This is an appeal filed by the LIC against judgment and award passed by District Forum, Nagpur in C.C.No.159/08 vide order dated 1/7/2008. While allowing the complaint partly, the forum below directed the Opponent Insurance Co. to pay to the widow of deceased Vasant Bante a sum of Rs.3 lac with interest @9% p.a. from 22/11/2006 besides Rs.20,000/- as compensation and Rs.5000/- towards cost.   Aggrieved by this order, LIC has preferred this appeal.

Facts to the extent material may be stated as under

Respondent/Complainant’s Vasant Bante had taken Jivan Anand policy with accident benefit for a sum assured of Rs.3 lac. He had made payment of premium of Rs.25,846/- and the policy was effective from 1/4/2005. Mr.Vasant Bante was taking treatment at Lata Mangeshkar Hospital, Nagpur where he died due to ailment on 22/8/2006. After his death, insurance claim was preferred by the complainant. However, even after receipt of all the documents pertaining to death of her husband, the claim was repudiated on the ground that deceased had suppressed pre existing disease while submitting the proposal form for the policy. Hence the consumer came to be filed.

Opponent filed written statement and admitted that Vasant Bante was given insurance cover on 21/1/2006 and it was effective from 1/4/2005. Opponent insurance company also admitted that after the death of Vasant, his wife had lodged insurance claim. But it submitted that since the death of Vasant occurred within 7 months from taking the policy, investigation was made and in the investigation it was revealed that said Vasant was suffering from ICH with PCP with Septicemia and he was taking treatment in Lata Mangeshkar Hospital prior to availing the insurance policy. However, while submitting the proposal form, he had not disclosed this fact and had fraudulently obtained the policy and, therefore, they had rightly repudiated the claim. Hence they denied any deficiency in service on their part.

However, the district forum, on consideration of documents and affidavits placed before it, held that deceased Vasant had not suppressed any material fact in respect of pre existing disease while submitting the proposal form. So, the District forum brushed aside the repudiation letter and the contention of LIC and it was held to be deficient in service in not honoring the policy issued to Vasant and, therefore, it was pleased to allow the complaint and directed the appellant to make payments as mentioned in opening para.

We heard submissions of Adv.Rohilla for appellant LIC and Adv.Murthy for the Respondent. We are finding that LICs contention that the deceased had suppressed some material facts from them while submitting the proposal form is not proved at all for the simple reason that LIC has not produced on record the proposal form duly filled in and signed by deceased Vasant before the forum and even before us at the stage of appeal. When the LIC is alleging that deceased vasant had suppressed material information about his ailment in the proposal form, it should have produced the same in support of its contention. When the proposal form itself is not produced before us, allegation of the LIC regarding suppression of material fact can not be accepted. On this ground itself the appeal is liable to be dismissed.

However, we also perused the documents. We are finding that Adv.Rohilla is relying on the document at page 70 which is a special query form filled in by the doctor in Lata Mangeshkar Hospital who was consulted by the deceased. In this form the doctor has mentioned the first date on which Vasant consulted him as 22/08/2009, but then he scored up the same presumably at the instance of LIC and rewrote it as 22/1/2006. Hence this appears to be a concocted document. Moreover, this document is procured on 9/8/2007 i.e. after the death of life assured Vasant. In the document at page 67 which is the Medical attendant’s certificate, the cause of death is shown as PC pneumonia ­C  septicemia, however, Dr.Bhrushundi has asserted therein that deceased was suffering from that disease since two weeks before his death. This document is also not helpful to the LIC to convince us that deceased had suppressed material facts about his pre existing ailment while filling proposal form. Thus, we are finding that there is nothing on record to show that deceased had suppressed material fact about his pre existing ailment in the proposal form filled in by him on 21/1/2006. And since the said proposal form is withheld from us by the appellant LIC, it would act against the appellant and adverse inference can be drawn that LIC is not submitting the proposal form because it would reveal its falsity. We are finding no substance in this appeal. It is liable to be dismissed.

Hence the order…

                                                            ORDER

1)     Appeal is dismissed.

2)     No order as to cost.

3)     Inform the parties accordingly.

Delivered on 12/07/2011.