions made at the bar and after going through the materials available in the record, from the own document of the claimants, i.e. the Ext. 3, which is the copy of the certificate of hospital treatment issued by RIMS, Ranchi under the signature of its Assistant Professor, Department of Medicine, goes to show that the undisputed fact, remains that the deceased Girdhar Pandey, was suffering from diabetes, for a period of five years, and dribbling of urine for a period of one year before his death, indicating thereby that by the time, he signed the proposal form, for the policy in question, he was aware of the fact that he was suffering from diabetes and dribbling of urine but in spite of that, the undisputed fact remains that in column 11 of the proposal form, he categorically inter alia stated that he was not suffering from diabetes and the same amounts to suppression of material fact, as has been held by the Hon’ble Patna High Court in the case of Ratan Lal and Anr. vs Metropolitan Insurance Co. Ltd. reported in AIR 1959 Patna 413, para 5 of which, reads as under, that suppressing ailment amounts to suppression of a material fact : “5. vs Metropolitan Insurance Co. Ltd. reported in AIR 1959 Patna 413, para 5 of which, reads as under, that suppressing ailment amounts to suppression of a material fact : “5. The well-settled law in the field of insurance is that contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission. And this duty to disclose continues up to the conclusion of the contract and covers any material alteration in the character of the risk which may take place between proposal and acceptance Xxxxxxxxxxxxxx 13. Under such circumstances, this court has no hesitation in holding that the permanent Lok Adalat committed grave illegality by setting aside the repudiation letter, issued by the writ petitioner and further directing the LIC of India to pay Rs. 2,00,000/-with simple interest even though the LIC of India being a body corporate, was not even a party to the dispute, before the Permanent Lok Adalat and only, different officers of which, were the parties. It is needless to mention that it is the fundamental principle of judicial procedure that a person or body corporate, if not the party to a quasi-judicial or judicial proceeding; no was order can be passed against it. 14. Now coming to the facts of the case, this court has no hesitation in holding that the Permanent Lok Adalat committed grave illegality by overlooking the fact which has been mentioned in Exhibit 3 i.e. the certificate of hospital treatment, issued by RIMS, Ranchi on the ground that the deceased did not take any leave from his service on the ground of ailment. Because when there was undisputed fact based on the documents that the deceased was suffering from diabetes for five years before his death and was having dribbling urine for a year before his death, simply because he did not avail, any leave, that will not obliterate, the facts that he was suffering from diabetes and from urine dribbling. Because when there was undisputed fact based on the documents that the deceased was suffering from diabetes for five years before his death and was having dribbling urine for a year before his death, simply because he did not avail, any leave, that will not obliterate, the facts that he was suffering from diabetes and from urine dribbling. For the same reason, the claim of the petitioner that the LIC of India made payment of another policy, in the name of Girdhar Pandey, without producing the document relating to the same, is certainly, not a legal and valid reason, to overlook the fact, that the deceased suppressed his ailment of diabetics and dribbling of urine from the insurance company, at the time of availing policy by signing policy proposal form. 15. Under such circumstances, this court is of the considered view that this is a fit case, where a writ of certiorari be issued to quash and the award dated 06.05.2017 (annexure 6) passed by learned Permanent Lok Adalat, Ranchi in PLA case no. 241 of 2013. 16. Accordingly, issue a writ of certiorari quashing the award dated 06.05.2017 (annexure 6) passed by learned Permanent Lok Adalat, Ranchi in PLA case no. 241 of 2013. 17. This writ petition is allowed accordingly.