Life Insurance Corporation of India vs INDIRA CHHATRI

THIS appeal, under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 1.5.2002 in Complaint No. 344/2001 by District Consumer Disputes Redressal Forum, Raipur (hereinafter called the ''District Forum'' for short) directing the opposite party/appellant herein to pay to the complainant/respondent a sum of Rs. 1 lac with interest thereon, under the Life Insurance Policy obtained by the husband of the complainant/respondent.

IT is not in dispute that complainant/respondent is the wife and nominee of the insured Manglu Chhatri. Insured Manglu Chhatri was employed as peon in Pt. Ravishankar Shukla University, and had obtained two life insurance policies, one bearing No. 381229779 for Rs. 50,000/- on 15.9.1992 and the other bearing No. 380083799 for Rs. 1 lac for the period from 15.9.1994 to 15.9.2009. The averments in the complaint were that though the appellant/LIC made payment of Rs. 50,000/- the assured sum under policy No. 381229779 but has chosen to repudiate the claim of the complainant nominee relating to policy No. 380083799 for Rs. 1 lac. It was averred by the complainant that repudiation of her claim under the second policy was not justified. The complainant, therefore, prayed that sum of Rs. 1 lac assured under policy No. 380083799 be directed to be paid to her with interest and compensation for deficiency in service by the appellant/insurer be also directed to be paid to her.

The complaint was resisted by the appellant insurer. It was averred that the insured suffered from the disease of sickle cell from before submission of the proposal form. However, he has suppressed the disease as above in the proposal form. It was also averred that though the insured stated in the proposal form that he was in service of Pt. Ravishankar Shukla University from 23.5.1993 but in fact the insured was employed by the University on 23.5.1994. It was averred that, had the correct information as regards the date of employment been given to the appellant insurer Corporation, it would not have accepted the proposal of the insured under non-medical scheme and medical check-up of the complainant would have been conducted and taken into consideration, before covering the risk of the life of the insured.

THE District Forum in the impugned order held that appellant Insurance Company has not produced any material to indicate that the insured suffered from disease of sickle cell, from before the submission of the proposal form. It was also held by the District Forum that the employment by Ravishankar University as peon from 23.5.1994 was preceded by one year service as contingency servant. THErefore, the statement by the insured in his proposal form that he was in employment from 23.5.1993 was not false. Hence, it was held that there was no justification for repudiation of claim of the complainant. Accordingly, the District Forum allowed the complaint and awarded the assured sum of Rs. 1 lac with interest thereon, in favour of the complainant/respondent. As noticed above, though two policies were issued by the appellant/insurer on the life of the insured Manglu Chhatri, the husband of the complainant/respondent, her claim under policy No. 381229779 has already been duly paid by the appellant/insurer. The grievance of the complainant is regarding non-payment of her claim under the other policy No. 380083799 for an assured sum of Rs. 1.00 lac. The proposal form for the said policy by the insured Manglu Chhatri was undisputably submitted on 2.9.1994. In the said proposal form the insured had stated in Clause 4(b) that he was under the employment of Pt. Ravishankar Shukla University, Raipur from 23.5.1993. He also stated in Clause 11 in personal history that he has not suffered from any disease and has not taken any treatment. As per appellant/insurer''s repudiation letter dated 6.9.1999, the claim of the complainant/respondent was rejected on the grounds that the insured suffered from the disease of sickle cell for a period of about 1 year and 11 months prior to submission of proposal form and that though he was employed on 23.5.1994 he had falsely stated in the proposal form that he was employed from 23.5.1993.

IN the foregoing circumstances, the question that arises for consideration is : as to whether there was any suppression of material facts as above by the insured in the proposal form? So far as his date of employment is concerned, as noticed above, the insured had stated that he was employed in Ravishankar University from 23.5.1993. The complainant in her letter after her claim was repudiated by the appellant/insurer, has clearly stated that her husband insured Manglu Chhatri was initially employed as daily paid contingency servant of Ravishankar Shukla University and thereafter he was appointed as peon on regular service. She has also requested the appellant/insurer that the above facts may be verified. There is no material on record to show that the appellant/insurer ever verified the contention as above of the complainant. Therefore, even if there is a letter from Ravishankar Shukla University issued to the appellant/insurer that the insured was employed as peon from 23.5.1994, it would not mean and imply that his service started from 23.5.1994. It is common knowledge that initially class-IV employees are recruited in contingency or daily paid basis and subsequently regularized by many organizations. In the circumstances, the findings of the District Forum that the information given by the insured that he was employed from 23.5.1993, was not false, appears to be justified. Accordingly repudiation of the claim of the complainant on the above ground was not proper.

THE other ground of repudiation by the appellant was that the insured suffered from the disease of sickle cell for a period of one year and 11 months. It may be noticed in the above context, that there appears to be no material on record to show that the deceased suffered from the above disease and knew about it. It may also be noticed that in the certificate of hospital treatment issued by Senior Consultant of J.N.M. Hospital and Research Centre, Bhilai, the cause of death was shown to be sickle cell, malaria, jaundice etc. It was also stated in the said certificate that the deceased was a known case of sickle cell disease for 3 years. However, the basis on which the certificate as above was issued by the Senior Consultant and the person who informed him about the history as above, has not been given. No treatment record of the deceased has been furnished to show that the deceased suffered from sickle cell from before submitting the proposal form or that he knew that he suffered from the said disease. Thus the appellant/insurer has failed to establish and substantiate its averments in the above regard. In the circumstances the District Forum was justified in holding that it was not proved that the insured suppressed any material facts.

ACCORDINGLY, it is clear that the grounds on which the claim of the complainant was repudiated by the appellant/insurer were not justified, as has been rightly held by the District Forum. The findings as above of the District Forum are affirmed. This appeal has no substance. It is accordingly, dismissed. Appellant shall bear its own cost of this appeal and shall pay that of the complainant which is quantified at Rs. 500/- (Rupees five hundred) only. Appeal dismissed.