JUSTICE A.P. SAHI, PRESIDENT

IA/10388/2024 (C/Delay)   

1.       Heard Mr. Rajul Shrivastav, learned counsel for the appellant. Delay of 41 days as reported by the office has been prayed to be condoned.

2.       Having heard learned counsel for the appellant, the cause shown is sufficient and the delay deserves to be condoned. The application is allowed and the appeal shall be treated to be within time.

Appeal

3.       The appeal questions the correctness of the impugned order dated 08.02.2024 passed by the Karnataka State Consumer Disputes Redressal Commission, Bengaluru.

4.       The dispute centers around a life insurance claim policy. Upon the death of the insured, who was 45 years of age and had been suffering from cancer,  a claim was set up by the appellant , who is the husband of the insured.

5.       The insurance policy, according to the appellant was acquired after a medical examination conducted by the LIC officials. The policy acquired in 2020 was subsisting on the date of the death of the insured on 30.06.2022.

6.       The appellant set up his claim before the Insurance Company that was repudiated vide letter dated 31.03.2023, which is extracted herein under:

“Ret Clams/Repudiations/2022-2023/646          Date 31-03-2023

To.

Ramakanth Somani,

H/o Late Smt Rajkanya,

H.No.3-553, Somani Avenue, Milan Chowk Gazipur,

KALABURAGI

PIN:585101

Sir,

Re: Death claim under Policy Number. 650688738 on the life of Late Smt. Raikanya

This has reference to your claim under the above policy on the life of Late Raikanya received by us. In this connection we have to inform you that afore stated policy has not completed three years from the date of commencement of risk, i.e. 15-06-2020.

As such we have examined the claim, keeping in view of provisions of Section 45 of the Insurance Act 1938. While examining the claim, we note that from the proposal form dated 11-06-2020 that, the deceased life assured had answered the following questions as noted below.

1. Personal and Family details of health/habits

We may, however, state that all these answers were false as can be seen from the Hospital reports. The DISCHARGE SUMMARY OF DURGABAI DESHMUKH HOSPITAL (ANDHRA MAHILA SABHAL HYDERABAD, DLA has a history of Ml from 2013 (THROMBOLYSED Right Angiogram), DLA was a known case of DIABETES MALLITUS from 2019, DLA was a known case of HTN from 2018, also a known case of HYPOTHYRODISM from 5 years, DLA had undergone 3 cycles of IVF, 6 cycles of IUI, DLA has OVARIAN MALIGNANCY STAGE III C (CANCER OF OVARY) and DLA was on MEDICATION.

This suppression of material facts, which have had a bearing on the granting of risk was clearly done with an intent to play fraud and deceive LIC. Hence the competent authority repudiated the claim as per policy terms and conditions.

In case, if you disagree with our decision and feel that we have not considered any particular facts and circumstances in support of your claim, you may send your representation within three months from the date of receipt of this letter for re-consideration of your claim to our Zonal Office at the following address.

The Zonal Manager,

LIC of India,

South Central Zonal Office,

Saifabad,

HYDERABAD-500 063

Yours faithfully,

Sd/-

Senior Divisional Manager

CC TO: CLAIMS DEPARTMENT, LICI B.O-1. KALABURAGI(646).”

7.       The ground for repudiation is categorical that the insured at the time of filling up of the proposal form and acquiring the policy had made a false disclosure regarding the status of the diseases from which the insured was already suffering. A perusal of the repudiation letter clearly demonstrates that the discharge summary of the hospital, where the insured had been admitted in 2021, against the column of complaints at the time of admission and clinical findings, the insured seems to have also intimated the concerned doctor that the patient had a history of Myocardial Infarction in 2013 (Thromobolysed). This endorsement is made on the discharge summary on 26.04.2021 by the Durga Bai Deshmukh Mahila Sabha (Andhra Mahila Sabha) Vidyanagar Hyderabad. The contents of the document of the discharge summary have been quoted in the repudiation letter.

8.       Learned counsel for the appellant vehemently argued that the said recital is wrong and the insured did not suffer from any heart disease in 2013.

9.       The aforesaid contention has to be noted for being rejected, in as much as, the discharge summary of 26.04.2021 referred to above was considered by the State Commission in paragraph 7 of the impugned order and the finding has been recorded on the strength thereof. There is no material whatsoever to contradict the said evidence and consequently the oral argument advanced by the learned counsel for the appellant has to be rejected.

10.     It can be clearly seen from the repudiation letter that the proposal form has been extracted therein, where under the heading of diseases (at item no. e.2), the question posed is ‘any disease of the heart or arteries’. Against this question the answer of the insured is ‘no’. This explicit answer in the proposal form therefore leaves no room  for doubt that the insured has not disclosed the correct fact of the Myocardial Infarction from which she suffered in 2013 and was recorded in the hospital record of 2021, which document could not be disputed by any evidence. Learned counsel vehemently urged that there was no document produced by the Insurance Company regarding such disease allegedly suffered by the insured in 2013. This argument would be unacceptable for the simple reason that the disclosure of this disease which has been recorded in the discharge summary of a hospital, where she was admitted, was a voluntary disclosure by the insured and therefore is an admission which remains unexplained. Nothing has been shown to demonstrate that the said recital in the discharge summary of the hospital was incorrectly or falsely recorded.

11.     Learned counsel submits that he cannot prove anything negatively when such disease had not actually been suffered by the insured. The said argument does not appeal to reason, in as much as, it was open to the complainant to have questioned the correctness of the said recital in  his complaint and ought to have appropriately disputed the said recital, which does not appear to have been done. This was all the more necessary when the repudiation letter categorically recited the same as a specific reason and was based on it. This having not been questioned by any appropriate pleading or evidence, the conclusion drawn in the repudiation letter and reliance thereon by the State Commission cannot be faulted with.

12.     The next argument of the learned counsel for the appellant is that the cause of death is nowhere related to the alleged heart disease. This issue is not relevant, in as much as, the repudiation is prominently on the ground of non-disclosure of previous existing diseases. Learned counsel submits that a reference to hypertension, diabetes and blood pressure as disease is patently misconceived. For this the learned counsel also submits that the medical test was carried out before the policy was issued and since there was no such disease indicated at the time of the acceptance of the proposal, such infirmities cannot be taken into account.

13.     Even assuming for the sake of argument that the deceased had undergone a medical checkup, the ultimate reason for repudiation is the non-disclosure of the diseases, which was essential keeping in view the column contained in the proposal form, which has been discussed and reasoned out hereinabove.

14.     Thus, the Insurance Company was fully justified in repudiating the claim. The deceased was also suffering from ovarian cancer and in such circumstances the recital contained in column e.7 is also incorrect.

15.     The aforesaid non-disclosures therefore have resulted in the repudiation of the claim by the Insurance Company, which finds support from the conclusions and the ratio of the decision of the Apex Court in the case of Reliance Life Insurance Company Limited & Anr. Vs. Rekhaben Nareshbhai Rathod, (2019) 6 SCC 175.

16.     One may have full sympathies on account of the loss of the spouse of the appellant, but at the same time insurance claims and contracts survive on the principle of uberrimae fidei, which appears to have been breached in the present case.  Consequently, the impugned order cannot be interfered with on the grounds raised for the reasons indicated above.

17.     The appeal lacks merit and is accordingly dismissed.