SOMA DEVI Vs. LIC OF INDIA

JUDGEMENT

(1.) THE complainant in this case is a widow of the insured late Shri Druv Singh Andotra who had obtained. "JEEVAN ANAND INSURANCE POLICY" which covered the risk of his life. The "Proposal Form" (Rl) was filled up on 2.1.2003; when already the Insurance Policy had come in operation with effect from 5.12.2002. The insured interest of insured (deceased) was to the extent of Rs. 5 lacs. Unfortunately, the insured died on 11.3.2003 (within a period of 3 months and 6 days) due to heart attack. The complainant being the only legal heir of the insured (deceased) raised the claim on 22.7.2003 which was repudiated on 5.3.2004. Thereafter, the complainant on 29.11.2004 approached Insurance Ombudsman, Chandigarh but the repudiation was confirmed by him on the plea that the insured had failed to disclose the material fact that he had undergone the surgery for removal of 'Gall Bladder'. The case of the complainant is that there was no wilful suppression of any material fact because the entries of the "Proposal Form" were not read over or explained to the insured but only his signatures were taken on the dotted places and entries were got filled up later on through somebody. That OP No. 4 had been acting in proxy for his wife (Smt. Meena Chauhan) who was the recognized Insurance Agent. That OP No. 4 had not obtained any information from the insured but only obtained his signatures on the places tick marked in the "Proposal Form" (Annexure R 1). The reliefs claimed by the complainant are:

(2.) THE claim has been resisted by OP Nos. 1 to 3. In their written version, preliminary objection has been taken to the effect that the insured had not disclosed in the "Proposal Form" that he was suffering from the disease of "Chelethiasis" and had undergone operation of Gall Bladder on 27.4.2002 at Batra Hospital, Jammu. It is a settled law that mis -declaration and the concealment of the material facts by the insured on the Proposal Form which leads the issuance of policy of insurance which is a contract of good faith between the parties (Contract Uberrima Fides) renders the contract as void. Had the insured disclosed full and correct particulars at the time of filling the "Proposal Form", the insurer would have called for special questionnaire regarding the disease of Gall Bladder and would have accepted the "Proposal Form" with extra premium or in the alternative the proposal would have been rejected. It is also pleaded that repudiation of the claim was made with valid reasons and being a speaking order it cannot be challenged in the Consumer Commission but the remedy lies in a Civil Court. On facts, it is admitted that two premium quarterly instalments dated 2.1.2003 and 6.3.2003 in the sum of Rs. 12,294 each were accepted. As it was a case of early death (the insured had died on 11.3.2003) so investigation was necessitated and investigator was appointed. The investigation disclosed that he had gone for operation of Gall Bladder on 27.4.2002. The complaint is not maintainable and requires dismissal.

(3.) THE complainant has appeared as her own witness and examined Surinder Singh Jamwal as a witness. The evidence was tendered on affidavits. In addition, Mrs. Meena Chauhan, wife of OP No. 4, was also examined as a witness on oath. OP Nos. 1 to 3 has examined Shri B.R. Virdi, Dr. K.S. Mehta, Dr. Jeet Raj and Dr. P.R. Sharma as witnesses. The complainant Soma Devi in her deposition has supported the contents of the complaint and in cross -examination has stated that her husband namely, Druv Singh had put his signatures on the "Proposal Form' in her presence. She does not know whether the "Proposal Form" is in Hindi, Urdu or English language. However, she admitted that on 27.4.2002, the insured was operated upon for "Call Bladder" in Batra Hospital. She has shown her ignorance about the agent who had filled the Form but she could recognize the agent if produced before her. Surinder Singh Jamwal witness of the complainant is her son -in -law and has deposed that the insured had put his signatures in his presence on the Proposal Form where there were "tick marks". According to him, the insured was matriculate and knew Hindi, Urdu and English languages. He has also admitted that deceased was operated for Gall Bladder in Batra Hospital, Jammu. The agent had assured in his presence after getting the signatures of the deceased that he would do all the rest of the formalities. That agent never met him again. Mrs. Meena Chauhan witness has stated that she is an authorized agent of OPs 1 to 3 and the Proposal Form in question was filled on the instructions of the insured but she does not remember who had filled the Form. She has admitted that most of the Proposal Forms are filled on her behalf by other persons whom she makes requests to do so. Sometimes those forms are filled by her husband or other persons present in the office or even by passers by. She admits that the Form in question was got filled by her. She admits that no medical test was conducted at the time of filling the Form. The Proposal Form R1 bears the attestation of Dr. P.R. Sharma who was not present at the time of its filling. That she deposited the form in the office only after getting it filled from somebody. The insured had signed the form only after it was filled. She denies the suggestion that only signatures on the Proposal Form were obtained on the columns mentioned for the signatures where tick marks had been put up. In cross -examination; she admits her ignorance that while filling the Form if some serious ailment is disclosed then what is the procedure which is adopted. In the 2nd breath she stated that in case the insured discloses some kind of serious ailment or disease, the insurer calls for special questionnaire as contained in Form No. 3327 and the Insurance Policy is postponed for one year or for getting the medical test. She further stated that in the past she had read Form No. 3327 but it now had forgotten its contents. OPs witness Mr. B.R. Virdi has stated that he had not processed the case in hand but got the record after it was rejected. In cross -examination, he stated that when an agent of the insurer fills the Proposal Form he fills the same not as an agent of insurer but of the insured. A person who is not an agent of the LIC cannot work as an agent. Dr. Jeet Raj has stated that after the death of the insured his relatives approached him for filling of Form No. 3784 and he filled the same on the information supplied by those relatives. Dr. K.S. Mehta, witness of OPs, has admitted that he had operated the deceased in Batra Hospital for the ailment of Gall Bladder. In cross -examination, he has stated that operation of Gall Bladder cold not be the cause for heart attack. Dr. P.R. Sharma has stated that he identified his signatures on Annexure Rl which were marked as Exp. Rl. Rl was filled by Development Officer on the basis of the information supplied to him by the insured. In cross -examination, he admitted that insured had put his signature on Rl in his presence. That Form is filled in order to get family backr ground and physical status of the insured,The insured was physically fit and had no ailment. He has also stated that Form Rl was filled on the information supplied by the insured but no medical test was conducted at that time.