Petitioner had taken the insurance policy for his daughter on 21.5.2000 for a sum of Rs.50,000/-. Daughter of the petitioner died on 23.4.2001. Petitioner lodged the claim with the respondent insurance company, which repudiated the same on the ground that the petitioner had withheld the health condition of the insured. Being aggrieved, petitioner filed complaint before the District Forum, which was allowed. Respondent filed an appeal before the State Commission and the State Commission has reversed the order passed by the District Forum and held that the petitioner was guilty of withholding material facts, which were within his knowledge regarding the health of his daughter while taking the policy for the insured. After going through the material on record, we agree with the finding recorded by the State Commission. State Commission in its order has held that the insured had taken treatment from CMC Ludhiana in the year 1991 and PGI Chandigarh. State Commission has recorded the following findings in its order : “Adverting to the merit of appeal : after perusal of pleadings of the parties, record of the case, impugned order and the grounds of appeal, we are of the considered opinion that contention of has merit that the District Forum has erroneously allowed the complaint. The record of the case shows that primarily the complaint was allowed by the Forum on the ground that the earlier ailment not disclosed by the life assured, Babita Rani had not nexus with her death. However the record of the case bears ample testimony to the fact that complainant was a known case of cervical laminectomy and had undergone surgery for the same in 1991 at CMC, Ludhiana. The life assured also had history of weakness of all the four limbs since 1991. The appellant authorities investigated the claim and in the history of the patient recorded by Dr.Harpreet Singh at PGI, Chandigarh, it is stated that this ailment of weakness of all the limbs since 1991 was reported by the patient herself to the doctor. The complainant later on underwent surgery for inter-meduliary tumor and she died of respiratory distress and hyper tension. It is unfortunate that she died at a very young age of 29 years, however the medical record shows that she was suffering from health problems since 1991. There is one document marked as Annexure A by the District Forum which is dated 2.11.1991 which also bears ample testimony to the fact that the complainant was suffering from some ailments. Dr. M.P. Rawelly the local doctor states that she has been complaining of weakness on the four limbs since 1991. It is also stated by the doctor in para-1 that she has been taking medical consultations from him since last 15 years (before 23.4.2001). However this was not disclosed at the time of taking the policy. This corroborates the version of the appellant that the life assured is guilty of suppression of material facts pertaining to her health and she deliberately gave the answers in the negative. She was suffering from various complications but did not disclose the same in the proposal form and thus violated the underlying principle of the insurance policy, which is based on declaration of utmost good faith. In the face of these facts that the health problems which the life assured was known to be suffering and were very much in her knowledge, render the contract void ab-initio and no deficiency could be alleged against the insurance company for the repudiation of the claim. In the facts and circumstances of the case on the basis of this record, the impugned order of the District Forum cannot be sustained and the same is set aside. The appeal is accepted, however without any order as to costs.” We agree with the view taken by the State Commission and find no infirmity in the same. Dismissed.
......................JASHOK BHANPRESIDENT ......................B.K. TAIMNIMEMBER | |