KUSUMBEN VALJI MOHD. KOHAR vs Life Insurance Corporation of India

THIS complaint is filed by widow of Vali Mohd. Kojar as regards deficiency in the service of the L.I.C. in not settling the death claim of her husband. The complainant alleged that her husband died at Bombay on 21.9.1990, who was covered by the Insurance Policy, bearing No. 830948019, for Rs. 2,00,000/- , issued by the Branch Office of the Life Insurance Corporation at Patan (in Gujarat State). It is the case of the complainant that her husband was at Patan, when the opposite party insured her husband. The proposal was submitted on 29.11.1988, after complying with all the requisite formalities. Thereafter, the complainant''s husband shifted to Bombay, along with his family members and was residing in Bombay'' till his death. It is alleged by the complainant that her claim was rejected by L.I.C. on the ground that her husband was suffering from tuberculosis for a period of 3 years, prior to the issue of Insurance Policy. The L.I.C. informed its decision, repudiating the complainant''s claim, vide letter dated 12.12.1991. Hence, this complaint has been filed, claiming the settlement of her claim with compensation, as repudiation of her claim was wrong. The L.I.C. filed its written version, dated 6th August, 1992.

WE have heard the complainant through Shri H.J. Balsania, Advocate; and the opposite party was heard through Shri Vedak, Advocate. The points that arise for our consideration are : (i) Whether there has been any deficiency in the service of the opposite party? and (ii) Whether the complainant is entitled to claim compensation on the ground of negligence on the part of L.I.C. in rendering necessary service?

The crucial circumstance to be decided is as to whether there. was suppression of material facts by the husband of the complainant, while obtaining the Insurance Policy in question? In a letter, dated 12.12.1991, addressed to the complainant, the L.I.C. has stated that "the complainant''s husband having with-held material/correct information regarding his health at the time of effecting the assurance". The L.I.C. decided to repudiate all liabilities under the policy. It is stated that, to a question No. 18, the deceased answered in negative. The question was "Do you suffer from tuberculosis? The answer is said to be "No". In order to support its defence, the L.I.C. relied on a certificate issued by Dr. M.V. Ganjawalla, dated 28.9.1991. The said certificate reads that "the deceased Vali Mohd. used to accompany his wife since 1985, who was under my treatment for tuberculosis". The word "who" used does not indicate Mr. Vali Mohd. but indicates the wife of Vali Mohd. It is further stated that Vali Mohd. had come on 26.5.1988, for treatment of cough, fever and Bronchitis". Nowhere in the said certificate, Dr. Ganjawalla has stated that Vali Mohd. was suffering from tuberculosis. On the contrary, at the end of the said certificate, in his opinion, Dr. Ganjawalla has stated that he was never hospitalised for any major illness of cardie or blood pressure. Thus, the defence of L.I.C. that Vali Mohd. was suffering from tuberculosis stands falsified by the aforesaid opinion of Dr. Ganjawalla, dated 28.9.1991. On the contrary, the complainant has produced on record Exhibit ''A'' the Medical Attendant''s Certificate, dated 11.12.1990, duly signed by Dr. M.V. Ganjawalla. In that certificate, Dr. Ganjawalla has stated that Vali Mohd. died on 21.9.1990, at 6.30 p.m. due to acute Myocardial Infaration sudden death." In column (5) Of that certificate, Dr. Ganjawalla has stated that the complainant, Dr. Ganjawalla has stated that the complainant was under his treatment. In columns Nos. 8 & 9, it is stated that the deceased used to come to Dr. Ganjawalla occassionally 4 years prior to the issue of the certificate for the treatment of seasonal fever, cough and cold. Nowhere, in the said certificate, Dr. Ganjawalla has stated that the deceased Vali Mohd. was coming to him for the treatment of tuberculosis. Under these circumstances, we find that the reason to reject the complainant''s claim is not only false, but a worst example of negligence in the administration of the Life Insurance Corporation of India. The L.I.C. further exhibited its negligence in its communication, dated 12.12.1991. It is a cyclostyled form and the blanks were filled-in by hand. The reason for repudiation of the liability of the policy in question is that the deceased answered in negative to a question "Whether he was suffering from tuberculosis?". The said statement of the deceased has not been found to be false from the record. Under these circumstances, we find that the L.I.C. has repudiated the complainant''s claim arbitrarily, unfairly and with no application of mind. We have, therefore, to allow this com plaint and, apart from directions for settlement of the complainant''s claim, the complainant is required to be compensated by granting interest for the delay in settlement of claim. Hence, we pass the following order :- ORDER

The complaint is allowed. The L.I.C. is directed to pay to the complainant an amount of Rs. 2,00,000/- in respect of Policy No.830948019, with all its accrual of Bonus and benefits, together with interest @ 18% from the date of rejection. The complainant be paid Rs. 500/- as cost. All the aforesaid amount be paid to the complainant by L.I.C. within 30 days from the date of receipt of this order, failing which the complainant is at liberty to move this Commission for action against L.I.C. under Sections 25 and 27 of the Consumer Protection Act, 1986. Complaint allowed with costs. ____________