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Judgment
Puneet Gupta, J
Sh. Dharub Singh Andotra obtained a Life Insurance Policy “Jeevan Anand” for an amount of Rs.5 lacs vide Policy No. 141353403 and an amount of Rs.12,294/- as first premium for the first quarter was paid by the insured with the proposal form dated 02.01.2003. The second premium was also paid to the Insurance Company vide dated 06.03.2003. The said insured Dharub Singh Andotra died on 11.03.2003 due to heart attack.
The respondent, Soma Devi (now deceased and represented by her legal representative-daughter) wife of the deceased Dharub Singh approached the appellants for realization of the Policy. The claim of the wife of the deceased was rejected which compelled the respondent-claimant to even approach office of the Insurance Ombudsman, Chandigarh for settlement of her claim but the same too was dismissed on 28.01.2005.
The claimant approached the State Consumer Commission for a claim based upon the Policy obtained by the deceased. The claim was contested by the appellants herein. The complaint was allowed by the State Consumer Commission vide Judgment dated 26.11.2010 and the appellants were directed to reimburse the claimant the payment of Rs. 5 lacs along with interest @ 8% per annum from the date of filing of the complaint till the whole awarded amount is paid. The claimant was also held entitled to litigation expenses to the tune of Rs.6000/-.
The grievance of the appellants-Insurance Company is that the deceased, who had obtained the Life Insurance Policy from the appellants did not disclose in the proposal form the fact that he had undergone operation of gallbladder on 27.04.2002 at Batra Hospital, Jammu. The insured failed to disclose all the necessary particulars in the proposal form which he was necessarily required to do so. In case the insured had disclosed all the information truthfully the Policy would not have been issued to the said Dharub Singh. The Consumer Commission had not appreciated the matter in its right perspective and awarded the amount in favour of the respondent No.1.
The learned counsel appearing for the appellants while reiterating the submissions made in the appeal has argued that the deceased was under an obligation to reveal all the details as required in the proposal form truthfully and the concealment of the disease and the operation which he had undergone prior to obtaining of the Insurance Policy deprived the claimant to receive the amount of Rs.5 lacs which was insured for the Policy obtained by the deceased. The deceased had consciously omitted to reveal the facts as required in the proposal form. The deceased being signatory to the proposal form shows that he was aware of the terms and conditions mentioned in the proposal form.
The learned counsel appearing for the respondent No.1 has argued that there is no reason to interfere with the claim allowed by the State Consumer Commission as it had taken all aspects into consideration while allowing the complaint filed by the respondent-claimant. The counsel has taken the court through the evidence in order to impress upon the Court that the proposal form was not filled by the deceased himself and only his signatures were obtained on the same and further that in any case the information sought for in the proposal form was vague and ambiguous one and therefore cannot disentitle the respondent of the claim made before the Commission. The emphatic case of the respondent is that the death of the insured was not related with the operation of gallbladder which he had undergone an year before his death.
The record of the State Consumer Commission is also before the Court.
The Consumer Commission has taken pains on the aspect of filling of the proposal form also while allowing the claim of the claimant. The Commission has particularly taken note of the statements of Meena Chauhan (LIC Agent) who is signatory to the proposal form marked as EXP-MC and Dr. P.R.Sharma who is also signatory to the proposal form and which according to the Commission are contradictory to each other. The bare perusal of the statement of Meena Chauhan reveals that she has not filled the proposal form though signed the same and that Dr. P.R.Sharma was not present at the time of filling of the proposal form. Dr. P.R.Sharma, on the other hand, has also admitted his signatures on the proposal form and has further stated that the Development Officer had filled the proposal form on the basis of the information supplied by the insured. No test of the insured is conducted at the time of filling of the form is also mentioned by the doctor-witness. The Commission on the basis of the contradictory stand taken by the witnesses held that there is no deliberate or willful suppression of the operation of gallbladder by insured which had a grave bearing on the contract of insurance.
The contention raised during the course of argument on behalf of the appellant that as the insured was signatory to the proposal form, therefore, the insured has to be attributed of the information that contained in the proposal form. The submission of the appellant may have some weight but the present case does not rule out that the insured who had retired as plant production mechanic from Agriculture Department may not have been in the know of all the niceties required to be mentioned in the proposal form. Not only the insured has to give correct information but it is also the duty of the insurer to make aware the insured of all the terms and conditions of the Policy so that the insured has also option to agree with the Policy which he intends to obtain from the insurer. On the overall evidence that has come on record and the findings of the Commission, this Court is of the opinion that the Commission has not taken such a view which can stated to be perverse which is required to be upset by this Court.
The main contention of the learned counsel for the appellant is that the insured failed to disclose that he had undergone operation of gallbladder on 27.04.2002 before obtaining the Policy from the appellant-Insurance Company in the month of January, 2003. Had the insured revealed of his medical condition and the operation performed upon him, the insurer might have refused the Policy in favour of the insured. He has referred to Clause 11 of the Proposal Form in this regard.
Learned counsel for the respondents has vehemently argued that the operation of gallbladder had no relation with the cause of death of the insured as he had died of heart attack. The death of the insured had happened due to heart attack is not in question.
The perusal of the record reveals that the statement of Dr. K.S.Mehta has been recorded before the Commission. He had operated Dharub Singh for gallbladder by laparoscopic procedure on 30.04.2002 and was discharged on 01.05.2002. The witness during cross-examination has particularly stated that removal of gallbladder cannot be a cause for the heart attack. The statement of Dr. Jeet Raj, who is signatory to the certificate EXP1 and is the form issued by LIC has not much bearing on the case as the doctor has only filled the form on the basis of information supplied by the family members of the deceased-insured. He has not treated the patient before his death. The doctor in his statement has also deposed that the other cause of death may be gallbladder stone. How come he can make such an assertion in his statement which is otherwise even flippery in nature when he had not otherwise examined the insured. His statement is more of an assertion in air.
The Court is of the view that the reliance placed by the Commission upon the statement of Dr. K.S.Mehta to hold that the cause of death is not relatable to the operation of gallbladder cannot be faulted with. The relation between the nature of operation and the cause of death must apparently co-relate so as to hold that the insured is not entitled to the benefits of the Policy if the insured had otherwise failed to disclose his disease/operation to the Insurance Company while taking the Insurance Policy.
In AIR 1991 SC 392, the Apex Court on facts held that the evidence of the Corporation’s doctors who had certified the good health of the insured at the time of taking out the Insurance Policy and has been examined as defence witnesses, disapproved the case of illness.
In Civil Appeal No. 8245 of 2015 titled “Sulbha Prakash Motegaonkar and ors. v. Life Insurance Corporation of India” decided on 05.10.2015, the Hon’ble Supreme Court held that the death of the insured due to ischaemic heart disease and myocardial infarction had nothing to do with his lumbar spondilitis with PID with sciatica. The court further held that as the concealment was not of such a nature as would disentitle the disease from getting his life insured, therefore, the claim could not be repudiated.
In the case in hand, the appellant has not been able to make out that the operation of gallbladder which the insured had undergone is in any way related to the death of the insured.
In view of the aforesaid discussion, the Court has no hesitation to uphold the order passed by the State Consumer Commission.
The appeal is without merit and is, accordingly, dismissed.
Record of the State Consumer Commission be sent back.