Rajasthan

StateCommission

FA/553/2014

Vishishti Mandal Manager , L.I.C. - Complainant(s)

Versus

Smt. Bhanwari Devi Sharma W/o Late Sh. Ramcharan Sharam - Opp.Party(s)

Prasant Mantri

15 Jul 2015

ORDER

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

 

 

FIRST APPEAL NO: 553 /2014

 

Special Divisional Manager, LIC of India, Jaipur II, A-20 Nangi Plaza, Anita Colony, Near Gandhi Nagar Rly.Station, Jaipur & ors.

Vs.

Smt. Bhanwari Devi Sharma w/o Late Sh.Ramcharan Sharma, 16-A, Chander Nagar, Gurjar Ghati, Amer Road, Jaipur.

 

Date of Order 15.7.2015

 

Before:

Hon'ble Mr.Vinay Kumar Chawla-Presiding Member

Mr.Liyakat Ali - Member

Mrs.Sunita Ranka -Member

 

Mr. Prashant Mantri counsel for the appellants

Mr.Prakash Kaushik counsel for the respondent

 

 

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BY THE STATE COMMISSION

 

This appeal has been filed against the judgment of learned DCF Jaipur 4^th dated 23.4.2014 by which it allowed the complaint.

 

Brief facts giving rise to this dispute are that the complainant's husband took a policy on his life on 28.2.2009. On 3.1.2010 the complainant's husband died of Cardiac Arrest. The complainant filed a death claim with the appellant company under policy no. 197590364. The death claim was repudiated on the ground that complainant's husband had suppressed facts about his health at the time of taking the policy. The appellant company filed its reply before the learned DCF stating that complainant's husband was suffering from Tubercular Arthritis of left ankle joint and Suspecion in lungs and before taking this policy he had taken treatment in SMS Hospital and Santokba Durlabhji Memorial Hospital, Jaipur. The appellant company submitted the medical record of the deceased before the learned DCF. The learned DCF rejected these documents on the ground that pre-existing illness should be proved by submitting affidavits of the concerned doctor as laid down in IV (2011) CPJ 112 and thus allowed the complaint directing the appellant

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company to settle the claim under the policy.

 

The learned counsel for the appellant has argued that the DCF has erred in rejecting the medical records on the ground of non-submission of affidavit of concerned doctor. He has laid reliance on IV (2009) CPJ 8 (SC) ( Satwant Kaur Sandhu Vs. New India Assurance Co. ) in which it was held that reliance can be placed on the medical record of the respondent obtained from the hospital without any affidavit. The learned counsel for the appellant has also placed reliance on 2008 ACJ 456 ( P.C> Chacko & ors. Vs. LIC of India ) in which it was held that the ssured had undergone major operation but he did not disclose it prior to obtaining the policy. The assured was aware of the consequences of making a misstatement of fact and such a person would ordinarily be estopped from pleading that even this fact had been disclosed it would not have made any material difference. Repudiation was held to be justified in that case. The learned counsel for the appellant has also relied on IV (2014) CPJ 658 (NC) ( LIC of India Vs. Neelam Sharma ) in which the assured did not disclose that he was suffering from Amoebic Liver Abscess and the repudiation was held to be justified. In another judgment of the Hon'ble National Commission reported in IV (2014) CPJ 132 (NC) ( Paramjit

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Kaur Vs. LIC of India ) there was deliberate suppression of material facts pertaining to health on part of the life assured. It was held that contract of insurance which is based on principle of utmost good faith gets vitiated and cause of death becomes irrelevant. On the basis of these the learned counsel for the appellant has argued that nexus of the pre-existing disease with the death is not relevant. It is only suppression which is to be considered material.

 

The learned counsel for the complainant has argued that the complainant was suffering from ankle pain since the year 2001 and he had been treated for that and have been totally cured by 2005. The policy was taken in the year 2009. It was not a major disease for the deceased though he felt continuous pain in his left ankle which has been later diagnosed as Arthritis/ Osteoporosis and this was not a cause of death of the deceased.

 

We have considered the respective arguments of the learned counsels.

 

The appellant company has alleged suppression of previous illness. In column no. 11 of the proposal form. Column no. 11 (A) requires the proposer to disclose whether during the

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last five years did he consult any medical practitioner for any ailment requiring treatment for more than a week. Column no. 11 (B) requires the proposer to disclose whether he had been admitted to any hospital for general check up for treatment or operation and column 11 (E) requires the proposer to disclose whether he is suffering from Diabetes, Tuberculosis, High Blood pressure, Low Blood pressure, Cancer, Epilepsy, Hemia, Hydracele, Leprosy of any other disease.

 

The main contention of the learned counsel for the appellant is that the deceased was suffering from Tuberculosis and in column 11 (E) he did not disclose anything about it.

 

We have considered this argument on the basis of the record available on the file and we cannot accept the contention that the deceased was ever suffering from Tuberculosis. The Tuberculosis is generally referred to the disease of lungs but the record does not show any evidence of TB in lungs. Though in the report dated 22.12.2003 Linear shadows in the right upper zone of the lungs was disclosed but no definite diagnosis of TB was made, and appearance seen was suspicious and further Skiagram was advised. The prescription Ex. R 5 also says that he was mainly treated and prescribed for ankle pain. Though

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there was doubts of suspension in lungs but no further treatment was given. The deceased had declined to go for biopsy etc. But it is natural had be been suffering from Tuberculosis or infection in lungs this could have further aggravated. However, he had not taken any treatment. The produced medical record does not say that he was ever treated for Tuberculosis. Though the record says that he was suffering from Tubercular Arthritis in left ankle joint but this problem started almost eight years before he took the policy. He was treated in the year 2003 and Ex. R 9 dated 3.1.2005 says that it was a follow up report of the earlier treatment. Ex. R 10 dated 20.3.2006 also says that he was again advised X-ray of the ankle as a follow up for his earlier treatment. There is no evidence that the deceased was ever admitted in the hospital. Though Ex. R 6 says that he was advised admission in the hospital on 26.12.2003 but it does not prove whether he was ever admitted to the Santokba Durlabhji Memorial Hospital or not.

 

Ex. R 11 which is an admission and discharge record of SMS Medical College and Hospital,Jaipur dated 30.6.2010 states the cause of death of the deceased as chest pain and he had been suffering from this for the last one day only. In view of this we can safely conclude that it was a sudden cardiac arrest

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of which he died. There is no history that he was ever suffering from hypertension or disease of the heard. The pre-existing disease of Tuberculosis Arthritis relates back to six years before the policy was taken.

 

In view of this discussion, we find that the repudiation of claim in this matter is not justified. Ofcourse there is no nexus of death with six years old disease of Tuberculosis Arthritis in Ankle joint which was cured. In the facts and circumstances of the case we do not wish to interfere with the order passed by the learned DCF. The appeal is dismissed.

 

 

(Sunita Ranka) (Liyakat Ali) (Vinay Kumar Chawla)

Member Member Presiding Member

 

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