Divisional Manager, Life Insurance Corporation of India vs SAVITRI DEVI

THIS appeal is directed against the order of the District Forum, Bilaspur dated 16.2.1998, whereby the appellants (hereinafter to be referred to as Insurance Company) have been directed to pay to the complainant Rs. 2,00,000/- alongwith bonus due if any till the date of the death of deceased alongwith the interest @ 18% and Rs. 350/- as costs.

THE relevant facts of the case which are not in dispute are that Shri Nikka Ram, the husband of the complainant had purchased two insurance policies each for Rs. one lac i.e. for total amount of Rs. two lacs in the year, 1994 and during the period when the aforesaid policies were in force, Shri Nikka Ram, the husband of the complainant expired on 11.12.1994 within two years after obtaining the aforesaid policies and that the insurance claim complete in all respects was submitted by the complainant to the Insurance Company for the amount due on these policies. However, unfortunately vide letter dated 2811.1996, the claim of the complainant was repudiated by the Insurance Company on the ground that deceased Shri Nikka Ram had given wrong answers to the questions of proposal forms submitted by him by merely giving negative answers whether he was a patient of Acidic Peptic disease and Alcoholic Dyspepsia.

According to the complainant, her deceased husband was having good health and he was not suffering from any such diseases. There is absolutely no dispute that the complainant is entitled to the amount due on these policies, as these policies were in force when Shri Nikka Ram expired. However, in case it is found that Shri Nikka Ram, the husband of the complainant was suffering from Acidic Peptic disease and Alcoholic Dyspepsia as being claimed by the Insurance Company, then of course, the Insurance Company shall be within its right to repudiate the claim of the complainant. The question which requires consideration is whether or not the Insurance Company has established on record that deceased Shri Nikka Ram was suffering from Acidic Peptic disease or Alcoholic Dyspepsia. No evidence whatsoever was produced about the suffering of Shri Nikka Ram from the disease of Alcoholic Dyspepsia.

HOWEVER, the learned Counsel for the appellants has drawn our attention to a letter dated 22.7.1996 (Annexure-B) of a Doctor written to the Branch Manager, LIC Branch, Sundernagar certifying that Shri Nikka Ram was suffering from peptic ulcer at the time of submission of proposal forms of insurance policies. The insured has dearly written answers by saying ''No'' in the relevant Column Nos. 11 and 18 of the proposal forms. We are afraid, this document cannot be taken into consideration, as this document is not quite legible and does not reveal the clear name of the Doctor, who has written letter dated 22.7.1996. Such letter is neither supported by any affidavit of the said Doctor nor has been proved on the basis of record of the Hospital in which the patient remained under treatment. Moreover, the aforesaid letter is without any attestation and cannot be relied upon. Further, on the perusal of the aforesaid letter, it reveals that the Doctor has stated that to rule out the possibility of peptic ulcer, the deceased Shri Nikka Ram was advised to have confirmatory tests like Barium Meals etc. at District Hospital, Bilaspur. But the deceased never got these tests done. This letter nowhere shows that Shri Nikka Ram was suffering from peptic ulcer and the Doctor had only suspicion of his having suffering from peptic ulcer. When the Doctor himself was not sure whether Shri Nikka Ram was suffering from peptic ulcer, how could Shri Nikka Ram know at the time of submission of proposal of insurance that he was suffering from peptic ulcer and it cannot be said that he gave wrong answers in Column Nos. 11 and 18 of the proposal forms. Furthermore, another certificate dated 12.10.1995 has been produced by the respondent from the Awasthi Clinic, Beri, District Bilaspur (P-43 of the record) which has been signed by Shri Kuldip Awasthi, B.A.M.S. (A.V.A.) which reveals that Shri Nikka Ram collapsed due to heart block and he was complaining severe chest pain (left side). Therefore, it cannot be said that deceased Shri Nikka Ram was suffering from peptic ulcer.

IT may be noticed that Shri Nikka Ram has signed the proposal forms but these have not been filled up by him, as the form has been filled up in different handwriting. IT appears that the agent of the Insurance Company, Shri L.R. Mahajan, who has been impleaded as respondent No. 3 and who is also the witness to the proposal form has filled up this form. There is actually no evidence to show that the proposal form which has been filled up by the agent of the Insurance Company was ever explained to me insured that the deceased-insured understood these questions and their implications and thereafter only he gave such answers. IT was incumbent upon the LIC to produce the evidence that the deceased- insured was told that the answers are intended to be comprehensive and his slightest mis- statement would be fatal to the policy and as such the LIC cannot repudiate the claim merely on such so-called inaccurate statements in the proposal form. This view has been taken by this Commission in Narbada Devi v. L.I.C. of India & Ors., II (1998) CPJ 520. As such the contention of the Insurance Company is not tenable in the eyes of law. In the light of above discussion, there is no force in the appeal and the same is dismissed with no orders as to costs. Appeal dismissed.