LIC OF INDIA vs Jivraj Bhai P Domadia

THIS revision petition has been filed by the petitioner against the order dated 11.09.2008 passed by the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (in short, ''the State Commission'') in Appeal No. 314 of 2006 LIC of India Vs. Jivrajbhai P. Domadia by which, while dismissing appeal, order of District Forum allowing complaint was upheld.

BRIEF facts of the case are that Complainant/respondent''s son Jayantibhai J. Domadia obtained insurance policy from OP/petitioner on 28.1.2004 on the basis of proposal form dated 20.1.2004. Jayantibhai J. Domadia died on 12.3.2004 due to brain fever and heart attack. OP was intimated and claim was submitted. OP repudiated claim on the ground that insured suppressed fact of malady at the time of taking policy. It was further submitted that insured''s son was strong and healthy and he had no malady. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that at the time of taking insurance coverage, deceased Jayantibhai J. Domadia was not healthy as he was suffering from malady of "Lt. Ear discharge" since 2-3 years before getting insured. It was further submitted that he died within 11/2 months from taking insurance coverage. As he suppressed material particulars in the proposal form, claim was rightly repudiated and prayed for dismissal of complaint. Learned District forum after hearing both the parties allowed complaint and directed OP to pay Rs.8,00,000/- with 9% p.a. interest and further allowed Rs.2,000/- as compensation for mental harassment and Rs.1,000/- as cost of complaint. Appeal filed by OP was dismissed by learned State Commission vide impugned order against which, this revision petition has been filed along with application for condonation of delay.

HEARD learned counsel for the parties and perused record. Delay in filing revision petition had already been condoned by order dated 8.4.2009.

LEARNED Counsel for the petitioner submitted that as petitioner had suppressed material disease in the proposal form and has shown his health being good whereas he was suffering from malady, learned District forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal, hence, revision petition be allowed and impugned order be set aside. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.

LEARNED Counsel for the petitioner submitted that insured had annual income of Rs.50,000/-, but obtained policy for Rs.8,00,000/- which creates suspicion for taking policy without disclosing material disease. Perusal of proposal form reveals that he was bachelor having annual income of Rs.50,000/- and his annual premium was only Rs.1806/- for the policy of Rs.8,00,000/-. It cannot be said that deceased took policy for high amount without means. Bachelor can easily take policy for Rs.8,00,000/- by paying premium of Rs.1806/- with income of Rs.50,000/- p.a. and thus, this circumstance does not create suspicion that deceased obtained policy for high amount by suppressing material disease.

LEARNED Counsel for the petitioner submitted that as deceased/insured was suffering from malady "Lt. Ear discharge "since 2-3 years and he had suppressed this fact in the proposal form, claim was rightly repudiated. In support of his contention he has placed reliance on certificate of treatment given by Dr. Bharat H. Kakadia and Dr. K.R. Shukla. No reliance can be placed on these two certificates of treatment because apparently these are not certificates of treatment but these documents have been provided by aforesaid doctors on 13.8.2004 to the petitioner during investigation. In both these documents date of death has been shown as 11.3.2004 whereas, as per death certificate insured died on 12.3.2004. These documents do not contain any endorsement from which date to which date treatment was given by them to the insured. Only this fact has been mentioned in these certificates that deceased reported that he was having "Lt. Ear discharge" since 2-3 years. Neither any prescription slip nor any document pertaining to treatment of deceased by these two doctors have been filed. In the written statement, it has been mentioned that deceased had taken treatment from Dr. B.H. Kakadia, Dr.Popat, Dr. Haplia and Dr. K.K. Shukla, but none of the documents pertaining to the treatment given by these doctors have been placed on record and in such circumstances, it cannot be presumed that before filling proposal form, deceased had taken any treatment pertaining to his "Lt. Ear discharge" from any of the aforesaid doctors.

EVEN in the affidavits filed by Dr. Popat, Dr. Haplia and Dr. Kakdia it has nowhere been mentioned that deceased has taken any treatment from them before filling proposal form. In such circumstances, it cannot be inferred that deceased ever took any treatment from any doctor pertaining to his "Lt. Ear discharge".

MERELY because aforesaid doctors have mentioned in so -called certificate of treatment and their affidavits that deceased expressed about "Lt. Ear discharge" since 2-3 years without any cogent evidence it cannot be presumed that deceased was suffering from malady pertaining to "Lt. Ear discharge".

SUPPRESSION of material facts pre -supposes knowledge. Petitioner has not placed any evidence on record by which it can be inferred that insured was having knowledge of "Lt. Ear discharge" before filing proposal form. He rightly expressed his state of health as good.

I do not find suppression of any material fact by the insured in the proposal form and petitioner has committed deficiency in repudiating claim on flimsy grounds.

LEARNED Counsel for the petitioner has placed medical literature obtained from Wikipedia before me in which it was observed as under: "Mastoiditis is usually caused by untreated acute otitis media (middle ear infection) and used to be a leading cause of child mortality. I agree with the aforesaid literature, but it does not help to the petitioner as there is nothing to suggest that insured was aware about "Lt Ear discharge" before filling proposal form.

HAD he been suffering from "Lt. Ear discharge" since 2-3 years he would have taken treatment when he was having income of Rs.50,000/- per annum. No one would like to remain without treatment when he has sufficient funds to take treatment.

LEARNED Counsel for the petitioner has also placed reliance on judgment delivered by me in R.P. No. 1322 of 2012 Smt. Satyavati Sharma Vs. Life Insurance Corporation in which repudiation of claim was upheld as deceased not only suppressed all material facts, but also answered in negative to the important questions in the proposal form. Aforesaid case is not applicable to the case in hand as I do not find any evidence for suppression of any disease in the proposal form.

I do not find any illegality, irregularity or jurisdictional error in the impugned order and revision petition is liable to be dismissed.

CONSEQUENTLY , revision petition filed by the petitioner is dismissed with no order as to costs.