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3. Learned counsel for the petitioner submits that the respondent was duty-bound to disclose all the material facts which also include the treatment undergone by the wife of the respondent i.e. the cesarean operation on 23.06.2021 (Annexure-

[2024:RJ-JD:1612] (3 of 9) [CW-18618/2023]

4). Learned counsel for the petitioner submits that in the proposal form, under the Head of "personal and family details for health", the respondent's wife concealed the material fact and answered in 'NO', whereas, the column of 'Ailment' requiring treatment and any operation undergone. Learned counsel for the petitioner further submits that the sole reason for repudiating the claim of the respondent was suppression of the material facts and the learned Permanent Lok Adalat has completely ignored the same. Learned counsel for the petitioner further submits that the respondent has cheated upon the petitioner-corporation as the LIC policy was taken and issued on 28.10.2021 and the date of commencement of the policy was chosen from 28.05.2021, while concealing the fact that the respondent had undergone a cesarean section on 23.06.2021 and if the fact of the cesarean delivery would have been mentioned in the requisite column, the petitioner-corporation would not have issued the policy before the six months of the surgery which also reflected from the guidelines. Learned counsel for the petitioner also submits that as per the guidelines issued on 11.05.2018 (Annexure-3), there are certain conditions/underwriting medical condition/diseases/complication, where the life insurance policy cannot be issued for the period since operation is of more than six months in which, the Lower Segment cesarean Section (LSCS) is also included. Learned counsel for the petitioner also draws the attention of the Court towards the proposal form filled up by the respondent's wife (Annexure-9) while submitting that the petitioner in the Column 'c' which pertains to the information in respect to "admission to any hospital or nursing home for general checkup, observation, [2024:RJ-JD:1612] (4 of 9) [CW-18618/2023] treatment or operation?, if yes, give details", the respondent had said 'NO' and also submits that against Column No.14 "any operation, accident or injury/any bodily defect or deformity", the respondent had mentioned 'NO', whereas, the respondent had undergone the cesarean operation on 23.06.2021 and the said proposal form was filled up by the respondent's wife on 26.10.2021. Learned counsel for the petitioner submits that on account of the cesarean section undergone by the respondent's wife on 23.06.2021, she gave birth to a child and on 23.12.2021 passed away because of heart attack, which is evident from Annexure-5 i.e. the outdoor slip issued by the Government Hospital. Learned counsel for the petitioner places reliance upon the judgment passed by the Hon'ble Apex Court in the case of Branch Manger, Bajaj Allianz Life Insurance Company Ltd & Other Vs. Dalbir Kaur reported in 2020 AIR SC 5210 and submits that as per the law laid down in the judgment, the Hon'ble Apex Court has held which is read as under:-

5. Per contra, learned counsel for the respondent submits that the wife of the respondent was duly admitted on 23.06.2021 on account of the pregnancy and she delivered the child on 23.06.2021 by way of cesarean section and she was discharged from the hospital on 25.06.2021 which is evident from the discharge summary (Annexure-4). Learned counsel for the respondent submits that upon the discharge from the concerned hospital, a certificate was issued in favor of the petitioner (Annexure-4) certifying that the petitioner was discharged from the hospital on 25.06.2021 in normal and healthy condition which reflects that there was no complication after the respondent's wife undergone the cesarean section on 26.03.2021.

6. Learned counsel for the respondent further submits that the respondent's wife has not concealed any material fact while filling up the proposal form as against column No.14, the requisite [2024:RJ-JD:1612] (6 of 9) [CW-18618/2023] information was in respect to any operation, accident or any injury/any bodily defect/deformity being suffered but in the present case, the respondent's wife had not suffered any illness or any accident or injury or any bodily defect or deformity and the cesarean section undergone by the respondent's wife therefore was not required to be disclosed under Column No.14 of Section III of the proposed plan. Learned counsel for the respondent further submits that as far as the information that was required to be given against Column 'C' of Section III of the proposed plan, the information was required to be given in respect to admission to any hospital or any nursing home or treatment or operation and as the respondent's wife was never admitted for the purpose of any treatment or operation in respect to any illness, therefore, she had accordingly marked 'NO' in the said column.

9. Admittedly, the respondent's wife underwent cesarean section on 23.06.2021 and the child was delivered on 23.06.2021 and the respondent's wife was discharged on 25.06.2021 and was in normal healthy condition as reflected from the Annexure-4 [2024:RJ-JD:1612] (7 of 9) [CW-18618/2023] which is placed on record. The respondent's wife had taken two life insurance policies on 28.10.2021 w.e.f. from 28.05.2021. Learned counsel further submits that the respondent's wife was not suffering from any prior illness as there is no medical report submitted by either of the parties and she was discharged from the hospital in a healthy condition after she had undergone the cesarean section and it was therefore on account of some medical illness that the wife of the respondent was admitted in the Government Hospital on 23.12.2021 and on the same date of admission after one hour, she collapsed and died. The purpose of seeking the medical condition/medical details of the policy holder is that if any person taking the policy is suffering from any pre- illness, then the corporation would not be liable to bear the brunt of such illness, if any, prior to issuing of policy and in the present case, if there had been any pre-medical condition existing with the respondent's wife and the same had been concealed while filling up the proposal form and on account of such pre-medical condition, the respondent's wife had expired then in such condition, the decision of the petitioner to repudiate the insurance claim of the policy holder would have been justified, however, in the present case, there was no pre-medical condition existing and the respondent's wife had not concealed any pre-existing medical condition and on account of sudden illness being suffered by her on 23.12.2021, the wife of the respondent died on the same day.