Ritaben G. Modi vs LIC OF INDIA

THE key question involved in this case is, "Whether the suppression of the disease ''epilepsy '', at the time of filling-up the proposal form, before the Life Insurance Corporation, becomes a ground for repudiation of complainant ''s claim? ". The facts of this case are as follows. Ms. Hitel Ben, Daughter of both the petitioners/ complainants obtained two insurance policies, for a sum of Rs. 1,00,000/-each, along with accidental benefit, in the year 2003. Ms. Hitel Ben, expired on 14.04.2005. While she was operating gas stove, fire broke out and she received burns. She was taken to the hospital, where she expired due to burns. The respondents were informed about her death on 27.05.2005. The claim of the petitioners was repudiated on the ''ground '' of ''suppression of epilepsy '', when she obtained the insurance policies.

THE complainants have denied that she had ever suffered from the above said ailment. Complainants also explained that at the time of obtaining the policies, Ms. Hitel Ben was married. In view of some differences, divorce was obtained and the insured was living separately with her parents. That is why, no claim was made by her husband. It was contended that the claim was wrongly repudiated on this point. The parents, under the circumstances, are entitled to get the insurance amount. The District Forum allowed the complaint but the State Commission reversed the said order and dismissed the complaint. However, the State Commission held that, whatever, amount was deposited with the LIC of India, by the deceased, be paid to the Advocate of the complainants, by A/c Payee Cheque, in the names of the complainants, along with interest accrued thereon, if any. Aggrieved by this order, the present revision petition has been preferred.

OUR attention was invited towards the proposal form which was filled in by the deceased. The relevant portion, clause 12(e), is reproduced, as under: - 12. Personal History Answers to be given in yes or no If answer is yes, give full details (a) xxx - - (b) xxx - - (c) xxx - - (d) xxx _ _ (e) Any illness happened or at present in existence for Diabitics, T.B., Blood Pressure (Higher/Lower), Cancer, "Epilepsy ", Hurniya, Coma, Hydropcele, Laprosy? No _

THE respondents, LIC of India has also placed on record, the Medical Attendant ''s Certificate which was completed by the Medical Attendant of the deceased. The same was filled up by Dr. Dinesh S. Chandana, Sheth v. General Hospital and Sheth CM. Hospital, Ahmedabad. Col. No. 6 of the said Certificate mentions that "the deceased was suffering from Epilepsy and Convulsion, off and on, since birth ". The history was reported by the patient ''s relative. It is clear that the non-disclosure of the above said ailment, demolishes the case of the complainants, root and branch. It was the duty of the deceased to answer all the questions, correctly and fairly, so that special care should have been taken by the LIC of India.

THE case of the respondents stands fortified by the authorities reported in Satwant Kaur Sandhu v. New India Assurance Co. Ltd., IV (2009) CPJ 8 (SC)=VI (2009) SLT 338, and in Dineshbhai Chandarana v. LIC of India and Anr., III (2010) CPJ 358 (NC)=First Appeal No. 242 of 2006, dated 27.07.2010 (NC). In Satwant Kaur Sandhu (supra) in Paras 12, 17 & 18 it was held as under : - "12 ... ... ... Nonetheless, it is a contract of insurance falling in the category of contract ''uberrimae fidei '', meaning, ''a contract of utmost good faith, on the part of the assured ''. Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not. Of course, obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known. The obligation to disclose necessarily depends upon the knowledge one possesses. His opinion of the materiality of that knowledge is of no moment. (See: Joel Vs. Law Union &Crown Ins. Co. [1908] 2 K.B. 863). 17. The term "material fact " is not defined in the Act and, therefore, it has been understood and explained by the courts in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the . premium or determining whether he would like to accept the risk. Any fact which goes to the root of the Contract of-Insurance and has a bearing on the risk involved would be "material ". 18. As stated in Pollock and Mulla ''s Indian Contract and Specific Relief Acts, any fact the knowledge or ignorance of which would materially influence an insurer in making the contract or in estimating the degree and character of risks in fixing the rate of premium is a material fact ".

For the foregoing reasons, we find no reason to interfere with the order of the State Commission. The revision petition is; therefore, dismissed, with no order as to costs. Revision Petition dismissed.