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2012 Supreme(Ker) 171

High Court of Kerala
S. SIRI JAGAN
P.V. Suresh Palakkad District
Versus
The Insurance Ombudsman, Kochi & Another
WP(C).No. 22679 of 2006 (Y)
Decided on: 16-02-2012

Advocates appeared:
For the Petitioner:T.C. Suresh Menon, Sreekanth. K.R, Jibu P Thomas, Sunil J. Chakkalackal. Advocates.
For the Respondents:Lal George. Advocate.

Headnote:Insurance Act, 1938, Section 45, Constitution of India, Article 226 - For rejection of claim it is not mandatory to prove the statements that are false at the time of assurance -Case decided by ombudsman can be interfered with the writ jurisdiction.

Judgment

1. Aggrieved by the order of the Insurance Ombudsman rejecting the complaint against the repudiation of a claim under a life insurance policy in favour of his deceased wife, the petitioner has filed this writ petition seeking the following reliefs:

"(i) call for the records leading to the passing of Exts.P3 and P5 orders by the respondents and quash the same by the issue of a writ of certiorari or other appropriate writ, order or direction;

(ii) issue a writ in the nature of mandamus directing the second respondent to honour the policy No.773896707 issued in favour of late Lalitha and disburse the amount due thereunder to the nominee, the petitioner herein.

(iii) declare that the reasons stated by the respondents to repudiate the claim put forward by the petitioner is highly unsustainable and vitiated by arbitrariness."

2. The petitioner's wife, Lalitha, took Ext. R2(a) insurance policy dated 28-2-2002, for ` 50,000/- from the 2nd respondent-Life Insurance Corporation of India. She died on account of cancer of the cervix on 9-9-2004. Before her death, she paid 10 quarterly premia amounting to ` 8860/- due on the policy. On the death of the life- assured, The petitioner preferred a claim for the insurance amount as per the policy, which was repudiated by the 2nd respondent on the ground that answers to two questions in the negative as to whether the life-assured had ever been admitted to any hospital or nursing home for general check-up, observation, treatment or operation and whether the life-assured was suffering from or had ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Leprosy or any other disease in Ext. P1 proposal made by the deceased was incorrect, since she had undergone treatment for Rheumatoid Arthritis and had taken treatment for the same in a hospital, from which it is evident that she had made deliberate and fraudulent misstatements and withheld material information at the time of effecting the assurance. The petitioner's complaint against the repudiation was answered by the 1st respondent-Insurance Ombudsman, by Ext. P5 order upholding the repudiation by the 2nd respondent, relying on Section 45 of the Insurance Act, 1938, but by granting an ex-gratia award of ` 5000/- holding thus:

"7. The Point:

Insurance is a contract of "utmost good faith" (Ubberrima Fide) and, more particularly in life insurance, the insurer, in many cases, has to go by what the proponent states about himself/herself in the proposal. From the insurer's point of view, the claim has to be settled within the legal frame work of the insurance contract -taking into account its terms and conditions, its limitations and restrictions. Whereas equity and fair play demand that the claims have to be settled according to the spirit of the insurance Contract rather than its letter, yet technical and social obligations to the entire insuring public demand that the claims have to be investigated thoroughly to detect possible fraudulent claims. It is also worth while to note that a party of full age and understanding is normally bound by his/her averments in the document (proposal form) whether he/she reads it, understands it or not. Equity does not save people from the consequences of their own folly. It is, further, profitable to note the principle that extravagant literality and immoderate folly do not, by themselves, provide a passport to equitable relief (Tufflow Vs. Sperni 1952 (2) TLR 516 at 519).

8. Having said so much about Insurance Contracts in general, this Forum now goes a little deep into the dispute on hand. The policy had commenced in March 2002 and even as far back as in the year 1999, the insured had undergone inpatient treatment at Jubilee Mission Hospital at Thrissur for Rheumatoid Arthritis. The question no.11 and its subsidiaries in the proposal form are very specific and having answered both these questions in the negative and to the advantage of the life assu


























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