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Judgment
This first appeal has been filed under section 19 of the Consumer Protection Act, 1986 against the impugned order dated 14.08.2009, passed by the Meghalaya State Consumer Disputes Redressal Commission (for short ''the State Commission'') vide which the complaint, CC No. 3(M) of 2005, filed by the present respondent Smt. Sita Dkhar against the appellant LIC was allowed and the petitioner was directed to pay to the complainant the amount of sum assured, i.e., Rs.15 lakh together with bonus as applicable to the insurance policy, alongwith interest @9% p.a. from 3.01.2004, till the date of payment.
The facts of the case are that the husband of the complainant Late Rabee Pun obtained a life insurance policy No. 481979869, effective from 25.05.2002 for a sum of Rs.15 lakh from the Opposite Party (OP), LIC of India and annual premium of Rs.98,113/- was paid for obtaining the said policy. The complainant was nominee of the deceased under the said policy. The life assured met with a road accident while travelling by car on 15.10.2002 and later succumbed to his injuries on 26.10.2002, while undergoing treatment at International Hospital at Guwahati. The complainant filed claim with the LIC alongwith relevant documents on 03.07.2003, but the claim was repudiated on 20.08.2004, i.e., after more than one year by the LIC, saying that the policy-holder had suppressed correct information about his health at the time of obtaining the policy and gave false answers to various questions in the proposal form. In reply to the question whether he ever used alcoholic drinks, narcotics, drugs or tobacco in any form, the insured replied in the ''negative''. However, it was contended by the OPs that they had indisputable proof to show that the insured was a regular ''ethanol-abuser'' for the last 15 years, before he took the policy in question. Following the repudiation, the complainant approached the Zonal office of the LIC for reconsideration of the matter, but even then, she was not given any relief. She, therefore, filed the consumer complaint in question, requesting for the grant of sum insured under the policy, i.e., Rs.15 lakh alongwith accident benefit amounting to Rs.10 lakh and bonus of Rs.97,500/- with interest @12% p.a. etc. In total, the complainant requested for the grant of Rs.32,49,825/- alongwith interest @12% p.a. till final payment of the claim.
The complaint was resisted by the LIC by filing a written reply before the State Commission in which they alleged that the insured was an ethanol-abuser since the last 15 years, but in response to various questions in the proposal form, he replied that he never used alcoholic drinks, narcotics, drinks etc. Since the deceased had withheld correct information about his health habits at the time of filling the proposal form, his claim had been correctly repudiated by them and hence, there was no deficiency in service or negligence on their part. The State Commission after taking into account the rival contentions, allowed the complaint and directed the OP to pay Rs.15 lakh alongwith bonus and other benefits as applicable and also compensatory interest @9% p.a. on the amount so calculated from 03.01.2004 till the date of payment. Being aggrieved against the order of the State Commission, the OP/appellant is before us by way of the present appeal.
During hearing before us, the learned counsel for the appellant has drawn our attention to a copy of medical attendance certificate in respect of the deceased, in which it has been mentioned that he was ethanol-abuser for the past 15 years. The learned counsel for the appellant has also drawn attention to the case summary of the deceased issued by the International Hospital, Guwahati in which it has been mentioned that after his road accident, he was admitted first at Woodland Hospital and diagnosed as a case of post-traumatic acute pancreatitis. He was referred to International Hospital for further treatment, but despite treatment he died on 26.09.2002 due to his illness, i.e., Post traumatic Acute Hemorrhagic, Pancreatitis with Billiary peritonitis, complicated by moderate renal failure, hyporoteinuria, jaundice and electrolyte imbalance. The learned counsel argued that the case summary showed that the death took place not on account of the injuries during accident, but due to his medical condition involving many diseases. Since the deceased had suppressed information about these diseases at the time of taking the policy, he was not entitled to the amount claimed under the policy. The learned counsel has also drawn our attention to medical literature on pancreatitis in support of his arguments. The LIC in their repudiation letter had also stated that he was regular ethanol abuser and he suppressed information about talking alcohol narcotic at the time of obtaining the policy.
The learned counsel for the appellant has drawn our attention to the orders passed by the Hon''ble Supreme Court and this Commission in a number of cases in support of his arguments. In particular, he has drawn attention to the orders in the cases, Mithoolal Nayak vs. LIC of India, 1962 AIR(SC) 814, LIC vs. G.M. Channabasamma, 1991 AIR(SC) 392, LIC & Ors. vs. Asha Goel & Anr., 2001 AIR(SC) 549 and LIC & Anr. vs. Ram Pal Singh Bisen, 1991 AIR(SC) 392. He has also drawn our attention to the order passed by this Commission in "HDFC Standard Life Insurance Co. Ltd. vs. Smt. Jayalaxmi" [RP No. 336 of 2007 dated 04.02.2011], in which it was stated that when there was credible medical evidence of the insured being alcoholic, it amounted to breach of terms and conditions of the policy and hence, the claim was not payable.
The learned counsel for the respondent stated on the other hand that the death of the insured was a result of the motor accident and hence, he was liable to be given the sum assured under the policy. The learned counsel has drawn our attention to a certificate issued by the International Hospital dated 10.01.2004 in which it is mentioned that the cause of death was directly related to the injury caused by the road traffic accident and not due to alcohol. In the final report filed by the police also, it is mentioned that it was ascertained during an inquiry that the case was purely accidental one, as he tried to save himself by diverting the car which dashed against the guard wall. The learned counsel argued that there was no evidence to prove that the deceased was ethanol abuser. The attendant Rajesh Thapa, who accompanied the deceased at the time of admission in the hospital, was not related to the deceased, and hence, he could not have given a wrong statement about his consumption of alcohol. The order passed by the State Commission was, therefore, in accordance with law and should be upheld.
In reply, the learned counsel for the appellant has drawn our attention to order of this Commission in "LIC of India vs. Kusum Patro" [RP No. 1585 of 2011 dated 19.03.2012], saying that even if there was no nexus with the cause of death, the non-disclosure of material information about the medical condition should result in the non-payment of the claim.
We have examined the entire material on record and given a thoughtful consideration to the arguments advanced before us.
It is an admitted fact that the deceased husband of the complainant obtained the life insurance policy in question effective from 25.05.2002 and that he died on 26.10.2002 while undergoing treatment at International Hospital Guwahati, following his injuries in the road accident on 15.10.2002. The basic issue that arises for our consideration is whether the repudiation of claim by the OP, LIC on the ground that he suppressed certain information from them regarding his food habits etc. at the time of obtaining the policy is justified or not. In their reply filed before the State Commission, the OP LIC took the stand that since he died just a few months after taking the policy, the case was investigated and it was found that he had been ethanol abuser for the last 15 years. The State Commission have observed in their order that even if the policy-holder was an ethanol abuser, the cause of death was solely, the road accident and the complications that resulted from it. It is not even the case of the OP that he was under the influence of alcohol while driving the vehicle at the time of accident. Moreover, the term ''ethanol user'' does not lead one to believe that his health condition or mental condition suffered on any account due to such abuse. The Doctor who recorded in the medical attendant''s certificate that he was ethanol abuser for the last 15 years also stated that following the accident, he developed acute pancreatitis and complications. A mere statement in the proposal form that ''he did not consume alcohol'', does not have any relevance with the facts and circumstances of the present case and hence, the repudiation of the claim by the Insurance company on this ground does not seem to be justified.
The medical certificate of death dated 26.10.2002 issued by the International Hospital, nowhere mentions that he was under the influence of alcohol at the time of accident and consumption of alcohol etc. was in any manner concerned with the accident and subsequent complications from which he had suffered.
It is further observed that in their reply filed before the State Commission, the OP LIC made reference to section 45 of the Insurance Act, 1938 saying that the case had been investigated as per requirements of the said section. The facts of the present case show that the deceased died just a few months after taking the policy. It is clear, therefore, that section 45 of the Insurance Act, 1938 is not applicable in the present case. The said section lays down restrictions on an insurance company to repudiate the claim if the death has taken place after the expiry of 2 years from the date of commencement of the policy. In that case, the claim can be repudiated only if there has been fraudulent suppression of material facts which were within the knowledge of the policy-holder. The facts of the present case are entirely different and hence, the authorities cited by the learned counsel for the LIC relating to section 45 of the Act are not applicable in the present case. Even otherwise, even if there was a suppression of fact about intake of alcohol on the part of the deceased, the same had no effect on the outcome of this case because the death has taken place following complications due to injuries suffered in an accident.
The Police report submitted in the case says it categorically that this was a purely accidental case, as the deceased tried to save himself by diverting the car which dashed against the guard wall. As stated already, there is no nexus at all with the cause of death and the eating and drinking habits of the deceased.
In the light of the discussion above, we do not find any valid ground to interfere with the well-reasoned order passed by the State Commission, since there is no illegality, infirmity or jurisdictional error in the same. The present appeal is, therefore, ordered to be dismissed and the impugned order upheld. There shall be no order as to costs.