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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
Ashok Bhan, President and Vineeta Rai, Member
LIFE INSURANCE CORPORATION OF INDIA AND ANR. - Appellants
Versus
LAXMAN SWAROOP - Respondent
First Appeal No. 665 of 2007 against Order dated 13.9.2007 in Complaint Case No. 80/2000(Hry)/RBT No. 121 of 2007 of State Consumer Disputes Redressal Commission, U.T. Chandigarh
Decided on : 11-01-2013
Mr. Ashok Kashyap, Advocate, for the Appellant; Mr. Narender S. Yadav and Mr. A. Anandan, Advocates, for the Respondent
The main legal point established in the judgment is the requirement for credible evidence to prove pre-existing diseases and the causal link between an event and its alleged consequences in insurance claims.
Headnote:
Insurance - Life Insurance Policy - Evidence Act, 1872, Section 32 - The court discussed the evidence presented by both parties regarding the health condition of the life assured and the cause of her death. The court highlighted the importance of credible evidence in proving pre-existing diseases and the causal link between the accidental fall and death. The court also emphasized the need for verified and confirmed documents to establish pre-existing conditions. The decision was influenced by the lack of credible evidence regarding the pre-existing disease and the absence of conclusive proof linking the accidental fall to the death.
Fact of the Case:
The respondent-complainant filed a complaint alleging deficiency in service by the appellant-Insurance Company for repudiating the claim under a life insurance policy after the death of the life assured. The appellant-Insurance Company contended that the life assured had suppressed material information regarding her health condition and that her death was not caused by the injuries sustained from an accidental fall.
Finding of the Court:
The court found that the appellant-Insurance Company failed to provide credible evidence to prove the pre-existing disease of the life assured and the causal link between the accidental fall and her death. The court set aside the State Commission's order directing the appellant-Insurance Company to pay the entire claim amount but held that the respondent-complainant was entitled to the insured amount of Rs. 3 lakh.
Issues: The issues revolved around the disclosure of material information by the life assured, the cause of her death, and the validity of the claim under the life insurance policy.
Ratio Decidendi: The court emphasized the importance of credible evidence in proving pre-existing diseases and the causal link between the accidental fall and death. It also highlighted the need for verified and confirmed documents to establish pre-existing conditions.
Final Decision: The appellant-Insurance Company was directed to pay the respondent-complainant Rs. 3 lakh with interest and litigation cost, setting aside the State Commission's order for the entire claim amount.
ORDER
Mrs. Vineeta Rai, Member - This appeal has been filed by Life Insurance Corporation of India and another (hereinafter referred to as appellants) being aggrieved by the order of the State Consumer Disputes Redressal Commission, U.T. Chandigarh (hereinafter referred to as State Commission), which had allowed the complaint of Shri Laxman Swaroop (respondent-complainant herein).
Facts:
2. In his complaint before the State Commission respondent-complainant had contended that his wife Smt. Sunita Devi (hereinafter referred to as the life assured) had taken a life insurance policy for an assured sum of Rs. 3 lakh with the maturity date of 7.11.2027. It was a double benefit accident policy and, therefore, as per the terms of the policy in case of death of the life assured, respondent/complainant was to be paid an additional sum equivalent to the sum assured under the policy, if the death was caused solely and directly as a result of an accident. It was further contended that before issuing the insurance policy, thorough inquiries about the health of the life assured had been made by the appellant/Insurance Company and she was also examined by its doctors and found to be in good health. On 15.1.1998 the life assured fell down from the staircase in her own house and sustained serious and multiple injuries, including head injuries. She was immediately taken to City Hospital and Maternity Home, Faridabad, where from she was referred to Dr. Puneet Mittal, Orthopaedic Surgeon, Faridabad on the same day. She, however, died three days later i.e. on 18.1.1998 due to the above serious injuries received by her as a result of her falling down from the staircase. After the death of his wife, respondent/complainant visited the office of the appellant-Insurance Company and informed it about the same and being a nominee of the life assured filed the necessary claim supported by relevant documents. However, even though all the required formalities were completed, the appellant-Insurance Company repudiated the claim vide its letter dated 2.11.1998 by levelling false allegations that the life assured was suffering from Koch's Chest (Tuberculosis) for over one year and she had consulted a medical practitioner for treatment and this important material information was suppressed while taking the insurance policy and, therefore, the appellant-Insurance Company was fully justified in repudiating the claim. Being aggrieved by the repudiation of the claim both on account of the death of his wife as also non-payment of the additional sum as per the double benefit accident clause, respondent-complainant filed a complaint before the State Commission alleging deficiency in service and requested that the appellant-Insurance Company be directed to pay the claim amount of Rs. 6 lakh under the life insurance policy taken by the life assured Smt. Sunita Devi since it was a double benefit accident policy along with interest @ 18% per annum from the date of her death till the date of actual payment to the respondent-complainant and also Rs. 1 lakh as damages and Rs. 11,000 as litigation cost.
3. Appellant-Insurance Company on being served filed written statement refuting these charges. It was contended that the contract of insurance being one of uberrima fides' i.e. contract of utmost good faith, the life assured was legally bound to disclose all material facts, including the status of her health, which she failed to do. On the other hand, as per information available from the City Hospital and Maternity Home, Faridabad dated 29.4.1997, it was clearly established that the life assured had been admitted in that hospital for medical complaints, which included Koch's Chest i.e. Tuberculosis. Therefore, appellant-Insurance Company was fully justified in repudiating this claim as per conditions of the insurance policy. Apart from this, it was further submitted that her death was not caused because of any injuries that she sustained when she fell down from the staircase, a
