Madhya Pradesh

StateCommission

A/14/256

LIC - Complainant(s)

Versus

SMT.MEENA BAI PATEL - Opp.Party(s)

SH.J.R.GUPTA

30 Nov 2022

ORDER

M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BHOPAL

PLOT NO.76, ARERA HILLS, BHOPAL

                              

                                    FIRST APPEAL NO. 256 OF 2014

(Arising out of order dated 12.12.2013 passed in C.C.No.11/2012 by the District Commission, Narsinghpur)

 

LIFE INSURANCE CORPORATION

OF INDIA, THROUGH BRANCH MANAGER,

BRANCH-NARSINGHPUR,

TEHSIL & DISTRICT-NARSINGHPUR (M.P.)                                                    …          APPELLANT.

 

Versus                

SMT. MEENA BAI PATEL,

W/O LATE JEEWAN SINGH PATEL,

R/O BELKHEDA, POST-KARAKBEL,

TEHSIL & DISTRICT-NARSINGHPUR (M.P.)                                                     …         RESPONDENT.                                  

                                  

BEFORE:

                  HON’BLE SHRI A. K. TIWARI                    :      PRESIDING MEMBER

                  HON’BLE DR. SRIKANT PANDEY             :      MEMBER 

                 

COUNSEL FOR PARTIES :

      Shri Jatin Rohit Gupta, learned counsel for the appellant-LIC.

      None for the respondent/complainant.                                                                             

                                                            

                                                            O R D E R

                                       (Passed On 30.11.2022)

                   The following order of the Commission was delivered by A. K. Tiwari, Member:    

                  The opposite party /appellant has filed this appeal against the order dated 12.12.2013 passed by the District Consumer Disputes Redressal Commission, Narsinghpur (for short the ‘District Commission’) in C. C. No. 11/2012 whereby the complaint filed by the complainant/respondent has been allowed and the opposite party/appellant Life Insurance Corporation of India (hereinafter referred to as ‘LIC’) is directed to pay to the complainant sum insured Rs.50,000/- with interest @10% p.a. from 15.03.2008 till payment. Compensation of Rs.5,000/- along with costs of Rs.3,000/- is also awarded.

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2.                Brief facts of the case are that complainant’s late husband Late Jeewan Singh Patel (hereinafter referred to as ‘deceased-insured’) during his life time on 15.03.2008 had obtained ‘New Bima Gold Policy’ bearing no. 355205526 for sum insured of Rs.50,000/- from the LIC.  During currency of the policy, policy holder died on 30.07.2009 due to heart attack in Nagpur and his wife Smt. Meena Bai Patel, the complainant, who was the nominee, filed an insurance claim along with requisite documents with the opposite party-LIC.  The opposite party-LIC repudiated the claim on the ground that the deceased-insured had concealed the material information regarding pre-existing disease while filing the proposal form for obtaining the insurance policy. The complainant therefore, alleging deficiency in service on part of the opposite party-LIC filed a complaint before the District Commission, seeking relief.

3.                The opposite party resisted the complaint stating that the deceased-insured had given incorrect information in Clause 11 of the proposal form regarding his health and concealed material facts while obtaining the insurance policy as he was suffering from heart & kidney disease before filing the proposal form and also died due to heart & kidney disease. The opposite party-LIC therefore repudiated the insurance claim and while doing so, it has not committed any deficiency in service.

4.                The District Commission vide impugned order holding the LIC deficient in service in repudiating the claim directed the LIC to pay to the complainant sum insured Rs.50,000/- along with interest @ 10% p.a. from

 

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15.03.2008 till payment.  Compensation of Rs.5,000/- along with costs of Rs.3,000/- has also been awarded.  Hence this appeal.

5.                Heard. Perused the record.

6.                Learned counsel for the opposite party /appellant argued that the District Commission has committed illegality and irregularity in passing the impugned order by ignoring the important aspect that the deceased insured had given false answers in the proposal form under the head of ‘Personal History’. The District Commission failed to appreciate the documents submitted by the LIC i.e. the case summary given by Spandan (Heart Institute and Research Centre) Nagpur that the deceased-insured was a known case of Rheumatic Heart Disease with Mitral Stenosis with Mitral Regurgitation with Aortic Stenosis with Aortic Regurgitation with PH. The history given by Care Hospital, Nagpur reveals that the deceased had a poor medical history and was inter-alia having Vascular Heart Disease.  However, the deceased-insured did not disclose the above material facts in the proposal form and entered in the policy contract on false grounds hence the order passed by the District Commission is rather sympathetically than legal and deserves to be set-aside. He relied upon the judgments of the Hon’ble Supreme Court in Civil Appeal No.2776 of 2002 (Satwant Kaur Sandhu Vs New India Assurance Co. Ltd.) decided on 10^th July, 2009

7.                The complainant has filed her affidavit along with 3 documents (C-1 to C-3) i.e policy, death certificate and repudiation letter. The opposite party-LIC has filed affidavit of Shti Sudhakar Mahata, Divisional Manager along with 10 documents.  We carefully observed the proposal form dated 20.02.2008 filled by

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the deceased-insured which is at Page no.33-38 in the record of the District Commission. We find that the LIC has denied the claim of the deceased-insured on the basis of alleged incorrect information given in Clause 11 (a) (b) (d) & (h) at the time of filing up the proposal form, which is as under:

11. Personal History	Answer “Yes’ or “No”	If “Yes” give details
(a) During the last five years did you ever consult a Medical Practitioner for any ailment requiring treatment for more than a week?	NO
(b) Have you ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation?	NO
(d) Are you suffering from or have you ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous system?	NO
(e) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?	NO
(h) What has been your usual state of health?	GOOD

                                                        

8.                Further, ECG report dated 25.08.2008 of Care Hospitals (Page 28) shows “Rheumatic Heart Disease, Severe Mitral Stenosis, Moderate Aortic Stenosis, Moderate Aortic Regurgitation, Mild tricuspid stenosis, Severe pulmonary hypertension, Normal LV systolic function, EF-56% and No clot or vegetation.” Chest Radiogram dated 25.08.2008 of Care Hospitals (Page 29) shows “Mild Cardiomegaly with features suggestive of pulmonary hypertension.” There is case summary dated 30.11.2009 of Spandan Heart Institute and Research Centre (at Page 30) filed by the opposite party-LIC, wherein it is mentioned that “Mr. Jeevanlal Patel Aged 28 yrs, Male, a known case of Rheumatic Heart Disease with Mitral Stenosis with Mitral Regurgitation with Aortic

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Stenosis with Aortic Regurgitation with PH, was admitted to Spandan Heart Institute and Research Centre, Nagpur on 29.07.2009 with history of fever since 15 days not responding to medications.”

9.                In the instant matter, looking at the evidence available in the record of the District Commission, there is no doubt that the deceased-insured was suffering from various illnesses/ailments, regarding which he had taken treatment in different hospitals and had given false information in reply to queries in the column 11 of personal history, while filling up the proposal form, for obtaining insurance policy.  We find that the District Commission has awarded sum insured without specifying and recording the reasons for the same.  On the other hand, from the record it is established that the policy holder (deceased-insured) had given incorrect information and had concealed material facts in order to obtain the insurance policy and therefore the contract of the insurance becomes invalid as per Section 45 of the Insurance Act.

10.               The deceased-insured had received treatment in various hospitals and was a known case of Rheumatic Heart Disease with Mitral Stenosis with Mitral Regurgitation with Aortic Stenosis with Aortic Regurgitation with PH.  Ultimately he died of heart disease. When the opposite party-LIC has rightly repudiated the insurance claim of the deceased-insured as he had suppressed the material facts, the District Commission has erred in allowing the complaint and giving directions to LIC to pay sum insured to the complainant.

 

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10.               Therefore, in view of the above discussion and on the basis of settled law we find that the District Commission has committed irregularity in ordering payment of sum insured to the complainant, when the deceased-insured had suppressed material information while obtaining the policy.

11.               The impugned order deserves to be and is hereby set-aside. This appeal by the appellant-LIC succeeds and is allowed.  However, there is no order as to costs.

                      (A. K. Tiwari)              (Dr. Srikant Pandey)  

              Presiding Member                    Member