Rajasthan

StateCommission

A/19/2015

Life Ins. Co. Ltd.through Manager - Complainant(s)

Versus

Imran Khan s/o Bholu Khan - Opp.Party(s)

Ashok Chaturvedi

15 Oct 2015

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO: 19/2015

 

Life Insurance Corporation of India,Divisional Office- Jeevan Prakash,Bhawani Singh Road, Post Box No. 65 Jaipur. Through Manager Legal

 

Vs.

 

Imran Khan s/o Late Bholu Khan r/o village Post Karansar Via Rainwal Tehsil Phulera Distt. Jaipur.

 

Date of Order 15.10.2015

 

Before:

Hon'ble Mr.Vinay Kumar Chawla-Presiding Member

Mr.Liyakat Ali- Member

Mr. Kailash Soyal -Member

 

Mr. Ashok Chaturvedi counsel for the appellant

Mr.Basant Saini counsel for the respondent

 

 

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BY THE STATE COMMISSION

 

This appeal has been filed against the judgment of learned DCF Jaipur 2^nd dated 14.11.2014 by which the complaint was allowed.

 

The complainant had submitted a consumer complaint before the learned DCF alleging that the insurance company has repudiated death claim of his father on the ground that his father had suppressed information about his disease at the time of taking the insurance. The learned DCF concluded that the proposal form is generally filled in by the agent. The deceased was an illiterate person and he was barely able to sign in Hindi. It was not proved whether the deceased had been informed of all the columns and information which was being filled in by the agent. Hence it allowed the complaint directing the insurance company to pay a sum of Rs. 2 lakhs as claim alongwith interest @ 9% p.a. The company has filed this appeal against the order of the learned DCF.

 

The learned counsel for the insurance company has submitted that it is a fundamental breach of the policy conditions as the insurance contract is based on utmost food

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faith by the parties and the insurance obtained through fraudulent means becomes void. He has drawn our attention to the proposal form in which the deceased has answered in negative about his previous illness. The learned counsel submitted that on investigation of the death claim the company found that the deceased was suffering from TB since 2007 and had taken treatment. The opposite party has submitted a certificate of TB Unit, Chomu, Jaipur alongwith treatment card of Revised National Tuberculosis Control Programme which proves that he was a patient of TB since 2006 and had taken treatment under the National Tuberculosis Control Programme. The learned counsel has relied on the following judgments: R.P. No. 3794-3796/ 2007 LIC of India Vs. Smt. Anupma and ors. In this case it was held that insured had suppressed material facts regarding his pre-existing disease which eventually led to his death. The repudiation was held to be justified.

 

In II ( 2012) CPJ 272 (NC) LIC of India Vs. Kusum Patro, in this case contention that insured had only signed the proposal form and contents were filled in by someone else was not accepted.

 

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In AIR 2008 SC 424 P.C Chacko Vs. Chairman LIC of India it was held that deliberate wrong answer which has a bearing on the contract of insurance if discovered may vitiated the contract.

 

In III ( 2002) CPJ 56 LIC of India Vs. Ganga Ma and ors., it was held that the deceased had malignancy and had taken treatment, the suppression was proved and claim was rightly repudiated.

 

In II (2014) CPJ 190 (NC) LIC of India Vs. C.Venkataramudu, it was held that sole responsibility of filling complete proposal form is on proposer. It is also the responsibility of proposer to read and understand the forms before signing the same.

 

In R.P. No.4488/2009 LIC of India Vs. Nirmala Babu, it was held that it is not necessary that there must be nexus between the suppression of disease and cause of death.

 

The learned counsel for the complainant has relied on S.45 of the Insurance Act. He has submitted that u/s 45 of the

 

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Insurance Act if the policy has run for two years, the insurer cannot repudiate the claim on the ground of suppression. In this case the policy has run only three days short of two years. He has further submitted that insured was an illiterate person. He barely managed to write his name and all the forms were filled in by the agent in Hindi. There is no evidence of the agent that before filling in the contents he had informed the insured. Thus, there was no mala-fide on the part of the insured. He has relied on the judgment of this Commission reported in I (2012) CPJ 378 LIC of India Vs. Dali Kunwar and another judgment of this Commission reported in II (2012 ) CPJ 19, Tata AIG Life Insurance Vs. Sita Devi and on the judgment of Hon'ble National Commission reported in II (2007) CPJ 242 (NC) LIC of India Vs. Patel Ganesh Bhai, in which it was held that assured was medically examined before issuance of policy, presence of TB was not found at that time, no suppression of material fact, claim wrongly repudiated.

 

We have considered the arguments of the learned counsels and have perused the record. Under section 45 of the Insurance Act, the insurer cannot repudiate the claim if the

 

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policy has run for two years on the ground of suppression of facts. The only exception is if the insurer is able to prove that the fact suppressed was a material one.

 

In the facts and circumstances of this case, it is not disputable that the insured was an illiterate person and he barely managed to sign in Hindi. The proposal form was filled in by the agent. Though the agent Ramesh Chand Sharma has declared on the proposal form that all the contents had been explained to the insured but no affidavit of Ramesh Chand Sharma has been filed by the opposite party. It is a common knowledge that insurance agents are eager to get the insurance proposal through, as the agents get a substantial amount of commission in the first premium. The agents are engaged by the LIC to procure business and are given requisite training for this purpose also. There is every possibility that the insurance agents in order to obtain business and to earn more money by way of commission do not disclose all the facts to the illiterate insurers and the insurance company accepts the proposal on their declaration and ultimately the legal representatives of the deceased suffer for their negligence and dereliction of duty.

 

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Even in this case if we presume that insured had disclosed the fact of his illness to the agent, the agent who had knowledge that this may delay the proposal or ultimately lead to rejection on the ground of illness did not enter the fact of previous illness is possible. We cannot apply the same parameters in case of literate and illiterate insured and deceased has no opportunity to rebut the statement of insurer that agent had explained everything to him. An illiterate person cannot verify that the form has been filled as per his directions. It is incumbent upon the insurance company to verify all these facts at the time of accepting the proposal of the illiterate persons who are not able to go through the proposal form in Hindi or in English. The insured can be held responsible only if he had fraudulently suppressed this information at the time of taking the insurance. The fact of fraudulent suppression is not evident on record. While we go through the papers submitted by the insurance company, first time the insured was diagnosed of TB in the year 2006 and on 23.1.2007 he was fully cured as per the record. There was relapse in 2007 which was also fully cured on 13.12.2007. Again relapse occurred on 16.9.2009 which was also fully cured on 14.6.2010 and again a certificate shows that on 30.5.2011 he was fully cured of this disease. May be in these

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circumstances the insured had not disclosed since he had been cured after taking the treatment or the agent did not mention it for his own interest. Relying upon the printed and formal declaration of the agent will be wholly unsafe. So there is no evidence on record that he fraudulently suppressed these facts to obtain the insurance.

 

In view of this fact we do not wish to interfere with the conclusion arrived at by the learned DCF and the appeal is dismissed.

 

 

(Kailash Soyal) (Liyakat Ali) (Vinay Kumar Chawla)

Member Member Presiding Member

 

 

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