Life Insurance Corporation of India vs PARVATI GOND

THIS appeal, under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 23.6.2003 in Case No. 221/2002 by District Consumer Disputes Redressal Forum, Bilaspur (hereinafter called the District Forum for short) awarding a sum of Rs. 50,000/- with interest claimed by the complainant/respondent. herein.

THE undisputed relevant facts are, that the complainants/respondents are the wife and children of Dinasingh Uike. THE said Dinasingh Uike obtained a life insurance policy on his life for an assured sum of Rs. 50,000/-. THE term of the siad policy was from 15.1.999 to 15.1.2020. Since the annual premium of Rs. 810/- was not paid in time, the said policy lapsed. THEreafter the said policy was got revived and as per rules and provisions the premium with penalty amounting to Rs. 1,784/- were deposited by the complainant/respondent No. 1 with the appellant Insurance Company. A declaration dated 23.8.2001 was also furnished regarding the state of his health by the deceased insured for obtaining revival of the said policy. THE deceased however, died on 18.9.2001 i.e. within a month of the revival of the policy. THE complainant/respondent No. 1 laid claim for the sum assured under the said policy on the life of her husband Dinasingh Uike. THE claim as above was however, repudiated by the appellant Insurance Company by its letter dated 16.7.2002 on the ground that there was material supression of facts by the deceased insured regarding the state of his health, at the time of revival of the policy. The complainants/respondents in their complaint averred that repudiation by the appellant was without justification and they prayed that it be directed that the insurer should pay the sum assured to the complainant.

The appellant in their written reply averred that the declaration of good health furnished by the deceased insured was to the effect that his general state of health was good and that he had not been suffering from hypertension or any disease of the liver, kidney etc. However, it was discovered on inquiry by the insurer that at the time the policy was got revived by the deceased insured, he was suffering from Liver cirrhosis and hypertension and he wilfully concealed the material fact as above. Hence the claim of the complainant was repudiated.

THE learned District Forum after considering the material placed on record, came to the conclusion that the deceased was not aware at the time he filled up declaration about his health and at the time of revival of the policy, that he was suffering from Liver cirrhosis and hypertenstion etc. which was the cause of his death. THE District Forum, therefore, held that there was no wilful material suppression of the fact by the deceased Dinasingh Uike. Accordingly the complaint was allowed. THE sum assured was awarded in favour of the complainants/respondents. The learned Counsel for the appellant submitted that they have placed the declaration as well as the special inquiry report answered by Dr. S.K. Goel and the medical certificates etc. issued by the treating Doctor which would indicate that the complainant was suffering from cirrhosis of liver and hypertension from before and prior to filling up declaration about his health for obtaining revival on 23.8.2001. Therefore, there was material suppression of fact of his ailments, which were the cause of his death. Therefore, the claim of the complainants/respondents was rightly repudiated. It was, therefore, urged that the learend District Forum erred in directing that the sum assured under the policy be paid to the complainants/respondents.

THE learned Counsel for the complainants/respondents however, supported the impugned order and contended that the learned District Forum after appreciation of documents and material placed on record justifiably held that there was no wilful suppression of facts by the deceased insured and the claim of the complainants/respondents was rightly allowed. In view of the rival contentions as above the main question that arises for consideration in this appeal is as to whether the deceased at the time of filling up the declaration regarding his health on 23.8.2001 was knowing that he was suffering from cirrhosis of the liver and hypertension etc. and that the material suppression as above was known to him at the time he filled up his declaration on 23.8.2001 for revival of the policy. The declaration filled up by the deceased at the time of revival of the policy on 23.8.2001 is placed on record and is captioned ''personal statement regarding his health''. In the said form the deceased had stated that he did not suffer from high blood pressure or any disease of the stomach, liver or spleen. The medical certificate issued by Dr. S.K. Goel dated 8.3.2002 would indicate that the deceased died of ''cirrhosis of liver, portal hypertension and G.I. Bleed''. It was stated in the said certificate dated 8.3.2002 that the deceased was suffering from the above ailments from a month prior to his death. It also appears from the original of the said certificate dated 8.3.2002 that initially date of knowledge of the disease by the deceased insured was mentioned as 17.8.2001 which was subsequently changed by overwriting to 27.8.2001. It is not clear as to who has made the above corrections by overwriting and changing the date of knowledge as above. In any case, there are other documents also which indicate that the deceased was aware of his ailments for about a month, prior to his death. In the above context the certificate dated 8.3.2002 by Dr. S.K. Goel may be referred to. In that certificate information given in column 4c and e would indicate that the deceased was suffering from the above ailment for a month prior to his death and that he had knowledge of that ailment since then.

THE deceased undisputably died on 18.2.2001. Thus the aforementioned certificate of Dr. S.K. Goel would indicate that the deceased was suffering from such ailment atleast from 18.2.2001 and that he was also aware of the same. This conclusion is further supported by the claimant''s own statement which indicates that the deceased was suffering from the said aliments for the last one month and had also the knowledge thereof. It also appears from other material placed on record that the deceased was also earlier admitted in the hospital for the treatment of said ailments on 10.9.2001 and was discharged on 11.9.2001. From the certificate issued by Dr. Rahman of Pandariya, it would also appear that the deceased was suffering from cirrhosis of liver, portal hypertension and ascites.

FROM the above material on record it is abundantly clear that the deceased was suffering from the cirrhosis of liver, hypertension and ascites which resulted in his death on 18.9.2001. It is also clear that the deceased had knowledge of the above ailments for the last one month before his death i.e. prior to 23.8.2001 when he filled up declaration form regarding his health, seeking revival of his policy. It may also be mentioned that cirrhosis of liver, hypertension etc. are diseases which gradually develop and normally do not lead to fatal end in a short period. It is, therefore, clear that the deceased must have suffered from the said diseases and had known about the same as has been certified by Dr. S.K. Goyal, for atleast a month prior to his death. Therefore, the declaration dated 23.8.2001 which was filled by the deceased within less than a month prior to death for revival of lapsed policy, suffered from wilful suppression of material facts, inasmuch as the deceased stated therein that he was not suffering from blood pressure or any disease of heart, liver, kidney etc. In view of the above, learned District Forum appears to have seriously erred in not considering and appreciating the above material on record, and in holding that the deceased did not know about his ailment on 23.8.2001 when he filled the form of declaration about his health for revival of his insurance policy. The said finding is not justified and cannot be sustained in the facts and on consideration of the documents, medical certificate etc. on record.

In view of the above, it is clear that the appellant Insurance Company was justified in repudiating the claim of the complainants/respondents under the policy which was got revived by the deceased Dinasingh Uike on 23.8.2001. The complainants in the circums-tances were not entitled to any claim under the policy so got revived, by the deceased Dinasingh Uike as the agreement of revival stood vitiated in the foregoing circumstances.

THE appeal is accordingly allowed. THE impugned order is set aside. THE complaint of the complainants/respondents stands dismissed. However, in the circumstances of the case the parties shall bear their own costs as incurred in this litigation throughout. Appeal allowed.