1. The life insurance claim in respect of the four policies of the late husband of the Complainant has been made the foundation for this complaint. The deceased husband of the Complainant was a contractor who took four life insurance policies one on 28.08.2006 for an assured sum of Rs.5,00,000/-. The second was taken on 22.02.2009 for a sum of Rs.25,00,000/-. The third policy was taken for a sum of Rs.4,00,000/- on 28.05.2010 and the last policy was taken on 04.11.2010 for a sum of Rs.1,00,00,000/-. The aforesaid policies were effective as on the date when the claim was set forth after the assured Mr. Rakesh Kumar Burdak expired on 13.08.2012 at the age of 35.
2. The first policy for a sum of Rs.5,00,000/- and the claim arising therefrom was accepted by the Life Insurance Corporation and the amount was disbursed. This disbursal, however, had been initially rejected on the ground that the past medical history of the assured had not been disclosed. However, while rejecting the clam of Rs.5,00,000/- at the initial stage the LIC in the repudiation letter indicated that the disclosure with regard to his ailment in December 2007 and in April and September 2009 about Pyrexia with Polyarthritis and KC of Coaches Abdomen (Tuberculosis in the Stomach) from which he was suffering had not been disclosed in the proposal form and therefore the claim was liable to be rejected. This communication by the regional manager LIC dated 17.09.2013 in respect of this policy of 2006 was appealed against by the claimant on the ground that any ailment of 2007 and 2009 could not have been disclosed when the policy itself was taken in the year 2006 and therefore there was no disease in existence requiring disclosure. Realizing this fault on the part of the Life Insurance Corporation, the sum was allowed by the higher authorities and the claim was accepted vide a communication dated 26.02.2014. Thus, the said policy had been incorrectly rejected by mentioning diseases the information whereof came into existence only in 2007 and 2009.
3.  So far as the other policies are concerned referred to above, they have been rejected on identical grounds, firstly on account of non-disclosure of previous ailment, and as will be discussed hereinafter also on account of non-disclosure of pre-existing policies. Thus, all the three other policies have been rejected on the said grounds.
4. Learned Counsel for the Complainant has advanced his submissions contending that the aforesaid allegations of an investigation about the past medical history of the patient have been denied both in the written statement as well as in the affidavit of evidence. The documents that were procured by the investigator and filed on record have not been proved and therefore the same cannot be read in evidence. In essence, the argument is that the medical records with regard to the past medical history and ailment of the patient have not been proved by the production of the person who had obtained the documents and therefore the said documents cannot be taken into account, for which reliance is placed on an order of this Commission in the case of Life Insurance Corporation of India & Ors. Vs. Pariapally Sujatha & Ors. (2010) 1 CPJ 106 decided on 05.08.2009. Relying on the said decision, it is urged that since no evidence of the concerned person was filed nor any record was produced as in that case, the contention of the Insurance Company cannot be said to have been proved in accordance with law.
5. It is therefore submitted that the repudiation in the above background where the previous medical history has been denied by the Complainant and has not been proved by the Opposite Party, the claim deserves to be allowed and the repudiation by the Insurance Company has to be declared as invalid.
6. Responding to the aforesaid submissions Mr. Lakshay Sawhney urged that so far as the first policy of Rs.5,00,000/- is concerned, there was no evidence with regard to any pre-existing ailment at that stage when the policy was issued in 2006. Hence any material with regard to subsequent ailments in 2007 or 2009 could not have been made the basis for repudiation and it is for this reason that the said policy of Rs.5,00,000/- was accepted and the amount was reimbursed after being rectified by the higher officers.
7. Coming to the other three policies, the consistent stand is that there is a complete non-disclosure of the ailment of the assured who was suffering from no less a fatal disease of AIDS. There were other complications as well and he had been admitted to the Fortis Hospital on a couple of occasions and had been discharged recording the aforesaid existing ailments. It is also urged that he had suffered from Chikungunya as well, and none of these facts were disclosed in the proposal forms of all these three policies. He has taken the Bench through the proposal forms one by one to demonstrate that there is a negative indication in all the columns that were to be filled up for disclosure of past ailment. Thus, there was deliberate concealment and a false declaration made. Hence in terms of the policy, the same deserves to be repudiated.
8. He then submits that the position is the same with regard to the disclosure of the other pre-existing policies taken by the assured. He has invited the attention of the Bench to the proposal forms to that effect also to indicate that either one or none of the policies have been disclosed which results in suppression of material information with regard to the other policies that have been referred to hereinabove. Thus, non-disclosure of previous policies is also one of the clauses under which the Insurance Company is entitled to repudiate the claim.
9. Concluding his submissions and after having pointed out the facts as on record, he has cited the following decisions in support of his submissions.

List of judgments on behalf of OPs

10. Having heard learned Counsel for the Parties, three policies are required to be examined in order to ascertain as to whether the grounds for repudiation for not disclosing the ailment of 2007 and 2009 and non-disclosure of pre-existing policies can be accepted. The first in this sequence is the policy no.197580503 dated 22.02.2009 for an assured sum of Rs.25,00,000/-. This policy has been repudiated by the letter dated 17.09.2013 referring to non-disclosure of the previous medical ailment history of the complainant of December 2007, April 2009 and September 2009.
11. The next policy is dated 28.05.2010 where the sum assured is Rs.4,00,000/- bearing no.198167925.
12. The third policy is dated 04.11.2010 where the sum assured is Rs.1,00,00,000/- and the Policy No. is 198301697, the other two policies have been repudiated through similar letters which are of the same date. The Complainant made an appeal before the higher authorities that have been declined.
13.  In this regard, the Life Insurance Corporation has brought on record the proposal forms regarding these three policies. In respect of the policy where the sum assured is Rs.25,00,000/-, the date of proposal mentioned therein is 09.03.2009. The column with regard to previous medical history which is column no.11 nowhere indicates any declaration of the ailment of the year 2007. The document which has been filed on record is a copy of the patient history indicating the treatment of the Complainant in Fortis Escorts Hospital where he was admitted on 27.12.2007. In the past medical history, hypertension and Tuberculosis were mentioned. The patient was suffering from swelling of joints and he was diagnosed being infected with Chikungunya. This document is on record at page 138 of the paper book. There is, however, one clarification in respect of this policy of Rs.25,00,000/- to the effect that it discloses the earlier policy of Rs.5,00,000/-.
14. The second document is yet another discharge summary from Fortis Escorts Hospital dated 22.04.2009 where again the assured has been shown to have suffered from Chikungunya in the past and he was diagnosed for K Abdomen Which is Tuberculosis of the Stomach. The said document is at page 146 of the paper book.
15.  The third medical document is of the same hospital where he was diagnosed for PUO. He was again admitted in the hospital on 02.09.2009 and discharged on 03.09.2009 where he remained hospitalised for a day.
16. The policy for Rs.4,00,000/- was taken where also no past medical history was disclosed.
17.  The third policy which was for Rs.1,00,00,000/- also suffers from the same status. However, this third policy mentions the policy taken previously for Rs.25,00,000/- but it does not mention the policies of Rs.4,00,000/- and of Rs.5,00,000/- that have been mentioned hereinabove.
18. On 20.07.2016, this Commission passed the following order:

“ORDER

After some arguments, the learned counsel for the opposite parties seeks permission to either file the affidavit of the investigator who collected the record from the Fortis Hospital, Jaipur or to summon the Medical Superintendent of the aforesaid hospital along with the record relating to admission and treatment of the deceased in the said hospital. In case, the affidavit is filed by the OPs, the complainant would be entitled to file an affidavit in rebuttal within next two weeks.

Re-notify on 6.9.2016.”

19. The order seems to have been passed as an objection was taken as with regard to the veracity of the documents that were obtained by the investigator from the hospitals as indicated above. It may be noted that the evidence by way of affidavit on behalf of the Opposite Party had been filed in January 2016 but in order to make sure the status of the said documents obtained by the investigator, an evidence by way of affidavit was filed by Mr. RK Jain, the investigator supporting the documents that have been exhibited through the written version before this Commission. The said affidavit dated 02.08.2016 is on record. Thus, the order dated 20.07.2016 was complied with and the said affidavit has not been controverted.
20. Consequently, the argument of the learned Counsel for the Complainant that the documents have not been proved by way of evidence is incorrect and against record.
21. Apart from this, it is not the case of the Complainant that the said documents are fake or forged or manipulated. In the background above, learned Counsel for the Opposite Party is correct in his submission that there is a clear violation of the disclosure clause as the past medical history has not been disclosed in any of the three policies and even though the previous policies acquired have been selectively mentioned, but the complete disclosure of all the three policies is absent. Thus on this count as well, since there was a suppression of the disclosure of all the material details of the policies taken by the Complainant, the repudiation clause on this count is clearly attracted. In the background above and on the facts as analysed and discussed hereinabove, it is evident that this non-disclosure or withholding of relevant material information is established.
22. There is one argument advanced by the learned Counsel for the Complainant that before extending the policy in the year 2009 a medical investigation was carried out by the LIC itself for HIV which was found to be negative. This document is being relied on by the Complainant to contend that prior to the issuance of the policy, the said blood test report indicates that he did not suffer from HIV/AIDS. It is also urged that the insured was also medically fit on other parameters including Diabetes.
23.  It is also urged by the learned Counsel for the Complainant that the claim was examined and it was forwarded to the higher authorities recommending acceptance of the claim which is Annexure C-6.
24. A recommendation in the opinion of this Commission does not amount to acceptance of the claim.
25.  The fact that he was infected with HIV has not been successfully controverted by the Complainant.
26. Thus, the clinical ailment status of the insured and the status of pre-existing polices had not been disclosed correctly in the proposal forms, and for which the reliance placed by the learned Counsel for the Insurance Company on the judgments referred to above are squarely applicable on the facts of the present case. The claims have been rightly repudiated and there is no element of deficiency in service on the part of the Opposite Party, Life Insurance Corporation.
27.  Consequently, the complaint is unsustainable and is hereby dismissed.