NATIONAL CONSUMER DISPUTES REDRESSAL
COMMISSION
NEW DELHI
REVISION PETITION NO. 3138 OF
2003
(Against the order dated
20.1.2003 in Appeal No.1335/02 of the
State Commission, Bhopal, M.P. )
Life Insurance Corporation of India (LIC) ........ Petitioners
Northern Zone Office
New Delhi
Live Insurance Corporation of India
Jeevan Bharti
Connaught Circus
New Delhi 110001.
Regional Manager
Life Insurance Corporation of India
Central Zonal Office
Hoshangabad Road
Bhopal
Vs.
Smt. Chandra Kanta Lohande ........
Respondent
W/o Late Shri Kanti Kumar Lokhande
R/o Bay Bridege Office, Near WCL
Ward No. 12, Junardev
Tehsil Junardev
District Chindwara
REVISION PETITION NO. 3139 OF
2003
(Against the order dated
21.1.2003 in Appeal No.1335/02 of the
State Commission, Bhopal, M.P. )
Life Insurance Corporation of India(LIC) ........ Petitioners
Northern Zone Office
New Delhi
Live Insurance Corporation of India
Jeevan Bharti
Connaught Circus
New Delhi 110001.
Regional Manager
Life Insurance Corporation of India
Central Zonal Office
Hoshangabad Road
Bhopal
Vs.
Smt. Chandra Kanta Lohande ........
Respondent
W/o Late Shri Kanti Kumar Lokhande
R/o Bay Bridege Office, Near WCL
Ward No. 12, Junardev
Tehsil Junardev
District Chindwara
BEFORE:
HONBLE JUSTICE MR. M.B. SHAH,
PRESIDENT
HONBLE MRS. RAJYALAKSHMI RAO, MEMBER
HON'BLE
DR. P.D. SHENOY, MEMBER
For the Petitioners : Mr.
S.P. Mittal with Ms. Meghna,
Advocates
For the Respondent : Ms. Kanchan Kaur Dhodi, Amicus Curiae
Dated
the 26th March,
2008
ORDER
DR P D
SHENOY, MEMBER
The issue to be decided
in this case is whether dyspepsia imperfect or painful digestion - is a
disease, which has to be mentioned in the proposal form of the LIC? Simple answer to the question is NO as
dyspepsia is not a disease in itself.
Further, in this matter, the main ground of repudiation is that the assured did not disclose the aforesaid disease he was suffering from. In support, it was stated that assured had taken medical leave. Western Coal Fields is a government owned public sector undertaking. In government departments and undertakings employees have the habit of exhausting all types of leave like casual leave, medical leave and earned leave. The first casualty is casual leave, which is exhausted first, then medical leave, which cannot be accumulated beyond a particular limit nor it can be encashed. Hence, they are liberally taken. But that should not be used as a ground for arriving at a conclusion that assured was suffering from some serious ailment, which required notice.
Facts of the case in brief are that Kantikumar S/o Govindrao Lokhande had obtained life insurance policy for an assured sum of Rs.50,000/- with a quarterly premium of Rs.1,404/- with the date of commencement as 28.3.1992. The widow of the insured submitted a claim, which was repudiated by the LIC. Denying the liability, LIC stated that assured did not pay premium instalments after September 1993 and policy was in a lapsed condition for three years without acquiring paid up value. According to LIC the assured got the policy revived by paying 12 instalments from December 1993 to September 1996 and submitted wrong information regarding state of his health duly signed on 31.12.1996. The assured was a chronic patient of Dyspepsia since May 1995 and was under regular treatment as an outpatient. LIC submitted the certificate issued by the employer incharge of Western Coal Fields, according to which, the assured availed medical leave for 7 days in the year 1993, 12 days in the year 1994, 9 days in the year 1995, 8 days in the year 1996 & 13 days in the year 1997 for his treatment as an out door patient. On the basis of these submissions of LIC, the complaint was dismissed by the District Forum.
Dissatisfied by the order
of the District Forum, the complainant filed an appeal before the State
Commission. The State Commission held
that the amount deposited by the assured i.e. Rs.19,498/- deserved to be returned
by the LIC to the poor helpless widow.
Accordingly, the LIC was ordered to return the amount to the complainant
with 9% interest p.a. from the date of the order. Operative part of the order of the State
Commission reads as follows:
We are of the view that the amount deposited by the life assured of
Rs.19,498/- deserves to be returned by the LIC to the poor helpless widow. In view of this the LIC is ordered to return
the amount of Rs.14,498/- to the appellant within a period of two months from
the date of receipt of the certified copy of the order failing which the amount
shall carry interest @9% p.a. from the date of this order.
The Ld. State Commission upon an application made by the Respondent
corrected the figure of Rs.14,498/- to Rs. 19,498/-.
Vide an application u/s 152 CPC it was pointed out by the LIC to the
State Commission that it had erroneously ordered refund of Rs.19,498/- to the
Respondent when the amount actually paid as total premium for revival of the
policy was Rs.9,458/- and not Rs.19,498/- and the mistake be corrected by
taking the figure of Rs.9,498/- instead of Rs. 19,498/-. State Commission did not consider this
application as it would amount to recall or review of its decision.
This revision petition is filed basically to set aside and quash the order dated 20.1.2003 modified on 4.4.2003 or to allow the correction of the revival premium amount directed to be refunded as Rs.9,458/- and not Rs.19,498/-.
When the revision petition was admitted this Commission observed as follows :
We have gone through the order
passed by the State Commission. It
appears that the State Commission has dismissed the appeal solely on the ground
that there was suppression on the part of the deceased with regard to the
ailment and the treatment taken by the deceased. As per the order, the deceased was having
ailment of dyspepsia and for that a certificate is produced on record. On that basis the State Commission dismissed
the appeal and held that the District Forum was justified in holding that the
Insurance Company has rightly repudiated the claim.
We have gone through the papers at
the time of hearing of this matter. We
have also heard the learned counsel for the LIC as well as the Respondent in
person. Prima facie, it appears the
order passed by the State Commission cannot be justified because dyspepsia is
not a serious ailment. It is a symptom
with regard to indigestion. Hence, order
passed by the State Commission requires reconsideration.
The Respondent who is the wife of
the deceased appeared in person and stated that she is a poor woman and has no
means to engage an advocate and therefore, revision petition was not filed.
Hence, in exercise of our power
under Section 21 (b) of the Consumer Protection Act, 1986, we issue notice to
the LIC as to why the impugned order should not be set aside. Mr. S.P. Mittal, learned Counsel appearing on
behalf of the LIC waives notice.
Secondly, dyspepsia cannot be considered as disease as the meaning of
dyspepsia as defined in the Tabers Cyclopedic Medical Dictionary, is : Imperfect or painful digestion.
Not a disease in itself but symptomatic of other diseases or
disorders. Characterized by vague
abdominal discomfort, a sense of fullness after eating, eructation, heartburn,
nausea and vomiting, and loss of appetite.
These symptoms may occur irregularly and in different patters from time
to time. The symptoms are increased in
times of stress.
In todays world, people face problems like acidity, indigestion, back pain and head ache, which are sometimes chronic in nature. These symptoms may occur from time to time with different levels of intensity. They cannot be considered as diseases, which require to be enumerated while answering the questionnaire of the LIC in its proposal form.
Accordingly, we feel the repudiation of the policy by the LIC is unjust and improper. Therefore, while dismissing the revision petition filed by the LIC, we set aside the impugned order, for which we had given due notice to the Ld. Counsel for LIC Mr. Mittal who was fair enough to waive the notice and argue the case on merits.
We, therefore, allow the complaint and direct the LIC to pay the sum assured i.e. Rs.50,000/- with 9% from 1.5.1999 (two months after the repudiation of the claim) till date of payment. LIC shall also pay Rs.10,000/- as costs.
The LIC has deposited Rs.20,000/- in response to our order dt.30.10.2007. This amount shall be released to the respondent and shall be deducted from the amount payable by the LIC.
We place on record our appreciation for the able assistance rendered by Ld. Amicus Curiae Ms. Kanchan Dhodi and also that of the Ld. Counsel Mr. S.P. Mittal.
..J
(M.B. SHAH)
..
(RAJYALAKSHMI RAO)
MEMBER
(PD SHENOY)
MEMBER
Rajani