Per Shri P.N. Kashalkar, Hon’ble Presiding Judicial Member
The District Consumer Disputes Redressal Forum, Mumbai Suburban passed the order in consumer complaint No.1219/1999 decided on 24/04/2001, whereby the President of the District Consumer Forum dismissed the complaint, one lady member allowed the complaint and directed to pay to the consumer a sum of `1 Lakh with bonus and interest @ 12% p.a. to be paid to the complainant within 60 days and third member also concurred with the judgement of lady member and also allowed the complaint. As such org. opponent/LIC has filed this appeal.
2. The facts to the extent material may be stated as under :-
Shri Kirtikumar Manilal Sanghavi had taken insurance policy from LIC for a sum assured of `1 Lakh. It was life assured policy and complainant- Smt.Chandrika Kirtikumar Sanghavi was nominee of the said policy. Deceased Kirtikumar M. Sanghavi died and as such claim was lodged by the complainant who was widow of the deceased. She had submitted all the requisite documents for settlement of death claim of `1 Lakh. LIC however repudiated the claim on 16/04/1999. She made representation to the Zonal Committee for reviewing the said decision of the LIC. But, her claim was negatived and therefore, she filed consumer complaint against the LIC. Opponent/LIC filed written version and pleaded that deceased husband of the complainant was 40 years at the relevant time. He submitted proposal form for life insurance on 27/03/1997 which was a deal accepted by the Corporation. Since the death claim was early one, the Corporation initiated inquiry. The Corporation called for particulars of cause of death of her husband and on going through the papers, it was discovered that the death of the deceased was primarily due to Septicemia, Acute Renal Failure and Disseminated Coagulopathy with toxic hepatopathy in operated case of intestinal fistula. Secondary cause being Intestinal Gangrene due to superior mesenteric artery thrombosis. The LIC learnt this fact on going through the certificate of hospital treatment where deceased was admitted through casualty on account of vomiting and diarrhoea. Laparotomy was done on 02/03/1998 and it was confirmed that deceased having epilepsy. The opponent pleaded that in the proposal form submitted by deceased assured he suppressed the material information or gave wrong information as to his disease at the time of procuring insurance policy. Deceased was supposed to fill in with true and correct facts and he should have signed it only after understanding its contentions fully. It was also made clear to the deceased assured that any false statement in the information sheet shall disentitle him of any benefit under the said contract of insurance. LIC pleaded that it was the condition of the policy that if any false statement is made in the proposal form, the contract of insurance shall be void and money paid would be forfeited by the LIC. According to the LIC, in proposal form while answering the question as to whether he is suffering from or has ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Lower Blood Pressure, Cancer, Epilepsy, etc., the answer given was in the negative and this was false statement made by the deceased assured and therefore, false statement contained in the proposal form entitled the LIC to treat the contract as void. According to the LIC, contract of insurance is contract of Uberrima fides requiring utmost good faith and life assured was supposed to disclose all material facts concerning to his health and habit while filling proposal form. Since the deceased had suppressed the material facts about his epilepsy, the complainant was not entitled to get any insurance claim. Therefore, it pleaded that it had rightly repudiated the claim.
3. On considering the affidavits and documents placed on record, President of the District Consumer Forum was pleased to dismiss the complaint on the ground that deceased had concealed material fact about his pre-existing ailment and about his operation performed earlier to taking of the policy and also about his epilepsy. As such, President of the District Consumer Forum held that there was no deficiency in service on the part of the LIC and was pleased to dismiss the complaint. But two Learned Members of the District Consumer Forum passed another judgement concurring amongst them inter se and allowed the complaint and directed the LIC to pay a sum of `1 Lakh with bonus along with interest @ 12% p.a. As such LIC has filed this appeal challenging the judgement and award.
4. We heard Mr.Rajiv Chavan, Advocate for the appellant/LIC and Mr.Uday Warunjikar, Advocate for the respondent/org. complainant.
5. We are finding that the Learned Members of the District Consumer Forum has rightly ignored the plea of the LIC/opponent before them because there was no material placed on record by the LIC. The case papers of the Jaslok Hospital were seen by us at page-51 of the appeal paper book. There was certificate of Jaslok Hospital wherein it has been clearly mentioned the past history of epilepsy known for last two years. So, before taking policy as per certificate of Jaslok Hospital for two years there was no epilepsy to the life assured. He had been fully recovered from the epilepsy and that is the reason why the life assured had not disclosed the material fact. One Sapna Health Care Centre, Ghatkopar has issued a certificate on 15/07/1999 where it was mentioned that, “it was certified that Mr.Kirtikumar M. Sanghavi was not suffering from epilepsy or any other medical illness during the course of his medical treatment in this hospital. He was not treated for epilepsy and there was no symptom of epilepsy.” Mere production of certificate from Jaslok Hospital and other hospital by the appellant is not sufficient to prove the contents therein. Doctors who gave certificates have to be examined to prove that particular person was suffering from illness. No affidavit of any doctor has been produced by the appellant/LIC before the District Consumer Forum. Life assured died of Septicemia, Acute Renal failure, Disseminated Coagulepathy with toxic Hepatopathy in operated Intestinal Fistula, Intestinal Gangrene due to superior mesenteric artery thrombosis and it was not related to attack of epilepsy observed by the Learned Members of the District Consumer Forum while allowing the complaint. According to the Learned Members of the District Consumer Forum before issuing policy, the life assured was examined by the Panel doctors of LIC and they found nothing wrong with the health of life assured and therefore, policy was issued. Therefore, they held that the claim was payable to widow particularly when the death was not because of epileptic attack which was allegedly suppressed by the life assured by not disclosing the same in the proposal form.
6. We are of the view that Advocate Mr.Warunjikar is right in submitting that the deceased had not suppressed any material fact deliberately or by way of any fraud on LIC. Deceased had recovered from epilepsy and therefore, he had not disclosed that he was suffering from epilepsy. Moreover, Advocate Mr.Warunjikar rightly submitted that it is the duty of the LIC to prove the fact that the deceased was suffering from so and so disease. He also submitted that Dr.S.K. Bhansali or any other doctor had not given affidavit in support of LIC to prove that deceased was suffering from epilepsy and other ailments which LIC alleged that deceased had suppressed from them while filling in proposal form. Therefore, in our view the order passed by the District Consumer Forum allowing the complaint is appearing to be just and proper and there is no merit in the appeal preferred by the LIC. In our view, the complaint was rightly allowed by the District Consumer Forum in favour of the complainant and same will have to be upheld. As such, we pass the following order :-
-: ORDER :-
1. Appeal stands dismissed upholding the order passed by two Members of the District Consumer Forum.
2. Parties are left to bear their own costs.
3. Copies of the order be furnished to the parties.
Pronounced
Dated 8th August 2011.
