PER S.K. NAIK, MEMBER

          Challenge in these two revision petitions is to the single/ common order dated 7.11.2007 of the State Consumer Disputes Redressal Commission UT, Chandigarh (hereinafter called the ‘UT Commission’) accepting the appeals against the common order of dismissal by the Consumer Disputes Redressal Forum, Chandigarh, UT Chandigarh (hereinafter referred to as ‘District Forum’) of the two complaints filed by the respondent/complainant – Smt. Mamta Manu.

            Briefly stated facts of the case are that the deceased husband of the respondent/complainant had obtained two life insurance policies from the petitioner – Corporation.  Policy No.160953055 dated 15.9.1997 was for Rs.25,000/-.  This policy had lapsed for non-payment of premium for  certain period which on payment, however, was revived on 31.7.2002.  The other policy No.162286651 for Rs.5,00,000/- was taken on 14.10.2002, within three months of revival of the earlier policy.  Husband of the complainant expired on 5.2.2003 in the hospital.  Claims filed by the complainant were repudiated by the petitioner LIC on the ground of suppression of material facts resulting in complaints being filed before the District Forum.

          District Forum dismissed the complaints primarily relying on the ‘death report’ (page 66 of the paper book) issued by Govt. Medical College and Hospital, Chandigarh in which against query No.17 asking if (deceased) used to habitually drink alcohol for how many years, it has been stated “10 years” and further the cause of death has been stated as “Alcoholic Liver Disease with ascites with Hepatic Encephalopathy”.  The District Forum was of the view that the deceased was a ‘habitual drunkard’ over a prolonged period which manifested in Alcohic Liver Disease (ALD).  The District Forum dis-believed the version of the deceased made on the proposal form that he only occasionally used alcoholic drinks and that he enjoyed good health.

          Aggrieved on the dismissal of her claims, respondent/ complainant filed appeals before the UT Commission, who, as already stated, set aside the order passed by the District Forum accepted the appeals and ordered the petitioner-LIC to pay the policy amounts with 9% interest p.a. from the date of repudiation till payment. 

          Dissatisfied with the order of the UT Commission,  the  petitioner – LIC has filed these revision petitions.

          Learned counsel appearing for the parties have been heard.  We have also perused the records of the case.

          Learned counsel for the petitioner – LIC has contended that the deceased life assured had knowingly not disclosed the whole truth about  his chronic drinking habits and had only stated that he drinks occasionally.  That he concealed the fact of being a chronic, alcoholic and habitual drinker is proved from the diagnosis of his ailment as a case of ALD which does not flare up in a short span of time.  The death report which makes a mention of 10 year period of habitual alcohol intake, corroborates this fact.  The UT Commission has failed to consider this aspect which is also supported by medical literature and erroneously held that the District Forum has wrongly dismissed the complaints on ‘surmises and flimsy grounds : He pleads that the case is covered under the decision of this Commission in Panni Devi Vs. LIC & Ors. Reported in III (2003) CPJ 15 (NC).

          We do not find sufficient weight and merit in the submissions made by the learned counsel for the petitioner for the reasons given hereafter.

          On facts, it is admitted by the petitioner – LIC that the deceased life assured while filling up the policy form against column II (h) asking :

II (h)  Do you use or have you ever used :

(i)   Alcoholic Drinks

has clearly stated that he drinks occasionally.

          It is also admitted that the life assured was medically examined,  both at the time of revival of the lapsed policy as well as the new policy taken on 14.10.2002. 

          In this background, it would not be just and proper to say that the life assured suppressed the truth. As rightly held by the UT Commission, the petitioner LIC ought to have been on its guard and got him thoroughly medically examined before getting him insured.  It is very easy in hindsight to label the life assured as a habitual/chronic drunkard but we find that no evidence to that effect has been adduced.  Admission into the hospital and treatment is only a post insurance happening.  In the absence of any affidavit by the doctor who prepared the death report where the period of 10 years has been over written has not been filed to ascertain the truth and to clarify as to the basis on which the deceased was stated to be a known case of ALD especially when he had never been hospitalized before taking these policies.  Besides affidavits of Charan Singh and Niranjan Singh who knew the deceased for many years stating that the life assured was not a habitual drinker and that to their knowledge, he had never been admitted to any hospital during the last five years preceding his death ; have not been rebutted by the petitioner.  Their evidence under the circumstances will have presumption of truth and cannot be ignored.

          Medical literature, too do not fully support the case of the petitioner.  Harrison’s Principles of Internal Medicine 15^th Edition at P1755 on the chapter on Cirrhosis and its complications states under:

“Diagnosis – Alcoholic cirrhosis should be strongly suspected in patients with a history of prolonged or excessive alcohol intake and physical signs of chronic liver disease.   However, since only 10 to 15 of individuals with excessive alcohol intake develop cirrhosis, other causes and types of liver disease may have to be excluded.”

In this case, not only there is no definitive history of prolonged or excessive alcohol intake by the deceased but the diagnosis was made purely on clinical examination without any corroborative test.  The deceased was a young man of 31 years and, it would  be illogical to infer that he would have been indulging in rash and excessive drinking on regular basis from the age  of 21 to fall in the 10 to 15% individuals. The petitioners on whom the onus to prove that the deceased life assured was for long a habitual, chronic alcoholic, have failed to discharge their burden.

            The case cited and relied upon by the counsel for the petitioner,  is clearly distinguishable, as in that case the life assured had disclosed at the stage of pre-anesthetic check up for a second operation that  he was operated upon 15 years back while replying to a query “whether he had undergone any radiological, cardio-logical, pathological test any time in the past?” the answer given was ‘No’. There is no such denial or suppression of the truth in this case.  Thus looked at from any angle, the petitioners have failed to prove suppression of material fact.  Their appeal was rightly dismissed by the UT Commission.  The revision petitions are accordingly dismissed with no order as to cost.  Petitioners are directed to comply with the order passed by the UT Commission within 30 days from today failing which the award would attract interest at the rate of 12% for the delayed period of payment.

.………………………J

(ASHOK BHAN)

PRESIDENT

…………………………

(S.K. NAIK)

 MEMBER

St/20 (A & B)