Rajasthan

StateCommission

A/1325/2017

Star Health & Allied Insurancer Co. Ltd. - Complainant(s)

Versus

Smt. Anita Kumar w/o Vijay Kumar - Opp.Party(s)

Prasant Mantri

14 Aug 2018

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO: 1325 /2017

 

Star Health & Allied Insurance Co.Ltd. Amar Plaza Complex, Near Bajrang Garh Chouraha, Subhash Udjyan,Ajmer & ors.

Vs.

Smt.Anita Kumar w/o Vijay Kumar r/o House No. 174 Shastri Nagar, Ajmer

 

Date of Order 14.8.2018

 

Before:

Hon'ble Mrs. Justice Nisha Gupta- President

 

Mr. Prashant Mantri counsel for the appellant

Mr. Rahul Kanwar counsel for the respondent

 

BY THE STATE COMMISSION ( PER HON'BLE MRS. JUSTICE NISHA GUPTA,PRESIDENT):

 

 

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This appeal is filed against the order passed by the District Forum, Ajmer dated 26.10.2017 whereby the claim is allowed against the appellant.

 

The contention of the appellant is that insured was suffering from chronic liver disease prior to filling of the proposal form. Material facts have been suppressed hence, claim should have been dismissed.

 

Per contra the contention of the respondent is that in view of sec.45 of the Insurance Act the claim was payable. Prior to the insurance the authorized doctor has examined the insured and no affidavit or certificate of doctor has been submitted. Hence, claim has rightly been allowed.

 

Heard the counsel for the parties and perused the impugned order as well as original record of the case.

 

As per proposal form Anx. R 1 policy was purchased on 30.3.2010 and question regarding health were answered in negative whereas as per Anx. R 5 to R 8 the complainant

 

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respondent was suffering from hypertension and chronic liver disease from 2009-2010 hence, the Forum below has rightly held that material facts have been suppressed.

 

The respondent has relied upon AIR 1962 SC 814 Mithulal Vs. LIC where after considering the provisions of sec.45 of the Insurance Act when material facts have been suppressed fraudulently repudiation was found justified. Further reliance has been placed on AIR 2008 SC 424 P.C.Chacko Vs. LIC of India , AIR 2001 SC 549 LIC of India V s. Asha Goel and judgment passed by the Punjab & Haryana High Court in RSA No. 4890 of 2010 Sunil Kumar Vs. LIC of India , judgment passed by Jharkhand High Court in LPA No. 52 of 2013 LIC of India Vs. Harjeet Kaur and judgment passed by Patna High Court in CWJC No. 20493 of 2011 Usha Jhunjhunwala Vs. Oriental Insurance Co. and judgment passed by National Commission in Revision Petition No. 485 of 2006 LIC of India Vs. Kulwant Kumari where sec. 45 of the Insurance Act is explained. There is no quarrel about this preposition which provided u/s 45 of the Insurance Act but here in the present case the respondent has suppressed the

 

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material fact of pre existing disease hence, the insurance company was justified in repudiating the claim.

 

The other contentions raised by the respondent were already answered in First Appeal No. 973/2017 LIC of India Vs. Jagdish Chand Jat and First Appeal No. 855/2015 LIC of India Vs. Sunita Devi decided by this Commission.

 

The respondent has also relied upon the literature on preventive strategies in chronic liver disease which has no bearing on the present case.

 

The appellant has rightly pointed out that both the claim nos. CLI/2015/221113/0011957 and CLI 2014/221113/0184878 were filed in first policy hence the claim for more than Rs. 3 lakhs was also not payable.

 

The contention of the respondent is that he pleaded for top up policy also. Be that may be the case but as per claim form the claims were filed in first policy only and otherwise this contention has no bearing on the present case as the respondent

 

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has suppressed the material facts and claim should have been dismissed.

 

In view of above, the appeal is allowed and the order of the Forum below dated 26.10.2017 is set aside.

 

(Nisha Gupta) President

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