1.       This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the order dated 8.7.2016 passed in appeal No. 1231 of 2013 by U.P. State Consumer Disputes Redressal Commission, Lucknow (for short, ‘State Commission’) whereby the appeal of the insurance company was allowed and the order dated 7.9.2012 of the District Forum was set aside.

2.       Brief facts are that the complainant’s husband, Sanjeev Pathak (since deceased-insured) obtained HDFC SL Crest Plan Insurance Policy from the OP for a sum of ₹ 5,00,000/- on 16.4.2011.  However, he expired after 26 days on 12-5-2011 in K. K. Hospital, Bareilly, due to acute Pancreatitis with Septicemia.  The cause of death was given as cardio-respiratory failure.  Thereafter, his wife as nominee had filed the death claim before the OP for the payment of the insured amount, but it was repudiated on the ground that the deceased life assured (DLA) had concealed his actual health status while filing the proposal form. Being aggrieved by the conduct of the OP/Insurance Co., the complainant filed a complainant before the District Consumer Dispute Redressal Forum, Bareilly (herein after referred to as “District Forum”) and prayed for payment of the insured sum of ₹5,00,000/- along with ₹25,000/- towards mental harassment.

3.       Before District Forum, OP did not file any reply even after receiving the notice. Therefore, District Forum allowed the complaint, ex parte and directed the OP to pay ₹ 5 lakh as the insured amount and ₹2,000/- as cost for litigation.

4.       Being aggrieved by the order of District Forum, first appeal was preferred by OP before the State Commission, U.P. (for short, State Commission’).  The State Commission held that the DLA had concealed his previous treatment and hospitalization in K.K Hospital, Bareilly for one week i.e. from 14.01.2011 to 20.01.2011.  The complainant filled the proposal form on 11.04.2011, without disclosing about his hospitalization. The State Commission vide order dated 29.06.2005 allowed the appeal and set aside the order of the District Forum.

5.       Being aggrieved by the impugned order, the complainant filed the present revision petition.

6.       Heard learned counsel for both the parties.  There is delay of 85 days in filing the revision petition.  For the reasons stated in the application for condonation of delay, the delay of 85 days is condoned.

7.       Learned counsel for the complainant submitted that at the time of filling up the proposal, DLA was healthy.   On 7.5.2011, he was admitted in K. K. Hospital for acute pancreatitis with septicemia and died due to cardiac respiratory arrest on 12.05.2011.  There was no co-relation with the previous disease and the cause of death. 

8.       Learned counsel for the OP submitted that before taking the policy,  the DLA was admitted in K. K. Hospital during 14.1.2011 to 20.1.2011 and he was treated for Septicemia with Rt. Pneumonitis and Encephalopathy with Dyselectrolylaemia.  After treatment, he was discharged in a stable condition.  The counsel submitted that the DLA had answered in ‘Negative for the questions in the proposal form related to suffering of any disease of the Liver, Kidneys etc. The counsel contended that the Insurance Co. was justified in repudiating the claim as the DLA had not disclosed the fact of his hospitalization while filling the proposal form.

9.       I have perused the proposal form, the medical record of K. K. Hospital, the laboratory test reports, other relevant documents and given thoughtful consideration to the arguments from both the parties.  The discharge summary dated 20.01.2011 of K. K. Hospital, revealed that the DLA was admitted in K. K. Hospital from 14.1.2011 to 20.1.2011 and treated for Septicemia due to Pneumonitis with Encephalopathy.  There was dyselectrolytemia also.  It is pertinent to note that, after three months only, i.e. on 16.04.2011, the DLA had filled the proposal form and the policy was issued by OP.  The DLA answered relevant questions in the proposal form,  No. 2-A and 2-B (in Section ‘C’ ) are reproduced as below:

“Section C (II) Short Medical Questionaire (SMQ) for health details of life to be Assured : (Please tick  □ the relevant box to indicate your choice)

          2A. Have you ever suffered or received treatment for any

                  Symptoms or medical conditions for any of the following?

                        Respiratory disease (excluding Asthma and Bronchitis)                   No

            2B. Have you ever suffered or received treatment for,

                Any symptoms or medical conditions for any of the

                following in last 2 years?

                 Asthma or Bronchits                                                                                  No

10.     In my view, prima facie, the instant case is of concealment of material facts. The DLA has not disclosed about his recent hospitalization but filled the proposal form after three months and got the policy.  If the DLA disclosed his previous illness and treatment, the company would have declined to offer the insurance cover.

11.     Considering the facts and peculiar circumstances of the instant case, I would like to consider that the DLA died on the 26^th day after issuance of the policy.  The death occurred was within very short period.  In my view, the forfeiture of entire premium i.e. huge amount of ₹50,000/- paid by the DLA towards first premium, is not justified.   Moreover, it is transpired that the policy was issued without carrying any medical tests of the DLA, which would have helped the insurance company to diagnose previous ailments.  Therefore, OP/insurance company shall refund the premium amount of ₹50,000/- to the complainant.

12.     Based on the discussion above, the revision petition is partly allowed and the OP shall refund ₹50,000/- i.e. first premium amount, to the complainant, within a period of four weeks from the date of receipt of a copy of this order, failing which, the amount shall carry interest @9% per annum till its realization.