Delhi

StateCommission

A/10/490

BRIJ MOHAN GUPTA - Complainant(s)

Versus

LIC OF INDA - Opp.Party(s)

24 May 2016

ORDER

IN THE STATE COMMISSION: DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

                                                             Date of Decision: 24.05.2016

First Appeal No. 490/2010

(Arising out of the order dated 14.01.2010 passed in Complaint Case No. 1050/2008 by the District Consumer Disputes Redressal Forum-III, 150-151, Community Centre, C-Block, (Behind Janak Cinema), Janakpuri, New Delhi-110058)

In the matter of:

Brij Mohan Gupta

R/o C-4/261, Sector 6

Rohini, New Delhi-110085                                           .........Appellant

 

Versus

 

1. Life Insurance Corporation of India

Through its:

Sr. Branch Manager

LIC of India, Sr. Unit 12-E

Local Shopping Complex, Narain

New Delhi-110028

 

2. Sr. Divisional Manager

LIC of India, Delhi Divn. III

Jeevan Pravah Tower

Distt. Centre, Janakpuri

New Delhi-110058                                            ..........Respondents

                                                                  

CORAM

 

N P KAUSHIK                         -                  Member (Judicial)

 

1.         Whether reporters of local newspaper be allowed to see the judgment? Yes

2.         To be referred to the reporter or not? Yes

 

 

N P KAUSHIK – MEMBER (JUDICIAL)

 

JUDGEMENT

1.     Present appeal is directed against the orders dated 14.01.2010 passed by the Ld. District Forum III, Janakpuri, New Delhi. Vide impugned orders, the complaint filed by the complainant Sh. Brij Mohan Gupta was dismissed.
2.     In brief, complainant’s wife Smt. Santosh Gupta had taken life insurance policy for an amount of Rs. 51,000/- under proposal dated 19.02.2004. She had also taken another insurance policy from LIC (in short the OP) for Rs. 49,000/- vide proposal dated 20.05.2004. At the time of insurance, Smt. Santosh Gupta was medically examined by one Dr. Usha Garg who was on the panel of OP. In November 2004, Smt. Santosh Gupta suffered from jaundice. She was admitted to Maharaja Agrasein Hospital on 14.04.2005. She died on 15.05.2005. OP repudiated the claim vide letter dated 9/12 November 2005 stating as under:

“We may, however, state that the above answers were false as we hold indisputable proof to show that before she proposed for the above policy she was a K/C/O CRF with HTN with ESRD with Hepatitis B & C for which she consulted a doctor and was under treatment since last 2 years. She did not however disclose these facts in her proposal form/personal statement.”

3.     OP while repudiating the claim referred to the declaration made by the deceased Smt. Santosh Gupta in the proposal form. Question and answers as given in the proposal form are reproduced below:

“11(a) During the last five years did you consult a                             No

           Medical Practitioner for any ailment or requiring

           Treatment for more than a week?

 11(b) Have you ever been admitted to any hospital                 No

  or nursing home for general  check up,

  observation, treatment or operation?

 11(d) Are you suffering from or have you ever suffered                    No

          from ailment pertaining to Liver, Stomach, Heart,

 Lungs, Kidney, Brain or Nervous System?

 11(e) Are you suffering from or have you ever                        No

 suffered from Diabetes, Tuberculosis,

 high Blood Pressure, Cancer, Epilepsy,

 Hernia, Hydrocel, Leprosy, or any other Disease?

 11(i) What has been your usual state of health?                      Good”

 

4.     Present complaint was filed by the husband and the nominee of the deceased Smt. Santosh Gupta. Ld. District Forum dismissed the complaint observing as under:

“At the very outset we would like to observe that OP have succeeded in establishing on record that deceased Smt. Santosh Gupta made false declarations in the proposal form regarding her state of health. We have already indicated above the replies given by Smt. Santosh Gupta to Questions No. 11(a) to 11(i) of the proposal forms whereby she declared that her usual state of health was good while the things were later on found otherwise. OP to prove that Smt. Santosh Gupta was a known case of CPF+HTN+ESRD+Hepetitis B & C have placed on record Medical Attendant’s Certificate exhibit OPW1/3 wherein Dr. M.N.Ansari (Gold Medalist) BUMS (DU) had declared that Medical Attendant of Smt. Santosh Gupta declared that he was attending to the deceased for her illness for the last two years and that Smt. Santosh Gupta was suffering from HT since 1996.  This Medical Attendant’s Certificate clearly states that primary cause of death of Smt. Santosh Gupta was Hepatitis B and secondary cause had been Hepatitis C+ renal failure+metabolic Encephalopathy. Then there is Certificate of hospital treatment exhibit OPW1/4 issued by Dr. B.S.Solanki, MD, DM which also confirms the findings of Dr. M.N.Ansari recorded in Medical Attendant’s Certificate exhibit OPW1/3. A copy of the treatment sheet of Maharaja Agrasein Hospital has also been placed on record by OP which has been proved as exhibit OPW1/5. In this death summary it is clearly stated that Smt. Santosh Gupta was a known case of CPF+HTN+ESRD+Hepatitis B & C. It is well known that Hepatitis B & C are both incurable and fatal disease. Then there is a definite declaration in the Death Summary regarding deceased Smt. Santosh Gupta which reads as under:-

“On maintenance Hemo dialysis since past 2 ½ years.”

 

5.     Present appeal has been filed on the grounds inter-alia that the deceased Smt. Santosh Gupta was insured after a comprehensive examination by the Dr. Usha Garg, a doctor in a panel of LIC. Contention of the appellant is that on the day of insurance i.e. 19.02.2004 the deceased was enjoying a good health. Next submission of the appellant is that the deceased fell ill only in November 2004 due to fever, mild blood pressure, vomiting and difficulty in breathing. She was brought to Maharaja Agrasein Hospital on 14.04.2005. She remained under treatment for about one month. She was declared a case of jaundice. She died due to cardiac arrest on 15.05.2005. Submission of the appellant is that the Ld. District Forum fell in error by accepting the death summary, certificate of hospital treatment and medical attendant’s certificate. In relation to the death summary, the appellant submitted that the mention of K/C/O CRF/HTN/ESRD/Hepatitis B and C were added to the summary as a cover from legal angles. Regarding certificate of hospital treatment dated 09.06.2005, appellant submitted that the District Forum wrongly relied upon the certificate issued by Dr. B.S.Solanki MD DM and ignored the answers to the question No. 4a, 4b, 5, 6a, B, C and D from which an inference could be drawn to prove that the deceased was suffering from any ailment prior to the insurance. Referring to the medical attendant’s certificate dated 15.05.2005 (issued by Dr. M.N.Ansari), wherein it is mentioned that the deceased was suffering from ailment much before her death. Date of first consultation was shown as November 2004. Here again appellant referred to the answers to question No. 7,8,9,10 & 11.
6.     Death summary of Smt. Santosh Gupta prepared on 15.05.2005 shows that the deceased was on maintenance Hemo dialysis for the past 2½ years. Clearly, the deceased made false declaration in her proposal form exhibits OPW1/1 and OPW1/2.

In the case of LIC of India vs. Krishan Chander Sharma in Revision Petition No. 1935/1999 decided by the Hon’ble National Commission the claim was repudiated on the grounds that the false information was given while filing up the proposal form. The deceased had given wrong declaration while giving answers to the various questions in writing. In the case of Monika Rani Vs. Life Insurance Corporation and Ors. decided by the Hon’ble National Commission in Revision Petition No. 734/2012 and in the case of Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. IV (2009) CPF 8 (SC), insured was found not entitled to the claim. In the case of Satwant Kaur Sandhu (Supra) it was held that a contract of insurance falling in the category of contract ‘uberrimae fidei’ meaning, a contract of ‘utmost good faith’, on the part of assured, the Hon’ble Apex Court observed that assured is under a solemn obligation to make a true and full disclosure of the information sought for. The obligation to disclose depends necessarily upon the knowledge one possesses.

In the case of Budhiben Pababhai Vs. LIC of India decided by the Hon’ble National Commission in Revision Petition No. 1312/2006, it was held that the endorsement made by the doctor is mostly on the basis of the information provided by the customer.

7.     In view of the discussion above and the case law, I am of the considered opinion that the appeal is devoid of merits. The same is dismissed.
8.     Copy of the orders be made available to the parties free of costs as per rules and thereafter the file be consigned to Records.
9.     FDR, if any, deposited by the appellant be released as per rules.

 

(N P KAUSHIK)
MEMBER (JUDICIAL