1.      The present Revision Petition (RP) has been filed by the Petitioner against Respondent as detailed above, under section 21 (b) of Consumer Protection Act 1986, against the order dated 03.10.16 of the State Consumer Disputes Redressal Forum Punjab (hereinafter referred to as the ‘State Commission’), in First Appeal (FA) No. 1202 of 2016 in which order dated 31.08.2015 of Ferozepur District Consumer Disputes Redressal Forum (hereinafter referred to as District Forum) in Consumer Complaint (CC) no. 215 of 2015 was challenged, inter alia praying for setting aside the order dated 03.10.2016.

2.      While the Revision Petitioners (hereinafter also referred to as Complainant) was Respondent before the State Commission and Complainant before District Forum and the Respondents (hereinafter also referred to as OPs) were Appellants before the State Commission and OPs before the District Forum. Notice was issued to the Respondents on 16.02.2018. Parties filed Written Arguments/Synopsis on 06.10.2023 ( Petitioner) and 27.10.2023 (Respondent) respectively.

3.      Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Forum and other case records are that husband of complainant Ravi Kumar ( DLA) obtained one life insurance policy dated 28.11.2012  from OP no.1 which was valid upto 28.10.2020  The complainant was a nominee in the said policy being legally wedded wife of the DLA as well as beneficiary of the policy.  DLA paid Rs.1138/- per month as insurance premium.  It is alleged by the complainant that agent of OP No.1 obtained the signatures of DLA on blank papers and filled the information on his own without explaining its contents to the DLA.  Thereafter, empaneled doctors of the LIC conducted health examination of the DLA in which DLA was found fit.  However, DLA was sick and was admitted to Mission Hospital, Ferozepur and on 23.04.2014, he was referred to CMC Ludhiana where he breathed last on 10.05.2014.  The complainant being the sole legal heir approached the OPs and submitted her claim papers with the OPs and OPs after lingering the matter on one pretext or other, repudiated the claim of the Complainant on 31.03.2015.  Being aggrieved, the Complainant filed CC before the District Forum and District Forum vide order dated 31.08.2015 allowed the Complaint of the Complainant.  Being aggrieved, the OPs preferred an Appeal before the State Commission and State Commission vide order dated 03.10.2016 allowed the appeal of the OPs.  Therefore, the Complainant is before this Commission now in the present RP.

4.      Petitioner(s) have challenged the said Order dated 03.10.2016 of the State Commission mainly on following grounds:

1. State Commission has totally ignored the proposal form from where it is proved that Dr. P.K.Garg was present when the proposal form was filled and he signed on the last page of the proposal form.  Thus, it is proved that husband of Petitioner was medically examined at the time of obtaining the insurance policy.

2. The State Commission has discarded the fact that total onus was on the respondent to prove that husband of Petitioner was suffering from diabetics pancreatitis prior to the taking of policy.

3. Respondents have not placed on record any affidavit of Dr. J Solomon to prove that husband of Petitioner was admitted in Frances Newton Hospital with the diagnosis of pancreatitis and he was discharged on 06.05.2011.  No medical certificate has been placed on record regarding said admission. 

4. The State Commission totally discarded the fact that Respondents have failed to place on file any certificate of leave of department from which it is proved that husband of the Petitioner took 83 days medical leave prior to filing of proposal form. 

5. State Commission discarded the fact that even the husband of the Petitioner was suffering from diabetes mellitus.  If test was conducted before issuing the policy, then why it was not detected in the report. 

6. Respondents have not placed on record any medical certificate of any hospital to prove that husband of the Petitioner was ever admitted or took any treatment from any hospital or the doctor regarding the alleged pre existing disease.  Even the case history and the discharge summary report from the hospital is not supported by the affidavit of doctor concerned.

7. Respondents have not filed any affidavit of any treating doctor that Petitioner was suffering from diabetes mellitus-II.

5.      Heard learned counsels of both sides.  Contentions/pleas of the parties, on various issues raised in the RP, Written Arguments, and Oral Arguments advanced during the hearing, are summed up below.

5.1    Learned counsel for the Petitioner repeated the points which have been stated  in para 5, ground for challenging the order of the State Commission,  hence the same are not being repeated here.   Learned counsel has relied on the following judgments :

a.      M/s ICICI Prudential Life Insurance Company Limited Vs. Veena Sharma and Others 2014 ( 4) CLT 507

b.      Life Insurance Corporation of India Vs. Priya Sharma and Others 2011 (3) CLT 549

c.       Harjit Singh Padda Vs. LIC of India and Others 2010 ( 3) CLT page      72.

5.2.   Learned counsel for respondents argued that DLA had made deliberate misstatement and had withheld material facts regarding health at the time of filling up of the proposal form dated 27.11.2012 wherein he had concealed the fact that he consulted and took treatment from Fances Newton Hospital Ferozepur for the disease of diabetes mellitus-II from 03.07.2012 to 06.07.2012 and for the disease of pancreatitis from Frances Newton Hospital, Ferozepur till 06.05.2011, both the treatments being prior to the date of proposal.  Therefore, both the treatments were taken by the deceased prior to the date of proposal form and, therefore, premium paid by DLA sands forfeited to the Corporation in view of the concealment made by the DLA in the proposal form. Learned counsel further argued that DLA was suffering from the disease of diabetes mellitus-II was revealed from the history reported by the DLA to Frances Newton Hospital, Ferozepur, where it has been certified by Dr. David Masih of Frances Newton Hospital on certificate of hospital treatment, regarding history given by DLA that he remained admitted in the said hospital from 03.07.2012 to 06.07.2012 for the disease of diabetes mellitus-II.

5.3.   It is further argued by learned counsel that deceased life assured had further concealed the disease of pancreatitis in the proposal form which is clearly apparent from the certificate of Frances Newton Hospital, Ferozepur, wherein it has been certified by Dr. J Solomon, that the DLA was admitted in the said hospital with the diagnosis of pancreatitis and was discharged on 06.05.2011.  Further, nothing is payable as per the declaration made by the DLA and under the terms and conditions of the policy bond. 

6.      The claim has been repudiated by the Insurance Company on the ground of  suppression of material facts with respect to pre existing ailments.  District Forum allowed the complaint after observing that case of the OP had certain grey areas, the insurer should have satisfied himself about the state of health or medical history of DLA.  No evidence has been brought on record that insured was indeed asked questions to which he supposedly gave incorrect answers.  It was argued by the OP that no doubt, the insured should satisfy himself about state of health but the state of health has to be given by the insured, and in case,  before taking the policy he had taken any treatment that was specifically in his knowledge, then it did not absolve the insured to state true facts of answers and questions asked from him at the time of filling the proposal form.  In case he has stated wrongly with regard to questions asked from him at the time of filling the proposal form, then later on he cannot blame the OP that OP did not satisfy themselves about the state of health of the complainant.  In this regard, in the proposal form, all questions relating to personal history of the insured were answered ‘No’, except one question “what has been your usual state of health”, which was answered ‘Good’.   In this regard, relevant observations of the State Commission are reproduced below:

“9.      The perusal of these coloumns will reveal that declaration as to whether he was ever admitted in the hospital / nursing home for general check up/observation, treatment or operation where he remained on leave from his place of work on the grounds of health ? Or whether he suffered from any ailment then its particulars ? Whether he suffered beyond diabetes/B.P. etc.? OPs have further placed on the record the certificate issued by Frances Newton Hospital Ex.OP1&2/3 in which it has been referred that Mr. Ravi, Hospital Unit No. 191858 was admitted in Frances Newton Hospital with the diagnosis of Pancreatitis and was discharged on 6th May, 2011. Then there is a Certificate by Employer Ex.OP1&2/4 in which he was stated that Ravi Kumar was on medical leave for 83 days. Then there is another document Ex.OP-182/7 issued by Frances Newton Hospital, Ferozepur Cantt. in which it was stated that he was admitted in this hospital on 3.7.2012 and was discharged on 6.7.2012. Then he was suffering from DM-2 and CVA. Therefore, these documents showed that before taking the policy, the insured remained admitted in Frances Newton Hospital and taking treatment for DM-2, CVA and Pancreatitis whereas when  he filed the proposal form Ex.OP1&2/1 he did not disclose of taking these treatment to  OPs and also did not state that he remained on medical leave from his department. Therefore, it is a concealment of material facts before taking the policy. Therefore, claim was not payable and was rightly repudiated. ……..”

7.      State Commission after considering the evidence before it, accepted the appeal and set aside the order of the District Forum, observing as follows :

“10. ……It was the duty of the insurer to disclose all the facts about his/her health.  No doubt that some times LIC get a medical examination of the insured from their empanelled doctor but empanelled doctor also conduct the medical examination on the basis of questions / answers given by the insured in the proposal form.  In the absence of any specific disclosure by the DLA, then it was very difficult to examine the DLA fro that angle and concealment of material facts with regard to the state of health by the DLA itself is a sufficient point to repudiate the claim of the complainant in view of the judgments of the Hon’ble Apex Court and Hon’ble National Commission referred above.  Therefore, the order passed by the District Forum is erroneous one and is liable to be set aside.”

8.      As has been held by the Hon’ble Supreme Court in catena of judgments, insurance contracts are special contracts based on general principles of full disclosure inasmuch as a person seeking insurance is bound to disclose all material facts relating to the risk involved.  In Manmohan Nanda Vs. United India Insurance Co. Ltd. and Anr. – (2022) 4 SCC 582, Hon’ble Supreme Court laid down certain basic rules to be observed in making a proposal for insurance, stating interalia that carelessness is no excuse unless error is so obvious that no one could be regarded as misled.  If the proposer puts ‘No’ when he means ‘Yes’, it will not avail him to say it was slip of pen,  the answer is plainly the reverse of the truth.  It is contended by the complainant that agent of OP No.1 obtained signatures of DLA on blank papers and filled the information on his own without explaining its contents to the DLA.  It was held by Hon’ble Supreme Court in Reliance Life Insurance Co. Limited and Anr. Vs. Rekhaben Nareshbhai Rathod – (2019) 6 SCC 175, a person who affixes his signature to the proposal, which contains a statement which is not true, cannot ordinarily escape from the consequences arising there from by pleading that he chose to sign the proposal containing such statement without either reading or understanding it.

9.      We have carefully gone through the orders of the State Commission,  District Forum, other relevant records and rival contentions of the parties and are of the view that State Commission has given a well-reasoned order and it calls for no interference at the revision stage.  There is no illegality or material irregularity or jurisdictional error in the order of the State Commission, hence the same is upheld.  Accordingly, Revision Petition is dismissed. 

10.    The pending IAs in the case, if any, also stand disposed off.