APPEAL NO: 1091/2008


Postal Life Insurance,

Rajasthan Circle, Jaipur

through Asstt.Divisional Manager.

Opposite party-appellant

Vs.

Smt. Shanti Devi

r/o Near Govt. Hospital Ward no.4,

Khertal, Distt. Alwar.


13.4.2009


Before:


Mr.Justice Sunil Kumar Garg- President

Mrs.Vimla Sethia-Member


Mr.S.S.Hasan counsel for the appellants

Mr.Rajendra Arora counsel for the respondent


This appeal has been filed by the appellants Insurance Co. against order dated 17.5.08 passed by the District Forum, Alwar in complaint no. 660/07 by which the complaint of the complainant respondent was allowed in the manner that the appellants were directed to pay a sum of Rs.50,000/- the amount of the insurance policy alongwith interest @ 9% p.a. from the date of death of the deceased and further to pay Rs.3000/- as amount of costs and if the above amount was not paid within 30 days, the rate of interest would be charged @ 12% p.a.


2. It arises in the following circumstances-

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That the complainant respondent had filed a complaint before the District Forum, Alwar on 11.12.07 inter alia stating that her husband Manoharlal Sharma, now deceased had taken a postal life insurance policy from the appellants for a sum of Rs.50,000/- bearing policy no. RJ 34947 CB and that policy was valid for the period 14.10.05 to 19.10.15. It was further stated in the complaint that after taking the policy, the deceased had developed some problem in liver and he was admitted in the Diamond Hospital, Alwar on 5.12.06 and thereafter he was referred to SMS Hospital, Jaipur where he had died on 6.12.06 and after the death of the deceased claim was preferred by the complainant respondent being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 5.12.07 on the ground that before taking the policy in question the deceased had filled in up a declartion form regarding his health on 11.10.05 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to that , the deceased had taken medical leave prior to taking the policy and since these facts were not disclosed by the deceased in his declaration form on 11.10.05 at the time of taking the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.


A reply was filed by the appellants and they have taken the same pleas which were taken by them in the repudiation letter dated 5.12.07 and it was prayed that


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claim was rightly repudiated by the appellants and complaint be dismissed.


After hearing the parties the District Forum, Alwar

through impugned order dated 17.5.08 had allowed the complaint inter alia holding that -


(i) That since there is nothing on record to prove the fact that prior to filling in up the declartion form

regarding his health on 11.10.05 the deceased had ever taken treatment from any hospital therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.


(ii) That the medical leave papers on which reliance has been placed by the insurance company goes to show that in none of them the deceased had taken medical leave on ground of liver disease and the leave which was taken by the deceased for the period 14.11.06 to 18.11.06 , that was on the ground of liver disease but that too after taking the policy in question.


(iii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.


Aggrieved from that order dated 17.5.08 passed by the District Forum, Alwar , this appeal has been filed by the appellants.


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3. In this appeal the main contention of the learned counsel for the appellants is that before issuance of policy in question, the deceased was suffering from the liver disease and he had remained on medical leave and since these facts were not disclosed by the deceased deliberately in his declaration form on 11.10.05 , therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 5.12.07 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.


4. On the other hand, the learned counsel appearing for the

respondent has supported the impugned order of the District Forum .


5. We have heard the learned counsel for the appellants as well as for the respondent and gone through the entire materials available on record.


6. There is no dispute on the point that the deceased had taken a postal life insurance policy for a sum of Rs.50,000/- bearing policy no. RJ 34947 CB and that policy was valid for the period 14.10.05 to 19.10.15.


7. There is also no dispute on the point that at the time of taking insurance policy , a declaration was made by the deceased and in that declaration on 11.10.05 , he had not mentioned that he


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was suffering from any kind of disease or had taken any treatment from any hospital.


8. There is also no dispute on the point that deceased had died due to liver disease on 6.12.06 meaning thereby within two years of the issuance of the policy.


9. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 5.12.07 on the grounds mentioned therein.


10. On file there are following sickness certificate which shows that the deceased had taken medical leave -


1. For the period from 1.902 to 7.8.02

2. " 7.1.03 to 11.1.03

3. " 2.5.03 to 6.5.03

4. " 10.8.04 to 16.8.04

5. " 14.9.04 to 16.9.04

6. " 20.11.04 to 25.11.04

7. " 13.4.05 to 15.4.05

8. " 31.3.05 to 12.4.05

9. " 19.4.05 to 23.4.05

10. " 25.4.05 to 29.4.05

11. " 22.8.05 to 25.8.05

12. " 2.5.05 to 14.5.05

13. " 23.9.05 to 28.9.05

14. " 21.11.05 to 28.11.05

15. " 15.12.05 to 20.12.05

16. " 9.1.06 to 21.1.06

17. " 27.1.06 to 4.2.06

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18. " 29.3.06 to 1.4.06

19. " 24.4.06 to 28.4.06

20. " 10.7.06 to 18.7.06

21. " 16.9.06 to 21.9.06

22. " 26.9.06 to 29.9.06

23. " 2.11.06 to 11.11.06

24. " 14.11.06 to 18.11.06

25. " 21.11.06 to 2.12.06 etc.etc.


11. From perusing the above certificates it is clear that in all the medical leaves except in the leave which was taken by the deceased for the period 14.11.06 to 18.11.06, case of liver disease was mentioned and in rest of them temporary illnesses were shown.


12. On file there is a discharge slip of Diamond Hospital, Alwar which shows that the deceased was admitted in that hospital on 5.12.06 and on the same day he was referred to the SMS Hospital, Jaipur and there is no dispute on the point that the deceased had died on 6.12.06 in the SMS Hospital and the cause of death of the deceased was liver disease.


13. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.


14. In our considered opinion, so far as the leave taken by the deceased prior to taking the policy are concerned, the diseases which were shown in the certificates were of trivial in nature and

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none of the leave was taken by the deceased on ground of liver disease and the liver disease was detected for the first time when the deceased was under treatment for the period 14.11.06 to 18.11.06.


15. It may be stated here that since in this case cause of death of the deceased was liver disease and that disease had developed after giving the declaration regarding health on the part of the deceased on 11.10.05, therefore, the very basis of repudiation of the claim of the complainant respondent is totally wrong and based on wrong assumption and so far as the medical leaves which were taken by the deceased prior to giving the declaration regarding his health, they show that he was suffering from temporary illness such as fever, cough, cold etc. and if same is not mentioned in the declaration form regarding health on the part of the deceased that would not amount to suppression of material facts regarding health on the part of the deceased in real sense.


16. It may further be stated here that death of the deceased is not connected with the so called temporary illness and the same is connected with the liver disease which had developed after taking the policy in question by the deceased and therefore, from that point of view also it could not be said that it was a case of suppression of material facts regarding health on the part of the deceased.


17. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainant respondent on the ground of suppression of material facts regarding health on the part of the deceased and the findings of the District Forum decreeing the claim of the complainant respondent are based on

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correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity or illegality or perversity and hence, no interference is called for with the same and this appeal deserves to be dismissed on merits.


On point of interest


18. In this case the District Forum has awarded interest @ 9% p.a. from the date of death of the deceased and if the amount was not paidwithin 30 days rate of interest would be 12% p.a.


19. In our considered opinion, the interest @ 12% p.a. as awarded by the District Forum appears to be on higher side and looking to the entire facts and circumstances of the case, we deem it proper to award interest at the rate of 9% p.a. instead of 12% p.a. and that too from the date of filing of the complaint and not from the date of death of the deceased and to that extent, the impugned order of the District Forum is liable to be modified.


Accordingly, this appeal filed by the appellants on merits is dismissed. However, the complainant respondent would get interest on the decreetal amount at the rate of 9% p.a. instead of 12% p.a. from the date of filing of the complaint i.e. 11.12.07 and to the above extent on point of interest , the impugned order of the District Forum,Alwar dated 17.5.08 stands modified accordingly.



Member President