Non-Disclosure Of Medical Ailment Is Not Suppression Of Material Fact For Deciding Insurance Claim: Allahabad High Court
Non-disclosure of a Fever/Enteric Fever/Urinary Tract Infection cannot be treated as suppression of a material fact while deciding an insurance claim, observed the Allahabad High Court, while dispensing that medical opinion furnished by the Doctor of the Corporation as contained in the certificate filed to the counter affidavit, when compared to the subsequent report of the Investigating Official of the Corporation, clearly established that cause of death had absolutely no co-relation with the fever suffered by the assured one year ago.
Elaborating on the issue, Justice Kshitij Shailendra observed that the sufferance of the deceased from fever in October, 2011 and five days’ hospitalization due to the same at Chitransh Hospital and Surgical Care Centre, Shivpur, Varanasi, could not be taken as a ground for repudiating the insurance claim of second respondent after the death of assured, which occurred after one year, particularly, when the Fever or Enteric Fever cannot be treated as a life threatening disease, more so, when cause of death has been described by the Investigating Official of the Corporation itself, as sudden severe pain in the chest of the deceased, when he died the same day during treatment in a Hospital situated in front of his house.
Advocate Pratik J. Nagar appeared for the Petitioner and Advocate Sunil Kumar Singh appeared for the Respondent.
In the present case, the Petitioner i.e., the LIC of India had repudiated the claim of second respondent on the ground that assured had remained hospitalized in Chitransh Hospital and Surgical Care Centre, Shivpur, Varanasi for a period of five days, while he was suffering from Enteric Fever and Urinary Tract Infection.
Therefore, when the Permanent Lok Adalat (PLA) allowed the claim made by second respondent directing the LIC to pay to the claimant-respondent a sum of rupees fourteen lacs only along with interest @ 9% per annum as covered by the Insurance Policy held by the insured, who was real brother of the claimant-respondent, the Petitioner approached the High Court challenging said judgment and award.
As regards the first contention of LIC that the claim made by second respondent had a valuation of rupees fourteen lac only and, therefore, as per section 22C of the Legal Services Authorities Act, 1987, the P.L.A. had no jurisdiction to entertain and decide the case, because as per the second proviso to section 22 C (1) of the Act, the pecuniary limits of jurisdiction of the P.L.A. were confined to the matters, where the value of property in dispute was only rupees ten lac only, was concerned, the Bench found that the plea of alleged lack of pecuniary limits of jurisdiction of the P.L.A. was neither taken in the written statement nor was it otherwise raised on behalf of the petitioner, who was defendant in the proceedings before the P.L.A.
Therefore, the effect of such omission would be fatal to the case of the petitioner, even if subsequent Notification dated 20th March, 2015 was ignored, which was published in the Official Gazette on the same date as the argument of counsel was to the effect that the case in reference was instituted prior to issuance of the said Notification, and therefore, on the date of institution of proceedings, the P.L.A. was not competent to even register the case, added the Court.
At the same time, the High Court clarified that the petitioner in the present case had a legal right to raise objections regarding pecuniary limits of jurisdiction immediately after registration of the case, or even thereafter. However, for the reasons best known to it, the said objection was admittedly not raised, and therefore, the same shall be deemed to have been waived.
Therefore, once it was clear that the plea of pecuniary limits of jurisdiction was neither taken in the written submission nor was argued before the P.L.A throughout the proceedings of the case in reference, this Court cannot allow the same to be raised for the first time in the present writ petition, added the Bench.
The Court accordingly held that on the date when the impugned judgment and award was passed by the P.L.A., the Court was well within its financial/pecuniary limits of power, competence and jurisdiction to adjudicate the same.
As per Section 22-C of the Legal Services Authorities Act, 1987, “the petitioner, before putting a blame on the P.L.A., should introspect itself in the light of pleadings and statements as referred to herein-above inasmuch as the words “ assist the parties in their attempt to reach an amicable settlement” used in sub-section (5) of the Section 22C of the Act and the words “ it shall be duty of every party to the application to cooperate in good faith with the Permanent Lok Adalat in conciliation of the dispute” make the legislative intent clear to the effect that conciliation proceedings can be held by the P.L.A. with the cooperation of the parties to the lis and in case, one of the parties is adamant not to enter into talks of compromise or conciliation, the P.L.A. cannot be expected to whip a party to conciliate the matter”, observed the Bench, while holding that the judgment of P.L.A. on merits after recording such refusal by the parties, cannot be faulted on the ground that it should not have been passed on merits in violation of provisions of “conciliation”.
Accordingly, the Court dismissed the Petition.
Cause Title: - L.I.C. Of India & Anr v. The Permanent Lok Adalat & Anr