w w w . L a w y e r S e r v i c e s . i n

LIC of India V/S Patel Ganesh Bhai Ramji Bhai


    Decided On, 28 February 2007


    By, MEMBER


Judgment Text

1. This first appeal is preferred against the impugned order dated 30th September, 1998 by the State Commission, Gujarat in complaint No. 130/93 whereby the complaint was allowed and the appellant was directed to pay the policy amount of Rs. one lakh with 12% interest from 1.10.1989 by 30.11.1998 failing which interest from 1.12.1998 would be payable at the rate of 15% till the amount is paid along with amount of Rs. 5,000 towards compensation for unjust and uncalled for harassment and mental torture and Rs. 2,000 towards cost.

2. Brief facts of the case are:

Respondent Patel Ganeshbhai is the brother of late Premjibhai who has taken a life insurance policy No. 831044652 for Rs. one lakh w.e.f. 28.3.1987. The life assured died on 23.5.1988 and the respondent herein being the nominee an

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d real brother made a claim which was repudiated by the appellant vide letter dated 14.3.1991. It is contended by the learned Counsel for the respondent that the policy was taken after the proposal form was filled up with the help and assistance of Insurance agent Dalsangbhai Jitabhai. Thereafter, in the presence of his agent, the life assured was medically examined by the panel doctor - Dr. Manusuri (Exhibit - 16) who after taking the x-ray has given the opinion that the life assured was not suffering from any disease or ailment and was healthy enough for issuing the policy. On the basis of the report submitted by the Insurance Agent and Insurance Panel Doctor, the appellant issued the insurance policy after accepting the premium of Rs. 2,712.50. Regular payment of the premium by the respondent is not under dispute.

The life assured Premjibhai developed some breathing trouble and took some medical treatment from Dr. Raval at Patan. It was diagnosed that his lungs were filled with water and after draining the water with the help of tube there were stitches on the cut made for insertion of the tube which did not heal. Since some septic got developed, Premjibhai was admitted to Civil Hospital for further treatment and was relieved after some minor operation. Thereafter, the stitches once again continued creating problem and Premjibhai had taken treatment from Dr. Karnavat at Palanpur and later he was shifted to Ahmedabad for further treatment by Dr. Tushar Shah where he was operated. Ultimately, he died on 23.5.1998. The respondent informed the appellant after filing all the documents filled in the claim form.

3. Appellant conducted inquiry and informed vide letter dated 14.3.1991 that the claim was repudiated on the ground that Premjibhai has suppressed the material fact that he was suffering from pre-existing disease namely, T.B. since about three months prior to taking the policy.

4. Learned Counsel for the appellant argues that in the certificate of hospital treatment dated 1.3.1991 as filed by one Dr. Vinod Raval of the Bharti Hospital, the following questions have been answered are as below:

4. What, at the time of admission, was (a) the nature of his (a) Pain in chest & complaint? breathlessness. (b) the duration of the (b) Gave history of treatment complaint as reported for... since 6 months. by him? 5. (a) What was the exact (a) Gave a h/o having history reported by the taken Anti T.B. treatment patient at the time of for 6 months C/o pain and admission? healtlessness. (b) Was the history reported (b) by patient, by the patient himself or by some one else? (c) If the history was not (c) -- reported by the patient himself the name and relationship of the person who reported. Was the patient present at the time and was he conscious? (d) To whom was the (d) By my Resident Doctor-- history Reported and by Dr Himanshu Shah, MS whom was it recorded"? (e) Is the doctor to whom (e) Not with the hospital the history was reported/ at present. He is in Bhuj. who had recorded the history still with the hospital and if not give his present address 6. What was the diagnosis Right Hydro... arrived at in the hospital?
5. According to the same certificate, Premjibhai who was 27 years old was admitted in the Bharti Hospital on 21.5.1987 and was discharged on 12.6.1987. Relying on this document, learned Counsel for the appellant argues that the insurance policy is based on good faith, and that the claim was rightly repudiated since life assured did not disclose information regarding treatment of T.B.

6. Learned Counsel for the respondent denied that Premjibhai took any treatment for T.B. and that there was no connection of death of the assured to the alleged treatment of the T.B. as argued by the appellant.

7. Secondly, it is contended that the panel doctor of the appellant- Dr. Manusuri had filed an affidavit (Exhibit-16) dated 10.1.1994 that he examined the x-ray of Premjibhai and gave a medical certificate of fitness after that. It is argued that if T.B. was existed then it would have reflected in the x-ray on the date of examination which is prior to taking the policy.

8. Thirdly, in the cross-examination of Dr. Vinod Raval, he admitted that one Dr. Himanshu Shah was working with him and that writing in the right column was by the said Dr. Shah. It is also further admitted by Dr. Raval that he had no knowledge as to which doctor treated the life assured; from which place; and lastly what kind of treatment was being taken. He had no idea of cause of death of the life assured.

9. We have heard both the parties and perused the record carefully. Firstly, Appellant has failed to inspire confidence on the documents relied by them which are placed by them in Annexure "C"-- specially the certificate of hospital treatment by Dr. Vinod Raval. Since Dr. Raval himself admitted that written note was recorded by Dr. Himanshu Shah who is now not working with the hospital, his certificate cannot be relied upon as this information is not within his personal knowledge as to history of T.B. and treatment of the same. Appellant has not filed affidavit of Dr. Himanshu Shah to prove this point.

10. Secondly, Dr. Manusuri who himself saw the x-ray was a panel doctor of the appellant and he has not found the presence of Tuberculosis during the period of T.B. treatment allegedly being taken by the life assured at the time of certificate of good health given by him before issuing the policy. Panel doctor would have definitely known the presence of T.B. by looking at the x-ray and there is no such averment or admission on record. Learned Counsel for the respondent also argued that LIC agent Dalsangbhai Jitabhai, who actually filled the form after getting the insured medically examined, has also not filed any affidavit to prove that the insured suppressed the disease of T.B. from him.

11. In our view the history record filed by Dr. Himanshu Shah which has been relied upon by the appellant is neither supported by any corroborative evidence in the form of affidavit nor does it prove that the said treatment has any nexus to the cause of death. The medical condition of Premjibhai is totally different regarding treatment taken by him for which he had been shifted to two or three different doctors /hospitals. We agree with the contention raised by the respondent that the panel doctor of the appellant-Dr. Manusuri could have easily noticed from the x-ray that Premjibhai was suffering from T.B. which he did not do. There is no suppression of material facts as alleged by the appellant and the documents filed are unreliable to prove these contentions taken by them.

12. The last argument of the learned Counsel for the appellant asking for reducing the interest does not also require any change considering this claim was wrongly repudiated in the very first place on flimsy grounds without any substantial evidence.

13. The appeal miserably fails on all the issues and there is no reason for us to interfere with the well reasoned order of the State Commission which allowed the complaint.

14. In the result, the appeal is dismissed with further cost of Rs. 5,000 and appellant to comply with the order of the District Forum within one month from the date of issue of this order.


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