PER MR SUBHASH CHANDRA, PRESIDING MEMBER

1.     This revision petition filed under section 21(b) of the Consumer Protection Act, 1986 (in short, the ‘Act’) assails the order of the Rajasthan State Consumer Dispute Redressal Commission, Circuit Bench, Jodhpur (in short, ‘State Commission’) in First Appeal No. 210 of 2008 dated 08.05.2017 dismissing the appeal against the order of the District Consumer Protection Forum, Pali (in short, ‘District Forum’) in Consumer Complaint No. 16 of 2008 dated 17.09.2008.

2.     The brief facts of the case as per the revision petitioner are that her husband, Babu Khan, had obtained a life insurance policy for Rs 50,000/- on 31.03.2001 from the respondent after a medical fitness certificate was issued. He paid the required premium of Rs 1763/- timely except on 28.09.2003 for which reason the policy lapsed. He then had the policy revalidated on 08.04.2004 after another medical examination and on paying the premium with penalty. As her husband Babu Khan expired on 31.12.2007 the petitioner filed an insurance claim. The claim was repudiated by the respondent on the ground that the cause of death was hypoxia and that the insured had been suffering from tuberculosis prior to the revival of the policy which had been done by concealing this material fact. As the policy claim was repudiated, the petitioner approached the District Forum in CC No. 16 of 2008 and vide order dated 17.09.2008 the complaint was allowed with direction to pay the insured amount of Rs 50,000/- with interest @ 9% from 31.12.2007 till realization and Rs 1,000/-  as costs. The respondents appealed against this order before the State Commission and this appeal came to be allowed in FA No. 210 of 2008 on 08.05.2017 after coming to a finding that the late Babu Khan had been suffering from TB at the time when he had the policy revived which fact had been concealed. The petitioner has impugned this order before this Commission.

3.     The petitioner’s case is that the order of the State Commission was without hearing her. It is averred that the respondent Insurance Company had relied upon a medical certificate dated 23.12.2006 issued by one Dr.Gopal Purohit at the time of the death of the insured which referred to the deceased suffering from tuberculosis since 1999. As prescriptions and medical bills produced by the respondents are subsequent to the date of revival of the policy on 08.04.2004 and the insured was not suffering from any ailment either at the time of obtaining the policy on 31.03.2001 or its revival on 08.04.2004 when he was examined medically by a doctor authorized by the respondent and found to be healthy, the cause of repudiation on ground of a pre-existing ailment is not justified. It is therefore prayed that the review petition be allowed as the State Commission has erred in reaching a finding that is contrary to facts.

4.     The respondents have asserted that the declaration of sound health filled up by the insured in the policy proposal was incorrect and false as it did not disclose the fact of a pre-existing illness (tuberculosis). They have also relied upon the medical certificate of Dr Gopal Purohit dated 23.12.2006 which mentions that the insured had been suffering from tuberculosis. 

5.     Heard the learned counsel for the parties and perused the records. Parties filed a written synopsis of arguments and case laws relied upon. It is the respondent’s case that the policy is void ab initio as it was based on false information by the insured regarding his sound health. The respondent has relied upon the previous orders of this Commission in:

(i)     SBI Life Insurance Co Ltd., vs Dune Bhagyalakshmi dated 05.04.2016 passed in RP no.2890 of 2014;

(ii)    Laxmibai, through her LRs and Ors., vs Birla Sun Life Insurance Co., Ltd., dated 12.04.2016 passed in RP no.497 of 2013;

(iii)    LIC of India vs Rekha Heda dated 10.02.2017 passed in RP no. 1161 of 2014;

(iv)   Smt T Pushpamma vs Senior Branch Manager, LIC of India and Anr. Dated 29.11.2016 passed in RP No.4770 of 2012; and

(v)    Smt Phoola Devi vs Life Insurance Corporation of India dated 29.08.2016 passed in RP no.2271 of 2011.

All these cases refer to pre-existing illnesses/ diseases which were not disclosed by the life insured. Therefore, these cases are distinguishable from the instant case where the declaration of no previous medical history was corroborated on two occasions by the authorized medical doctor of the respondent who examined the life insured and certified that he was of sound health. Therefore, the cases relied upon by the respondent will not apply in this case. The petitioner’s contention is that her late husband was of sound health at the time when the insurance policy was taken and its subsequent revival when it is supported by a medical examination report of the doctor authorized by the respondent also cannot be found fault.

6.     From the facts on record, it is apparent that the finding of the State Commission that the deceased life insured was suffering from tuberculosis as a pre-existing disease is based on the medical certificate dated 23.12.2006 of Dr Gopal Purohit which has not been proved before it. The finding also relies upon the responses by the late Babu Khan to queries in the policy form and the revival form. However, the respondent has not been able to provide a suitable rebuttal to the fact that the insured had been examined medically both at the time of being insured on 31.03.2001 and its revival on 08.04.2004 by a medical doctor authorized by the respondent and found to be medically fit. The acceptance of the premium and the revival penalty was based upon this medical examination which established the responses to the queries. The statement of the said Dr Purohit is also that he started the treatment from 23.11.2006, which is clearly after the policy was obtained. It is therefore not valid for the respondent to repudiate the claim on the ground of a false declaration by the insured that he did not suffer from a pre-existing illness.

7.      For the foregoing reasons, I find merit in the revision petition which is allowed. The impugned order of the State Commission is set aside and the order of the District Forum is affirmed.