Raj Kumari had taken a policy of Rs 2 lakh from LIC. When she died on February 14, 2016, her son Rajesh Kumar made a claim under the policy. It was rejected on the grounds that false answers were given to the questions in the proposal form, pre-existing ailments had been suppressed, and wrong information was furnished about the leave taken by the insured.
LIC merely offered to refund the premium of Rs. 81,216. Rajesh Kumar filed a complaint before the district forum, which ordered the claim to be paid. LIC’s appeal to the Himachal Pradesh State Commission was also dismissed. LIC then went in revision before the National Commission, arguing that orders were passed without considering the evidence produced by it.
LIC relied on the previous treatment record and leave certificates which showed Raj Kumari was suffering from rheumatic heart disease, diabetes and hypertension since 2010, but she had suppressed these ailments in the proposal form submitted on March 4, 2013 by intentionally giving false answers.
Rajesh Kumar contended that LIC’s panel doctor had examined his mother prior to issuance of the policy and had found her to be in good health. The National Commission rejected this argument, observing it may not be possible to detect all ailments during a clinical examination and tests conducted at that time, especially when the documentary evidence clearly established that treatment had been sought for pre-existing ailments, and that her leave record at work coincided with her hospitalization. The Commission pointed out that the insured had failed in her duty to disclose relevant information by truthfully answering the questions in the proposal form.
Rajesh Kumar tried to argue that the form had been filled in by the agent without consulting the proposer, in this case Raj Kumari herself. The Commission held that a proposer who signs the form cannot normally disown the statements made. Since such an allegation was neither made in the complaint nor was the agent made a party to the dispute, the Commission rejected this argument. By its order of October 15 delivered by Justice V K Jain, the National Commission upheld the LIC’s stand and dismissed the complaint.
