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Judgment
SMT. Meena Mahalawat, the nominee widow of late Shri Vijendra Singh insured, has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (''the Act'') alleging that her deceased husband had obtained Life Insurance Policy Nos. 190376135 for Rs. 70,500/-, 191263842 for Rs. 3,00,000/- and 191263856 for Rs. 4,00,000/- on 14.10.1989, 28.7.1996 and 25.11.1996 respectively, that Shri Vijendra Singh insured died on 28.9.1997 at 11.00 p.m. in S.D.M. Hospital, Jaipur in the course of his treatment for jaundice, that on a joint claim having been filed by her to the O.P. Insurance Company., whereas her claim in respect of Policy No. 190376135 for Rs. 70,500/- was accepted and the sum assured with other benefits thereunder was paid to her on 21.4.2000; her claim in respect of the other two policies, as detailed above, was repudiated on 20.9.1999 on the ground of the deceased having suppressed correct and material facts relating to his health at the time of submitting the proposal forms. She, therefore, claimed, (i) interest @ 18% p.a. for the period from 28.9.1997 to 21.4.2000 in respect of delayed payment of the sum assured and other benefits under Policy No. 190376135; (ii) sum assured with bonus and other benefits under the other two policies with interest @ 18% p.a.; (iii) Rs. 1 lakh as compensation for mental agony and Rs. 25,000/- as cost of litigation.
IN the reply filed by it, the O.P. INsurance Corporation contended that although complainant''s claim under Policy No. 190376135 was false and unreasonable but an amount of Rs. 1,00,000/- was paid to her in respect thereof as ex gratia payment. IN respect to the other two policies, it was averred that since the deceased was a chronic alcoholic much before obtaining such policies and had died of Hepatitis as a result thereof but such a relevant and material fact about his habit and health was knowingly and fraudulently suppressed by him while submitting the proposals in respect thereof, the claim in respect thereto was repudiated in good faith after holding proper inquiry and investigation. We heard the learned Counsels for the parties at length and examined the evidence relied upon by them in support of their respective versions. In our opinion, this complaint should succeed.
A study of the material placed by the parties on our record discloses that the insured was admitted in S.D.M. Hospital, Jaipur on 1.7.1997 on complaints of alcoholic ingestion for the last 10 days and drowsiness for the last three days. His was a follow-up case (FUC) of Alcoholic Hepatitis with acute exaurbalion and Cholelithiasis. He was treated for five days and discharged on 6.7.1997 at 11.00 p.m. Dr. G.R. Singhvi, his medical attendant, declared his condition as "improved". But he was again admitted to the same Hospital on 13.9.1997 on complaints of jaundice for the last three days and hemalopoiesis. He was treated for the same but he expired on 28.9.1997. In his bed head ticket and discharge certificate, it was mentioned that the deceased was reported to be a known case of alcoholic. It is on this observation of the doctors that has made the basis for the O.P. Insurance Corporation for repudiation of the claim of the complainant.
THE consistent stand taken by the complainant filed in her complaint and the supporting affidavit is that the fact that the deceased insured was an alcoholic for the last 20 years had been disclosed by him in the proposal forms, which were filled in by O.P.''s agent. We find that such facts were stated by the complainant in para 6 of the complaint and para 7 of the affidavit. THE O.P. Insurance Corporation did not specifically deny the averments made in para 6 of the complaint. THE additional affidavit was filed disputing and denying the truth in the version of the O.P. Insurance Corporation in their reply. O.P''s conduct of not producing the proposal forms, which by their very nature, were in its possession, and accepting complainant''s claim in respect of Policy No. 190376135, despite the set of facts remaining the same for the purpose of processing and deciding the claim in respect of all the three policies believes the truth in their version. Withholding by a party such a material piece of relevant evidence which could have supported the case of the O.P. Insurance Corporation can reasonably give rise to an adverse inference to be drawn against such party to the effect that if such evidence would have been produced, it would have adversely affected his version. Further, non-explaining by the O.P. Insurance Corporation the circumstances attending upon taking two different views by it of the same sets of evidence in the same facts and circumstances in respect to the same person affords strength to the adverse inference talked of above. Facts in the cases of L.I.C. v. Smt. Laxmi Devi, Appeal No. 2492/97 decided on 11.7.2000, and L.I.C. v. Smt. Pushp Kanwar, Appeal No. 360/97 decided on 3.7.2000, were materially different and distinguishing. Instead, the decision of the Hon''ble Rajasthan High Court in S.B. Civil 1st Appeal No. 62/91, L.I.C. v. Smt. Veerwati Devi, decided on 1.3.2000, fully supports the view we have taken in the facts and circumstances of this case. In view of the above discussion, we hold that the O.P. Insurance Corporation rendered deficient services to the complainant by repudiating her justified claim in respect of Policy Nos. 191263842 and 191263856 for Rs. 3 lakhs and Rs. 4 lakhs respectively.
IN the result, this complaint is partly allowed and the O.P. INsurance Corporation is directed to pay to the complainant the assured sums with bonus and other benefits under Policy Nos. 191263842 and 191263856 with interest @ 9% p.a. from 1.1.1998 within a period of three months from the date of receipt of the copy of this order by it failing which interest would be payable @ 12% p.a. IN addition, the O.P. INsurance Corporation shall further pay a sum of Rs. 5,000/- to the complainant towards cost. Other reliefs, as prayed for in the complaint are denied and refused. Complaint partly allowed.