PER MR.B.S.WASEKAR, HON’BLE PRESIDENT 

1)                The present complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986. According to the complainant, her son Jayanta Kumar Pradhan took home lone of Rs.7,69,432/- from the O.P.No.2. He took insurance policy from the O.P.No.1 as pre condition of the home loan policy. Insurance policy was taken on 30^th September, 2010 for twenty years. Her son was paying premium per annum. On 20^th June, 2011, her son died accidentally due to high voltage electric shock. She submitted her claim to the O.P.No.1/Insurance Company.  The O.P.No.1 paid only Rs.1 Lakh as against the claim of Rs.15,38,864/-.  She was depending on her son.  She has no earning source.  As the O.P.No.1 failed to pay her claim, she has filed this complaint for recovery of the claim of Rs.14,38,864/- with interest. She has also claimed compensation of Rs.50,000/- and expenses of Rs.25,000/-.

2)                The O.P.No.1 appeared and filed written statement. The policy is admitted. It is submitted that son of the complainant was suffering from Congenital Heart Disease with Large Ostium Secondum Artial Septal Defect prior to the proposal for policy. He was hospitalized for treatment.  As per discharge summary from hospital, he was admitted on 4^th May, 2008 and discharged on 12^th May, 2008. The insured suppressed the material fact from this opponent. Therefore, the complainant is not entitled for the claim as prayed.  However, the claim of Rs.1 Lakh was paid as ex gratia payment. 

3)                The O.P.No.2 remained absent though duly served therefore it was proceeded ex parte. 

4)                After hearing the complainant and the O.P.No.1 and after going through the record, following points arise for our consideration.

POINTS

REASONS

5) As to Point No.1 & 2 :- The policy is not disputed.  According to the O.P.No.1, in the proposal form, the insured has stated that he was not suffering from any disease and he was not admitted in the hospital for any treatment.  The proposal form is produced on record.  The O.P.No.1 has also produced discharge summary from Asian Heart Institute showing that the insured was admitted in the hospital on 4^th May, 2008 and discharged on 12^th May, 2008. As per final diagnosis, the insured was suffering from Congenital Heart Disease with Large Ostium Secondum Artial Septal Defect. The insured was hospitalized in May-2008 and the proposal form was submitted on 4^th October, 2010.  It is apparent that the insured has suppressed the material fact of his disease from the O.P.No.1 at the time of taking policy. It is vehemently submitted by the learned advocate for the O.P.No.1 that suppressing of material fact disentitled the complainant from claiming the policy benefit.  On the other hand, it is submitted by the learned advocate for the complainant that insured died accidentally due to high voltage electric shock and heart disease has no concern with it.  For this purpose, he has placed reliance on the judgment of Hon’ble National Commission in Revision Petition No.1438 of 2006 in the case of Durga Devi –Versus- National Insurance Company Limited, decided on 10^th September, 2010.  In that judgment, there were two different medical opinions.  The Hon’ble National Commission accepted the medical opinion of the doctor who personally examined the deceased.  In that judgment, there was no evidence to show that the deceased was treated for any pre existing disease. 

6)                On the other hand, it is submitted by the learned advocate for the O.P.No.1 that suppression of material fact itself disentitled the complainant from claiming any relief.  For this purpose, he has placed reliance on the recent judgment of the Hon’ble National Commission in Revision Petition No.1184 of 2008 in the case Life Insurance Corporation of India –Versus- Veena Manje Gowde, decided on 14^th March, 2014. In para 8 of the judgment, the Hon’ble National Commission has laid down as under :

Apparently, it appears that on account of heart disease, insured collapsed.  Even if it is presumed that that cause of death had no nexus with the disease suffered by the insured, complainants were not entitled for any claim as held by this Commission in II (2007) CPJ 51 (NC) – Life Insurance Corporation of India Vs. Krishan Chander Sharma as there was clear suppression of material facts regarding insured’s health.

The learned advocate for the O.P.No.1 has also placed reliance on the judgment of Hon’ble National Commission in the case of Life Insurance Corporation of India –Versus- Krishan Chander Sharma decided on 23^rd January, 2006.  In this judgment, the Hon’ble National Commission has held under :

Ultimate cause of death of the deceased has no relevance whatsoever to the disclosing of information regarding health as required by aforementioned Clauses (a), (b), (d) and (i) of Clause 11 of the proposal form.  Obviously, the answers given by the deceased who was suffering fro asthma and allergic bronchitis etc., to these questions were false to her knowledge and petitioner-Insurance Company was, thus, justified in repudiating the claim by the said letter dated 30.3.1995.  Order passed by Fora below legally erroneous, deserves to be set aside.

Identical facts are before us. In this complaint, the deceased had suppressed the fact that he was suffering from Congenital Heart Disease with Large Ostium Secondum Artial Septal Defect.  The O.P.No.1 has produced discharge summary from the Asian Heart Institute. It is not challenged by the complainant. The insured died within nine months from the date of policy. Thus, the evidence on record is sufficient to show that the insured had suppressed the material fact about his health while taking insurance policy from the O.P.No.1. Therefore, the complainant is not entitled for any benefit under the insurance policy.  The O.P.No.1 has already paid Rs.1 Lakh to the complainant as ex gratia payment. Therefore, we came to the conclusion that there is no deficiency in service on the part of the O.P.No.1.  Hence, we proceed to pass the following order.

ORDER

1. Complaint stands dismissed.
2. Parties are left to bear their own costs.
3. Inform the parties accordingly

Pronounced on 10^th February, 2015