Life Insurance Corporation of India vs AHMEDABAD JILLA GRAHAK SURAKSHA SANGH

THIS appeal arises from order dated 5.2.1999 rendered by the learned Consumer Disputes Redressal Forum, Ahmedabad City, Ahmedabad in Complaint No. 299 of 1998. Impugned order reads as under : "The opponent is directed to pay to the complainant No. 2 the sum of Rs. 35,000/- with the interest at the rate of 18% per annum from 1.8.1995 till payment with all the consequential benefits and to pay Rs. 5,000.00 as compensation and Rs. 5,000.00 as cost."

IT was the complainants'' case that deceased Bhaskarbhai Jashbhai Patel, brother of complainant No. 2 had taken two life policies in the sum of Rs. 10,000/- and Rs. 25,000/- respectively dated 15.12.1992 and 18.1.1994. Unfortunately, the insured died on 16.7.1994. Complainant No. 2 being the nominee, preferred claim before opponent Life Insurance Corporation of India (LIC for short). But the LIC repudiated the claim on the ground that the deceased insured suppressed material facts with regard to he having suffered from P. Falciperam Malaria resulting into severe anaemia prior to the date on which he took first policy. Opponent LIC made reference to column No. 11(e) referring to the question whether the insured suffered from diabetes, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia, hydrocele, leprosy or any other disease and the insured gave the answer in the negative. The complainant approached the learned Forum in the aforesaid complaint. After considering the respective affidavits, the learned Forum came to the conclusion that the opponent LIC failed to prove the case with regard to suppression of material facts by the insured at the time when he had taken the first insurance. The learned Forum has observed that the opponent did not produce any original certificate or affidavit of the medical officer on the basis of which the claim was repudiated. Under such circumstances, the learned Forum passed the aforesaid order. We have heard the learned Advocates for the parties. We have gone through the impugned order. We have also gone through the respective printed statements. However, the learned Advocate appearing for opponent LIC has not been able to show us any original medical certificate indicating whether the insured suffered from P. Falciperam Malaria prior to the date of first insurance and had also consequential symptoms of anaemia right from that time. Assuming for the sake of argument that the insured did suffer from such an ailment it would amount to some disorder resulting from mosquito bite and can hardly be said to be a disease which can be clubbed in the aforesaid question. In fact the question does not include malaria of any sort and, therefore, insured was not bound to answer whether he suffered from any sort of malaria including P. Falciperam Malaria. Whereas rivex malaria has impact on liver, P. Falciperam Malaria has impact on brain. Therefore, there must be some weakness having been suffered by the person down with P. Falciperam Malaria. In that view of the matter, the usage of words ''mentally retarded'' in the printed statement of LIC are misleading inasmuch as it is the case of the opponent LIC itself that the insured had weakness of mind on account of he having suffered from P. Falciperam Malaria as can be seen from the repudiation letter. The statement obviously would amount to secondary evidence. It is based on some primary document which the opponent LIC might be having with it. It is not in dispute that LIC has not produced any original medical report before the learned Forum. In that view of the matter, factual finding of the learned Forum cannot be faulted. To reiterate, even if it is assumed that the insured was down with P. Falciperam Malaria at any time in the year 1992 he was not obliged to disclose that fact and, therefore, it cannot be said that he suppressed material fact. We would fruitfully refer to the decision of Honourable National Commission in the case of Alia Begum v. LIC of India, reported in III (1997) CPJ 106 (NC)=1997 (2) CPR 60 (NC). There National Commission had an occasion to observe that intermittent fever and body ache would be trivial ailments and non-disclosure thereof could not be construed as fraudulent suppression of material facts. Regarding joint pains and swelling it has been observed that the same must have been noticed by the doctors who examined the deceased on behalf of the Insurance Company before finalisation of the policy. Had it been a serious problem, it would have been mentioned in the report.

The decision in the case Draupadi Devi S. Chaudhari v. United India Insurance Company Limited reported in I (1993) CPJ 94 (NC)=1993 (1) CPR 224, deals with repudiation of the claim by the insurer based on history of the patient recorded in the hospital discharge card. In the present case, we do not have any hospital discharge card before us as stated. In the case before the Honourable National Commission, the hospital discharge card revealed that the insured suffered from chest discomfort since 10 years and ultimately the claim was with regard to by-pass surgery which was relatable to chest discomfort which was not disclosed. In that view of the matter, decision in the case of Draupadi Devi S. Chaudhari v. United India Insurance Company Limited (supra), can hardly have any application to the facts of this case.

NOW, so far as award of compensation and cost respectively in the sum of Rs. 5,000/- each as well as award of interest @ 18% is concerned, we have heard the learned Advocates for the parties. It is a different matter that factually, the LIC has not been able to justify the repudiation. However, the reason for repudiation given by the opponent LIC does not smack of malafide. In that view of the matter, award of compensation in the sum of Rs. 5,000/- without any particulars in respect thereof set up and proved by the complainants and award of cost in the sum of Rs. 5,000/- would not stand justified. Same would hold good with regard to award of interest @ 18%. Under such circumstances, we propose to reduce the rate of interest from 18% to 9% relying upon the decision of the Honourable Supreme Court in the case of Kaushnumma Begum v. The New India Assurance Company Limited. We accordingly set aside the order of compensation and cost in the sum of Rs. 5,000/- each while awarding cost of complaint in the sum of Rs. 500/-. Following order is, therefore, passed. ORDER Amount of award in the sum of Rs. 5,000/- and cost in the sum of Rs. 5,000/- is hereby set aside while awarding cost of complaint in the sum of Rs. 500/-. Rate of interest is also reduced from 18% awarded by the learned Forum to 9%. Rest of the order is maintained. Impugned order will stand modified accordingly. This appeal is partly allowed in these terms with no further order as to costs. Both the parties will give joint application for withdrawal of the amount stated to have been deposited in this Commission, as per the aforesaid order and payment will be made accordingly on their joint working by Account Payee cheque to the respective parties after due verification. This appeal will accordingly stand disposed of. Appeal partly allowed.