IRAM GULZAR vs LIFE INSURANCE CORPN. LTD.

THIS order will dispose of two Appeals, No. 70/2002, Ms. Iram Gulzar v. LIC, and No. 71/2002, LIC v. Ms. Iram Gulzar. Both the appeals have been filed against the same order dated 8.7.2002 passed by the DF whereby DF has allowed the complaint of appellant in Iram Gulzar v. LIC and has directed the respondent LIC in Complaint No. 260 of 2000 to pay Rs. 2.00 lacs insurance amount to the complainant along with accrued bonus.

APPELLANT Iram Gulzar are aggrieved of the order simply on the fact that no interest and compensation has been allowed to them by the DF. APPELLANT in Appeal No. 71/2002, LIC v. Iram Gulzar, is also aggrieved of the order that DF has wrongly appreciated the evidence and has allowed the complaint. While the fact is that no medical record of Batra Hospital has been taken into consideration and deceased insured at the time of obtaining the insurance had filled up the proposal form and had concealed the material facts about his ailment and treatment when he was already suffering from Lung Cancer and was admitted in Batra Hospital. The facts barely needed for the disposal of these appeals are that Gulzar Ahmed Raja deceased had secured insurance cover for Rs. 2.00 lacs from 28.5.1996 to 28.11.2002. It is an admitted fact that the proposal for such insurance contract was submitted on 17.2.1997. The case of the complainant in Complaint No. 260/2000 is that on 28.5.1997 deceased had a fall from the staircase and he had suffered fractures and had sustained head injury and ultimately died of Cardiac Arrest due to Brain Haemorrhage. LIC resisted the claim on the ground that the death of the deceased caused only after 2 months and 3 days from the date of acceptance of the proposal i.e. 25.3.1997 and the deceased insured had submitted his proposal only after 17 days from the date of his discharge from Batra Hospital. Due to suspicion they got the case investigated and found that the deceased had a Lung Cancer and was hospitalized in Batra Hospital, Delhi and died due to Cancer. Appellants/complainants made the frivolous claim just to obtain the insurance amount from the opposite party. The claim was resisted on the ground that the insured/deceased suppressed the fact of his ailment and medical treatment in Batra Hospital so insurance contract is void ab initio.

Heard the Counsel for the parties. We have perused the record. DF had contended that Batra Hospital record was not produced in original and the Doctor who treated him in Batra Hospital was not examined by the LIC, so the DF has not gone into the point raised by the Counsel for LIC that the deceased had suppressed the facts of his earlier disease and hospitalisation. The original medical treatment records issued by the Batra Hospital is on the record of the DF.

DF has wholly and solely relied on the basis of certificate of Ahmed Hospital who have certified that deceased died of Cardiac Arrest. We have given thoughtful consideration to the argument advanced before us and perused the records. We see that the DF has dealt with the matter sweepingly and has not gone into details as to whether the deceased was really admittedly in Batra Hospital only 17 days before the insurance proposal form was submitted. Secondly, especially when the Batra Hospital has given a clean chit that the deceased was hospitalized in their hospital from 27.1.1997 to 31.1.1997. It is also exhibited that the patient was suffering from Lung Cancer. Learned Counsel for the complainants/appellants has vehemently denied that the patient was hospitalized for 7 days according to him he was right in claiming that patient was not hospitalised. But it is not only one question which he has suppressed while filling up the proposal form but the deceased had totally denied to had any ailment before submitting the proposal form. He had answered all the questions in Negative in the proposal form. DF has to see whether the deceased had the knowledge of the ailment or was he in know of the fact of Cancer disease he was suffering from. DF has not called the record of treatment from the Bone and Joint Hospital where the deceased was treated first according to the complainants/appellants. The DF should have examined the reports of X-rays and would have convinced itself whether the deceased had any head injury and should have consulted the Batra Hospital and Ahmed Hospital record. Df has not examined the record of the Batra Hospital nor has given reason to reject it. It is an admitted fact that the deceased at the first instance was taken to Bone and Joint Hospital. Neither the record of the Bone and Joint Hospital has been called nor any Doctor has been examined who attended the deceased there. No X-ray report has been called which would have thrown light as to whether deceased had received any head injury. No Doctor from Ahmed Hospital has been examined in order to show as to what was the cause of death. For these reasons we, therefore, set aside the impugned order and remand the case back to the Forum to look into the case afresh in view of the observations made above and to allow the parties to adduce the additional evidence if they choose to do so and give a fresh finding regarding the matter within a period of 3 months from today.

PARTIES are directed to appear before DF on 21.10.2002. Records be sent to the DF forthwith. Appeal disposed of.