KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD, THIRUVANANTHAPURAM APPEAL No.873/02 JUDGMENT DATED: 28.1.2008 Appeal filed against the order passed by CDRF, Kollam in OP.No.222/01 PRESENT SHRI.M.V.VISWANATHAN : JUDICIAL MEMBER SHRI.S.CHANDRAMOHAN NAIR : MEMBER The General Manager, : APPELLANT Life Insurance Corporation of India, Bombay. (By Adv.G.S.Kalkura) Vs. Bhavani Amma, : RESPONDENT Madhava Vilasam, Mampallikunnam, Chathannoor, Meenad Village, Kollam. (By Adv.K.Sreedharan) JUDGMENT SRI.M.V.VISWANATHAN : JUDICIAL MEMBER The above appeal is preferred from the order dated 21st October 2002 passed by CDRF, Kollam in OP.No.222/01. The complaint in the aforesaid OP 222/01 was filed by the respondent herein as complainant against appellant as opposite party claiming the insurance amounts covered by two insurance policies dated 15.11.1994 and 28.4.99. The aforesaid claim for insurance amounts was repudiated by the opposite party on the ground that there was misrepresentation and suppression of material facts regarding the health of the life assured. But the Lower Forum accepted case of the complainant to a greater extent and thereby allowed the complaint in OP.222/01 on the ground that there was no nexus between the cause of death of the life assured and the material facts suppressed by the life assured. Thereby the opposite party Insurance Company is directed to pay the insurance amount of Rs.1,00,000/- with 12% interest and cost of Rs.2000/-. Aggrieved by the said order present appeal is filed. 2. We heard the counsel for the appellant and the respondent. The learned counsel for the respondent has also submitted his notes on argument. The learned counsel for the appellant submitted his arguments based on the grounds urged in the memorandum of the present appeal. He also relied on Exts.B1. to B10 documents produced from the side of the opposite party Insurance Company and pointed out the suppression of material facts by the life assured Manmadan Pillai. On the other hand, the learned counsel for the respondent/complainant supported the findings and conclusions of the Lower Forum and requested for dismissal of the present appeal. He also relied on the decision rendered by the Hon’ble Supreme Court in the case of Life Insurance Corporation of India Vs. Asha Goel reported in 2001 (3) KLT-55 Short Note case No.73. 3. The points that arise for consideration are:- 1) Whether the appellant/opposite party Insurance Company can be justified in repudiating the insurance claim putforward by the complainant in OP.222/01? 2) Is there any legally sustainable ground to interfere with the impugned order dated 21.10.02 passed by the CDRF, Kollam in OP.222/01. 4) Points 1 and 2:- There is no dispute that the complainant is the legal heir of the life assured, Manmadhan Pillai and that the aforesaid life assured Manmadhan Pillai took Ext.P1 and P2 policy of insurance which were issued by the appellant/opposite party LIC of India. Admittedly the life assured died on 16.10.99. Ext.D7 series would show that the life assured Manmadhan Pillai died. Postmortum report issued by the hospital authority attached to MY Hospital, Indore would show that the life assured Manmadhan Pillai died dues to cardio respiratory failure as a result of multiple pathology to the body. It is the case of the appellant/opposite party Insurance Company that the life assured was having ailments from 1.7.94 onwards. The Insurance Company relied on the Ext.D7 series medical attendant certificate, D8 treatment certificate from 1.7.94 and Ext.D9 report of the colleagues of the life assured Manmadhan Pillai . D8 and D9 documents would show that the life assured was having viral fever from 1.7.94 to 12.7.94 and that he was also suffering from typhoid with relapse of typhoid fever from 18.10.95 to 9.12.95. It would also show that life assured had undergone treatment from 13.9.96 to 23.9.96 for typhoid fever. D9 series of statements given by colleagues of the life assured would show that the life assured Manmadhan Pillai was having continuous illness for morethan 4 years. D6 series of records would show that the life assured had availed sick leave for the periods from 1.7.94 to 12.7.94; 13.9.96 to 23.9.96; 25.9.96 to 27.12.97. All these records would make it clear that the life assured was having continuous ailments from 1994 onwards. Ext.D1 series of proposals with D2 English translation would make it clear that the life assured Manmadhan Pillai suppressed material facts regarding this ailments at the time of taking the second policy on 28.4.99. So, the suppression of material facts regarding the health condition of the life assured would justify the appellant/opposite party Insurance Company in repudiating the claim. 5. Admittedly the 1st policy which was taken on 15.11.94 was lapsed and the same was revived only on 16.11.98 by accepting the Ext.D3 revival letter. In Ext.D3 revival letter, the life assured had given a statement regarding his health condition as good. The Ext. D6,D7,D8 and D9 documents would make it clear that the aforesaid statement given by the life assured regarding the condition of his health in D3 revival declaration was a misrepresentation or suppression of material facts. So, the appellant Insurance Company is also justified in repudiating the claim with respect to the 1st policy bearing No.341351715 dated 15.11.94. 6. It is a well settled position that suppression of material facts can be taken as a sufficient ground for the Insurance Company to repudiate the Insurance claim. The contract of insurance is based on the principles of utmost good faith. The insured is legally bound to disclose the material facts and the suppression of material facts would make the insurer competent to repudiate the claim as and when the same is detected within the stipulated period. In their case the provisions of Section 45 to the insurance Act cannot be made applicable as the suppression of material facts have been detected or disclosed within 2 year of taking the 2nd policy and within 1 year of the revival of the 1st policy. The Lower forum has gone wrong in allowing the Insurance claim on the ground that there was no nexus between the suppression of material facts and the cause of death. It is held by the Hon’ble supreme Court in a very recent decision in the case of P.J.Chacko and another appellant Vs Chairman LIC of India and others respondents in civil appeal No.5322/07 dated 20th November 2007. Therein it is held that suppression of material facts is sufficient for the insurer to repudiate the insurance claim. The question of nexus between the cause of death of the life assured and suppression of material facts does not arise for consideration. Even if there was no nexus between the so called suppression of material facts and the cause of death of the life assured, then also the insurance company can very well repudiate the insurance claim on the ground of suppression of material facts. In the present case there cannot be any doubt about the fact that there occurred suppression of material facts as far as the health condition or medical treatment of the life assured is concerned. So, we are of the strong view that the appellant/opposite party Insurance Company is fully justified in repudiating the Insurance claim put forward by the respondent/complainant as legal heir of the life assured Manmadhan Pilla (the life assured). The principle laid down by the Hon’ble Supreme Court in the decision in Life Insurance Corporation of India Vs Asha Goel would only support the case of the appellant herein. It is held that if there are any misstatements or suppression of material facts, the policy can be called into question. If that be so, the impugned order passed by the Lower Forum is liable to be set aside. Hence we do so. In the result the appeal is allowed. The impugned order passed by the Lower Forum is set aside. There will be no order as to costs. SHRI.M.V.VISWANATHAN : JUDICIAL MEMBER SHRI.S.CHANDRAMOHAN NAIR : MEMBER | 
