JAMNABEN SHAMBHUBHAI MANGE vs MANAGER, LIFE INSURANCE CORPORATION OF INDIA

This revision petition has been filed under section 21(b) of the Consumer Protection Act, 1986 against the impugned order dated 29.04.2011, passed by the Gujarat State Consumer Disputes Redressal Commission (hereinafter referred to as ''the State Commission'') in Appeal No. 1413/2008, "The Manager, Life Insurance Corporation of India vs. Jamnaben Shambhubhai Mange" vide which, while allowing the appeal, the order dated 26.11.2008, passed by the District Forum, Jamnagar in consumer complaint No. 156/2008, filed by the present petitioner, allowing the said complaint, was set aside.

The facts of the case are that the younger son of the complainant, Jamnaben Shambhubhai Mange, named Hitesh, had taken two insurance policies, one for 5 lakh and the other for 2 lakh with numbers 813980826 and 813980628 respectively, for which the proposal form was filled on 22.03.2006 by Dipak Bhai Chandra, the authorised agent of the respondent/OP LIC. It is stated in the consumer complaint that the said younger son Hitesh was doing the business of cutlery and earning his livelihood by selling china items. The complainant stated that her son did not suffer from any previous illness before taking the policies and had not undergone any medical treatment. He, however, suffered from fever on 29.08.2006, following which, they consulted Dr. V.B. Mungra of Jamnagar. Dr. Mungra got certain diagnostic tests conducted on her son and referred him to Sri Ananda Bawa Kidney Dialysis Centre. He was also referred to GG Hospital for treatment. It is stated that the doctors diagnosed kidney related ailments and hence, the son of the complainant was subjected to dialysis and also given vaccine for jaundice. However, her son could not survive and died on 8.11.2006. The complainant filed claim with the respondent LIC under the policies in question, but they repudiated the same vide letter dated 01.03.2007, saying that while filling up the proposal form, the insured had not given correct information in response to various questions in the said form. The deceased had earlier taken treatment for pain in the abdomen and for renal disease, but these facts were not disclosed at the time of taking the policies. The consumer complaint was then filed, seeking directions to the respondent LIC to pay the claim of 7 lakhs under the policies, alongwith 12% interest and 50,000/- for deficiency in service and the litigation cost. The complaint was resisted by the OP, LIC by filing a reply before the District Forum, in which they stated that the contract of insurance was based on mutual trust between the parties and hence, for the failure to disclose correct information to the insurance company, the said contract was not valid. The OP LIC referred to a certificate given by Dr. Miten P Mehta in which, it is mentioned that he had history of chronic abdominal pain for the last one year. There was, therefore, no deficiency in service on the part of the OP in rejecting the claim.

The District Forum after considering the averments of the parties, allowed the consumer complaint and directed the OP LIC to pay a sum of 7 lakh under the two policies, alongwith interest @9% p.a. with effect from 1.03.2007. A sum of 2,000/- towards deficiency in service and 1500/- as cost of the complaint was also allowed. Being aggrieved against the said order, the OP LIC filed an appeal before the State Commission, which was allowed vide impugned order, stating that true facts about the health condition of the deceased were not stated in the proposal form. The order passed by the District Forum was set aside and the complaint was ordered to be dismissed. Being aggrieved against the said order, the complainant is before this Commission by way of the present revision petition.

The learned counsel for the petitioner submitted during arguments that the deceased had been examined by the panel doctor of the LIC and no illness had been detected by the said doctor, meaning thereby that there had been no suppression of material information at the time of taking the insurance policies. The learned counsel argued that the insured suffered from health problems and took treatment, after the policies had been obtained from the OP LIC.

The learned counsel for the respondent LIC stated, however, that in the proposal form, the insured had declared that he did not suffer from any ailment, at the time of obtaining the policies in question. However, on the other hand, there is a document signed by Dr. Miten P Mehta, Consultant Nephrologist, Sri Ananda Bawa Kidney Dialysis Centre which says that the insured suffered from abdominal pain since one year. This document is signed by the doctor on 11.12.2006, meaning thereby that at the time of obtaining the policies, the insured did suffer from health problems, but did not disclose correct information about his health, in the proposal form.

We have examined the entire material on record and given a thoughtful consideration to the arguments advanced before us.

There is a delay of 50 days in filing the present revision petition. However, the said delay was ordered to be condoned vide order dated 06.12.2013 passed by this Commission.

The main thrust of the argument led by the OP LIC for repudiating the claim in question, is based on the "Certificate of hospital treatment" recorded by Dr. Miten P. Mehta, Consultant Nephrologist, Sri Ananda Bawa Kidney Dialysis Centre. As per the certificate, the insured had been suffering from abdominal pain since one year. It is to be examined whether the non-disclosure of ''abdominal pain'' amounts to suppression of material information on the part of the insured, while filling up the proposal form for obtaining the policies in question. There is no evidence on record to show whether the insured had taken medical treatment for the same, or was admitted in any hospital for any kind of treatment. It is also not indicated anywhere, whether any specific disease or problem in the kidneys was detected before obtaining the policies in question. A perusal of the proposal form, a copy of which is on record, indicates that there are questions in the form, regarding admission for any treatment in hospital and absence from work due to illness etc. There is another question whether he had any ailment in liver, stomach, heart, lungs, brain, kidney or nervous system etc. The insured has given replies in the negative in response to all these questions. Even if, he was suffering from stomach pain, headache, etc., there was no need or occasion to mention the same in the proposal form, unless some specific disease is indicated and the treatment for the same is taken. In the light of these facts, the allegation of suppression of material information against the insured is not established. It is also stated that the insured was subjected to examination by the panel doctor of the insurance company and nothing adverse was noticed against him.

There is a medical attendance certificate dated 18.12.2006 on record given by the Dr. Trivedi on the proforma of the LIC, in which it is stated that the disease was first observed on 04.09.2006. It is also stated that the insured had been suffering from the disease three months before his death. These facts indicate that at the time of filling up the proposal form in March 2006, the deceased was not suffering from the disease of chronic renal failure (CRF) and hence, he cannot be charged with the allegation of non-disclosure of material information.

Based on the foregoing discussion, it is held that the order passed by the District Forum, partly allowing the claim, is based on a rational analysis of the facts and circumstances on record, whereas the view taken by the State Commission that true facts were not declared in the proposal form, is not correct. The order passed by the State Commission is, therefore, perverse in the eyes of law. The revision petition is, accordingly allowed, the order passed by the State Commission is set aside and the order passed by the District Forum is restored. The OP LIC is directed to make payment of the amount in question as ordered by the District Forum within four weeks from today. There shall be no order as to costs.