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Judgment
Late Shri Shivdutta Singh, husband of the complainant, took a life insurance policy from the respondent LIC of India on 20.8.2004 for a sum assured of Rs.1,00,000/-, paying a premium of Rs.1729/-. The assured died within one month of taking the policy, allegedly on account of heart failure. A claim was lodged by the complainant, widow of the insured seeking benefits payable under the life insurance policy taken by her husband. The claim having not been paid, a complaint was filed by her before the District Forum.
The complaint was resisted by the Corporation taking a preliminary objection that it was barred by limitation having been filed more than two years after the death of the insured. On merits, issue of the policy was not denied. It was, however, stated that on investigation being made by the Corporation, it had been revealed that the deceased died from Jaundice and he was suffering from the aforesaid ailment, for the last 4-5 months before his death.
The District Forum, vide its order dated 26.11.2009, dismissed the complaint. Being aggrieved, the complainant approached the concerned State Commission by way of an appeal. The said appeal was dismissed by the State Commission vide its order dated 19.9.2014. Being aggrieved, the complainant is before this Commission by way of this revision petition.
The only question which arises for consideration in this case is as to whether there was any evidence produced by the respondent Corporation to prove concealment of a material fact by the deceased insured. The reply filed by the Corporation before the District Forum does not disclose any concealment except that it was not disclosed to the Corporation that the deceased was suffering from Jaundice.
The Corporation did not produce the proposal submitted by the insured, before the District Forum. Consequently, it cannot be known what exactly was the information disclosed by him to the Corporation in the proposal submitted by him. In the absence of the proposal, it cannot be known whether the insured was required to disclose his allegedly suffering from the Jaundice at the time the proposal was submitted. The claim submitted by the complainant was never repudiated by the respondent Corporation at any point of time. The complainant, therefore, did not come to know why the claim was not being paid to her. Even the reply filed before the District Forum does not disclose, as to answer to which question given by the deceased insured was false. In the absence of the proposal form, it would be difficult to say that at the time of taking the insurance policy, the insured was required to disclose that he was suffering from Jaundice.
It has to be kept in mind that the deceased insured was a villager. Considering his background, it is not sure that he would be aware of the exact ailment from whom he was allegedly suffering at the time the proposal was submitted. In Jaundice, the patient would normally develop low grade fever after some time and not immediately after the germ/bacteria has entered his body. It is, therefore, necessary to know as to when exactly the bacteria/germ of Jaundice entered the body of the deceased and when he started having low grade fever. In case, he did not have any symptom of Jaundice such as low grade fever, there will be no occasion for him to disclose the same in the proposal form. In fact, a villager may not consider an ailment such as a low grade fever to be a sickness unless it reaches an advance stage. There is no evidence of the Jaundice of the deceased having reached an advance stage at the time the proposal was submitted by him to the respondent Corporation. Therefore, it would be difficult to accept the case of the Corporation that the insured had suppressed from the Corporation that he was suffering from a disease.
More importantly, there is no credible evidence of the deceased actually suffering from Jaundice at the time the proposal was submitted. No medical record has been collected by the investigator appointed by the respondent Corporation to prove that the insured was already suffering from Jaundice and was under treatment of some doctor at the time the proposal was submitted. The entire case of the respondent Corporation is based upon the statements of two witnesses alleged to have been recorded by the investigator and no enquiry from any doctor or hospital was made pursuant to the statements alleged to have been made by the villagers residing in the village where the deceased was residing.
I have carefully perused the statements recorded by the investigator. The firs statement purports to be of one Mr. Chandan Kumar, the name of the father of the witness has not been noted in the statement nor does it give any other particular of the witness except the name of the village and concerned post office and police station. In his statement, this person inter alia stated that the deceased had expired in August 2004. This part of his statement is obviously incorrect since the deceased expired on 16.9.2004. This witness also stated that the deceased was treated in Mumbai and government hospital in Banaras and was also under the treatment of one Dr. Binod Shankar Singh of Bhabua. However, the investigator did not bother to record the statement of Dr. Binod Shankar Singh of Bhabua nor did he collect any record from any hospital in Mumbai or from the government hospital in Banaras to show that the deceased was treated in the aforesaid places. In my view, in such a case, the Investigator should have first asked the witness as to what was the source of his information that the deceased was treated at Mumbai, Banaras and Bhabua. After ascertaining the source of information, the Investigator should have visited the doctors/hospitals named by the witness and collected the record of the treatment if any by the named doctor/hospital. A statement based on hearsay will not constitute ''evidence'' justifying rejection of the claim. In the absence of such an enquiry, the oral statement of Mr. Chandan Kumar, in my view, recorded by the Investigator will not be sufficient to discharge the onus placed upon the Corporation. This is more so when neither the affidavit of the witness was filed nor he was produced before the District Forum. The investigator also recorded the statement of one Guddu Kumar. He also gave wrong month of the death of the deceased. His statement was almost identical to the statement of Chandan Kumar but no investigation in terms of his statement was made and no documentary evidence was collected to prove that the deceased was under treatment of a doctor either before or at the time the proposal was submitted by him. In these circumstances, I have no hesitation in holding that the respondent has failed to prove the alleged concealment on the part of the insured.
The learned counsel for the respondent Corporation submits that a concurrent finding of fact having been returned by the Fora below, this Commission may not be justified in interfering with the said finding. It is settled legal proposition that a revisional forum will not interfere with a finding of fact recorded by a forum below unless the said finding of fact is shown to be perverse. The finding returned by the Fora below, in this case in my view, is perverse since no reasonable person acting on the material available to the District Forum could have returned the finding which the Fora below returned in this case. Consequently, this Commission would be absolutely justified in upsetting the said finding.
As far as the issue of limitation is concerned, since the claim never came to be repudiated by the respondent Corporation, the complaint cannot be said to be barred by limitation.
For the reasons stated hereinabove, the impugned orders are set aside and the respondent Corporation is directed to pay the sum assured of Rs.1,00,000/- to the complainant along with interest on that amount @ 8% p.a. from the date of the complaint till the date the said amount is paid. The payment shall be made by crediting the same directly in the bank account of the complainant after verifying the particulars of the said bank account. The complainant is directed to furnish the particulars of her bank account to the respondent Corporation by Regd. Post within four weeks from today. The payment shall be made within four weeks thereafter.