29-04-2015 - Heard Mr. Sachin Kumar, learned counsel appearing on behalf of the O.Ps.- appellants- Life Insurance Corporation of India ( LIC for short) on the prayer for condoning the delay of about 81 days in filing this appeal as well on merits.

2.       Regarding the delay he submitted that no true and free copy was ever sent to the appellants. However, it was received by the Branch Manage on 5.12.2014, when he visited the District Consumer Forum in connection with another case and thereafter about one month was taken in the official process.

3.       The statements made in the limitation petition are absolutely vague and general. The appellants were appearing before the learned District Consumer Forum and therefore it cannot be accepted that it learnt about the impugned judgement for the first time only on 5.12.2014.

4.       Thus, there is no proper and satisfactory explanation for the condonation of delay.

5.       Heard Mr. Sachin Kumar also on merits. He submitted that the insured suppressed the materials fact that she was pregnant at the time of taking the policy and therefore the insurance claim was rightly repudiated on that ground.

6.        Mr. Sachin Kumar referred to the prescription dt. 8.2.2007 to show that L.M.P (last menstrual period) was disclosed as 18.12.2006 before the Doctor, whereas in the proposal forms, the insured disclosed the date of last menstruation as 26.12.2006. He further submitted that from the discharge summary dated 10.2.2007, it will appear that  at the time of Medical Termination of Pregnancy (MTP), approximately  10 weeks pregnancy was found,  which shows that the insured was pregnant at the time of taking the policy but she suppressed this material fact.

7.       He further submitted that after about ten months the insured was admitted in hospital on 10.12.2007 for pain in lower abdomen - for six months. She was discharged on 13.12.2007 after treatment of  chronic appendix. Thereafter she was again taken to hospital on 16.12.2007, when she was found dead by the Doctor.

8.       In these circumstances, he submitted that even if there was no nexus between the cause of death and the suppression of the pregnancy, LIC rightly repudiated the claim for suppression of material fact. He relied on certain judgements.

9.       It appears that insured filled up two proposal forms on 7.1.2007 for two policies for Rs. 1, 50,000/- and 5 lacs respectively. The proposal forms dated 11.1.2007 were accepted on 12.1. 2007 and the policies were issued

 It further appears that in the proposal forms filled up on 7.11.2007, the date of last menstruation was mentioned as 26.12. 2006 and in the medical prescription it is written as 8.12.2006. Even if 8.12.2006 is taken as the last date of menstruation, there was a delay of a couple of days in menstruation on 7.11.2007, when the proposal forms were filled. Only by such delay of couple of days, the insured could not know for sure that she was pregnant. It also appears that the insured met with the doctor for termination of her pregnancy on 8.2.2007 i.e. after about a month from the filling up the proposal form. The doctor opined that there was “approx 10 weeks pregnancy”. In our opinion, the LIC could not prove that the insured had knowledge that she was pregnant at the time of taking the policies. Further there is nothing to show that after the insured’s pregnancy was terminated on 10.2.2007, she had any complication in regard.   

It further appears that after about 10 months, she was treated for Chronic Appendicitis. Thereafter some complication developed. She was rushed to the hospital on 16.12.2007 where she was found dead.

From these facts and circumstances it cannot be concluded that the insured deliberately suppressed the material fact of her pregnancy at the time of taking the policies

10.     It is relevant to note here that the insured had two other running policies worth Rs. 2 lacs and her husband had several running policies worth Rs. 7.5 lacs at the time of filling up the proposal forms.

11.     The judgments relied by Mr. Sachin Kumar are not relevant in the present case. In the case reported in II  ( 2014)  CPJ  95 ( NC) LIC vs Veena , it was held that, even if committing suicide by the insured had no nexus with the known disease suppressed by him , the LIC could repudiate the claim. In the present case, we have found that LIC could not prove that the insured knew that she was pregnant at the time of taking the policies. For the same reason, the judgement reported in I (2014) CPJ 409 (NC) LIC vs Sangeeta Bhardawaj , it also not applicable. The judgement reported in ( 2009) 8 SCC 315 Satwant Kaur Sandhu  vs New India Assurance Co., it also not relevant as in that case it was found that insured was aware that he was suffering from diabetes as also chronic renal failure and was on regular Heamo- dialysis , which  he suppressed at the time of taking the policies. In that context, it was held that such factors could influence and guide the Insurance Company to enter into a contract of Mediclaim insurance with the insured.

The Hon’ble Supreme has said that the judgements are to be read in the context of the fact situation obtaining in the case and not as statutes.

12.      After hearing, Mr. Sachin Kumar at length we find that even if the delay of about 81 days in filing this appeal is ignored, no grounds are made out for interfering with the impugned judgement. Accordingly this appeal is dismissed.

This matter was heard by the bench consisting of the President and the Member Mr. Ajit Kumar.  After the order was dictated with his consent, Mr. Ajit Kumar had to rush to Bombay for treatment of cancer.  He informed that he may not be available for about a month.  Therefore this order is being pronounced and signed by the President,  Keeping in view the judgement of Hon’ble Kerala High Court dated 25.02.2013, passed in W.P. (C) No.30939 of 2010 (N) - P.K. Jose - vs - M. Aby & Ors.

            Issue free copy of this order to all concerned for information and needful.

            Ranchi,

           Dated:-29-04-2015