LIC OF INDIA vs R. ANAGAYARKANNI

THE complainant''s husband had taken two insurance policies, one being Money Back Policy for Rs. 1 lakh on 28.9.1996 and the other policy being Endowment Policy for Rs. 1 lakh on 17.7.1997. THE complainant''s husband died on 2.2.1998 leaving the complainant as his sole legal heir and nominee. THE complainant is, therefore, entitled to the amount due under the insurance policies which has not been paid by the opposite party in spite of repeated demands. Hence, the complaint.

THE opposite party contended that since it was an early claim, investigation was made and the opposite party came to know that the deceased had taken treatment for disease called ''Myalgia and Chronic Lumbo Sacral Strain'' in April, 1996. But he had suppressed this and, therefore, the claim was repudiated by the opposite party. THE insured died due to cerebral haemorrhage. As there was suppression of facts relating to the health, the claim was properly repudiated by the opposite party. Hence, the complainant was not entitled to the amount claim. The lower Forum accepted the claim and directed the opposite party to pay the amounts due under the policies. Aggrieved by the same, the present appeal has been filed.

The complainant''s husband had insured his life under two policies, one was a Money Back Policy in a sum of Rs. 1 lakh on 28.9.1996 and the other was an Endowment Policy for a sum of Rs. 1 lakh on 14.7.1997. The complainant''s husband died on 2.2.1998 and, therefore, the wife being his sole heir and nominee of the policy made claim to the opposite party. The Medical Attendant''s Certificate shows that the insured died on 2.2.1998 at the Government Hospital, Kumbakonam due to brain haemorrhage. It further says that it was a sudden onset. It also mentions that his condition was observed only about two hours before his admission. The insured became suddenly unconscious and was rushed to the hospital where he apparently died. The certificate of treatment issued under Ex. A17 would show that the diagnosis arrived at by him as Myalgia. The other certificate issued under Ex. A 18 showed that it was a Chronic Lumbo Scral Strain. The Medical Attendant Certificate clearly mentions that it was a sudden onset and the deceased became unconscious and due to haemorrhage in brain, he died. Therefore, in such circumstances, the contention that there has been suppression of certain facts relating to his health is not acceptable. The haemorrhage in brain could not have been anticipated. It is not the case. Nor there is any record to show that the deceased was suffering from hypertension. Myalgia is only muscular pain. Myalgia and Chronic Lumbo Sacral Strain cannot be termed to be dangerous diseases. On the other hand, the certificate under Ex. B3 clearly shows in Col. 8 that on 27.1.1998 when he treated him, patient was clinically normal and at that time, he was suffering only from fever. For every human being fever is something which is an illness which occurs now and then. Back pain, hip pain and muscular pain are common ailments. Therefore, one cannot expect a person to make mention of all the instances. Therefore, taking the broad aspect of the case, we find the only reason given for the repudiation is that it was an early claim and that the insured was taking treatment for Myalgia and Chronic Lumbo Sacral Strain in April, 1996. Myalgia and Chronic Lumbo Scral Strain could have set in later on as well after the commencement of the second policy. Further the records produced did not reveal that the deceased actually underwent any such treatment or for any course of time at any particular doctor or any particular hospital for these conditions. Therefore, the opposite party cannot clutch at a non existing straw to say that there is suppression of material facts. The certificate produced clearly shows that when the doctor examined him on earlier occasions, he was normal and the death was sudden due to haemorrhage in brain. Therefore, the burden is upon the opposite party to show that there is suppression of material facts. They have failed to prove that there was really any suppression and the insured was aware that he was suffering from serious illness on the date when he sent the proposals suppressing the same, he submitted the proposals. Therefore, the certificates issued by Dr. Suresh under Ex. B3, is not helpful to establish the contention that there has been suppression of material particulars regarding his health condition. Even the Document Ex. B4 is not helpful. If at all it shows that the deceased underwent treatment for low back pain. Back pain is a common thing in these days of stress and strain. Therefore, one cannot attach any significance to it in the sense that it amounts to suppression of material particulars regarding health condition. Therefore, considering the nature of the claim and the nature of evidence adduced before the Court and the nature of illness alleged, we are of the opinion that it is not a case where it can be contended much less successfully by the appellant that there has been any material suppression of truth by the insured and, therefore, it follows that the repudiation of the claim is not proper. Hence, there is deficiency in service. Therefore, we do not find any reason to interfere with the order of the lower Forum.

IN the result, this appeal is dismissed, but in the circumstances without costs. The order passed by the lower Forum is hereby confirmed. Appeal dismissed.