Tripura

West Tripura

CC/14/21

Smt. Supriya Rani Saha. - Complainant(s)

Versus

Divisional ManagerLife Insurance Corporation of India and others. - Opp.Party(s)

Mr.S.Paul, Mr.S.S.Dutta, Mr.T.Choudhury.

16 Jan 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

    CASE NO:  CC- 21 of 2014
    
Smt. Supriya Rani Saha,
W/o- Lt. Sishu Kumar Saha,
Santinagar, Teliamura,
District- Khowai, Tripura.            ...........Complainant.        
          
         __________VERSUS_________

1. The Divisional Manager,
    Life Insurance Corporation of India,
    Divisional Office Meherpur, Shilchar-15,

2. The Divisional Manager,
    Life Insurance Corporation of the India,
    Division No.1, Agartala,
    District- West Tripura,

3. The Branch Manager, 
    Life Insurance Corporation of the India,
    Teliamura Branch, 
    District- Khowai, Tripura.         .......Opposite parties.
    
                    __________PRESENT__________

 SRI S. C. SAHA
PRESIDENT,
  DISTRICT CONSUMER  DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SHR. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

C O U N S E L

For the Complainant         : Sri Sukumar Pal,
                  Sri Sushanta Dekhar Dutta and 
                  Sri Tanmoy Choudhury,
                  Advocates.
                       
For the O.Ps            : Sri P. K. Debnath,
                  Advocate.
                  

        JUDGMENT  DELIVERED  ON : - 16.01.2014

J U D G M E N T

                This is a complaint U/S 12 of the Consumer Protection Act, 1986 (herein after referred to as 'the Act') filed by the complainant, Smt. Supriya Rani Saha, resident of Santinagar, Teliamura, District- Khowai, Tripura against the O.Ps, namely The Divisional Manager, Life Insurance Corporation of India, Divisional Office, Meherpur, Silchar and 2 others over a consumer dispute alleging negligence and deficiency in rendering service on the part of the O.Ps.

2.        The fact of the case as gathered from the record is that the complainant's husband late Sishu Kumar Saha had taken 2 insurance policies on his own life, one for a sum assured of Rs.2,30,000/- under Jeevan Anand (with profits) with half yearly premium of Rs.7,793/- in pursuance of the proposal No.7596 dated 06.07.10 and the second for a sum assured of Rs.2,50,000/- under LIC's Jeevan Saral(with profits) with premium of Rs.3,062/- in pursuance of the proposal No.25209 dated 21.01.10. Having accepted the proposals, policies issued by the LIC are No-492790367 and No-492712088 respectively. The assured died in Apollo Hospital, Chennai on 19.02.12 within 2 years of commencement of the policies. The complainant, who is the nominee U/S 39 of the Insurance Act, lodged claim under the said policies with LIC. By a letter dated 29.08.13, the LIC repudiated the liability under the policies on account of the deceased having withheld correct information effecting the assurance regarding his health. Hence, this complaint.

3.        The O.Ps contested the case by filing joint written objection. They opposed the claim of the complainant mainly on the ground that as the insurance contracts based on the principle of utmost good faith, there is responsibility cast on the insured to give full and correct information to the question contained in the proposal forms and as the assured withheld the material information and gave wrong answers as to his previous medical history, the claim was repudiated. Further that, the life assured died within 2 years of the commencement of the policies. At the time of taking the policies the life assured was suffering from type II DM(Diabetics Mellinitus) for 15 years. He also under went operation for laproscopic cholecystities and was suspected as CLD before submission of the proposal for the policies. But the deceased suppressed the said illness and gave false declaration with an intent to commit fraud upon the LIC. According to the O.Ps, they rightly repudiated the claim of the complainant for violation of the provisions of Indian Contract Act. It is denied that they were negligent and deficient in rendering service to the complainant.

4.        In support of the case, the complainant has examined herself as P.W.1. No documentary evidence has been adduced by the complainant. The complainant has relied upon the documents filed by the O.Ps.  
        
5.        On the other hand, one Sri Niranjan Bal, Administrative officer of the LIC, Branch No.1, has examined himself as O.P.W. 1 and two others, namely one Sri Madhusudhan Pal and one Sri Sanjib Chandra Roy, both agents of LIC as O.P.W. 2 and 3 respectively as witnesses  of the O.P. side and has proved and exhibited 52 sheets of documents filed vide firisti dated 01.08.14 as Exhibit- A series.        
FINDINGS:
6.        The points that would arise for consideration in this proceeding are;
        (i) Whether the assured with held material facts in the proposal forms dated 06.07.10 and 21.01.10 regarding his pre-existed ailments; 
        (ii) Whether the O.Ps rightly repudiated the claim of the complainant and 
        (iii) Whether the action of the O.Ps are guilty of negligence and deficiency in rendering service.

7.        We have heard the arguments advanced by the learned counsel appearing for the parties. Also perused the pleadings, documents on record, evidence adduced by the parties and the memorandum of written argument filed on behalves of the O.Ps meticulously.

8.        While arguing the case, the learned counsel appearing for the complainant had contended that the policies were issued to the complainant's husband by the LIC after medical examination of the deceased by the authorized medical expert of the LIC. If the deceased was not having sound health, certainly the authorized medical officer concerned would not have certified the deceased to be fit for taking policies. Further that, so called ailment for which the deceased was treated in the Apollo Hospital have no nexus whatever with the cause of death which is stated in the death certificate to have been 'Ischemic Gut Septic Shock MODS'.

9.        On the other hand, it is the case of the O.Ps that while submitting the proposal forms the deceased suppressed the materials facts regarding his previous ailments that before commencement of the policies he had been suffering from diabetes (Type II DM). According to the O.Ps, suppression of material facts and withholding of material information from the LIC alone entitles the LIC to repudiate the claim of the complainant and hence the LIC rightly repudiated the claim of the complainant on the ground of suppression of material facts  in the proposal forms.

10.        From the history sheets of the treatment (exhibit-A series) received by the deceased in Apollo Hospitals with effect from 10.02.12 it appears that he was suffering from diabetes for the last 15 years in the category of Type II DM (Diabetic Mallinitus). This apart, he had undergone operation for laproscopic cholecystities 5 years back and was suspected as CLD. From the medical documents on record it clearly suggests that the deceased was suffering from Type II diabetes long before taking of policies in question. During cross-examination of the O.P.W. 1, Sri Niranjan Bal, no question was put to him by the learned counsel for the complainant disputing the genuinity of the medical documents produced by the O.Ps. In this context, we find no reason to doubt the authenticity of medical documents produced by the O.Ps being received from the Manager, Medical records of Apollo Hospitals. Surprisingly, the complainant has not submitted a single medical document as to the nature of treatment received by the deceased in Apollo Hospitals to controvert the plea of the O.Ps. This smacks of something else. Naturally, an adverse inference can be drawn against the complainant that if the medical documents as to the treatment of the deceased in Apollo Hospitals were produced, her contention would have been proved false. As it appears, the deceased took the policies on 23.2.10 and 6.7.10 and he was admitted in Apollo Hospitals for treatment on 10.2.12. Had he been suffering from diabetes(Type II DM) for the last 15 years as reflected in the medical records, then certainly he was a diabetic patient for more than 12 years before the commencement of the policies. In this circumstance, it can be unhesitantly said that while giving answers to the question no.11 of the 2 proposal forms with respect to his state of health, he suppressed the material fact that he was suffering from diabetes of type II  DM. 

11.        In this connection, it is advantageous here to refer to the decision of the Hon'ble Supreme Court in Satwant Kaur Sandhu Vrs New India Assurance Co. Ltd. as quoted in the decision of the Hon'ble National Commission in Revision Petition No-527/07(LICI Vrs. Francis and Antony D. Souza, it is held that ''It is fundamental principle of insurance law that utmost faith must be observed by the contracting parties. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain from his ignorance of that fact and his believing the contrary.''

        The Hon'ble Supreme Court in Mithoolal Nayak Vrs LIC of India, AIR 1962 SC 814, it is held that ''The principle underlying the explanation to S. 19 of the contract Act is that a false representation, whether fraudulent or innocent is irrelevant if it has not induced the party to whom it is made to act upon it by entering into a contract. We do not think that the principle applies in the present case the terms of the policy make it clear that the averments made as to the state of health of the insured in the proposal from and the personal statement were the basis of the contract between the parties, and the circumstances that Mahajan Deolal had taken pains to falsify or conceal that he had been treated for a serious ailment by Dr. Laxmanan only a few months before the policy was taken shows that the falsification or concealment had an important bearing in obtaining the other parties consent. A man who has so acted can not afterwards turn brown and say: ''it could have made no difference if you had known the truth''. In our opinion, no question of waiver arises in the circumstances of this case, nor can the appellant can take the advantage of the explanation to S. 19 of the Indian Contract Act.'' 

12.        In our opinion,  If a person withholds any information doctor would not know it, unless it is visible. We all know that diabetes is not visible. The mere fact that the medical officer of the LIC of India certified the life assured as good is not of much consequence in view of the false answers to the question 11 in the proposal forms given by the assured.

13.        Having gone through the provision laid down in section 45 of the Insurance Act and also keeping in mind the principles of law enunciated by the Hon'ble Supreme Court in the above cited decisions, we are of the view that the deceased while giving answers to the question no.11 of the 2 proposal forms suppressed the material facts as to his pre-existed ailments of Type II Diabetes. The suppression of material facts in the proposal forms is sufficient to repudiate the claim of the complainant. That being so, we are of the view that the O.Ps did no illegality by repudiating the claim of the complainant and no charge of negligence and deficiency in service is attributable to the O.Ps.

14.        In the result, therefore, the complaint u/s 12 of the Act filed by the complainant is dismissed on contest being devoid of merit. However, we make to order as to the costs.        
            
15.                A N N O U N C E D

 

SRI S. C. SAHA
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

 

SHRI. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM, 
  AGARTALA, WEST TRIPURA.