This revision petition has been filed by the petitioner Mrs. T.Manjulatha & anr. against the order dated 03.10.2012 of the State Consumer Disputes Redressal Commission, Andhra Pradesh, (in short ‘the State Commission’) passed in FA No.903 of 2011.

2.      Brief facts of the case are that on 03.01.2008, the life insured, the husband of the petitioner No.1 had taken Dream Plan Life Coverage Policy No.0011298728 from the Birla Life Insurance Company Ltd., for initial face amount of Rs.11,70,000/- and the policy was issued on 27.11.2007. The mode of payment was annual and the policy will be maturing on 27.11.2027.  Later on due to enhanced sum assured to Rs.15,00,000/-, the life insured was paying premium regularly to a tune of Rs.50,347.80/-.  The Birla Sun Life Insurance Company received premium for the above policy for the period of 01.04.2007 to 03.01.2008. On 01.07.2008, the Government of Andhra Pradesh, Department of Medical & Health issued “Death Certificate” of life insured in the form No.6 through Greater Hyderabad Municipal Corporation vide registration No.369.  On 18.08.2008, the Birla Sun Life Insurance repudiated the claim of the petitioner/complainant on  the ground of suppression of material information.  The complainant filed a consumer complaint being CC No.492 of 2010 before the Consumer Disputes Redressal Forum-I, Hyderabad.  On 22.08.2011, the District Forum allowed the complaint directing the opposite parties to pay jointly and severally a sum of Rs.15,00,000/- to the complainant with interest @9% p.a. from the date of repudiation of the claim i.e. 18.08.2008 till the date of realization and to pay a sum of Rs.2,000/- towards costs of the litigation. 

3.      Aggrieved with the above order of the District Forum, the opposite party/respondent filed an appeal before the State Commission, which was allowed vide its order dated 03.10.2012.

4.      Hence, this revision petition.

5.      Heard the learned counsel for the parties and perused the record.  Learned counsel for the petitioners stated that the husband of the complainant had taken a policy from the opposite parties and the claim of death was filed before the opposite parties.  However, the opposite parties repudiated the claim on 18.08.2008 on the ground that the Deceased Life Assured (DLA) was suffering from disease of dengue and he consulted doctor for the treatment of dengue and this information was suppressed in the proposal form dated 12.11.2007.  The opposite parties have also raised the issue in their written statement that the DLA had taken two more policies, but no information was provided in the relevant column by the DLA in the proposal form.  Learned counsel argued that this issue was not raised in the repudiation letter and therefore, the same cannot be considered by the consumer forum.  The State Commission allowed the appeal of the opposite parties and dismissed the complaint on the ground that the DLA had taken treatment for dengue in Aditya Medical Care Centre.   The case summary dated 25.09.2007 given by Aditya Medical Care Centre states that the DLA consulted Aditya Medical Care Centre and DLA was suffering from dengue.  In fact, the DLA was not admitted there and the DLA again visited the Aditya Medical Care Centre after a week and the progress in the platelets was recorded and certain medicines prescribed. This was a temporary fever and after the medicines the DLA was fully cured.  It is wrong to say that the DLA suffered from one ailment or the other as a consequence of dengue. When the DLA was admitted in the Yashoda hospital, the hospital in its death summary has indicated the following:-

“Final Diagnosis:

Septicemia with mods

Ards

Septic Shock

Toxic hepatitis

Acute Renal Failure

Focal segmental glomerular Sclerosis

History of Present Illness

Mr. Maria Mohan Reddy Thumma, presented with complaints of shortness of breath since 3 days, exacerbated since last night (10/05/2008), moderate to high-grade fever and productive cough with whitish expectoration since 3 days.

Past History

Case of Focal Segmental Glomerulo-Sclerosis diagnosed in month of February 2008 on Steroid therapy and Hypertension-on treatment.”

6.      The learned counsel for the complainant argued that the cause of death is not related to dengue. Moreover even the past history does not mention anything about dengue fever and the only ailment that is mentioned in the past history has been stated to be present since February, 2008.  Thus, it is wrong to say that the DLA never recovered from dengue.  From the death summary of Yashoda hospital, it is also clear that the disease was present only since February, 2008 which is after the date of filing of the proposal form. Learned counsel further stated that there was no separate column for mentioning the dengue fever or any fever in the proposal form.  Hence no information could be provided in respect of dengue fever.  Moreover, the DLA was totally free from any disease at the time of filing of the proposal form.  The opposite parties have also filed the leave record from the employer which clearly shows that before filing of the proposal form, leave was taken for dengue fever only in September 2007.  As stated earlier, the learned counsel reiterated that there was no specific column in the proposal form to report the dengue, hence, there was no question of reporting the same. 

7.      Learned counsel for the complainant further stated that if there is any suppression in the proposal form, the burden of proof lies on the opposite parties to prove the same. In this regard, learned counsel relied on the judgment of the Hon’ble Supreme Court in Life Insurance Corporation of India vs. Smt. G.M.Channabasamma, (1991) 1 SCC 357.

8.      On the other hand, learned counsel for the respondent Insurance Company stated that there was a clear suppression in the proposal form as the information in respect of treatment of dengue fever was not provided in the proposal form.  The proposal form clearly asked whether the proposed insured had consulted any doctor in the past five years.  The DLA had replied ‘No’ to this question.  This answer is overtly wrong and untrue as the DLA had consulted Aditya Medical Care Centre for treatment of dengue just before 2-3 months. 

9.      Learned counsel for the respondents also stated that the DLA had taken more policies, but no information was given in the relevant column of the proposal form.  One policy was taken from the ING Vysya Life Insurance Company Ltd. and the second policy was taken from Bajaj Allianz Insurance Company Ltd..  As the amounts were less in these two policies, the same have been paid by those companies. This does not imply that the insurance amount under the policy in question should also be paid. Clearly, the DLA is responsible for suppressing material information in respect of his illness of dengue and in respect of consultation with doctor within five years as well as the information in respect of other policies.  Learned counsel for the Insurance Company also stated that it cannot be said with certainty that the cause of death is not related to dengue as no expert report has been filed by the complainant in this regard.  Further even if the cause of death is not related to pre-existing disease and if the information is not given in the proposal form, the claim can be repudiated as held by the Hon’ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd., (2009) 8 SCC 316.  In the present case, the suppression of material information has been alleged on the basis of case summary given by Aditya Medical Care Centre.  The State Commission has relied on this document, however, no doctor or anybody of the centre has deposed to prove the said summary.   The complainant in the complaint has admitted that the DLA had consulted Aditya Medical Care Centre and after a week his platelets count was 108 and on 24.09.2007 his platelets count was normal and the doctor found him cured from dengue.  Thus, there is no question of proving the case summary given by Aditya Medical Care Centre by any doctor or any staff of the centre as the same is admitted by the complainant.

10.    I have given a thoughtful consideration to the arguments advanced by the learned counsel for the parties and examined the record.  In the present case, the repudiation is based on the ground that the DLA did not disclose that he suffered from dengue 2-3 months ago from the time of filing of the proposal form.  The complainant in the complaint has admitted that the DLA had consulted doctor in  Aditya Medical Care Centre and he was diagnosed dengue, but he was successfully treated.  Thus, the case summary given by Aditya Medical Care Centre cannot be doubted.  In the proposal form, there is a column “whether you have consulted the doctor within five years”. In reply to this question ‘No’ answer has been given which is basically wrong as the DLA had consulted  Aditya Medical Care Centre for his treatment of dengue as also admitted by the complainants.  As there is an admission from the side of the complainants, no doctor or staff of the medical centre was required to be examined for proving its case summary.

11.    Another objection raised by the Insurance Company in its written statement is in respect of nondisclosure of two other policies taken by the DLA.  It has been admitted in the complaint that the DLA had taken one policy from ING Vysya Life Insurance Company Ltd. for Rs.3,00,000/- and another policy from Bajaj Allianz Insurance Company Ltd.  for Rs.1,80,000/- and both these policies have been settled.  The Hon’ble Supreme Court in Reliance Life Insurance Co. Ltd. & anr. vs. Rekhaben Nareshbhai Rathod, II (2019) CPJ 53 (SC) has dealt with this question and the following has been observed:-

27. In the present case, the insurer had sought information with respect to previous insurance policies obtained by the assured. The duty of full disclosure required that no information of substance or of interest to the insurer be omitted or concealed. Whether or not the insurer would have issued a life insurance cover despite the earlier cover of insurance is a decision which was required to be taken by the insurer after duly considering all relevant facts and circumstances. The disclosure of the earlier cover was material to an assessment of the risk which was being undertaken by the insurer. Prior to undertaking the risk, this information could potentially allow the insurer to question as to why the insured had in such a short span of time obtained two different life insurance policies. Such a fact is sufficient to put the insurer to enquiry.

 “29. ……….  We are of the view that the failure of the insured to disclose the policy of insurance obtained earlier in the proposal form entitled the insurer to repudiate the claim under the policy.”

12.    Once it is found that the DLA has suppressed the material information in respect of other policies and in respect of his disease of dengue and consultation with a doctor for its treatment, it would not be material whether the DLA died of the disease of dengue or some other disease as held by the Hon’ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. (supra).  The observation of the Hon’ble Supreme Court in Reliance Life Insurance Co. Ltd. & anr. vs. Rekhaben Nareshbhai Rathod (supra) as mentioned above are also equally applicable in the present case.

13.    Based on the suppression of material information at the time of filing of the proposal form, I find no illegality, material irregularity or jurisdictional error in the order dated 03.10.2012 of the State Commission which calls for any interference from this Commission.  Accordingly, the revision petition no.273 of 2013 is dismissed.