Dated 05.02.2024

As per Sanjay Kumar, President.

O r d e r
 

1. Present appeal has been filed on behalf of appellants/opposite parties for setting aside the judgment and order dated 11.03.2016 passed by learned District Consumer Forum, Vaishali in Consumer complaint case no. 73 of 2011 whereby and whereunder appellants have been directed to pay sum assured amount of Rs. 10,75,000/- with interest @10% per annum from the date of death of life assured within 45 days from the date of receipt/production of a copy of order failing which interest @15% per annum shall become payable.
2. Briefly stated the facts of the case is that father of complainant Surya Narayan Sah had purchased two life insurance policies dated 09.02.2010 and 24.01.2010 from opposite party/insurance company for sum assured amount of Rs. 10,00,000/- and Rs. 75,000/- for which annual premium amount of Rs. 2,00,000/- and Rs. 15,000/- was paid. Complainant was made nominee in both insurance policies.
3. After medical checkup conducted by the panel doctor of insurance company the proposal was accepted and insurance policy and policy bond was issued to life assured.
4. Father (life assured) of complainant suffered severe cold attack on 07.01.2011 and was treated by local doctor at his residence but died on 08.01.2011 due to severe cold attack.
5. Complainant submitted his claim after duly filling the claim form along with all relevant documents, however, claim was repudiated by letter dated 20.04.2011 on ground of suppression of material fact as at the time of submission of proposal form life insured did not disclose in proposal form that he was suffering from a pre-existing disease i.e chronic asthama.
6. Aggrieved by repudiation of claim by letter dated 20.04.2011 complainant filed consumer complaint case before the District Consumer Forum, Vaishali upon which notices were issued to opposite parties for their appearance. Opposite parties 1 & 2 appeared but neither file any written statement nor contested the case as such case proceeded ex-parte against them. Opposite party no. 3 (doctor) did not appear even after valid service of notice.
7. The District Consumer Forum after considering and appreciating the evidence on record held that from certificate granted by treating Doctor Dr. B. Jha as well as medical prescription of treating doctor Dr. B. Jha it is apparent that deceased life insured was suffering from severe cold attack and subsequently died due to severe cold attack.
8. The District Consumer Forum has considered certificate given by doctor Dr. B. Jha in which it was stated that deceased life assured was suffering from chronic asthama for last 7 years and was under his treatment and on basis of which claim of complainant was repudiated by the insurance company not be reliable and trustworthy.
9. The District Consumer Forum has observed that insurance policy was issued after insured had undergone medical check up by empaneled doctor of insurance company who found insured in good health condition.  It was further observed that in the certificate granted by treating doctor and medical prescription of treating doctor nowhere it is stated that deceased had history of Asthama and set aside the letter of repudiation and allowed the complaint case with direction to pay the sum assured amount with interest, aggrieved by which present appeal has been filed by insurance company before the State Commission.
10. Heard counsel for the parties and considered their submissions. Perused the impugned order and written arguments filed by parties as well as materials available on record.
11. It is submitted that deceased life assured Surya Narayan Sah had stated in negative at steps 8B-5(e) and step 8B-7 of the proposal form where specific questions under health details of life assured were asked to declare but the life insured declared intentionally and knowingly in negative.
12. It was further submitted that claim being an early claim and the insurance company got the case investigated through investigator who after detailed investigation found that life insured was suffering from chronic asthama since last 7 years for which a medical certificate dated 07.01.2011 was issued by the same doctor Dr. B. Jha (opposite party no. 3).
13. On the other hand counsel for the respondent has supported the order passed by District Consumer Forum and submitted that same has been passed after due consideration and appreciation of evidence on record. Onus was upon the insurance company to establish that there was concealment of material fact by the deceased life assured. Insurance company has failed to discharge said onus.
14. Even assuming that deceased life assured did not disclose in the proposal form that he was suffering from chronic asthama but his cause of death was not chronic asthama but he died due to severe cold attack and there was no nexus between alleged pre-existing disease and cause of death. In case of Life Insurance Corporation of India Vs. Sunita Ors. 2020-JX(Con)-0-208 in paragraph no. 9 & 10 it has been held:
15. In the present case, the deceased assured was suffering from diabetes mellitus and chronic liver disease when bought to the hospital. But, the death was due to cardiac arrest.  In our view the cause of death is nowhere connected to his pre - existing disease.  Our view dovetails from the decision of Hon'ble Supreme Court in the Civil Appeal No. 8245 of 2015 titled Sulbha Prakash Motegaoneker and Ors. v. Life Insurance Corporation of India, decided on 05.10.2015,  wherein it was observed that suppression of information regarding any pre-existing disease , if it has not resulted in death or has no connection to cause of death , would not disentitle the claimant for the claim.
16. 10.    We find the Orders of the District Forum and the State Commission to be well-appraised and well-reasoned. The State Commission concurred with the findings of the District Forum. We note in particular the extracts of the respective observations made by the two fora, quoted in paras 4 and 5 above. Within the meaning and scope of section 21(b), we find no grave error in appreciating the evidence by the two fora below, as may necessitate re-appreciation of the evidence in revision. We find the award made by the District Forum (quoted in para 4 above), and as affirmed by the State Commission, to be just and appropriate. We find no jurisdictional error, or a legal principle ignored, or miscarriage of justice, as may necessitate interference in the exercise of the revisional jurisdiction of this Commission. 
17.  The appeal is devoid of any merit and is accordingly, dismissed however, rate of interest is reduced to 8% per annum from the date of filing of complaint case till its payment.  
18. A copy of this order be supplied to both the parties free of cost as mandated by the Consumer Protection Act. Office is directed to send a copy of this order to the District Commission, Vaishali by E-mail forthwith and order to be uploaded on the website of the Commission.
19.    Let the file be consigned in the record room along with copy of this order.
     

(Ram Prawesh Das)                            (Md. Shamim Akhtar)                                        (Sanjay Kumar,J)

      Member                                                Member                                                           President

Md. Fariduzzama