HIGH COURT OF ORISSA
I. M. QUDDUSI, Actg. C. J. AND S. C. PARIJA, J.
KUNI LATA SAHOO
VS.
SENIOR DIVISIONAL MANAGER, LIC OF INDIA, CUTTACK
W. P. (C) No. 3552 of 2003
Decided On: AUGUST 06, 2009
Insurance - Misstatement - Section 45 of the Insurance Act - [Gastritis and Peptic Ulcer] - [Section 45 of the Insurance Act] - The court discussed the application of Section 45 of the Insurance Act, which states that a policy of life insurance cannot be called into question on the ground of misstatement after two years unless the insurer shows that the statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose. The court also referred to various judicial pronouncements to determine the materiality of the facts not disclosed and emphasized that trivial ailments suffered temporarily cannot be construed as fraudulent suppression of material facts to repudiate the contract of insurance.
Fact of the Case:
The widow of the deceased-insured filed a writ petition challenging the action of the Life Insurance Corporation of India (LIC) in repudiating all liabilities under the insurance policy on the ground that the deceased-insured had withheld correct information regarding his health at the time of effecting the insurance policy. The deceased-insured had stated his usual state of health as good and had answered negatively to questions regarding ailments in the proposal form. The LIC repudiated the policy and forfeited all amounts paid by the deceased-insured towards insurance premium.
Finding of the Court:
The court found that the non-disclosure of minor ailments like Gastritis and Peptic Ulcer, which did not affect the life expectancy of the deceased-insured, was not material. The cause of death of the insured was unrelated to the previous ailments, and therefore, the repudiation of the policy and rejection of the claim by the LIC was not proper and justified.
Issues: The issues involved the non-disclosure of the deceased-insured's minor ailments and the application of Section 45 of the Insurance Act.
Ratio Decidendi: The court emphasized that trivial ailments suffered temporarily cannot be construed as fraudulent suppression of material facts to repudiate the contract of insurance.
Final Decision: The writ petition was allowed, and the LIC was directed to pay the sum assured under the policy of insurance to the petitioner.
JUDGMENT
S. C. PARIJA, J.
( 1 ) THE widow of the deceased-insured has filed this writ petition assailing the action of the Life Insurance Corporation of India (for short 'lic') in repudiating all liabilities under the insurance policy bearing No. 580572572 on the ground that the deceased-insured had withheld correct informations regarding his health at the time of effecting the insurance policy with LIC. Accordingly the petitioner has prayed for quashing of the letter of repudiation dated 18-3-1997 (Annexure-6) and to direct payment of the sum assured under the said policy.
( 2 ) THE brief facts of the case is that the husband of the petitioner-Babaji Charan sahoo submitted a proposal for taking a life insurance policy with the LIC, Branch Office, Nimapara, in the district of Puri, on 21-2-1992. The proposal was accepted by the lic on 28-3-1992 and the insurance policy bearing No. 580572572 for an assured sum of Rs. 40,000/- was issued by the LIC in favour of the insured. The insured-Babaji charan Sahoo died on 4-6-1993 at the age of 31 years, leaving behind his wife, a daughter and a son along with his old parents. The death of insured-Babaji Charan Sahoo, as certified by the doctor was due to Viral Encephalitis and Cardio Respiratory arrest. After the death of her husband, the petitioner submitted claim application in he prescribed form along with original Insurance Policy and Death Certificate on 2-7-1993, for getting the sum assured under the policy.
( 3 ) LIC kept the matter pending and after a lapse of about three and half years, the cuttack Divisional Office of LIC, vide their letter dated 18-3-1997 intimated the petitioner that the LIC has decided to repudiate all liabilities under the policy on the ground that the deceased-insured had withheld material informations regarding his health at the time of effecting the assurance with them. It was further mentioned in the said letter that at the time of submitting the proposal for assurance dated 21-2-1992, the deceased-insured had stated his usual state of health as good and that he had not consulted any Medical Practitioner for any aliment requiring treatment for more than a week. Similarly he had answered some other questions in negative as mentioned in the said letter dated 18-3-1997. According to Divisional Office of LIC, the answers given by the deceased-insured were found to be false and the insured had in fact suffered severe Gastritis and pyloric Canal Ulcer with gross deformity for which he had consulted a doctor and had taken treatment only one year before he took the policy. Accordingly, the petitioner was intimated that as the deceased-insured had not disclosed these facts and gave false answers regarding his health at the time of taking the policy, the LIC has repudiated the policy and forfeited all amounts paid by the deceased-insured towards insurance premium.
( 4 ) LEARNED counsel for the petitioner submits that as the petitioner suffered from Gastritis and Peptic Ulcer, which was not a serious disease at all and as the deceased-insured admittedly died of Viral Encephalitis and cardio Respiratory arrest, which had no remote nexus with the ailments which the deceased-insured was suffering prior to taking of the policy, the non-disclosure of such fact cannot be a ground for rejecting the claim. Accordingly it is submitted that LIC has repudiated the claim mechanically and without application of mind.
( 5 ) LEARNED counsel appealing for the LIC, opposite party Nos. 1 and 2, with reference to the counter-affidavit filed submitted that the deceased-insured had withheld material informations regarding his health while submitting the proposal for taking insurance coverage of his life on 21-2-1992. The deceased-insured expired on 4-6-1993. As the claim was an early death claim, an enquiry was made by the LIC for settlement of the claim made by the petitioner. On enquiry, it came to the knowledge of the LIC that the deceased-insured was suffering from Peptic ulcer pr
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