1.       This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the order dated 10.02.2016 passed in FA No. A/14/824 by Maharashtra State  Consumer Disputes Redressal Commission, Circuit Bench at Aurangabad (in short, ‘the State Commission’) whereby the State Commission allowed the appeal of the insurance company by setting aside the order of District Consumer Disputes Redressal Forum, Latur (in short, ‘District Forum’) and dismissed the complaint.

2.       The brief facts are that the complainant’s mother, Satyabhama Dattatraya Patre had obtained an insurance policy from SBI Life Insurance Company Ltd./OP, which was commenced from 7.1.2010.  She died on 29.9.2010 due to viral fever with low platelet count at Lokmanya Hospital at Latur.  On 13.12.2010, her son, the complainant, Mr. Prakash Dattatraya Patre, filed a death claim with the OP, but it was repudiated by the OP on 5.1.2011, stating that the life assured has suppressed the material particulars about the health while obtaining the policy.    Against the alleged unlawful repudiation, the complainant filed a complaint before the District Forum, Latur claiming the policy amount of Rs.2,50,000/- alongwith interest @ 18% and Rs.50,000/- towards mental agony.

3.       The OP filed written version before the District Forum and resisted the complaint on the ground that the deceased-life assured filled the proposal form and answered the question No. 8(iii) and 8(xiv) as ‘Negative’.   The death of the life assured occurred within a year from the commencement of the policy, therefore, investigations were made and revealed that the life assured was treated for Non-Hydgkin Lymphoma (in short, ‘NHL’) from 28.11.2009 to 5.4.2009 in Latur Cancer and Laparoscopic Centre under Dr. Ajay Punpale.  Therefore, the claim was rightly repudiated on the ground of concealment of material facts. 

4.       On hearing both the parties, the District Forum allowed the complaint and directed to OP to pay Rs.2,50,000/- in equal proportion between the complainant, two sisters and the deceased father.  The District Forum also directed the complainant to pay exemplary costs of Rs.10,000/- as the life assured answered both the questions 8(iii) and 8(xiv) in ‘Negative’.  Being aggrieved, the insurance company filed an appeal before the State Commission, Maharashtra.  The State Commission allowed the appeal and consequently dismissed the complaint.

5.       Being dissatisfied with the impugned order, the Petitioner/Complainant had filed this revision petition.

6.       I have heard the learned counsel for both the parties.  Ms. Prachiti R. Deshpande, the learned counsel for the petitioner/complainant submitted that the petitioner was not given opportunity before the State Commission as it was the technical issue.  The OP issued the SBI Life Insurance policy for a period of 10 years commencing from 7.1.2010.  It was issued after medical examination by the panel of doctors of OP.  The counsel brought my attention to the medical examination form signed by Dr. Meghna Gugle, who examined the insured and after due verification and satisfaction, the OP accepted the proposal.  The counsel further submitted that the deceased Satyabhama took the treatment for her viral fever with chills and difficulty in breathing at Latur Cancer and Laparoscopic Centre from 23.09.2010 and when the breathing problem increased, she was shifted to Lokmanya Hospital ICU where she expired on 29.9.2010.  The treating doctor, Dr. Punpale had issued the certificate, which suggests that there were no signs of NHL after doing blood test and CT Scan, therefore, the death was not due to NHL i.e. previous disease.  The counsel for the complainant relied upon the decision of Hon’ble Supreme Court in Sulbha Prakash Motegaonkar and Ors. Vs. Life Insurance Corporation of India, civil appeal No. 8245 of 2015 decided on 5.10.2015.

7.       Learned counsel for the OP/respondent, Mr. G. L. Chawla submitted that the proposer has concealed about her disease status while filling the proposal form.  Satyabhama was suffering from NHL and treated by chemotherapy during 28.11.2008 to 5.4.2009.  Despite this fact, in the proposal form, she answered questions No. (xiii) and (xiv) in ‘Negative’.  The counsel further submitted that the contract of insurance is a contract of ‘utmost good faith’.  He relied upon the decisions of this Commission in FA No. 242 of 2006- Dineshbhai Chandarana vs. LIC of India decided on 27.7.2010, Reliance Life Insurance Co. Ltd. and Anr. vs. Madhavacharya decided on 2.2.2010.

8.       I have perused the proposal form, it revealed that the proposer has answered the question No. 8(xiv) as ‘Negative’.  The question (xiv) is reproduced as under:

 “xiv. Are you suffering from, or did you suffer or undergo investigation in the past from or have you been advised to undergo investigation or treatment for:

                             a.       Cancer/Leukemia/Lymphoma              No.”

9.       I have perused the relevant documents available on the file like FNAC report, the medical record and the certificate issued by Dr. Ajay Punpale  and the proposal form.  The deceased underwent FNAC and the report issued by Krishna Surgical Pathology Laboratory dated 14.11.2008 had made diagnosis of malignant lymphoma – high grade.  Therefore, she was hospitalized in Cancer and Laparoscopic Centre at Lature from 28.11.2008 to 5.4.2009 and was given three cycles of Chemotherapy for NHL.  I have perused the certificate dated 30.9.2010 issued by Dr. Ajay Punpale, who treated the patient for viral fever also.  It is reproduced as below:-

“Dated 30/09/2010

To,

Whomsoever it may be concerned

Referring herewith MRS. Patre Satyabhama Datttatraya, 55/F, was admitted in Latur Cancer and Laparoscopy Centre on 23/09/10 for fever with chills, difficulty in breathing, weakness.

As she is my old patient and I have treated her for NonHodgkin’s lymphoma from 28.11.2008 to 5.04.2009, I suspected if these complaints are related to her previous disease.  After doing blood tests and CT scan of chest and abdomen, it was found that she had no findings related to her previous disease.  The tests pointed towards she is suffering from viral fever with very low platelet count.

          She was treated with medicines and blood transfusions.  However, she maintained her health till 29/9/10 when her breathing problem increased. She was shifted to Lokmanya ICU at 6.30 PM.  But she deteriorated further and expired at 7.10 p.m. on 29/9/10.

10.     The certificate issued by Dr. Ajay Punpale does not carry any significance because on bare reading of the certificate, itself establishes that Satyabhama was suffering from NHL and treated for that prior to filling the proposal form.  Even though, she was suffering from viral fever with very low platelet count.  It cannot rule out the effects of NHL and Chemotherapy was persistent on the patient.  Moreover, the patient with NHL have tendency towards bleeding and low platelet count.  The District Forum has erred which on the one hand allowed the complainant, but in contrary imposed exemplary costs of Rs.10,000/- upon the complainant, because the life assured had answered both the questions in ‘Negative’. Learned counsel for the complainant relied upon the judgment of Hon’ble Supreme Court in Sulbha Prakash Motegaonkar and Ors. (supra); in my view, the facts are different from the instant case.  In the instant case, NHL was a major disease.  The insured took Chemotherapy treatment for Non Hodgkin’s Lymphoma.  It is a High Grade malignant lesion.  It is not a common health ailment like fever, headache, common cold hypertension or diabetes.  Non disclosure of common ailment is not a material concealment.  But, non disclosure of NHL is a clear case of fraudulent suppression while filling the proposal form.  I would like to rely upon the decision of Hon’ble Supreme Court in the case of PC Chacko & Anr. Vs. Chairman, LIC of India – (2008) 1 SCC 321.  Hon’ble Supreme Court observed in paras 15 and 16 of its judgment on fraudulent suppression, as below:

“15. The insured furthermore was aware of the consequence of making a misstatement of fact. If a person makes a wrong statement with knowledge of consequence therefor, he would ordinarily be estopped from pleading that even if such a fact had been disclosed, it would not have made any material change”.

16. The purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law”.

          In the same judgment, Hon’ble Supreme Court clarified about what constitutes a material suppression.  In para 21, it is reproduced as below:

“21.    If there are any misstatements or suppression of material facts, the policy can be called into question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person”.

11.     On the basis of foregoing discussion, it is amply proved that deceased life assured, Satyabhama was suffering from NHL and underwent Chemotherapy for the same in the year 2008, which was prior to signing the proposal form on 31.12.2009.  She did not disclose this fact and answered ‘Negative’ to the medical questionnaire in the proposal form.  It amounts to concealment of material fact.  Therefore, the complainant is not entitled for any relief in the instant case.  The repudiation of claim by the OP is justified.  I do not find any error apparent in the well reasoned order of the State Commission, which needs any interference. 

12.     The revision petition is dismissed.  However, there shall be no order as to costs.