JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER This revision is directed against the order of the State Commission Uttar Pradesh dated 08.12.2016 whereby the State Commission allowed the appeal preferred by the respondent insurance company, set aside the order of the District Forum and dismissed the complaint. 2. Briefly stated, the facts relevant for the disposal of the revision petition are that petitioner filed consumer complaint against the respondent opposite party alleging that he purchased Unit Linked Insurance Policy from the opposite party on payment of premium of Rs.6041/-. The policy was valid w.e.f. 28.01.2008 to 28.01.2018. The policy also extended the medical insurance cover. The case of the complainant is that on 11.04.2009 he suffered with the complaint of giddiness and anxiety. The complainant was, therefore, taken to Pushpanjali Hospital, Delhi Gate, Agra, where he was treated in ICU for a day. Thereafter, the complainant was referred to Delhi for further treatment. It is alleged that at Delhi, the complainant was treated at City Hospital, a unit affiliated with Sir Ganga Ram Hospital till 17.04.2009 when he was discharged. On 25.04.2009 the condition of the complainant again became bad and he got himself admitted in Pushpanjali Hospital and Research Centre on 25.04.2009 where he was treated till his discharge on 03.05.2009. It is further the case of the complainant that though as per the insurance policy, he was entitled to cashless treatment but aforesaid facility was not extended to him. It is alleged that petitioner has spent a sum of Rs.5,00,000/- on his treatment including medicine, doctor’s fee and expenses for ambulance but his claim has been repudiated by the insurance company. 3. The respondent insurance company in its written statement admitted issue of insurance policy in favour of the petitioner. The respondent, however, justified repudiation on the ground that petitioner had obtained insurance policy by concealment of material fact i.e. he was suffering from Diabetes Mellitus. 4. The District Forum on consideration of the pleadings allowed the complaint and directed the opposite party to pay to the complainant medi-claim amount of Rs.4,00,000/- besides compensation of Rs.50,000/- and Rs.1500/- as legal expenses. It was also ordered that directed amount be paid within one month from the date of the order failing which the amount shall carry 8% interest p.a. till realization of amount. Being aggrieved of the order of the District Forum, the respondent preferred an appeal before the State Commission. The State Commission on re-appreciation of evidence came to the conclusion that insurance policy was obtained by the complainant by concealment of material fact i.e. he was suffering from Type II Diabetes Mellitus. The State Commission, therefore, took the view that insurance claim was rightly repudiated by the opposite party. As a consequence the appeal was allowed and order of District Forum was set aside. 5. Learned counsel for the petitioner has contended that State Commission has fallen in error in failing to appreciate that opposite party has failed to produce any cogent evidence that the petitioner at the time of answering the questionnaire regarding his health condition in the proposal form was aware that he was suffering from Diabetes Mellitus. It is argued that if the petitioner was not even aware of his medical condition, he cannot be said to have obtained the insurance policy by concealing the material fact. 6. We do not find merit in the contention of the petitioner. On perusal of copy of the proposal form, we find that in response to the health questions, insured has answered all the questions in the negative. Question no. 23 h (i) is reproduced as under: “Have you ever suffered or are suffering from any of the following - Diabetes / High Blood Sugar”
7. This question has been answered by the insured in the negative. At the end of the proposal form, the petitioner has signed the following declaration: “I/We declare that I/We have fully answered the questions in the proposal form after being explained by the advisor of the ICICI Prudential Life Insurance Co.Ltd. (hereinafter referred to as Company) and have fully understood the nature of the questions including health related questions and the importance of disclosing all material information while answering such questions. I/We further declare that the answers given by me/us to all the questions in the proposal form and the information given to the Medical Examiner of the Company as to the state of health and habits of the Life Assured are true and complete in every respect and that I/We have not withheld any material information or suppressed any material fact. I/We have made no statement to the Insurance Advisor, Medical Examiner, or any other person associated with ICICI Prudential Life Insurance Company Limited which in any way modifies the answers and statements on this application. I/We undertake to notify the Company of any change in the state of health of the Life Assured or as to his occupation subsequent to the signing of this form and before the acceptance of the risk by the company. I/We also understand that in case of any mis-statement or suppression of material information the company has the right to repudiate the claim under this policy. The policy shall become void where it is found that the policy was issued on the basis of fake/tempered documents and/or proofs. I/We also certified that I/We have read and understood the benefits illustration as published by the Company that were handed over to me/we alongwith this proposal form. I also understand that terms and condition including the premium and benefits under the policy are subject to taxis/duties/charges in accordance to the applicable laws. I confirm that all premium will be paid from bonafide sources. 8. On reading of the above, it is clear that while giving information about his health condition in the proposal form, the petitioner categorically denied having been suffering from Diabetes Mellitus. The aforesaid declaration of the insured is belied by his medical treatment record. On perusal of prescription slip dated 11.04.2009 given by Dr. Prahlad Garg to the insured, it is recorded that patient is a case of DM ( Diabetes Mellitus) for the last 8-10 years. Similarly, on perusal of copy of the Discharge Summary of the insured patient issued by the City Hospital, we find that it records history of the petitioner insured as under: “History 44 years old male patient known case of type-II DM for 20 years had on episode of hypoglycemia 10 days back which was corrected. He later had loose motion with fever about 4 days back. He took treatment at local hospital at Agra and was relieved. However, he started developing pedal edema and deranged RFT. He became drowsy since 2 days. No h/o chest pain, pain abdomen, cough, burning micturition. No h/o CAD, TB HTN.” 9. On reading of the above, it is clear that the petitioner is known case of DM for 20 years. From the above two documents, it is clear that petitioner was a known case of DM since at least 8-10 years prior to filing of the proposal form, in which he has denied that he was suffering from DM. Thus, we do not find any fault with the finding of the State Commission to the effect that petitioner had obtained the insurance policy by concealment of material fact regarding his medical condition. The State Commission, therefore, was justified in holding that repudiation of insurance claim of the petitioner for reimbursement of expenses incurred on the treatment of Diabetes Mellitus was justified. 10. Learned counsel for the petitioner in order to wriggle out of the situation has submitted that State Commission has committed a grave error in relying upon the prescription slip of Dr. Prahlad Garg and Discharge Summary of City Hospital as those documents have not been proved by the primary evidence i.e. by examining Dr. Prahlad Garg or the witness from the City Hospital. We do not find merit in this contention for the reason that proceedings before the consumer fora are summary proceedings in which strict technical rules of procedure and evidence are not applicable. Otherwise also, the petitioner has not shown anything on the record that he in his evidence denied correctness of prescription slip and the discharge summary. It is also argued by learned counsel for the petitioner that recording of previous history of Diabetes Mellitus does not mean that aforesaid opinion was given by the petitioner or that he was aware of his ailment. We do not find merit in this contention. Both doctor Prahlad Garg and the concerned doctor of City Hospital have recorded about the previous history of Diabetes Mellitus of the patient. This history obviously must have been given by the petitioner himself or his friend / relative, who took him to the doctor concerned or the hospital. Therefore, there is no reason to suspect that concerned doctors of their own have recorded the previous history. 11. In view of the discussion above, we do not find merit in the revision petition. It is accordingly dismissed. | 
