JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL) 1. Late Sh. Haridaya Narain Singh obtained an insurance policy from the respondent company, the benefit payable to his nominee under the said policy being Rs.2,50,000/-. He died on 21.09.2008, within two years of taking the policy, allegedly due to shunt infection with intraventicular haemorrhages and DIC septicemia. The insured had undergone a surgery of right VP shunt with right frontal burrhole in April 2005, as he was suffering from Hydrocephalous. On his death, a claim by the petitioner/complainant was lodged with the respondent company. The claim was rejected on the ground that the deceased, while taking the insurance policy, had concealed a material fact of his having undergone a surgery in April 2005. Being aggrieved from the rejection of the claim, the complainant/petitioner approached the concerned District Forum by way of a consumer complaint. The complaint was resisted by the respondent primarily on the same ground on which the claim had been rejected. 2. The District Forum having allowed the complaint, the insurer approached the concerned State Commission by way of an appeal. Vide impugned order dated 16.08.2016, the State Commission allowed the appeal and consequently, dismissed the complaint. Being aggrieved from the dismissal of the complaint, the petitioner/complainant is before this Commission. 3. It is not in dispute and is an admitted position that the deceased insured had undergone the above referred surgery in April 2005. The insurance policy was taken by him on 12.03.2007, more than one year after the said surgery was performed. It is also not in dispute that while applying for the policy, the insured was asked whether he had ever been treated or was currently under treatment for the following conditions: (m) injured, sick, operated, given a medical consultation, given a medical advice on health, care in any hospital. Admittedly, the aforesaid question was answered by the insured in the negative, meaning thereby that he represented to the insurer that he had never been operated nor had any medical consultation or care in any hospital. The insured thus, concealed the material fact with respect to his health from the insurer. An information which would influence the decision of the insurer as to whether it should accept the proposal or not and whether it should grant the insurance policy or not, would be a material fact, which a person seeking to obtain an insurance policy must necessarily disclose to the insurer that he had undergone a surgery in April 2005. Had he disclosed the said information, the insurer might or might not have accepted the proposal submitted by him. The insurer might also have asked him to undergo additional investigations in order to verify the state of his health and the risk to his life on account of the surgery he had undergone in April 2005. It could also have asked for a higher premium, on account of the insured having undergone the aforesaid surgery. Since the insured withheld the aforesaid material fact from the insurer while applying for the insurance policy, the insurer was fully justified in rejecting the claim on account of the aforesaid concealment. The view taken by the State Commission, relying primarily on the decisions of the Hon’ble Supreme Court in P.C. Chacko and another Vs. Chairman Life Insurance Corporation of India and Others 2016 (1) CPR 451 S.C. and Life Insurance Corporation of India and others Vs Asha Goel (Smt.) and another; 2001 SCC 160, cannot be faulted with. 4. For the reasons stated hereinabove, the revision petition is hereby dismissed with no order as to costs. |
