National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Help Line Grahak Mandal & Anr. on 11 March, 2014
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 4240 OF 2011 (From the order dated 19.09.2011 in First Appeal No. 244 of 2008 of the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad) Life Insurance Corporation of India Jeevan Prakash Building, Relief Road Ahmedabad 380 001 Through its Branch Manager Petitioner/Opp. Party (OP) Versus 1. Help Line Grahak Mandal Through its Trustee Sh. Mukesh Shah, 4/B, Durvankar Apartment Kharivav Road, Near GPO, Vadodara 390 001 2. Shefaliben Mukeshbahi Patel Bhatvada, Vaadi, Vadodara Respondents/Complainants BEFORE HONBLE MR. JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER HONBLE DR. B.C. GUPTA, MEMBER For the Petitioner : Mr. Amit Bansal, Advocate For the Res. Nos. 1& 2 : NEMO/Ex-parte PRONOUNCED ON 11th March, 2014 O R D E R
PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER This revision petition has been filed by the petitioner against the order dated 19.09.2011 passed by the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (in short, the State Commission) in Appeal No. 244 of 2008 Life Insurance Corporation of India Vs. Shri Mukesh Shah (Trustee of Helpline Consumer Mandal) by which, while dismissing appeal, order of District Forum allowing complaint was upheld.
2. Brief facts of the case are that Mukesh Patel husband of the complainant No. 2/Respondent No. 2 obtained insurance policy for Rs.5,00,000/- on 30.11.2000 from OP/petitioner. Mukesh Patel died on 13.12.2000. Complainant preferred claim before OP, which was repudiated on the ground of suppression of illness in proposal form. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that insured died within 13 days after taking policy and suppressed material fact regarding his health; though, he had taken treatment from 18.11.2000 to 22.11.2000 and 1.12.2000 to 13.12.2000 and claim was rightly repudiated; hence, complaint be dismissed. Learned District Forum after hearing both the parties, allowed complaint and directed OP to pay Rs.5,00,000/- along with interest @ 9% p.a. and further allowed Rs.3,000/- towards cost of proceedings.
Appeal filed by the petitioner was dismissed by learned State Commission by impugned order against which, this revision petition has been filed.
3. None appeared for respondent even after service and they were proceeded ex-parte.
4. Heard learned Counsel for the petitioner and perused record.
5. Learned Counsel for the petitioner submitted that deceased suppressed material facts regarding his health, disease, previous treatment and hospitalisation and died within 13 days of obtaining policy and petitioner rightly repudiated the claim, but learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal; hence, revision petition be allowed and impugned order be set aside.
6. Perusal of record reveals that in the proposal form submitted by the deceased insured on 30.11.2000, his reply to personal history runs as under:
11 Personal History: : No
(a) During the last five years did you consult a : No Medical Practitioner for any ailment requiring treatment for more than a week?
b) Have you ever been admitted to any hospital : No or nursing home for general check-up, observation, treatment or operation?
c) Have you remained absent from place of work : No. on grounds of health during the last five years?
(d) Are you suffering from or have you ever suffered : No from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous system?
(e) Are you suffering or have you ever suffered : No from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?
(f) Do you have any bodily defect or deformity? : No
(g) Do you ever have any accident or injury? : No
(h) Do you use or have you ever used: Reply : No
i) Alcoholic drinks : No
ii) Narcotics : No
iii) Any other Drugs : No
iv) Tobacco in any form : No
(i) What has been your usual state of health? : Good
(j) Have you ever received or at present ailing/ : No undergoing Medical advice, treatment or tests in connection with Hepatitis 'B' or an AIDS-related condition?
On the contrary, record reveals that deceased consulted Dr. Bipin N Shah on 18.11.2000 with history of fever of 3 weeks duration and he was diagnosed to have Infective Endocarditis that is on Prosthetic Aortic valve by Echo Cardiogram. It further appears that Aortic valve replacement was done by Dr. Rajesh Desai at Rajasthan Hospital in Ahmedabad before 2 years. It further reveals that on 30.11.2000 insureds health started worsening his kidneys started disfunctioning and his mentation approached to decline and he was referred to Mumbai for further treatment. Record of Medical Research Centre (New Wing) of Bombay Hospital Trust also contains similar endorsement and as per death certificate issued by Public Health Department of Mumbai, Mahanagar Palika, death caused due to Cardio Respiratory failure on account of Multi Organ Failure Septicaemia with Hepatic Failure with Renal failure.
7. Perusal of record clearly reveals that insureds health was not good and he was admitted in the hospital just prior to obtaining insurance policy; even then, he suppressed material fact regarding his health and illness and previous treatment and in such circumstances, OP has not committed any error in repudiating claim in the light of judgment of Honble Apex Court reported in (2009) 8 SCC 316 Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. in which it was held that:
A. Insurance Health insurance Mediclaim policy Nature and object of Objection of insured to disclose true and full information sought in proposal form Extent of said disclosure necessary when information on a specific aspect is asked for in the proposal form, held, the assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge Obligation to disclose extends only to facts which are known to the applicant and not to what he sought to have known Whether the information sought for is material for the purpose of the policy is a matter not to be determined by the proposer.
In present case, although insured was aware of the fact that he was suffering from chronic diabetes and renal failure, he did not disclose the said fact in proposal form for the policy Hence, insurer was fully justified in repudiating the insurance contract.
8. In the light of above discussion, it becomes clear that petitioner has not committed any deficiency in repudiating claim on account of suppression of material fact while taking policy from the petitioner and learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal and revision petition is to be allowed.
9. Consequently, revision petition filed by the petitioner is allowed and impugned order dated 19.9.2011 in Appeal No. 244 of 2008 Life Insurance Corporation of India Vs. Shri Mukesh Shah (Trustee of Helpline Consumer Mandal) and order of District Forum dated 31.1.2008 passed in CC No. 741 of 2003 is set aside and complaint stands dismissed with no order as to costs.
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( K.S. CHAUDHARI, J) PRESIDING MEMBER ..Sd/-
( DR. B.C. GUPTA ) MEMBER k