Life Insurance Corporation of India vs JASHODABEN MAGANBHAI CHAUHAN

THIS appeal is directed against the order dated 27.2.1997 rendered by the learned Consumer Disputes Redressal Forum, Panchmahals at Godhra in Complaint No. 30 of 1995 directing the opponent (appellant herein) Life Insurance Corporation of India to pay to the complainant Rs. 50,000/- being the amount of policy taken by her husband Maganbhai Chauhan (since deceased) in 1991 and to pay interest @ 15% p.a. as well as cost quantified at Rs. 150/-.

THE stand of the opponent was that deceased Maganbhai had suppressed two facts (i) he had taken insurance on earlier occasions (which insurance amount has been paid by LIC of India); and (ii) he suppressed the fact that he was having some sickness prior to the taking of policy in question. The learned Forum discarded the defence on the ground that it was not supported by any affidavit.

Undisputed further development of the matter is that the opponent was required to deposit the ordered amount in execution which was transmitted to the Civil Court and the amount has been withdrawn by the complainant who remained present before the Commission yesterday when the matter was fully argued by the learned Advocate for the appellant.

AS a matter of fact on a settled principle of law burden of proof with regard to the allegation that the insured suppressed material facts is on the Insurance Company or the Life Insurance Corporation of India as the case may be, and such burden has not been discharged by the LIC in the present case. That precisely is the ground on which the learned Forum has entertained the complaint. However, we have proceeded to consider the matter on merits as well. The LIC had repudiated the claim as per letter dated 2.3.1995 which has been shown to us. It has inter alia been recited in this letter that Question No. 9 pertains to whether the insured had any accident or injury and it was replied in negative and Question No. 11(a) with regard to whether the insured consulted any medical practitioner for any ailment for treatment more than a week was answered in the negative and whether insured remained absent from place of work on the ground of health since last five years as per Clause 11(a) was answered in the negative and the answers were found to be not correct saying that the LIC had indisputable proof to show the facts contrary to the same. It has also been recited that such facts would indicate that the insured suffered from hypertension and injury on leg and had consulted a medical man and had taken treatment from him during the period between 2.11.1989 to 10.11.1989, 17.9.1990 to 28.9.1990 and 22.9.1990 to 12.10.1990. It was this repudiation letter that gave rise to the complaint in question before the learned Forum. Mr. S.C. Shah, learned Advocate appearing for the appellant has shown Xerox copy of the certificate of the employer of deceased insured laying stress on particular period 2.11.1989 to 10.11.1989, 17.9.1990 to 28.9.1990 and 22,9.1990 to 12.10.1990 indicating against these columns the nature of leave to be sick leave specifying dental trouble and injury on leg to be the cause of sickness. Now, this sickness as appearing in the Xerox copy of the certificate do not coincide with the sickness cited in the repudiation letter, except that injury on leg does appear in the repudiation letter There is no material produced on the record even at this stage to show that any investigation was carried out by the LIC from any of the medical practitioners consulted by or alleged to have been consulted by the deceased insured. Therefore, the present case not only suffers from the vice of absence of proof but also suffers from the vice of statement of necessary particulars with regard to the facts alleged to have been suppressed by the deceased insured.

IN the above light we would now consider the decisions which had been submitted by Mr. Shah for our consideration. (a) The first one is in the case of United INdia INsurance Company Limited v. Biman Krishna Bose, II (1995) CPJ 62 (NC). IN that case the sickness which was alleged to have been suppressed was hypertension and the Honourable National Commission came to the conclusion that there was nothing to show that hypertension was temporary or casual. Suppression of fact with regard to hypertension was found to be material suppression in the context of the facts before the National : Commission. (b) Second decision is in the case of Ajay Prakash Mittal v. Life INsurance Corporation of INdia, I (1998) CPJ 2 (NC), where the National Commission was required to consider suppression of fact with regard to pregnancy of the insured in the context of her death following soon after pregnancy. IN that context referring to the relevant condition and clauses, the National Commission came to the conclusion that the fact was a material fact, the suppression of which would vitiate the insurance. It may be noted that the insured lady died of jaundice soon after pregnancy. (c) Next is a decision of Gujarat State Consumer Disputes Redressal Commission in Dr. Harish Jamnadas Mandvia v. Life INsurance Corporation of INdia, I (1997) CPJ 349. IN that case the insured was a doctor. Soon after taking of insurance, the insured was required to be examined in respect of pain in abdomen and vomiting and it was found that the insured was suffering from malignancy in stomach. After prolonged treatment, the insured succumbed to the disease on January 27, 1991, i.e. within one year from the date on which the insurance was taken. IN the background of such facts and in the background of the investigation with regard to the deceased suppressing material fact this Commission had an occasion to uphold the contention that the complainant and the deceased knew about the fact that the deceased insured was suffering from cancer when the proposal for insurance was given. (d) Reference then has been made to a decision of Honourable National Commission in the case of LIC of INdia v. Smt. Lily Rani Roy, I (1997) CPJ 46 (NC). This was also a case where the National Commission was required to hold on facts that at the time of giving answers the deceased intentionally and fraudulently concealed the fact of illness requiring treatment over a week as indoor patient and had knowledge that he was suffering from papillary carcinoma. In our considered opinion, none of the aforesaid decisions will have any application to the facts of the present case as noted hereinabove. In all fairness, Mr. Shah also submitted that he was aware of the decision of the Honourable Supreme Court in LIC of India v. Smt. G.M. Chanabasemma, AIR 1991 SC 392, and LIC of India & Ors. v. Smt. Asha Goel & Anr., I (2001) SLT 89=AIR 2001 SC 549., both of which deal with burden of proof with regard to allegation regarding suppression of facts at the time of taking of insurance. In our considered opinion, both these decisions will squarely apply to the present case.

IN the result, this appeal will fail. Same is accordingly dismissed, with no order as to costs. Appeal dismissed.