This appeal is directed against the final order dated 27.6.2019 delivered by the Ld. D.C.D.R.F., Uttar Dinajpur in reference to CC No. 31 of 2018. The fact of the case in a nutshell is that one Pampu Roy since deceased and employee of FCI purchased one LIC endowment policy on 28.12.2015 Bearing Policy No. 445963821 at a quarterly premium Rs. 4,712. The assured sum of the policy was Rs. 2 Lakh. The policy holder due to his physical illness on 08.07.2016 was admitted to the Madanganga Nursing home at Raiganj where he breathed his last on 21.07.2016, due to Cerebral Vascular accident. The claimants that is the legal heirs of the deceased submitted a claim before the appellant company in due time for death benefit which was repudiated on 16.03.2017. The claimants/complainants then sent a letter to the Zonal Office of LIC, for further consideration of their claim which was not entertained and for that reason the complainant/claimants registered a Consumer complaint before the Ld. D.C.D.R.F, Uttar Dinajpur. The appellant as O.P. of that case has contested the Consumer complaint by filing a Written Version and contended Inter-alia that the deceased Pampu Roy at the time of submitting the proposal form for obtaining the LIC policy by inserting some false statements regarding his state of health and suppressed his various illness and ailments and in this way mislead the LIC and purchased the said policy fraudulently. Further case of the LIC, Appellant since the year 2013 the insured was suffering from enteric fever for seven days from 02.01.2013 to 08.01.2013 and for Hepatitis from 27.04.2014 to 19.5.2014 and in Viral fever from 06.08.2015 to 16.08.2015 and during this suffering period he enjoyed earned leave for his absence in his official duty and this fact has been totally suppressed in proposal form of the policy which he executed on 16.01.2016 and for that reason the case of the complainant was liable to be dismissed. The complainant in support of their case has tendered their evidences by affidavit and she was cross-examined by the LIC appellant. The LIC appellant did not adduce any evidence before the Ld. Forum. Ld. Forum after hearing argument of both sides has come to a conclusion that mere sufferings from Hepatitis or Enteric Fever or from Viral Fever did not suggest that general physical condition of the insured at the time of opening the Insurance Policy was not sound. The Ld. Forum further held that the deceased has left the world for his suffering in the disorder of CVA and ICH. Which had no nexus with his earlier deceases like Enteric Fever or Viral Fever or Hepatitis and for that reason the Consumer complaint was allowed and Rs. 2 Lakh 15 Thousand was awarded in favour of the legal heirs of the deceased Pampu Roy.

Being aggrieved with the said order this appeal has been preferred by a memorandum of appeal and contended that one’s life is insured on the basis of the information furnished by the proposer in the proposal form and after relying all the questions properly. One declares any policy required to be given by the proposal as to the correctness of those answer and the proposal need to speak out all the information correctly to the best of his knowledge and believe of utmost good faith. But here in this particular case the insured did not disclose the material facts and intentionally mentioned his good health in the Question No 11(1) in the proposal form by suppressing his earlier deceases and for that reason the statements in the Consumer complaint was frivolous and false and the judgment based on the frivolous complaint should be set aside. The respondent Gita Roy and Others as legal heirs of deceased Pampu Roy had contested the appeal through their Ld. Advocates and during the course of argument the Written Note of argument was furnished from the end of both sides. The case of the appellant was conducted by the Ld. Advocate appointed by the appellant and argument of respondent side was canvased through Ld. Advocate who also produced the list of judgment of higher Forums.

Decision with Reasons

 Admitted position is that deceased Pampu Roy has purchased the endowment LIC policy on 28.12.2015 by furnishing the proposal form which was duly accepted by the LIC Authority and during the policy period Pampu Roy had suffered from the diseases like CVA and ICH and he breathed his last on 21.07.2016 at Modonganga Nursing Home at Raiganj. It is also not disputed that in the year 2013 to 2015 the deceased Pampu Roy was suffering various ailments like Enteric Fever, Viral Fever, and Hepatitis and during these periods of illness he was absent in his Official duty and sought the earned leaves which was duly sanctioned by his employer FCI. Now the question is whether such physical problems suffered by the deceased Pampu Roy was fatal in nature and not disclosure of such diseases violated the terms and conditions of the policy or not. The Ld. Advocate of the appellant at the time of his argument mentioned that the Official records, medical papers clearly shows that the deceased Pampu Roy(insured) has suppressed the health disorders in the proposal form and he intentionally disclosed the condition of state of health as good which was not at all correct one, and in this way he has violated the terms and conditions of the Insurance Policy and for that reason Insurance Company should not be compelled to obliged the false Insurance claim. In support of his argument referred a judicial decision reported in (iv) (2009) CPJ8(SC) where it was held that contract of Insurance, contract of UVERIMAEFIDEI where insured under obligation to make true and full disclosure of information within his knowledge. If, suppression of material facts in proposal form is proved the repudiation on the part of Insurance Company is justified enough. In another judgment referred by the Ld. Advocate of the Insurance Company reported in 1(2009) CPJ6(SC). Where it was held that in contract of Insurance rights and obligations strictly governed by policy of Insurance and no relaxation can be made on ground of equity. Another judgment of Hon’ble Apex Court also cited in this case in reference to Civil Appeal No. 4261 of 2019 where in any document executed by the insured leading to the issue of the policy was inaccurate or false such Insurance Policy should not be entertained. Ld. Advocate of the respondent has countered this argument by mentioning that Enteric Fever, Hepatitis and Viral Fever are not the cause of CVA with right side. There was no nexus of enteric Fever, Hepatitis and Viral Fever with CVA. Rather, at the time of submitting the proposal form the insured had no ailment in his body and he has consciously and in sound health has submitted the proposal form and there was no suppression on his part about any fatal diseases. After carefully going through the proposal form produced by the appellant side, it appears that in Column No. 11(D) and E, he had mentioned the word “no” regarding any diseases like Liver, stomach, heart, lung, kidney, brain or nervous or Diabetes, tuberculosis, High B.P, low B.P, cancer, Hydrocele, leprosy or any of the disease. The diseases like Hepatitis, enteric fever or Viral Fever are not called as fatal diseases and for that reason the Insured has mentioned in proposal form regarding his state of health “good”. Mere suppression of Column No. 11(a)(b)(c) is not well enough to repudiate a claim of Insurance whereas in the main column there was no suppression of any material fact in proposal form. After hearing the valuable argument canvased before this Commission through their Ld. Advocates this Commission finds that before going to the Insurance contract the insured was suffering from enteric fever, Hepatitis and viral fever. Those, diseases had no relation with the fatal disease like CVA for which the insured had passed away. Rather at the time of entering into the contract of Insurance it is not established that the insured Pampu Roy was suffering from any fatal disease and for that reason due to his death the sum assured in the endowment policy should be provided by the LIC to the heirs of the diseased and the Ld. Forum has rightly observed that there were lapses on the part of the Insurance Company at the time of repudiation of litigant’s claim. This Commission has a considered view that the final order of Ld. Forum does not suffer from any irregularity. So, there was no merit in the appeal and if the appellant/LIC pays the entire money awarded by the Ld. D.C.D.R.F, Uttar Dinajpur dated 27.06.2019 within 45 days from this day then no interest will carry over the total awarded money. In default the order of Ld. Forum should be treated as it is.

Hence It is ordered

That the appeal be and the same is hereby dismissed on contest without any cost. Let a copy of this order be handed over to the parties of appeal free of cost and a copy of order be communicated to the Ld. D.C.D.R.F, Uttar Dinajpur at Raiganj through e-mail.