Decided on April 06,2004

LIC Respondents


- (1.) THE complainant is the appellant who has preferred the appeal against the order dated 3.2.2003 passed by District Forum, Nawadah in Complaint Case No.81/99 where -under the complaint was dismissed.
(2.) THE brief fact of the case is that late Asha Devi mother of appellant No.2 took a life insurance policy for a sum assured of Rs. one lac vide Policy No.511009566 from the L. I. C. -respondent at Nawadah Branch with effect from 28.2.1997. The life assured had filled up the form and deposited the required premium amount which the L. I. C. accepted. The assured had nominated the appellant -complainants as nominee in the proposal form (Annexure -1 ). Asha Devi has joined CRPF as peon on 27.12.1995 and she was found medically fit at the time of joining. She has taken only once medical leave from 2.12.1996 to 5.12.1996 due to excess bleeding in her mensuration period. The assured Asha Devi suddenly died on 22.10.1997 due to cardic respiration failure in operation theatre on the same day when she was admitted in the hospital due to uterine bleeding (Annexure -2 -Postmortem report ). The case of the complainant was that Asha Devi died in the hospital due to medical negligence and Annexure -3 paper cuttings filed in its support. The sons and nominees approached the L. I. C. for the sum assured but their claim was turned down on technical ground alleging that Asha Devi has furnished wrong information in the proposal form and concealed the fact that she was admitted for treatment in CRPR hospital for five days and repudiated the claim on this ground. Asha Devi was literate only read upto Class -VII. She had no knowledge that the fact on excess bleeding once should also be written in the proposal form which she considered as a routine affair for a lady. The complainant has not violated any terms while filling up the proposal form of utmost good faith. The post -mortem report reveals that she died due to cardiac respiration failure rather than due to excessive bleeding in course of mensuration. Therefore, there was no concealment of any serious ailment by the assured in her proposal form nor the concealment of the fact that only once she was admitted for excessive bleeding was intentional or to commit fraud. Such excessive bleeding is normal feature to most of the lady and she never considered it a disease much the less a serious one.
(3.) ON receipt of the notice the O. P. -LIC appeared and its main contention was that as the death of the assured occur within three years the policy and inquiry in the matter by the LIC was required as per rules. It revealed during the inquiry that the deceased has concealed some of the material information and furnished incorrect information in the proposal form. She concealed that she was absent from her office on the ground of health which she was to mention in Column -11 of the proposal form. She also concealed that she was ever admitted in the hospital for treatment. These columns have been answered in negative. She was admitted in the hospital from 2.12.1996 to 7.12.1996 and was on medical leave. This period was subsequently regularized as commuted leave. The L. I. C. has filed the certificate of Asha Devi granted by Chief Medical Officer, CRPF in support of the above contention. She was admitted in the hospital on 22.10.1997 as she had dysfunctional uterine bleeding and on the same day she died. Earlier also as stated above she was admitted in the hospital on 2.12.1996 for excessive bleeding, therefore, her disease for which she was treated earlier was the cause of her death. Therefore, this concealment was material on her part and as per term and condition of the L. I. C. this concealment amounts to claim fraud and violation of the terms of the agreement. As such she was not entitled for the claim of the assured amount. The L. I. C. was justified in repudiating the claim. Other facts as stated on behalf of the complainant had not been denied by the L. I. C. After hearing the parties and considering the material on record the District Forum held that the concealment of her ailment in the proposal form by the life assured was material because she died of the same disease, excessive bleeding for which she was earlier treated in between 2.12.1996 to 7.12.1996. Therefore, the Forum held that the contract was void ab initio and on this basis the complainant were not entitled for the amount assured and further held that repudiation by the L. I. C. was justified. The appellant's learned Lawyer submitted before us that life assured had died after about 10 months of the date of policy. She was on medial leave in between 2.12.1996 to 7.12.1996 on medical ground as she was treated for excessive bleeding and after obtaining fitness certificate from the doctor she joined her service on 8.12.1996. This was the only period when she was treated and hospitalized for excessive bleeding. The excessive bleeding is a common feature in most of the woman and it is never considered a serious ailment. From the post -mortem report as on record, her death was due to sudden cardiac failure and it is further mentioned in it that there is no definite finding of cause of death. It is case of the complainant that the lady doctor who has done D and C was not an expert anaesthetist and due to her negligence she died in operation theatre itself.;

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