LIC OF INDIA vs Shantidevi Thakur

THIS appeal filed by org. O.P. is directed against the order dated 10.9.2004 passed by Central Mumbai District Consumer Forum.

WE propose to dispose of this appeal at the admission stage. One Devraj B. Thakur was working for M/s. Hindustan Petroleum Corporation Ltd. at Chembur, Mumbai as a ''Forklift Operator''. He got himself insured by obtaining three policies. The sum assured under third policy was Rs. 50,000/ -. The insured being in the employment, premium was deducted by his employer from his monthly salary and was remitted to the Life Insurance Corporation of India. The insured died on 7.2.1995. The widow of deceased submitted claim. The Insurance Company repudiated the claim mainly on the ground that there was material suppression of habit of excessive consumption of alcohol.

BEING aggrieved by the repudiation of claim, the widow of deceased insured filed consumer complaint before the District Consumer Forum. The said complaint was resisted by the Insurance Company. It is contended by the Insurance Company that because of material suppression, the claim was rightly rejected. The District Consumer Forum rejected the defence raised by the Insurance Company and allowed the complaint. Consequently, Insurance Company is directed to pay Rs. 50,000 to the widow of the deceased insured together with interest @ 9% p.a.

FEELING aggrieved by the impugned order under challenge, the org. O.P. -Insurance Company has filed this appeal. We heard Mr. A.S. Vidyarthi, Advocate for the appellant and Mr. Shirish Deshpande, Advocate for the respondent at length. The defence of the Insurance Company is mainly based upon the cause of death shown in the Medical Certificate. In the Medical Certificate, immediate cause of death is shown as ''Alcoholic Encephalitis'' and secondary cause of death is shown as Cirrhosis of Liver''. The learned Advocate Mr. A.S. Vidyarthi submitted that the insured at the time of submission of proposal suppressed his habit of excessive consumption of alcohol and, therefore, the repudiation of the claim is well justified. On the other hand, learned Advocate Mr. Shirish Deshpande submitted that the consumption of alcohol is not cause of Cirrhosis of Liver. According to him, Cirrhosis of Liver was caused due to jaundice. He also brought to our notice the opinion of Expert Dr. Ram Bijlani.

FROM study conducted by Howard J. Woman, M.D. with regard to ailment of Cirrhosis, it is seen that there are many causes, which lead to Cirrhosis of Liver. Following are the main causes of Cirrhosis of Liver: * Alcoholic liver disease. * Chronic viral hepatitis B, C and D * Chronic autoimmune hepatitis * Inherited metabolic diseases (e.g. hemochromatosis, Wilson disease) * Chronic bile duct diseases (e.g. primary biliary cirrhosis) * Chronic congestive heart failure * Parasitic infections (e.g. schistosomiasis) * Non -alcoholic steatohepatitis (liver inflammation that can be caused by fatty liver) * Long term exposure of toxins or drugs.

ALCOHOL abuse is one of the causes of Cirrhosis of Liver. However, consumption of alcohol is not the sole and final cause of Liver Cirrhosis. In the Medical Certificate, immediate cause of death is ''Alcoholic Encephalitis''. The secondary cause of death is Cirrhosis of Liver. There is no concept as Alcoholic Encephalitis in medical science. It is nowhere stated that the Cirrhosis of Liver was caused due to alcohol abuse. The Expert Dr. Ram Bijlani in Para 4 of his affidavit has made a positive statement that the deceased was referred to Dr. Gurmeet Singh for Ultrasound Test and on the basis of test carried out, it was found that the deceased was suffering from jaundice for which treatment was given. Dr. Ram Bijlani treated the deceased in his Hospital and has positively made a statement that at the time of treatment, there was no Cirrhosis of Liver. In para 5 of his affidavit, Dr. Ram Bijlani has stated that Encephalitis is totally a different reason and not connected with alcoholism but is referred to indicate the damage to the brain, which may be due to raised enzymes in the blood. Dr. Ram Bijlani has also stated in para 6 of his affidavit that the deceased Devraj Thakur was treated in Jaslok Hospital for Jaundice. After careful perusal of the entire medical record, we are of the clear opinion that there was no material suppression by the deceased insured. The deceased insured died because of inflammation to the brain. In the case of New India Assurance Co. Ltd. v. P.P. Khanna, II (1997) CPJ 1 (NC)=1986 -99 Consumer 4043 (NS), the Honble National Commission has held that in case of fraudulent suppression of material facts, onus probandi rests heavily on the party alleging fraud namely the Insurer. It is further held by the National Commisison that the Insurer cannot avoid consequences of insurance contract by simply showing inaccuracy or falsity of statement. It is further observed by the National Commisison that the Insurer has to prove that the statement was fraudulently made by the policy holder and has suppressed the material facts, which had not been disclosed. In the case in hand, the Insurance Company has failed to discharge heavy burden.

AFTER having scanned all evidence on record and after having heard the oral submissions at length, we are of the clear opinion that the impugned order under challenge passed by the District Consumer Forum does not suffer from any illegality. No interference is called. In the result, we pass following order: ORDER 1. Appeal stands dismissed summarily. 2. No order as to costs. 3. Copies of the order be furnished to the parties

Appeal dismissed.