Life Insurance Corporation of India vs Rehana Begum

APPELLANTS in F.A. No. 697/2004 are the opposite parties 1 to 4 in C.D. No. 48/2003 on the file of District Forum, Adilabad.

THE brief facts as set out in the complaint are that the complainant is the wife of late Md. Arifuddin who worked as a conductor in R.T.C. and took two proposals with the opposite parties vide policies bearing Nos. 683026676 and 683027927 for a sum of Rs. 25,000/- each commencing from 28.10.2001 to 28.10.2016 and 15.12.2001 to 15.12.2016 with Rs. 1,796/- and Rs. 951/- as instalments respectively. On 15.1.2002 Md. Arifuddin expired due to heart attack when he was on duty. THE complainant herein is the nominee and is entitled for all the benefits. Subsequently the complainant made a claim with the opposite parties, who repudiated the claim on the ground that the deceased suppressed the facts at the time of taking the policy. Hence the complaint. Opposite parties filed counter stating that they have issued three policies to the deceased for Rs. 25,000/- each which commenced from 28.10.2001, 15.12.2001 and 28.8.2001 respectively and the life assured died on 15.1.2002. The contention of the opposite parties is that he availed medical leave prior to the date of the proposal which he did not disclose in his proposal and suppressed the facts. The matter was also referred to the Zonal Office for reconsideration on 26.5.2003 but there was no information.

Based on the pleadings and the evidence adduced and also Exs. A1 to A15, the District Forum came to the conclusion that there is deficiency of service on behalf of the opposite parties and directed them to pay the death benefits covered under policy Nos. 683026676 and 68302927 with interest at 9% p.a. from 29.11.2003 till realisation and also costs of Rs. 300/-.

AGGRIEVED by the said order, the opposite parties preferred this appeal. The learned Counsel for the appellants contends that the observation of the District Forum viz., ''when the appellants have settled two polices covered under Exs. A14 and A15 and repudiated the said policy, the appellants were not fair enough and have taken double standards'', is baseless and submits that the earlier policies were not early claims and, therefore, they were settled. The life assured has obtained five policies with the appellants and has paid the premiums. The appellants herein have repudiated the claims in three policies and relied on Ex. A5 leter dated 6.1.2003 stating that the life assured suffered from enteric fever for which he took treatment in a hospital and availed leave on medical grounds prior to the date of proposal but did not disclose this fact in his proposal. Enteric Fever like Typhoid is a common ailment and can be suffered by any common person and is not a chronic or acute disease for the appellants herein to repudiate the claim. There is also no nexus between the alleged suppression of Enteric Fever and the actual cause of death which is admittedly due to heart attack. It is held by the National Commission in III (1996) CPJ 136 (NC)=1996 (3) CPR 229 (NC) in Smt. B. Chinnamma v. Divisional Officer, LIC of India, that "when the assured underwent treatment for peptic ulcer and died of heart attack which has no nexus with the peptic ulcer, repudiation made by the insurer is arbitrary. It is also stated that so-called ailment for which the deceased was treated in the hospital during the said period had no nexus whatsoever with the cause of death. It is stated in the death certificate that he died of ''heart stroke''" It is also held by this Commission in 1992 (2) ALD (Cons.) 93 in Branch Manager, LIC of India, Cuddapah v. M. Parvathi @ Radha & Others, that ''mere production of doctor certificates enclosed with the application for leave on medical grounds without examining the doctors does not prove that the insured was in fact suffering from the disease and that they have been suppressed by the insured. Heavy burden lies on the Insurance Company to prove that the insured has indeed suppressed these facts."

KEEPING the facts and circumstances of the case in view which are similar to the facts in the judgments cited, we find no substantial grounds to interfere with the order of the District Forum, The appeal, therefore, fails and is accordingly dismissed. In the result, this appeal fails and is accordingly dismissed. Time for compliance six weeks. Appeal dismissed.