Heard learned counsel for petitioner and respondent. Briefly put facts are that deceased insured, son of respondent had obtained one LIC policy from petitioner Corporation for assured value of Rs. 2,00,000/- on submission of proposal form making declaration as to status of health as on 5.5.2004. Mode of payment was half yearly and premium of Rs. 5,657/- was paid by deceased insured. While so, during currency of policy, deceased died on 26.10.2004 pursuant to which claim was preferred by claimant father, which was repudiated by petitioner Corporation holding suppression of material facts, insured having suffered HIV positive and having undergone treatment and testing in hospital. Aggrieved by repudiation, a consumer complaint was filed with District Forum, when on a move made by petitioner Corporation, records relating to deceased insured’s treatment papers were summoned from Medical Officer of Voluntary Council and Test Centre, Jamkhandi. However desired information could not be had, reporting officer having informed District Forum that as government maintains secrecy in the matter of HIV positive patients, no further information can be rendered in the context. Claim of respondent was resisted by petitioner Corporation also on premises that apart from information rendered by Medical Officer of Voluntary Council and Test Centre, Jamkhandi about deceased insured having suffered HIV positive, deceased insured had also taken treatment in Bijapur Hospital during the period of 30.9.2004 to 24.10.2004. The District Forum however having over-ruled contentions raised on behalf of petitioner, while accepting claim granted substantial relief to respondent. An appeal too preferred by petitioner did not find favour and State Commission too while affirming aforesaid finding dismissed appeal. 2. Learned counsel for respondent referring to finding of District Forum submits that claim of respondent was accepted by District Forum on consideration of untenable grounds on which valid claim of respondent was repudiated by petitioner and that apart, had there been suppression of material fact in proposal form, that was submitted by deceased insured, it was open to petitioner to make thorough investigation before issuance of policy. 3. Since it was a non-medical claim, admittedly medical test was not necessitated at the time of issuance of insurance policy. The counsel for petitioner puts reliance primarily on two documents which are treatment papers of Bijapur Hospital and HIV testing report issued by Voluntary Council and Test Centre, Jamkhandi, which show that sample of blood of deceased insured was tested Positive for HIV. This document appears to have been issued with respect to test carried out on 2.6.2003. As for treatment papers of Bijapur Hospital which shows treatment of deceased insured, during the period of 30.9.2004 to 25.10.2004 admittedly relates to a period when policy had already commenced, hence this document did not espouse cause of petitioner as for suppression of material fact by deceased. However information received from Voluntary Council and Test Centre, Jamkhandi evidently shows that test was positive for HIV and aforesaid test was carried out on 2.6.2003, before commencement of policy and this is a tacit evidence to suggest that even though deceased suffered critical illness as early as on 2.6.2003 material facts were suppressed in proposal that was submitted to secure policy. The fraudulent suppression of material facts as was held by Hon’ble Apex Court in case of Mithoo Lal Naik Vs LIC of India, AIR 1962 SC 814 is governed by following conditions : - a) Suppression must be of a material matter or must suppress facts which it was material to disclose; b) Suppression must be fraudulently made by policy holder and c) The policy-holder must have knowledge at the time of making statement that it was false or had suppressed facts which it was material to disclose. Since as early as on 2.6.2003 even when policy had not commenced the insured was diagnosed HIV positive, evidently material fact was suppressed by him while submitting proposal form to insurance corporation. Finding of State Commission does not appear to have been based on meticulous appreciation of issues involved and revision petition resultantly succeeds. Finding of State Commission is set aside but with no order as to cost. Deposits made by petitioner be refunded to them with interests, if any.
......................JB.N.P. SINGHPRESIDING MEMBER | |