Respondents (Legal Representatives) having not chosen to contest proceeding for they having failed to appear even today after lapse of more than 30 days from date of issuance of notice by registered post, matter was taken up today, which was on Board. Factual matrix are that deceased A.C. Garg (son of deceased respondent) had obtained LIC policy for Rs. 3,00,000/- commencing from 28.04.1996 with a yearly mode of premium of Rs. 3,143/-. Declaration about ‘status of health’ was made by deceased insured in proposal form in negative terms in response to questions set therein. After insured died in Apollo Hospital, Indore on 28.08.1998, nominee – respondent (mother of deceased insured) invoked petitioner – Corporation for payment of assured value which was repudiated. Repudiation necessitated nominee – respondent/claimant (since deceased) to file a complaint with District Forum claiming assured value of policy and also compensation. Respondents are legal heirs of deceased claimant. Grounds of repudiation, in the proceedings were also reiterated by petitioner – Corporation holding that since assured was suffering from Juvenile Diabetes Mellitus for last three years, as would be evident from treatment papers of Apollo Hospital and factum of element which he suffered was suppressed by insured in declaration of ‘status of health’ in proposal form, complaint case merited dismissal. District Forum, evaluating pleadings of parties and also putting reliance on citation of National Commission having accepted repudiation of claim by Insurance Company, while dismissing complaint, unsuited respondent. Aggrieved respondent went in appeal and State Commission noticing discrepant version in treatment papers about period from which assured suffered from diabetes and also there being no evidence about fraudulent suppression of material facts by life assured at the time of taking of policy, having reversed finding, directed Insurance Corporation to pay assured value of Rs. 3,00,000/- along-with interest @ 6% p.a. Cost of proceeding of Rs. 1,000/- too, was awarded. Aforesaid finding of State Commission is under challenge in revision. Sh. Ashok Kashyap, learned counsel for petitioner Corporation having drawn our attention to treatment papers issued by Apollo Hospital, Indore, would strenuously urge that though insured made declaration of ‘status of his health’, answering questions in negative terms, treatment papers issued by Apollo Hospital would unmistakably show, insured being under treatment of Apollo Hospital during year 1997-98 for treatment of chronic pancreates and Juvenile Diabetes Mellitus. Firstly, he was admitted in hospital in February, 1997 and he was admitted in aforesaid Hospital twice on 14.07.1998 where he eventually died on 28.08.1998. Treatment papers would, however, disclose that insured suffered these diseases since last three years and also that he was alcoholic. Treatment papers show that case of insured was of a non-Juvenile Diabetes Mellitus for three years. State Commission reckoning period of two years from when treatment paper was issued by Apollo Hospital has come to conclusion that assured was not having such ailment on 28.04.1996, when he obtained policy. However, we feel that observations made by Apollo Hospital, may be based on statement of either of insured or person attending him and should not be taken with mathematical precision which, in any case, may vary for months on either side. Since repudiation of claim was made by Insurance Corporation on valid grounds, no deficiency in service can be attributed to them and we accordingly, while setting aside order of State Commission, restore that of District Forum. Revision petition accordingly, succeeds, with no order as to cost.
......................JB.N.P. SINGHPRESIDING MEMBER ......................S.K. NAIKMEMBER | |