- This is the Revision Petition filed by the Petitioner, who is the husband of the deceased life assured (DLA) against the Order of the State Consumer Disputes Redressal Commission, U.P. (in short, the State Commission), which had dismissed the Appeal filed by the Complainant / Petitioner against the Order of the District Consumer Disputes Redressal Forum, Bijnor (in short, the District Forum), which had dismissed the Complaint.
- The issue in this Revision Petition is the repudiation of claim of the Petitioner / Complainant by the letter dated 31.03.2008 of the Respondent on the ground of concealment of “right information” by the Policy Holder with regard to her health at the time of purchasing the Policy.
- The Policy was taken in the name of the Petitioner’s wife for an assured sum of Rs. 70,000/- from the Respondent effective from 15.11.2006. The Policy Holder died on 11.04.2007. The basic document filed as evidence is the report of the Respondent’s Doctor dated 07.08.2007, wherein, it has been stated that the DLA was admitted to the hospital on 07.12.2006 with a history of pain / ulcer / swelling in the tongue for the past two months. The patient was discharged on 18.01.2007. Both the State Commission and the District Forum have dismissed the Complaint on the ground that there was no proper disclosure of the health condition by the DLA. The learned Counsel for the Respondent argued that the DLA was suffering from oral cancer, which was not disclosed in the proposal form. Being a concurrent finding, the scope of this Commission is very limited and therefore, the Petition may be rejected.
- The learned Counsel for the Petitioner submitted that there was no hiding of any information and that mere pain in the tongue cannot be construed as a non-disclosure of a pre-existing disease. Further, the DLA was admitted in a hospital only after the Policy having come into effect. There is no record to prove that there was any other prior hospitalisation or any treatment having been taken before filling the proposal form. Therefore, the question of non-disclosure does not arise.
- Heard the arguments of both the parties as well as went through the record.
- Though, it is a case of concurrent finding, I do not see any evidence of non-disclosure by the DLA and the report of the Respondent’s Doctor is very clear, which states that the patient before admission in the hospital on 07.12.2006 had complained of pain / ulcer / swelling in the tongue and the duration of such complaint was only two months as provided by the patient. This history was reported by only the patient. There is no other record available beyond this information. The DLA was a housewife living in a village. The question before me is whether the Insurance Company can repudiate the claim on this ground alone. It is a commonplace that villagers do suffer pain but do not report it as a matter of routine or as a disease. Only when it goes out of control when they visit a doctor or a hospital. It is also in hindsight possible that after obtaining the Insurance Policy on 15.11.2006, the pain and the swelling might have abnormally increased and forced the DLA to seek medical attention and get hospitalised. Suffering from cancer is not very easily diagnosed at an early stage. It rapidly worsens. Therefore, expecting the DLA, to inform about the pain as a pre-existing disease at the time of filling the proposal form, may not be of such a serious breach as made out by the Insurance Company. Therefore, benefit of doubt in the circumstances of this case needs to be given to the Complainant and to this extent, the Insurance Company is liable for deficiency of service.
- In view of the aforesaid discussion, the Revision Petition is allowed and the Insurance Company is directed to pay to the Complainant the sum assured being Rs. 70,000/- alongwith rate of interest @ 6% per annum from the date of filing of the Complaint till its realisation within a period of six weeks, failing which, the rate of interest will be @ 9% per annum for the same period.
- The Orders of the State Commission and the District Forum are set aside.
- Pending applications, if any, stand disposed of.
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