National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Ms. Mamta on 12 January, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO.3223 OF 2010 (From the order dated 24.5.2010 in Appeal No.18/2008 of the Delhi State Consumer Disputes Redressal Commission, Delhi) Life Insurance Corporation of India Through: Divisional Manager, Life Insurance Corporation of India Divison-III, at Jeevan Prakash Tower, District Centre, Janakpuri, New Delhi Petitioner Versus Ms. Mamta W/o Late Shri Mahesh Chander Bhardwaj R/o Village and post Office, Ranikhera, Delhi-110 081 ... Respondent BEFORE: HON'BLE MR.JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER HON'BLE MRS. REKHA GUPTA, MEMBER For the Petitioner : Mr. Amit Bansal, Advocate For the Respondents : Mr. Sanjay Kumar, Advocate PRONOUNCED ON 12th JANUARY, 2015 ORDER
(PER JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER,ORAL) This revision is directed against the order of the Delhi State Consumer Disputes Redressal Commission (in short, the State Commission) dated 24.5.2010 whereby the State Commission set aside the order of dismissal of complaint passed by the District Forum and directed the petitioner/opposite party to pay a sum of Rs.1 Lakh to the respondent/complainant against the insurance claim.
2. Briefly stated, facts relevant for the disposal of the revision petition are that Shri Mahesh Chand Bhardwaj, late husband of the petitioner obtained an insurance policy of Rs.1 Lakh from the respondent on 21.3.2005. He died on 28.8.2005. The respondent preferred an insurance claim which was repudiated on 13.4.2006 on the ground that the insurance contract was not valid because the life assured has obtained the insurance policy by concealing the fact that he was suffering from diabetes mellitus. Claiming this to be deficiency in service, the respondent/complainant filed the consumer complaint.
3. The District Forum on consideration of pleadings of the parties and the evidence came to the conclusion that it was a case of concealment of material fact and as such repudiation of claim was justified. Accordingly, the complaint was dismissed.
4. Being aggrieved by the order of the District Forum, the respondent/complainant approached the State Commission in appeal. The State Commission vide impugned order allowed the appeal, set aside the order of the District Forum and directed the petitioner to pay the claim of Rs.1 Lakh to the respondent/complainant. It is against this order the opposite party has preferred this revision petition.
5. We have heard respective counsel for the parties and perused the material on record.
6. Learned Shri Amit Bansal, Advocate for the petitioner has contended that the impugned order of the State Commission is not sustainable because the State Commission has failed to appreciate that insurance policy was obtained by the life assured by concealment of his previous ailment. In support of this contention, learned counsel for the petitioner has taken us through proposal form submitted by the life assured wherein in the column of personal history in response to the question are you suffering or have you ever suffered from diabetes---- the life assured has answered in the negative. Learned counsel has contended that the State Commission while accepting the appeal against the order of the District Forum has failed to appreciate that in the medical record pertaining to the treatment of the life assured it is clearly indicated that as per the information conveyed to the treating doctor at the time of admission in the hospital on 19.8.2005, the attendants of the patient informed that the patient was having a history of diabetes mellitus for the past five years. It is contended that from the said record it is clear that the life assured concealed said ailment while obtaining the insurance policy and as such in view of the judgment of the Honble Supreme Court in the matter of Satwant Kaur Sandhu Versus New India Assurance Company Limited (2009) 8 SCC 316 and the judgment of this Commission in the matter of Kokilaben Narendrabhai Patel Vs. LIC of India 2010 CTJ 920 (CP) (NCDRC) as also The Marketing Manager, LIC of India Vs.Smt. Vijaya, CPC (1995) (1) 341, the insurance company was within its right to repudiate the claim.
7. Learned Shri Sanjay Kumar, Advocate for the respondent/complainant has contended that the above argument is of no avail to the petitioner for the reason that from the medical record, identity of the person who informed about previous history of ailment is not established. It is further contended that the petitioner company cannot take advantage of the plea of concealment of fact because before issue of insurance policy the life assured was put to medical test and as such the petitioner cannot claim that it was misled while entering into the insurance contract due to concealment of fact by the life assured.
8. We find merit in the contention of learned counsel for the petitioner. On perusal of the treatment-sheet pertaining to the treatment of the life assured at Maharaja Agrasen Hospital, it transpires that the life assured was admitted in the hospital on 19.8.2005 and at the time of the admission the doctor was informed that the patient had a history of diabetes mellitus for the last five years and was on insulin for the last three years. Even as per the medical attendance certificate Ext. P6 it is clear that the life assured was suffering from diabetes mellitus (2) for the last five years as informed by his attendants and secondary cause of death of the life assured was diabetes mellitus (2). If the life assured was suffering from diabetes mellitus for the last five years prior to the date of his admission in Maharaja Agrasen Hospital i.e. 19.8.2005 and was on insulin treatment for the last three years he obviously was aware of his ailment at the time of filling in proposal form dated 23.3.2005 wherein he has concealed his aforesaid ailment from the petitioner/opposite party. Thus, this is clear case of concealment of material fact regarding previous ailment by the life assured. That being the case, in view of the judgment of the Honble Supreme Court in the matter of Satwant Kaur Sandhu (supra) as also the judgment of Co-ordinate Bench of this Commission in Kokilaben Narendrabhai Patel (supra), the petitioner cannot be faulted for repudiating the claim on the ground that the insurance policy was obtained by concealment of previous ailment of the life assured. The State Commission while reversing the order of the District Forum has totally ignored the above-referred medical evidence. Therefore, the impugned order cannot be sustained.
9. In view of the discussion above, revision petition is allowed, impugned order is set aside and the complaint filed by the respondent/complainant is dismissed with no order as to cost.
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(AJIT BHARIHOKE, J.) PRESIDING MEMBER ....
(REKHA GUPTA) MEMBER Raj/