The husband of complainant had taken LIC policy for Rs.1,00,000/- w.e.f. 20.3.1999 and the insured died on 06.10.1999 on account of peptic ulcer. The death of the complainant was within two years of taking of the policy and as such the insurance Company investigated in terms of Section 45 of the Insurance Act. After the said investigation, Insurance Company repudiated the claim on the ground the petitioner has suppressed the fact that he was suffering from peptic ulcer and had taken treatment for peptic ulcer in 1996 as also leave taken on medical ground.The District Forum had partly allowed the claim and ordered payment of Rs.10,000/- as compensation towards deficiency of service on account of non settlement of claim. This order was challenged by the complainant before the State Commission. LIC has also filed appeal before the State Commission. The appeal filed by LIC was dismissed and the appeal of the complainant was allowed. The Insurance Company was ordered to pay sum of Rs.1,00,000/- to the complainant with interest at 6% per annum from the date of the complaint till realization. This order is subject matter of challenge in this revision. We have heard counsel appearing for both sides. Learned Counsel for petitioner has taken us through the leave certificate of the husband of the complainant from the employer as also the hospital records from Government hospital, Hospet, which are attested by Senior Surgeon, Govt. Hospital Hospet. It has also been pointed out that the complainant’s husband had given false information relating to his health in the proposal form wherein he had denied medical consultation for any ailment requiring treatment for the last five years or having been admitted in any hospital for the general check up or having remained absent from duty on health ground during the last five years or having suffered any ailment including liver, stomach heart, lungs kidney, brain or nervous system. Therefore, it is submitted that the complainant is not entitled to any amount and the revision be allowed. On the other hand learned Counsel for complainant submitted before us that no doctor was examined to prove the records and it has not been established that said record pertains to husband of the complainant. According to him, State Commission has very rightly allowed the claim and the same does not call for interference in revision. The record shows that the husband of the complainant had taken medical leave during the period 20.3.1996 to 6.10.1999 on different occasions as per certificate issued by the employer to the husband of the complainant. In the proposal form it has been categorically denied by the husband of the complainant that he had remained absent from the place of work on the ground of health during last five years. Thus, the husband of the complainant suppressed taking leave on various occasions on medical ground. Besides this, the Insurance Company filed the records from GovernmentHospital, Hospet, which record pertains to D. Babu husband of the complainant. The record is also signed by A.Shanti Complainant for willingness for the operation. Discharge certificate dated 7.9.1996 from the Government Hospital Hospet shows that the husband of the complaint was suffering from petic ulcer and he was operated for the same. The operation note shows closure of duodenal perforation. The husband of the complainant ultimately died on 06.10.1999 and the cause of death was peptic ulcer. The policy had been taken just about six months prior to death. Therefore, Section 45 Insurance Act comes into play. The certificate from the GovernmentHospital, Hospet, which is also attested by Senior Surgeon of the GovernmentHospital, Hospet, Billari, District does not call for further proof. The said certificate has been issued in discharge of public duties and is admissible. Thus, there is ample evidence on record that the husband of the complainant had suppressed material facts relating to health. It is now well settled that the contract of insurance is of utmost good faith. In our opinion, on account of suppression of material facts, the complainant is not entitled for claim made and Insurance Company has very rightly repudiated the claim. The revision is accordingly allowed. The Orders of the fora below are set aside. In the facts and circumstances of the case there shall be no order as to costs. |
