L.I.C. vs REKHA

THE appeal is delayed by 16 days. THE delay is condoned for the reasons mentioned in the application for condonation of delay. THE appeal has been registered to its regular number. THE case has been heard for final disposal.

THIS appeal has been filed against the order of the learned District Forum, Sirohi dated 3.11.1998 whereby the District Forum has decreed the claim of the complainant for payment of Rs. 50,000/- i.e. the insured sum with 12% interest and has awarded Rs. 3,000/- for mental agony and Rs. 200/- as costs of litigation. We have heard Mr. R.K. Soni appearing for the LIC and Mr. S.L. Songara appearing for Smt. Rekha widow of deceased Naresh Kumar. It is alleged in the complaint that Naresh Kumar had a fall from the stairs on 11.6.1995. He was insured with the L.I.C. The head injury was quite serious and, therefore, he was referred to Ahmedabad for treatment where he expired on 16.10.1995 i.e. after the expiry of 127 days. The claim for payment of the insured sum alongwith accidental benefit was filed with the LIC. That claim has been repudiated by the LIC on the ground that the Ahmedabad doctor who treated him has recorded in the history sheet of the patient's history that he is a known case of alcohol for the past two years. The proposal form was filed on 30.1.1995. Its first receipt was issued on 4.2.1998 and Naresh Kumar died on 16.10.1995 i.e. it is a case of death within 8 months and, therefore, deep enquiry was held and as Naresh Kumar was habitual to take alcohol and, therefore, the claim was repudiated.

Mr. R.K. Soni has submitted that they have submitted the photo copy of the doctors'' certificate before the District Forum in which the Ahmedabad doctor has recorded that he is a known case of alcoholism since last two years. Only a photo copy of that certificate has been filed. It is not known who has issued that certificate. Even the copy has not been certified as a true copy of the document which was issued by the doctor. No affidavit of that doctor has been filed to show as to from whom he collected this information that he is a known case of alcoholism for the past two years. In absence of any other proof mere photo copy of the certificate recorded by a doctor whose name is not known, whose particulars have not been disclosed and whose affidavit has not been filed cannot be made the basis of repudiation of the claim. National Commission has held that before repudiation evidence should be collected by the concerned authorities so that a reasonable man may be satisfied that repudiation has been made for valid reasons. There may not exist fool-proof reasons but if there are valid reasons then the matter should be agitated before a competent Civil Court. But here the repudiation is based on an uncertified photo copy of a record issued by a doctor whose identity is not known to us. Under these circumstances if the learned District Forum has held that repudiation is unsustainable, that order of the District Forum cannot be called unjust or improper. Thus the grounds on the basis of which the repudiation has been communicated by the LIC to the nominee of the insured are totally unsustainable. In matter pertaining to life insurance when one gets himself insured he expects that if he meets a sudden death his heirs or nominees will receive the amount for their sustenance and, therefore, before such a claim is repudiated by the LIC sound and convincing reasons must exist before it which may convince a reasonable man that the repudiation is well founded and has been made for valid reasons. Those factors are totally absent in this case. Mr. Songara has however submitted that Naresh Kumar was under coma and whatever information had been suplied to the treating doctor of Ahmedabad was supplied by somebody else and thus it is a hearsay testimony. There is no proof on record that when the patient was taken to Ahmedabad he was in coma. Thus to this extent argument of Mr. Songara cannot be sustained without legal proof.

KEEPING in view the aforesaid circumstances we are firmly of the view that the order rendered by the District Forum, Sirohi needs no interference and, therefore, the appeal is hereby dismissed at the admission stage with no orders as to costs. Appeal dismissed.