D.P.S. Choudhary, President:
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.
4. The appellants 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.
5. It was further argued on behalf of the appellant that L.I.C. in grab of excused that she has not mentioned about her earlier hospitalization disallowed the claim of the complainant which is not justified in view of several decisions of the National Commission as well as of State Commission. The repudiation by the L.I.C., is in order to debar the claimant (appellant) of their genuine claim and this amounts to deficiency in the service of the L.I.C. The case referred on behalf of the L.I.C Smt. Minu Kalltas case is altogether different fact and the reliance placed on it by the District Forum is bad both in law as well as on fact. In that case the life assured was suffering from cancer and bed ridden which was not mentioned in the proposal form. In the instant case the life assured was hospitalized for a common disorder found in the most of the women, i.e., excessive bleeding and it cannot be considered from any angle as serious ailment which must be mentioned in the proposal form much the less by a semi literate lady. The doctor who examined her never mentioned in the medical form that she was suffering from any serious ailment which she was not suffered at all. It is settled law that non-disclosing of the fact about temporary nature of the disease is not a fraud and material suppression and on this basis the claim cannot be repudiated by the L.I.C. The learned Lawyer of the appellant placed reliance on the decisions of the State Commission, New Delhi in Appeal No. 431/2001 as reported in Upbhokta Sanrakshan case 2002 the copy of which has been annexed. It was also argued on behalf of the appellant that physical fitness is a pre-requisite condition for the appointment in para military force in which the assured lady was employed. At the time of her service she was medically checked upon and was found fit. She was in service since 8.12.1996. She was insured on 28.2.1997. The learned Lawyer of the respondent-L.I.C. submitted before us that during course of inquiry it was found that Asha Devi was hospitalized from 2.12.1996 to 7.12.1996 and this fact has not been denied on behalf of the complainant-appellant. This fact is not mentioned in the proposal form rather in this column the word negative is mentioned. This amounts that life assured has purposely concealed this material fact and subsequently after about 8 months she died from the same disease, i.e., due to excessive bleeding. The concealment of this disease co-related with the disease of her death, as such, it amounts to material concealment and on this ground the repudiation of the claim of the complainant-appellant is justified and as per rule of the L.I.C. The District Forum has rightly held that repudiation of the claim was justified and L..I.C. cannot be held deficient in its service.
6. We have carefully considered the facts of the case which are not in dispute on any material point. Admittedly the life assured Asha Devi was hospitalized from 2.12.1996 to 7.12.1996 for excessive bleeding for which she was treated and subsequently found fit by the doctor and then she joined her duty in CRPF on 8.12.1996. She was employed there as a peon. At the time of employment since 8.12.1996 she has taken leave only once. She was employed after found fit in the medical test. She was in para military force where fitness is a pre-condition for the employment. She died in the hospital on 22.10.1997 on the date when she was admitted for excessive bleeding. She was removed to operation theatre and at the time of operation she died. We have perused the post-mortem report (Annexure-2) where it is mentioned that in the opinion of the doctor who conducted the post-moretem she died due to cardiac respiratory failure and for cause of death no definite opinion could be given. The post-mortem report does not mention that she died due to excessive bleeding nor it mentions that she was suffering from any disease from before. The lady assured was suffering from excessive bleeding from before and admittedly she has not mentioned in the proposal from but we agree with this contention of the appellant that this common disease in the ladies and it was never considered a serious disease unless it leads to some complication. Therefore, we agree with this contention of the appellant that not mentioning this fact in the proposal form was bona fide and it was not a mala fide nor it was intentional. This ailment was not a deadly disease nor it was the cause of her death. It is true that she was removed in the hospital second time for excessive bleeding and the doctor while performing D.S. operation she died in the operation theatre itself. It is said that she was not properly administered anaesthesia. The post-mortem report mentions only sudden cardiac arrest without giving any definite cause of death.
7. After considering these facts and the submissions made on behalf of both the parties we are of the view that the concealment of her hospitalization between 2.12.1996 to 7.12.1996 was not a wilful concealment in order to have some gain from the L.I.C. or she committed fraud while filling the proposal form. This was a common disease found in most of the women and non-mentioning of this disease in the proposal form was only a bona fide act. We do not find substance in the contention of the L.I.C. that this was a material suppression in order to obtain the L.I.C. policy and L.I.C. was justified in repudiating the claim on this ground.
8. In the fact and circumstances, we are of the view that repudiation of the claim of the complainant-appellant is not justified and it amounts to deficiency in service of respondent-L.I.C. Admittedly the policy of the life assured was for a sum of Rs. one lac and the policy was valid since 28.2.1997. She died on 22.10.1997. She has paid the premiums due. In the fact and circumstances, we are of the view that she was entitled for the amount for which she was assured by the L.I.C.-respondent i.e., Rs. one lac. In the fact and circumstances, we come to the finding that impugned order is not in accordance with the facts and in law and is fit to be set aside.
9. In the result, the appeal is allowed. The impugned order is set aside. The appellants who are nominees under the policy of the life assured are entitled for the amount assured, i.e., Rs. one lac with 10% interest from the date of repudiation of the claim till the date of payment which the respondent (L.I.C.) is directed to pay within three months from the date of order.
Appeal allowed.