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NATIONAL CONSUMER DISPUTES
REDRESSAL COMMISSION, NEW DELHI
Honble Mr. Justice V. Balakrishna Eradi, President;
Mr. Justice S.S. Chadha & Mr. S.P. Bagla, Members
LIFE INSURANCE CORPORATION OF INDIA—Petitioner
versus
S. HYMAVATHI—Respondent
Revn. Petn. No. 656 of 1994—Decided on 14.8.1995

Advocates:
Counsel for the Parties :
For the Petitioner:Mr. M.L. Visweshwaraiah, Advocate.
For the Respondent:Mr. Sunil Kumar Reddy, Advocate.

The insurer has the burden of proving that the policy holder made a fraudulent statement or deliberately suppressed material facts in order to repudiate a claim.

Headnote:

INSURANCE - REPUDIATION OF CLAIM - WRONGFUL - INSURANCE ACT, 1938 - SECTION 39 - CONSUMER PROTECTION ACT, 1986 - SECTION 12 - BURDEN OF PROOF - INSURER FAILED TO ESTABLISH FRAUDULENT STATEMENT OR DELIBERATE SUPPRESSION OF MATERIAL FACTS - REPUDIATION NOT BONA FIDE - CLAIM ALLOWED.

Fact of the Case:

The complainant's husband had taken two insurance policies on his own life. After his death, the complainant, as the nominee, filed claims under the policies. The L.I.C. repudiated the claims on the ground that the deceased had withheld correct information regarding his health at the time of effecting the assurance.

Finding of the Court:

The District Forum and the State Commission found that the policy holder had undergone a Mitral Valvectomy operation 15 years back, which was a congenital defect cured by surgery. They also found that the policy holder had worked as a driver for 15 years without any complaints, indicating his good health. They held that the policy holder was not required to disclose the operation that was done 15 years back and that the leave on medical grounds was not related to any heart ailment or serious disease.

Issues: Whether the L.I.C. was justified in repudiating the claims under the insurance policies.

Ratio Decidendi: The burden of proof lay on the L.I.C. to establish that the policy holder had made a statement fraudulently, knowing that the statement was false or there is a deliberate suppression on material facts. The L.I.C. failed to discharge this burden and the act of repudiation was not bona fide.

Final Decision: The Revision Petition was dismissed and the amount deposited by L.I.C. as a condition of stay was ordered to be paid to the complainant.

ORDER

Mr. Justice S.S. Chadha, Member—This Revision Petition has arisen out of the order dated 3.8.94 passed by Andhra Pradesh State Commission at Hyderabad dismissing the appeal of Life Insurance Corporation of India (for short called L.I.C.) and confirming the order dated 15.9.93 of District Forum, Warangal wherein it was held that the claims under the two insurance policies were wrongfully repudiated by the L.I.C. and directing payment of the amount covered by the policies with interest at the rate of 12% per annum.

2. The facts lie in a narrow compass and may be noticed. The Complainant's husband Shri S. Narasaiah had taken two insurance policies on own life, one for Rs. 7,000/- in pursuance of the proposal dated 28/29.3.88 and the second for Rs. 25,000/- in pursuance of proposal dated 23.10.88. The policies issued by L.I.C. are No. 840166220 and No. 880200863 respectively. The assured died on 13.5.91. The complainant who is the nominee under Section 39 of the Insurance Act, lodged two claims under the said policies with L.I.C. By two separate but identical letters dated 22.1.92 L.I.C., repudiated all liability under the policies on account of the deceased having withheld correct information at the time of effecting the assurance regarding his health. The Complainant then filed the complaint under Section 12 of the Consumer Protection Act, 1986 before the District Forum at Warangal (Andhra Pradesh) being C.D. No. 382/92. On being noticed L.I.C. filed its counter reiterating that as the insurance contracts are contracts based on the principles of utmost good faith, there is a responsibility cast on the assured to give full and correct information to the questions contained in the proposal form and as the assured withheld material information and gave wrong answers as to his previous medical history, the claim was repudiated. It is contended that the complaint was not maintainable as the matter was investigated by L.I.C. and considering all aspects their liability was rightly repudiated.

3. Before the District Forum the parties filed affidavits and documents. L.I.C.'s stand is that there is indisputable proof that the policy holder was a known patient of chronic Rheumatic Heart Disease with Mitral Stenosis and Atrial Febrillation and that he underwent Mitral Valvectomy 15 years back and that the policy holder suffered from breathless for about one year before the proposal and was on medical leave for 170 days from 15.5.88 to 31.10.88 but the policy holder failed to disclose those facts in the proposal forms and also during medical examinations. Reliance was placed on the certificate of hospital treatment issued by the Doctors of Apollo Hospital as well as on record of medical leave approved by Andhra Pradesh State Road Transport Corporation. The District Forum as well as the State Commission found that the policy holder underwent a Mitral Valvectomy operation of heart 15 years back and that it must be a congenetal defect cured by undergoing operation, that subsequently the policy holder worked on the tedious and strenuous job of a driver of Andhra Pradesh State Road Transport Corporation vehicle for at least 8 hours a day without any complaint for 15 years and it is an indication of the health of the policy holder. It is for this reason the policy holder said 'NO' against the Column No. 18(b) referring to "high blood pressure, reheumatic fever, pain in chest, breathlessness, palpitation, infarction or any disease of the heart or arteries". Both the District Forum and the State Commission held that on these facts the policy holder need not say about the operation that was done 15 years back. As far as the leave on medical grounds is concerned the District Forum and State Commission came to concurrent finding that no ailment had been mentioned in the leave applications and no medical certificate is produced to show for which ailment assured applied for leave and that in the absence of any medical evidence showing that the policy





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