State Consumer Disputes Redressal Commission
1. Life Insurance Corporation Of India vs Manjinder Kaur on 15 April, 2013
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH First Appeal No. : 91 of 2013 Date of Institution : 04.03.2013 Date of Decision : 15.04.2013 1. Life Insurance Corporation of India, through its Branch Manager, LIC India Branch, SCO No.1110-1111, Sector 22-B, Post Box No.939, Chandigarh. 2. Division Office, Life Insurance Corporation of India, Sector 17, Chandigarh, through it Divisional Manager. Appellants/Opposite Parties V e r s u s Manjinder Kaur wife of Late Sh.Jagjit Singh, R/o H.No.153, Ground Floor, Housing Board, Sector 19, Panchkula. ....Respondent/ complainant Appeal under Section 15 of the Consumer Protection Act, 1986. BEFORE: JUSTICE SHAM SUNDER (RETD.), PRESIDENT. MRS. NEENA SANDHU, MEMBER.
Argued by: Sh. Ravi Kumar Bhatti, Advocate for the appellants.
Sh. Anil Malik, Advocate for the respondent.
PER JUSTICE SHAM SUNDER (RETD.), PRESIDENT This appeal is directed against the order dated 29.01.2013, rendered by the District Consumer Disputes Redressal Forum-I, U.T., Chandigarh (hereinafter to be called as the District Forum only), vide which, it accepted the complaint, filed by the complainant (now respondent) and directed the Opposite Parties (now appellants), as under:-
In view of the foregoings, we are of the opinion that the complainant has fully proved her case. Therefore, the complaint stands allowed. The OPs are directed to pay Rs.2,30,000/- to the complainant, being the total sum assured amount against both policies of deceased Jagjit Singh, husband of the complainant, along with interest @ 10% p.a. w.e.f. the date of repudiation i.e. 31.3.2011 till its actual payment. The OPs are also directed to pay Rs.15,000/- towards cost of litigation.
This order be complied with by the OPs, within a period of 30 days from the date of receipt of copy of this order, failing which they shall be liable to pay the above awarded amount of Rs.2,30,000/- along with penal interest @18% per annum from the date of repudiation of claim i.e. 31.3.2011 till its actual payment, besides paying litigation cost of Rs.15,000/-, as aforesaid.
2. The facts, in brief, are that Sh.Jagjit Singh, deceased husband of the complainant, had purchased two Life Insurance Policies, bearing nos.163037442, for the sum assured of Rs.1,05,000/-, for the period from 01.11.2008 to 01.11.2028, with monthly premium of Rs.627/- and 301896390, for the sum assured of Rs.1,25,000/-, for the period from 17.11.2009 to 17.11.2025, with monthly premium of Rs.510/-, from the Opposite Parties. It was stated that Jagjit Singh, husband of the complainant, made a complaint of chest pain, on 07.5.2010. He was immediately admitted to Arya Hospital, Kalka Highway, Manimajra, Chandigarh, where it was diagnosed that he had suffered Myocardial Infarction (acute cardiac attack), as a result whereof, he died. Thereafter, the complainant, being the nominee of the deceased of both the Policies, aforesaid, filed claim, with the Opposite Parties, and also submitted the Medical Attendent`s Certificate (Annexure C-2), issued by Dr.V.K.Arya, M.D. of Arya Hospital, with regard to the cause of death of the deceased. The complainant also completed all the requisite formalities of the Opposite Parties, for settlement of her claim.
However, the Opposite Parties, illegally and arbitrarily, repudiated the claim of the complainant, against both the Policies, on the ground, that the deceased/life assured, withheld material information, regarding his health, at the time of obtaining the said Policies, as also, gave false answers, to the questions, contained in the proposal form.
3. It was further stated that the deceased died after more than 1 years, of obtaining the Insurance Policies, due to Myocardial Infarction (acute cardiac attack), which had no nexus with the answers given to the questions, contained in the proposal form. It was further stated that the deceased had no previous history of any heart disease, at the time of obtaining the Insurance Policies. It was further stated that illegal and arbitrary, repudiation of the claim of the complainant, by the Opposite Parties, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice, on their part. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Parties, to pay a sum of Rs.2,30,000/-, i.e. the claim amount of both the Insurance Policies, alongwith interest @18% P.A., from the date of death of the deceased, till realization; compensation, in the sum of Rs.50,000/-, for mental agony and physical harassment; and cost of litigation, to the tune of Rs.25,000/-.
4. The Opposite Parties, in their joint written version, admitted that the Insurance Policies, in question, for the period mentioned therein, were obtained by Sh.Jagjit Singh, deceased, husband of the complainant. It was stated that since the life assured died, within 2 years, from the date of commencement of risk, under both the Policies, the Opposite Parties, asked the complainant/nominee of the deceased, to submit a certificate from his (deceased) employer, with regard to his attendance at the place of work; certificate of hospital treatment and medical attendents certificate. It was further stated that, Annexures R-5 to R-7, revealed that the life insured was sick, even before obtaining the first Policy, on 01.11.2008. It was further stated that he had been regularly on sick leave, from his office, from the year 2007 and was taking treatment from various hospitals, including Arya Hospital and IVY hospital, for the disease-Diabetes Mellitus. It was further stated that this fact was confirmed by the doctor of Arya Hospital namely Dr.V.K.Arya, vide Annexures R-6 and R-7. It was further stated that Dr.V.K.Arya, had certified that the primary cause of death of the life assured was Myocardial Infarction and the secondary cause of his death was diabetes mellitus. It was further stated that though the life assured, died of Myocardial Infarction (acute cardiac attack), but, as per the medical literature, a person suffering from diabetes mellitus, was more prone to heart attack. It was further stated that the life assured, knowingly, willfully and fraudulently suppressed his ailment of diabetes mellitus, at the time of filling up the proposal form. It was further stated that even wrong answers were given by the life assured, to the questions, put to him, with regard to the state of his health, at the time of filling up the proposal form fraudulently. It was further stated that, the contract of insurance, being the contract of UBERRIMAE FIDEI i.e. utmost good faith, therefore, the life assured was legally bound to disclose, all the relevant and material facts, within his knowledge concerning his health, in the proposal form, but he failed to do so. It was further stated that the claim of the complainant was rightly and validly repudiated by the Opposite Parties. It was further stated that neither there was any deficiency, in rendering service, on the part of the Opposite Parties, nor they indulged into unfair trade practice. The remaining averments, were denied, being wrong.
5. The Parties led evidence, in support of their case.
6. After hearing the Counsel for the Parties, and, on going through the evidence, and record of the case, the District Forum, accepted the complaint, in the manner, referred to, in the opening paragraph of the instant order.
7. Feeling aggrieved, the instant appeal, has been filed by the appellants/Opposite Parties.
8. We have heard the Counsel for the Parties, and, have gone through the evidence, and record of the case, carefully.
9. The Counsel for the appellants/Opposite Parties, submitted that the contract of insurance, being based on utmost good faith, it was the duty of the insured, to disclose, as to whether, he was suffering from, or had suffered from any disease(s), at the time of signing and submission of the proposal form. He further submitted that the life assured, at the time of filling up the proposal form, was put questions, as to whether he had ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation; whether he remained absent from his place of work, during the last five years; whether he was suffering from or had ever suffered from diabetes, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia, hydrocele, leprosy or any other diseases; and what has been his usual state of health. He further submitted that, to the first three questions, the answers of the life assured, were no, whereas, to the fourth question, his answer was good. He further submitted that, as per the medical attendent`s certificate Annexure C-2/R-7 dated 24.07.2010, the life assured had been suffering from diabetes mellitus, for the last two years, the primary cause of his death was Myocardial Infarction (acute cardiac attack) and secondary cause was diabetes mellitus. He further submitted that even, as per the official record of the deceased Annexure R-5, he remained on sick leave, right from 2007 to 2010, a number of times. He further submitted that since, the information on the aforesaid material facts, was suppressed knowing and willingly, by the life assured, the contract of insurance, being based on fraud, stood vitiated and his nominee was not entitled to any benefit, after his death, under the same (Policies). He further submitted that the claim, submitted by the complainant, was, thus, rightly repudiated by the appellants/Opposite Parties.
10. On the other hand, the Counsel for the respondent/complainant, submitted that, since the death of life assured, took place on account of Myocardial Infarction (acute cardiac attack), which had no nexus with the disease diabetes mellitus, from which, the life assured was suffering, it could not be said that, he concealed the material facts, from the Opposite Parties, at the time of filling up the proposal form. He further submitted that the mere fact that the life assured remained on sick leave, right from 2007 to 2010, a number of times, from his employment, did not mean that he concealed the material facts. He further submitted that even the affidavit of Dr. V.K. Arya, in whose hospital, the life assured was admitted, was not produced on the record, and, as such the certificate of hospital treatment, copy whereof, is Annexure R-6, and medical attendent`s certificate, copy whereof, is Annexure R-7, did not have any authenticity, and were rightly ignored by the District Forum. He further submitted that the District Forum was right, in coming to the conclusion, that the claim of the complainant was illegally and arbitrarily, repudiated by the Opposite Parties, and, as such, they were deficient, in rendering services. He further submitted that the District Forum was right, in accepting the complaint, and granting relief, to the complainant.
11. After giving our thoughtful consideration, to the rival contentions, advanced by the Counsel for the Parties, and on going through the evidence and record, we are of the considered opinion, that the appeal is liable to be accepted, for the reasons to be recorded hereinafter. It has been repeatedly held that the contract of insurance falls in the category of contract of UBERRIMAE FIDEI meaning thereby, a contract of utmost good faith, between the parties. When information, on a specific aspect, is asked for, in the proposal form, the insured is under a solemn obligation, to make a true and full disclosure of the same (information), on the subject, which is within his knowledge. Of course, obligation to disclose, extends only to the facts, which are known to the assured, and not to what he ought to have known. The Hon`ble Supreme Court of India in United Insurance Co. Ltd. Vs. M.K.J. Corporation, III (1996) CPJ 8 (SC)= (1996) 6 SCC 428, laid down the principle of law, that it is a fundamental principle of Insurance Law, that utmost good faith must be observed, by the contracting parties. Good faith forbids either party from non-disclosure of the facts, which the party privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing to the contrary. To the similar effect, the principle of law, was laid down in Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd., II (2000) SLT 323 = I (2000) CPJ 1 (SC) . In P.C. Chacko and Anr. Vs. Chairman, Life Insurance Corporation of India and Ors, III(2008) CPJ 78 (SC), it was observed as under:-
11 Section 45 of the Insurance Act reads as under:-
45. Policy not to be called in question on ground of mis-statement after two years- No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose.
Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal form.
12. Section 45 postulates repudiation of such policy within a period of two years. By reason of the aforementioned provision, a period of limitation of two years had, thus, been specified and on the expiry thereof the policy was not capable of being called in question, inter alia on the ground that certain facts have been suppressed which were material to disclose or that it was fraudulently been made by the policy holder or that the policy holder knew at the time of making it that the statement was false. Statute, therefore, itself provides for the limitation for valid repudiation of an insurance policy. It takes into account the social security aspect of the matter.
13.There are three conditions for application of Second Part of Section 45 of the Insurance Act which are:
(a) the statement must be on a material matter or must suppress facts which it was material to disclose;
(b) the suppression must be fraudulently made by the policy-holder; and
(c) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose.
12. The purpose of taking a Policy of insurance is not, in our opinion, very material. It may serve the purpose of social security, but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated, if a fraudulent act is discovered. The proposer must show that his intention was bonafide. It must appear from the face of the record. In a case of this nature, it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered, may lead to the Policy being vitiated in law.
13. In Rampreeti Yadav Vs. U.P.Board of High School & Intermediate Education & Ors, V(2003) SCT 394= JT 2003 (Supplt.I) SC 25, the principle of law, laid down, was to the effect that it is well settled law that mis-representation itself amounts to fraud, in some cases.
14. Keeping in view the principle of law, laid down, in the aforesaid cases, now let us see, as to whether, in the instant case, the insured(now deceased), at the time of taking the Insurance Policies suppressed the material facts by answering the questions aforesaid, in the negative fraudulently or had made a wrong declaration or not. Copy of the proposal is at page 12/34 of the District Forum file, on the basis whereof, one of the Policies, aforesaid was issued. The insured was put the following questions, interalia, to which he answered as under:-
i. Have you remained absent from place of work on grounds of health during the last 5 years= NO ii. Are you suffering from or have you ever suffered from diabetes, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia, hydorcele, leprosy or any other diseases= NO iii. Have you ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation= NO iv. What has been your usual state of health= GOOD After giving answers to these questions, the life assured signed the same. Not only this, even the life assured, signed the declaration that the foregoing statements and answers have been given by me after fully understanding the questions and the same are true and complete in every particular and do agree and declare that these statements and this declaration shall be the basis of the contract of annuity between me/us and the Life Insurance Corporation of India and that if any untrue averment be contained therein the said contract shall absolutely be null and void and all moneys which shall have been paid in respect thereof shall stand forfeited to the Corporation. From the perusal of the answers to the questions, put to the life assured, it is evident, that that he had not been suffering or had not suffered from diabetes mellitus; had not remained on sick leave, during the last five years; and that he was never admitted to any hospital or nursing home for general checkup, observation, treatment or operation. On the other hand, it is evident, from Annexure C-2/R-7, copy of the medical attendent`s certificate dated 24.07.2010, given by Dr. V.K. Arya, M.D., of Arya Hospital, that the life assured had been suffering from diabetes mellitus, for the last two years. It is further evident, from this certificate that primary cause of death of the life assured was Myocardial Infarction (acute cardiac attack) and the secondary cause of his death was diabetes mellitus. This information was supplied by the life assured, to Dr. V.K. Arya, when he (life assured) was admitted in Arya hospital, on the night of 05.05.2010. Even, it is further evident, from Annexure R-6, copy of the certificate of hospital treatment, issued by Dr. V.K. Arya, that the life assured (Jagjit Singh), had been suffering from diabetes mellitus, for the last two years and had been running fever for ten days, when he was admitted in his hospital. He was also having symptoms of breathlessness, fever and cough. In this document, it was also mentioned by Dr. V.K. Arya, that the life assured(Jagjit Singh), was first admitted in his hospital for the treatment of diabetes mellitus, two years ago. Not only this, it is evident, from Annexure R-5, copy of the office record of the life assured (Jagjit Singh), who was working as Assistant Branch Officer of the Oriental Insurance Company Limited, at Panchkula, that he remained on sick leave, right from 2007 to 2010, a number of times. Thus, the answers given by the life assured, that he never remained absent from the place of work, on the ground of health during the last 5 years; he was not suffering from diabetes mellitus; that he never remained admitted in the hospital for treatment of any disease and that he was having a good usual state of health, were certainly false. The life assured suppressed the material facts, aforesaid, within his knowledge, fraudulently. By answering the questions aforesaid, falsely and suppressing the material facts, fraudulently, within the knowledge of the life assured, the contract of insurance stood vitiated. Under these circumstances, the Opposite Parties, legally and validly repudiated the claim of the complainant. The District Forum was wrong, in holding otherwise.
15. The next question, that falls for consideration, is, as to whether, in the absence of the affidavit of the Doctor, certificate of hospital treatment, copy whereof, is Annexure R-6 and medical attendent`s certificate, copy whereof, is Annexure R-7, could be taken into consideration or not. In Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., IV (2009) CPJ 8 (SC), in para 22, the Apex Court held as under:-
Answers given by the proposer to the two questions were Sound Health and Nil respectively. It would be beyond anybodys comprehension that the insured was not aware of the state of his health and the fact that he was suffering from diabetes as also chronic renal failure, more so, when he was stated to be on regular haemodialysis. There can hardly be any scope for doubt that the information required in the afore-extracted questions was on material facts and answers given to those questions, were definitely factors, which would have influenced and guided the respondent - Insurance Company to enter into the Contract of Mediclaim Insurance with the insured. It is also pertinent to note that, in the claim form, the appellant had stated that the deceased was suffering from Chronic Renal Failure and Diabetic Nephropathy from 1st June, 1990, i.e. within three weeks of taking the policy. Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was palpably untrue to his knowledge. There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent - insurer was fully justified in repudiating the insurance contract. We do not find any substance in the contention of learned Counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated. Apart from the fact that at no stage the appellant had pleaded that the insured was not treated at Vijaya Health Centre at Chennai, where he ultimately died. It is more than clear from the said certificate that information about the medical history of the deceased must have been supplied by his family members, at the time of admission, in the hospital, a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorises the insurer to seek information from any hospital he had attended or may attend concerning any disease or illness which may affect his health.
16. In the said case, the Apex Court, without insisting on the affidavit, in support of the certificate, issued by the Doctor, and by relying upon the same, held that the insured was guilty of suppression of material facts, in disclosing the disease, she was suffering from. Similar principle of law, was laid down, in Puspha Chauhan Vs. Life Insurance Corporation of India, II (2011) CPJ 44 (NC). In view of the principle of law, laid down, in the aforesaid cases, the certificate of hospital treatment, copy whereof, is Annexure R-6 and medical attendent`s certificate, copy whereof, is Annexure C-2/R-7, could be taken into consideration, even without the affidavit of the Doctor, who prepared the same. The submission of the Counsel for the respondent/complainant, therefore, being without merit, must fail, and the same stands rejected.
17. The next question, that falls for consideration, is, as to whether, the type of disease i.e. Myocardial Infarction (acute cardiac attack), on account of which the deceased died, had any nexus with the disease diabetes mellitus. As stated above, Dr. V.K. Arya, in the medical attendent`s certificate, copy whereof, is Annexure R-7, in clear-cut terms, stated that the primary cause of death of the life assured was Myocardial Infarction (acute cardiac attack) and secondary cause of his death was diabetes mellitus. Annexure R-8, the literature submitted by the Counsel for the Opposite Parties, before the District Forum reveals, as to how, coronary artery disease (CAD) and diabetes mellitus, are related to each other. It is also evident, from this literature that type 2 diabetes is a major risk factor for CAD and the CAD is the major cause of morbidity and mortality with type 2 diabetes. In other words, diabetics are more likely to develop CAD, than non-diabetics. These two diseases also share a number of risk factors, notably obesity & physical inactivity and metabolic characteristics, notably dyslipidemia. So, type 2 diabetes is certainly related to CAD. The mere fact that, in Annexure R-7, Dr. V.K. Arya, against the disease type, in column 9 (a), wrote diabetes mellitus, a minor ailment, did not mean that it had no connection with Myocardial Infarction (acute cardiac attack), on account of which the life assured died, especially when he gave the secondary cause of death as diabetes mellitus. The District Forum was wrong, in coming to the conclusion, that Myocardial Infarction (acute cardiac attack) and diabetes mellitus, had no correlation, with each other and, as such, the claim was illegally and arbitrarily repudiated by the Opposite Parties.
18. Even if it assumed, for the sake of arguments, that diabetes mellitus had allegedly no co-relation with Myocardial Infarction (acute cardiac attack)-on account of which the life assured died, it may be stated here, that the key question for determination, in this appeal, is, as to whether, there was a suppression of material facts, in his knowledge, by the life assured, fraudulently, at the time of filling up the proposal form, or not, and, as such, there was breach of the terms and conditions of the contract of insurance or not. In the instant case, as stated above, the Insurance Policies were obtained by the life assured, by intentionally giving false answers, to the questions, put to him, and, thus, he suppressed the material facts fraudulently. Condition no.5 of the Conditions and Privileges within Referred to of the Insurance Policy, Annexure R-3, reads as under:-
Forfeiture in certain events:- In case the premiums shall not be duly paid or in case any conditions herein contained or endorsed hereon shall be contravened or in case it is found that any untrue or incorrect statement is contained in the proposal personal statement, declaration, and connected documents or any material information is withheld, then and in every such case but subject to the provisions of Section 45 of the Insurance Act, 1938, wherever applicable, this policy shall be void and all claims to any benefit in virtue here of, shall cease and determine in all moneys that have been paid in consequence here of shall belong to the Corporation excepting always in so far as relief is provided in terms of the Privileges herein contained or may be lawfully granted by the Corporation
19. It is evident, from the afore-extracted Condition no. 5 of the Conditions and Privileges within Referred to of the Insurance Policy, Annexure R-3, that if any material information is withheld by the life assured, in the proposal form, the Policy shall be void and all claims under benefits, shall cease, subject to the provisions of Section 45 of the Insurance Act 1938. In the instant case, as stated above, material facts, as mentioned in paragraph number 14 above, within the knowledge of the life assured were fraudulently suppressed and concealed by him. In these circumstances, whether diabetes mellitus was allegedly having correlation with the disease, Myocardial Infarction (acute cardiac attack), which was the primary cause of death of the deceased, was hardly of any consequence, for repudiating the claim of the complainant.
In Kokilaben Narendrabhai Patel Vs. Life Insurance Corporation of India, IV (2010) CPJ 86 (NC) deceased husband of the complainant, took an Insurance Policy for Rs. 1 lac, on 28.03.1993. He died on 21.06.1996, due to heart attack. At the time of filling up, and signing the proposal form, he gave false answers, to the questions and, thus, suppressed material facts. The claim of the complainant was repudiated, by the Insurance Company, on the ground, that it was not disclosed that 11 months prior to taking the Insurance Policy, the insured, suffered from typhoid (Enteric fever), remained admitted, in the hospital, for one day and was advised complete bed rest. He took 17 days leave, from the bank, where he was working. In these circumstances, the National Consumer Disputes Redressal Commission, New Delhi, held that though, the disease, on account of which, the insured died, had no nexus, with the false answers to the questions, given by him, yet, as he suppressed the material facts, at the time of filling up the proposal form, he was not entitled to any benefit, under the Policy, and repudiation of his claim was rightly made by the Opposite Party/Insurance Company. The principle of law, laid down, in the aforesaid case, is fully applicable to the instant case. The submission of the Counsel for the respondent/complainant, thus, being devoid of merit, must fail and the same stands, rejected.
20. The Counsel for the respondent/complainant placed reliance on New India Assurance Co. Ltd. Vs. Lalit M. Bhambani and Anr., I (2002) CPJ 23 (NC), a case decided by the National Consumer Disputes Redressal Commission, New Delhi, and Life Insurance Corporation of India Vs. Asha Goel, AIR 2001, Supreme Court 549, in support of his contention that since the answers given by the life assured, to the aforesaid questions, at the time of filling up the proposal form, had no correlation, with the disease, on account of which the life assured died, repudiation of the claim, was illegal. In New India Assurance Co. Ltd.`s case (supra), the answers given by the life assured, in the proposal form, were not negated, by any material placed, on the record, by the Opposite Parties. Under these circumstances, it was held that repudiation of claim of the life insured was illegal. In Life Insurance Corporation of India`s case (supra), it was not proved that the life assured had suppressed the material facts, within his knowledge, fraudulently at the time of filling up the proposal form. It was, under these circumstances, held that the repudiation of claim was illegal. In the instant case, as stated in paragraph number 14 above, it was proved from the certificate of hospital treatment, Annexure R-6 and medical attendent`s certificate, Annexure R-7, issued by Dr. V.K. Arya, that the answers given by the life assured, to the questions, at the time of filling up the proposal form, were wrong, and, thus, he concealed the material facts, within his knowledge, fraudulently, from the Opposite Parties. The facts of New India Assurance Co. Ltd.`s and Life Insurance Corporation of India`s cases (supra), being distinguishable from the facts of the instant case, no help can be drawn by the Counsel for respondent/complainant, from the same. The submission of the Counsel for the respondent/ complainant, in this regard, therefore, being without merit, must fail, and the same stands rejected.
21. No other point, was urged, by the Counsel for the Parties.
22. In view of the above discussion, it is held that the order passed by the District Forum, being not based on the correct appreciation of evidence, and law, on the point, suffers from illegality and perversity, warranting the interference of this Commission.
23. For the reasons recorded above, the appeal is accepted, with no order as to costs. The order of the District Forum is set aside.
24. Certified copies of this order, be sent to the parties, free of charge.
25. The file be consigned to Record Room, after completion Pronounced.
15.04.2013 Sd/-
[JUSTICE SHAM SUNDER (RETD.)] PRESIDENT Sd/-
[NEENA SANDHU] MEMBER Rg