Decided on August 27,2009

Karuna Verma, Wd/O Late Sh Gopal Singh Verma Respondents


- (1.) SINCE both these appeals are directed against the order passed by the District Forum, Shimla, passed on 19.1.2009 in Complaint No.290/2005, as such they were heard together and are being disposed of by this common order.
(2.) ADMITTED position as it emerges is that Smt. Karuna Verma, hereinafter referred to as the complainant, filed a complaint against Life Insurance Corporation of India as well as its Divisional Manager at its Shimla Divisional Office, hereinafter referred to as the OPs, alleging therein that her late husband Shri Gopal Singh Verma had obtained a policy in the sum of Rs.5,00,000/ - on 15.1.2002. He died on 4.5.2004 due to head injury as he was going to his fields to reap his crop during the currency of the said Insurance policy. When claim was lodged with the OPs for being indemnified in the sum insured, it was repudiated by them. Ground set out while repudiating the claim was that the complainant had suppressed material information regarding his state of health at the time when he obtained the insurance policy. This complaint was also resisted on the same ground. With a view to justify the repudiation, stand of the OPs was that contract of insurance is based on the doctrine of uberimma fides, therefore since this is a clear cut case of intentional, incorrect statement of material facts with a fraudulent intent so far deceased having undergone medical treatment and having availed medical leave in this behalf is concerned, as such OPs were not liable to indemnify the complainant. At the time of filling -in proposal form before getting insured, deceased was duty bound in law to have mentioned in it regarding his having availed medical leave as also having undergone treatment. Due to suppression of these material facts in the proposal form, policy in question was void ab initio, therefore according to OPs, the repudiation was perfectly justified. However, after hearing the parties, District Forum below has directed the OPs to pay Rs.5,00,000/ - with interest @ 9% per annum from the date of filing of the complaint i.e. 19.10.2005 till its realization besides Rs.2,000/ - as litigation cost. OPs have been directed to comply with this order within 45 days after the receipt of the copy of the same.
(3.) IN the aforesaid background, Appeal No.122/2009 has been filed by the OPs challenging the said order and Appeal No.152/2009 by the complainant for enhancement of compensation on account of non -settlement of her claim within reasonable time , thus causing harassment and mental torture to her. Ops cannot challenge a policy of life insurance after expiry of two years from the date on which it was effected on the ground that statement made in the proposal for insurance or in any report of a Medical Officer, or referee, or friend of the insured, or in any other document leading to the issuance of the policy, was inaccurate or false, unless the insurer like Ops also shows that 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 at the same time he was aware when he made such a statement that it was false or that the suppressed facts was material to disclose. This is the import of Section 45 of the Insurance Act, 1938. Therefore, in order to succeed Ops were duty bound in law to have established by cogent, reliable and legally acceptable evidence that the life assured i.e. the late Shri Gopal Singh Verma was in the knowledge of the facts regarding his state of health after expiry of two years of getting the policy that the inaccurate or false or facts falsely stated was on a material matter and disclosure of such facts was material and at the same time it was fraudulently made. When reference is made to the complaint file, none of these ingredients of Section 45 of Insurance Act, 1938, is made out.;

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