Life Insurance Corporation of India vs VEENA PURI

APPELLANT is aggrieved from the order dated 22. 3. 2004 passed by the District Forum, Kangra at Dharamshala in Consumer Complaint No. 169/2002. By means of impugned order, while allowing the complaint of the respondent, appellants have been directed to pay Rs. 50,000 and Rs. 75,000 with 9% interest from the date of repudiation of the claim i. e. 31. 3. 2001 till the payment of said amount to the respondent or is deposited with the Forum. Appellants have also been burdened with costs of Rs. 1,000.

AT the time of hearing, deceased Rakesh Puri husband of the respondent being the assured life having obtained two policies on 28. 7. 1997 in the sum of Rs. 50,000 and on 15. 2. 1999 in the sum of Rs. 75,000 is admitted. He died on 1. 6. 1999. Because claim of the respondent was not settled by the appellants, therefore, she filed consumer complaint under Section 12 of the Consumer Protection Act, 1986 for redressal of her grievance. After conclusion of proceedings in the complaint, above referred relief (s) have been granted to the respondent against the appellants. Main thrust of the submission of Mr. Singh, learned Counsel for the appellants was that both the policies were obtained by the deceased by suppression of true and material facts; and the contract of insurance being based on utmost good faith and bona fide which has become void ab initio, he also invoked the doctrine of uberrima fides. As according to him, when the deceased obtained policies, he was suffering from Adult Polycystic Kidney disease for the last 10 years. In this behalf, he placed reliance on Ex. R. 4, Forum No. 3816, issued by the Senior Resident, Department of Urology, Postgraduate Institute of Medical Education and Research (PGMIER), Chandigarh as also the leave record of the deceased Exs. R. 7 and R. 8, besides placing reliance on Exs. R. 10, the discharge summary of the deceased issued by Consultant Dr. S. K. Singh. All these pleas were controverted by Mr. Harsh Behl, learned Counsel appearing for the respondent. According to him, firstly there was no suppression of any material fact and alternatively without conceding, he urged that even if there was suppression, unless it was shown to be intentional, purposeful as well as fraudulent, then mere suppression by itself is no ground to revoke the claim of his client.

Another plea urged on behalf of the appellants was that insurance was on a standard life, whereas he had died within 13 months of the subsequent policy dated 15. 2. 1999, therefore, according to Mr. Singh, this clearly supports his plea that the deceased was suffering from the above referred diseases. Mr. Behal contested this plea as well.

IN order to succeed, appellants were duty bound to have produced material on record in the shape of cogent, reliable and acceptable evidence to prove that the deceased was suffering from the above referred disease and it had direct nexus with the causing of death. When a reference is made to Ex. R. 4, it is clear that history was given to the Senior Resident by the patient who had recorded the same and was still in the Hospital. Similarly, Senior Resident, Department of Urology who had recorded the history, his name is also not given. In these circumstances, it cannot be said that the Senior Resident under whose signatures Exhibit R. 4 is issued was the same person to whom either history was given or who had recorded the same. Reliance was placed by Mr. Singh on Col. 5 (a) of this Exhibit. Here it is mentioned - "diagnosed case of APKO - 10 years - illegible - Prostrate flame. 2 months, vomiting, loss of weight and appetite, Hypertension". Deceased being suffering from APKO for 10 years, was a disease that was diagnosed, therefore, it cannot be assumed by any stretch of imagination that this fact was given by the deceased himself. There is no material on record to suggest produced by the appellants that deceased being in the know of his suffering from the diagnosed disease still withheld this fact. In addition to this, when a reference is made to the discharge summary, Exhibit R. 10, it is evident that this document is incomplete and is not signed by the person/authority who had issued it. Therefore, no reliance can be placed on Exhibit R. 10. Similarly, Exhibit R. 4 does not improve the case of the appellants. Minimum that was required of them was that affidavit of Doctor to whom history is stated to have been given and/or the doctor who had recorded the same, should have been filed. Now coming to the submission of Mr. Singh based on Exhibit R. 7 and Exhibit R. 8, leave record of the deceased. In Exhibit R. 7, from 13. 2. 1995 to 23. 2. 1995 he had proceeded on earned leave for checkup at PGI, Shimla. Thereafter, he had availed leave for treatment from 17. 2. 1999 to 1. 6. 1999. Similarly as per Exhibit R. 8, deceased was on earned leave on medical ground from 17. 2. 1999 to 28. 2. 1999. Again, he was on medical leave from 20. 4. 1999 to 1. 6. 1999. From both these documents, it is evident that he was on medical leave. There is no medical evidence to suggest that the case as set out with reference to the disease from which the deceased is alleged to be suffering at the time of obtaining policies was of such a nature and/or had a direct nexus with the cause of his death. As such, we are of the view that there is no evidence worth the name to uphold the plea of Mr. Singh in this case. Thus, reliance placed on Exhibits R. 4, R. 7, R. 8 and R. 10 is wholly misconceived.

FOR the view that we have taken on the basis of evidence on record, plea of the appellants that deceased had died within 13 months of the second policy for holding that they had insured the standard life and not the life of a sick person is likewise rejected. For the view that we have taken in this judgment, we are supported by the decision of National Commission as well as State Commissions. To some such decisions reference is being made hereinafter. In 2006 (1) CPC 460, Oriental Insurance Company Limited v. Asim J. Pandya, the National Commission while rejecting the contention of the Insurance Company that disease was pre-existing having not been proved, upheld the order of the State Commission, after setting aside the order of the District Forum whereby insurance claim of the complainant was rejected on the ground of pre-existing disease. In the case of Life Insurance Corporation of India and Others v. Dr. P. S. Aggarwal, I (2005) CPJ 41 (NC), while dealing with the information collected from the Hospital and doctor who had prepared the summary having not been produced, it was held by the National Commission that such information was not the primary piece of evidence and also there was no direct nexus between the death and the disease. Thus, repudiation of claim was held unjustified and appeal of the Insurance Company was dismissed.

IN Life Insurance Corporation of India v. Sudesh Gandhi, III (2006) CPJ 249=2006 (1) CPC 514, Punjab State Commission while upholding the order of the District Forum, repudiated the plea of concealment of illness as well as allegation that insured had been taking treatment of certain disease as it did not prove the concealment of disease.

IN Life Insurance Corporation and Another v. Bachhi Devi, I (2005) CPJ 21, Bihar State Commission held that on suppression of material facts when no document was produced in support thereof, thus it being a mere allegation without proof, same was not acceptable and consequently appeal of the Insurance Company was dismissed. To similar effect are the decisions of Jammu and Kashmir State Commission in Life Insurance Corporation and Another v. Hadam Lal Dharmania, I (2005) CPJ 45 and of Chhattisgarh State Commission in Sushila Bai Shukla v. Life Insurance Corporation of India, I (2005) CPJ 78 and Life Insurance Corporation of India v. Manju Parwani, II (2006) CPJ 20. Rajasthan State Commission also took similar view in Life Insurance Corporation of India and Others v. Ramswaroop Meena and Others, II (2006) CPJ 206. Keeping in view the facts of this case and the above decisions, we are satisfied that no exception can be taken to the impugned order, therefore, in view of the aforesaid discussion, there is no merit in this appeal which is accordingly dismissed, leaving the parties to bear their own costs. All interim orders passed from time-to-time in this appeal stand vacated forthwith. Office shall make available copy of this order to the parties free of cost as per rules. Appeal dismissed.