SENIOR DIVISIONAL MANAGER, L.I.C. OF INDIA vs Jeeto Devi

THIS in an appeal against the order of the learned District Forum, Solan, dated 16.8.93, whereby the appellants (hereinafter to be referred to as the Life Insurance Corporation) has been directed to pay an amount of Rs. 35.000/- to the respondent (hereinafter to be referred to as the complainant) alongwith costs of Rs. 1000/- and also damages of Rs.5000/-.

THE husband of the complainant Smt. Jeet Devi, had got himself insured vide two insurance policies, one bearing No. 160051635 for Rs. 10.000/-and the other bearing No. 160051854 for Rs. 25.000/- i.e., for Rs. 35,000/- in all. THE husband of the complainant, deceased Shri P.C. Saini, was employed as Superintendent in Dr. Y.S. Parmar University of Horticulture & Forestry at Nauni in Solan District and these insurance policies were taken by him somewhere in 1987. Unfortunately, during September, 1988, when he was on official tour to Kinnaur district, he suddenly fell down while crossing the nallah at Sholding Bridge, as a result of which he became unconscious. He was taken to P.G.I., Chandigarh where he died after two days i.e., on 29.9.88. THE complainant, widow of Mr. Saini preferred the claims with the Life Insurance Corporation in respect of aforementioned insurance policies, but, unfortunately the claims on account of these two policies were repudiated by the Life Insurance Corporation on the ground that Shri P.C. Saini, at the time of getting himself insured in 1987, had concealed material facts from the Life Insurance Corporation that he had undergone operation in C.M.C. Ludhiana in 1979. Mr. S. Dixit, learned Counsel for the Life Insurance Corporation has very vehemently argued that Mr. P.C. Saini, at the time when he got hismelf insured with the Life Insurance Corporation in 1987, did not disclose the fact that he had undergone operation in C.M.C., Ludhiana in 1979 with the result that the claim of the insured is untenable as he was supposed to disclose every and all ailments at the time of getting himself insured. We are unable to agree to this contention raised by Mr. Dixit, learned Counsel. It appears that Shri P.C. Saini was operated upon at C.M.C. Ludhiana for Carotid Artery Aneurism in the year 1979. However, the operation was successful and Mr. Saini had been keeping good health and never visited C.M.C., Ludhiana thereafter nor he had any problem concerning this very disease for which he had been operated upon. It has come in the evidence that Mr. Saini was working as Superintendent in Dr. Y.S. Parmar University of Horticulture and Forestry at Nauni, District Solan and he was enjoying good health after having been operated upon for the disease referred to above at C.M.C., Ludhiana. He had been attending the office without any serious ailment and no problem had arisen on account of the aforesaid operation which he had to undergo in C.M.C., Ludhiana in 1979. Further, he did not taken any medical leave during the period of three years prior to September, 1988. It has further come in evidence that Mr. Saini had a fall in Kinnaur district and he became unconscious with the result that he was brought to P.G.I., Chandigarh where he died. The medical treatment which was given to Mr. Saini in P.G.I., Chandigarh does not show that he has died due to same disease for which he had been operated upon in 1979 in C.M.C., Ludhiana. There is no manner of doubt that having regard to the overall circumstances that the deceased had died because of the fall he had in Kinnaur district while he was crossing the Nallah at Sholding Bridge during September, 1988 and as a result of which he became unconscious and he died after two days on 29.9.88 and not because of the disease for which he was operated in 1979.

Mr. S. Dixit, learned Counsel for the Life Insurance Corporation has tried to substantiate by relying upon a document i.e., Medical Attendant''s certificate issued by Dr. L.N. Tripathi, Neuro Surgeon, P.G.I., Chandigarh that Mr. Saini had died because of the problem or the disease for which he had to undergo operation in 1979. This document is at page 59 of the file. This document cannot be taken into consideration for the reason that this has not been produced before the District Forum, as an evidence. This document even before this Commission has been placed on the file without any affidavit and as such cannot be received as an evidence more so when no attempt has been made by the Life Insurance Corporation by means of an application for producing this document as additional evidence. Moreover, this is not an independent certificate issued by the Neuro Surgeon, P.G.I. Chandigarh but it is on the pad/format of the Life Insurance Corporation. Even otherwise, this document does not advance the case of the Life Insurance Corporation as the primary cause for the death is ''CEBEBEROLYCALLAR ACCIDENT".

MR. Dixit, learned Counsel for the Life Insurance Corporation, in order to substantiate his contention has relied upon the authority of the National Commission in a case titled Divisional Manager, Life Insurance Corporation & Others v. Smt. Sunita Sharma, Revision Petition No. 198 of 1993 decided on 10th November, 1993, whereby it has been held that the suppression of material facts in the proposal form disentitles the insured from any amount under the insurance policy. In this case, the deceased had been suffering from mitral stanosis for about 17 years, from breathlessness for 7 years and that about 9 months prior to the submission of the proposal for the issue of the policy he had undergone operation for appendicitis and was on medical leave, but the present case is on different footing and distinguishable. In the present case, after operation in 1979 for Carotid Artery Anearism at C.M.C., Ludhiana, MR. Saini had been enjoying good health and discharging the official duties normally in the Horticulture University and nobody has complained about his ill-health during the intervening period he served in the aforesaid University. On the other hand, the Counsel for the complainant has relied upon the order of the National Commission in case Life Insurance Corporation of India v. Parmeshwari, I (1994) CPJ 319. The National Commission has held that there should be nexus between the ailment and the death. In the present case also, the deceased has died due to fall and not because of the disease for which he had to undergo operation in 1979. The National Commission in Life Insurance Corporation v. Sanjeev Mehendralal Shah, 1996 (1) CPR 129 also has held that the insured is not required to disclose casual ailments not requiring any treatment or consultation with a medical doctor. Sickness, ailment which is required to be disclosed is with reference to serious disorders in health. In view of what is stated above, we have no hesitation to hold that only those material facts which are of decisive importance and have nexus and relevance with the death of the insured can disentitle the insured from claiming the amount under the insurance policy and not otherwise.

IN the result, there is no force in this appeal and the appeal is accordingly dismissed. There is no orders as to costs. Appeal dismissed.