L I C OF INDIA vs Shobha Devi Sunder Lal Patni

FIRST Appeal No. 391 of 1994 This Appeal No. 391 of 1994 has been filed by the Life Insurance Corporation of India against the order of the State Commission, Maharashtra, in Complaint No. 529 of 1992.

SHRI Sunderlal Patni, the husband of Mrs. Shobhadevi Sunder Lai Patni, had obtained two insurance policies on his life from the Life Insurance Corporation for a sum of Rs. 25,000/ - in December, 1988 and for a sum of Rs. 1,50,000/ - in November, 1988. He died on 15.9.90 at Bombay due to heart attack. The LIC of India did not settle the claim till the 15th November, 1991 when a letter was sent to the claimant, Mrs. Shobhadevi Sunderlal Patni, repudiating their liability for the reason that the insured had withheld correct information as regards his health. The State Commission after going through the record and hearing the Counsel accepted the claim of the wife of the deceased insured and directed the LIC to pay to the complainant the sum assured on both the policies viz., Rs. 1,75,000/ - with interest at the rate of 18% p.a. from the 16th November, 1991 till payment, alongwith compensation of Rs. 5,000/ - and costs at Rs. 500/ -. The contention of the LIC is that the deceased was suffering from numbness of head and feet and had a history of nausea/vomiting and Schizophrenia which he did not disclose in his proposals for life insurance in 1988 and 1989. In paragraph 10 of their written version, the LIC has stated that the cause of death is coronary artery disease due to respiratory failure in case of Schizophrenia. It is an admitted fact that the complainants husband died due to heart failure, but the cause thereof is disputed by the respondent herein.

THE Insurance Company has produced the report of Bombay hospital, where the assured died, wherein it is recorded that the patient was a known case of Schizophrenia. However, in the column for cause of death, the entry is ''unknown''. The Hospital Authorities, therefore, have not been able to establish the cause of death, but opined that the death was unnatural and, therefore, the body of the deceased was sent for a post -mortem examination which was held at the J.J. Morgue. The memorandum of postmortem report relating to body No. 2839 of 1993 shows that a copy of it was applied on 20.10.90 which was made ready on 29.8.91 and delivered on 9.9.91. In the memorandum of post mortem, the opinion was reserved for histo -pathology report, in the first instance. The histo -pathology report after examination of liver, kidney, spleen, heart, cerebrum, stomach and aorti concluded that there was no pathology in respect of these organs. However, the report indicated that the microscopic examination of live showed severe fatty change and the sections of lung showed mild pulmonary haemorrhage and oedema. The Medical Officer attached to the Police Hospital indicated the final cause of death of the deceased as coronary artery disease with fatty liver with terminal respiratory failure in case of Schizo - phrenia as alleged. It is significant to note that he has not attributed the artery disease or the respiratory failure to Schizophrenia in a clear and precise manner. What the Medical Officer has stated is ''Schizophrenia as alleged''.

SCHIZOPHRENIA is a mental disease and the person suffering from a sort of psychological disorder, as a Schizophrenia, may not be aware of this decease, unless and until he is told about it or he is put on medication for it. Therefore, the fact that he is having Schizophrenia is not something which a person would know, unless he is made aware of it by a Doctor or he is put on medication for this purpose. After perusing theI record we find that there is no evidence to show that he was on medication for Schizophrenia or that he was aware of it. Even the report of the Bombay Hospital, where his body was taken after his death on 13.9.90 by his nephew Mr. Rajesh, the reason for mentioning that the patient a known case of Schizophrenia has not been indicated on the support of any medical record. In any case, the cause of death is not directly linked to Schizophrenia which generally is not considered to be a fatal disease. The histopathology report indicates fat in the liver and mild pulmonary haemorrhage and oedema in the lung, again not directly related to Schizophrenia. There is no history of these two ailments, in respect of the deceased, in the record produced by the L.I.C. We are, therefore, of the opinion that it was indeed a callousness on the part of the LIC to have put the widow of the deceased to a considerable inconvenience and mental agony by not settling the claim in time; in fact, repudiating it on the ground which is totally untenable. The order of the State Commission is just and fair and needs no interference. Accordingly, we dismiss this appeal. We also direct that a sum of Rs. 2,000/ - shall be paid as costs by the L.I.C. to the respondent herein.

THIS order also disposes of First Appeal No. 421 of 1993 because it is on the same issues and also between the same parties. Appeals dismissed.