NCDRC

NCDRC

RP/1027/2006

LIFE INSURANCE CORP. OF INDIA - Complainant(s)

Versus

SMT. PUTTHAYAMMA - Opp.Party(s)

S.P.MITTAL

01 Apr 2010

ORDER


NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSIONNEW DELHIREVISION PETITION NO. 1027 OF 2006
(Against the Order dated 31/01/2006 in Appeal No. 699/2004 of the State Commission Karnataka)
1. LIFE INSURANCE CORP. OF INDIAJEEWAN BHARATI CONNAUGHT PLACE NEW DELHI 1 ...........Petitioner(s)
Versus
1. SMT. PUTTHAYAMMAR/O 4TH CROSS LEELAVATHI EXTENSION MADDURLIMAR MP 574112 ...........Respondent(s)

BEFORE:
HON'BLE MR. JUSTICE B.N.P. SINGH ,PRESIDING MEMBERHON'BLE MR. S.K. NAIK ,MEMBER
For the Petitioner :NEMO
For the Respondent :NEMO

Dated : 01 Apr 2010
ORDER

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Factual backgrounds are that life assured A.S. Mahendra secured two life insurance policies, one on 16.09.1995 bearing Policy No.721640841 commencing from period 28.09.1995 for Rs.2,00,000/- and other on 28.02.1997 commencing from same date for Rs.75,000/- seeking insurance coverage for his life, from petitioner Corporation. Life assured, however, died on 08.06.1998. When insurance company was moved by wife of deceased who was nominee in both policies, for settlement of claim, insurance company, however, repudiated claim in respect of both policies holding that even though life assured had suffered myocardial infraction, a heart disease, right from 12.08.1995 for which he took treatment in hospital and had also availed leave from his employer, had suppressed these facts while submitting proposal to company. Aggrieved with repudiation of claim, widow moved District Forum, filing a complaint, which putting reliance on hospital treatment records and also affidavits put on record by parties, dismissed complaint holding repudiation of claim by insurance company to be valid. In appeal that was preferred by aggrieved complainant, while claim in respect of first policy bearing No. 721640841 taken on 16.09.1995 was accepted, claim in respect of other policy bearing No. 721686626 taken on 28.02.1997 did not find favour with State Commission. Insurance company seeks to impeach finding of State Commission holding that well reasoned order of District Forum in respect of claim for first policy had not been given due consideration by State Commission. Repudiation of claim of widow in respect of first policy that was taken on 16.9.1995 was made by insurance company, for life assured having suffered blood clot, for which he was treated for AWMI at Mandya during September, 1995. No hospital treatment record, however, was put on record before lower fora about aforesaid treatment of assured in Mandya hospital except, its reference in treatment document issued by Sri Jayadeva Institute of Cardiology (SJIC), Bangalore. It is for this reason that State Commission having taken notice of paucity of evidence suggesting life assured having secured treatment for his illness during September, 1995 in Mandya Hospital that claim in respect of first policy was accepted by State Commission. No eye-brows can be raised for acceptance of assured sum covered by this policy for want of unimpeachable evidence. We are not oblivious that contract of life assured is Uberrima fide i.e. ‘a contract of utmost good faith’ and person seeking insurance is to disclose all material facts relating to state of health having bearing on risk of life sought to be covered by policy of insurance. Rightly such contract would get vitiated if there happens to be non-disclosure or mis-representation of facts which were within his/her knowledge. Inspiration can be drawn from decision of Hon’ble Apex court in case of Mithoolal Nayak Vs. LIC of India - AIR 1962 SC 814 in which the Hon’ble Apex court had occasion to observe that for application of second part of section 45 of Insurance Act, three conditions have to be satisfied, which are reproduced below :- i) The statement must be on a material matter or must suppress facts which it was material to disclose ii) The suppression must be fraudulently made by the policy holder and iii) The policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose. Treatment papers of assured put on record suggest treatment of assured for heart ailment in SJIC, Bangalore during the period of 03.06.1996 to 10.06.1996, 03.08.1996 to 08.08.1996 and 12.11.1997 to 26.11.1997. Since second policy was secured by life assured on 28.02.1997 and he eventually died on 08.06.1998, he was expected to disclose at the time of securing policy for treatment which he received during period of 03.06.1996 to 08.08.1996. Last treatment secured by assured during period of 12.11.1997 to 26.11.1997 was, however, not germane to the issue that being subsequent event after policy was secured on 28.02.1997. However, in respect of first two treatments taken by assured at Bangalore prior to 28.02.1997, there was suppression of material facts as to ‘status of health’ which would manifestly vitiate the contract. There had been affidavit put on record by petitioner Corporation to buttress their contention about assured having taken treatment during aforesaid period. That apart, as assured is shown to have died following heart stroke, in view of the matter also, we notice that cause of death was in close proximity with treatment for disease which he had undergone in SJIC, Bangalore. We find no good reasons to disturb well reasoned findings of State Commission which we accordingly affirm. Revision petition being bereft of merit is dismissed, with no order as to cost. Insurance Company is directed to honour award of State Commission within two months from date of this order.



......................JB.N.P. SINGHPRESIDING MEMBER
......................S.K. NAIKMEMBER