Late Shri Sasidharan K.M. obtained an insurance cover from the LIC of India on his life for a sum assured of Rs.15 lakhs.  The proposal for obtaining the life insurance cover was submitted on 29.09.2003 and the policy was issued effective from 04.11.2003.  He died on 07.01.2004 within a few months of taking an insurance cover.  A claim was lodged by the complainants/appellants for payment of the benefit available in the insurance cover by the deceased.  The claim, however, was repudiated primarily on the ground that the complainant had incorrectly answered the questions contained in the proposal, thereby concealing material facts, and in fact he had met with an accident and had taken treatment from hospital.  It was further stated that in the repudiation letter that the deceased was diagnosed as IVDP L4-L5 tardy ulnar nerve palsy left, Type II diabetes mellitus.

(2)     Being aggrieved from the rejection of the claim, the complainants approached the concerned State Commission by way of Consumer Complaint.  In the said complaint, they impleaded the Development Officer as OP-5 and the agent Mr. K.M. Abdul Asharaf as OP-6.  The complaint was filed against the LIC and its officers being the concerned Zonal Manager, Senior Divisional Manager and Branch Manager.  The Development Officer filed written version before the State Commission.  The agent Mr. K.M. Abdul Asharaf did not file a written version contesting the complaint.  It was inter-alia stated in the written version filed by the Development Officer before the State Commission, that the deceased who was a PWD contractor had knowledge of English and that he (the agent) had personally enquired and collected all the details required to fill-up the application form from the deceased himself and then asked him to put his signatures.  He denied that the deceased has disclosed of his personal details including state of his health to him and the Development Officer.  He also denied that the application form was not read over and explained to the deceased and that the deceased has signed the form on the assurances given by him.  He also supported the repudiation of the claim by the insurer.  The State Commission having dismissed the Consumer Complaint.  The complainants/appellants are before this Commission by way of this appeal. 

(3) The Medical Disability Certificate issued by the Department of Orthopaedics, Medical College, Trichur on 16.07.2003 to the extent the said certificate is relevant, reads as under:

“I Dr. Jayakumar.M Asst professor of Orthopaedics Medical college hospital Thrissur herebycertify that on 16.07.2003 I have personally examined a male person by name Sasidharan 41 years S/o Madhavan Kallepilly house, Vellanikara post, Trichur district and assessed his permanent physical disability said to have following the injuries sustained in a road traffic accident.

As per the medical records he was admitted at Medical College hospital Thrissur on 06.03.2002 following a fall from a bike and sustained an acute low backache which was diagnosed as intervertebral disc prolapse and that was proved by a magnetic resonance imaging.  He was treated with pelvic traction and other supportive measures.  He was discharged from Medical College Hospital Thrissur on 01.04.02 and then periodically reviewed as an out patient.

He was then admitted in Medical college hospital Trivandrum on 03.04.2002 with the same problems and discharged on 06.04.2002.

On 17.04.2002 he was admitted with backache radiating to right lower limb.  He was treated with bed rest analgesics and other supportive measures and discharged on 26.04.2002.

His present complaints are difficulty in standing, climbing the stairs and uphill.  He is also having loss of sensation on the dorsum of the right foot.

The examination findings are given below:

1. Tenderness over the L4 L5 andL5 S1.

2. Straight leg raising test is positive for 30 degrees.

3. Extensor halluces muscle is grade 3 power right side.

4. Ankle jerk is absent in the right side.

5. Movement of the spine painfully restricted in all directions.

6. Sensation grossly reduced in the L5 dermatome.

Since his neurological problem is persisting even after more than one year of treatment his problem may be settled with surgery.”

(4) The above referred certificate issued by the Assistant Professor of a Government Medical College clearly shows that the answers given in the proposal form were incorrect.  The said questions and answers given to them are as under:

(5) He had consulted the doctors for ailments requiring treatment for more than one week.  He was admitted to a hospital and he also had disability to the extent referred in the certificate dated 16.07.2003.  He was admitted in Medical College Hospital, Trichur on 06.03.2002 and was discharged from there on 01.04.2002.  He was again admitted in the said hospital on 03.04.2002 and discharged on 06.04.2002.  He was yet again admitted to the hospital on 17.04.2002 and discharged on 26.04.2002.  His numerology problem persisted even taken treatment for more than one year.  Thus, it can hardly be disputed that the deceased had made concealment with respect to the state of his health while seeking insurance cover from the respondent corporation.

(6) The case of the applicant is that the proposal form was filled up by the agent of his own in the presence of the Divisional Officer.  As noted earlier, the Development Officer was impleaded as OP-5 in the Consumer Complaint and had filed a written version denying the allegations made in the complaint.  Even the agent who is alleged to fill up the application form submitted an explanation to LIC in respect of show-cause notice issued to him by the Corporation.  In his response, the show-cause notice, the agent inter-alia stated as under:

“I brought the partly to my branch office and introduced him to out Asst. Branch Manager and Development Officer.  After a long discussion the proposed form was completed in his presence by me and I asked all questions and recorded the answers in the proposal form.  He read all the answers carefully and put his signature in the proposal form.  He had not revealed any information regarding his accident and subsequent treatments taken.”    

(7) It would thus be seen that neither the Development Officer nor the agent supported the case set out in the Consumer Complaint and then mentioned that the information contained in the proposal form was based upon the answers provided by the deceased himself.  It would be pertinent to note here that the deceased was not illiterate, he had studied upon the 10^th standard and he was a PWD contractor.

(8) The Hon’ble Supreme Court in Civil Appeal No.4261/2019—Reliance Life Insurance Co. Ltd. & Ors. Vs. Rekhaben Nareshbhari Rathod held as under:

“Finally, the argument of the Respondent that the signatures of the assured on the form were taken without explaining the details cannot be accepted.  A similar argument was correctly rejected in a decision of a Division Bench of the Mysore High Court in VK Srinivasa Setty V. Messers Premier Life and General Insurance Co. Ltd. MANU/KA/0032/1958 : AIR 1958 Mys 53 where it was held:

Now it is clear that a person who affixed his signature to a proposal which contains a statement which is not true, cannot ordinarily escape from the consequence arising therefrom by pleading that he chose to sign the proposal containing such statement without either reading or understanding it.  That is because, in filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from the insurer to write the answers in the proposal form.

If an agent nevertheless does that, he becomes merely the amanuensis of the insured, and his knowledge of the untruth or inaccuracy of any statement contained in the form of proposal does not become the knowledge of the insurer.  Further, apart  from any question of imputed knowledge, the insured by signing that proposal adopts those answers and makes them his own and that would clearly be so, whether the insured signed the proposal without reading or understanding it, it being irrelevant to consider how the inaccuracy arose if he has contracted, as the Plaintiff has done in this case that his written answers shall be accurate.”

(9) Considering the facts and circumstances discussed hereinabove and in view of the decision of the Hon’ble Supreme Court in Civil Appeal No.4261/2019—Reliance Life Insurance Co. Ltd. & Ors. Vs. Rekhaben Nareshbhari Rathod, the view taken by the State Commission does not call any interference by this Commission in exercise of its appellate jurisdiction.  The appeal being devoid of any merit is hereby dismissed.