JUSTICE SUDIP AHLUWALIA, MEMBER

          This Revision Petition has been filed by the Complainant Vandana Nigam under Section 21(b) of the Consumer Protection Act, 1986 against the impugned Order dated 02.09.2016 passed by the State Consumer Disputes Redressal Commission, Uttar Pradesh in F.A.  No. 651 of 2016, vide which the Appeal filed by the Respondents was allowed, the Order of the District Forum was set-aside and the Complaint was dismissed.

2.      The factual background, in brief, is that the Complainant’s husband Late Ravindra Pratap Nigam obtained a Postal Life Insurance (PLI) Policy in January 2012 based on the representations of the agents of the Respondents. The Policy bearing no. UP-256645-CS was issued on 02.01.2012, having Policy Value of Rs. 5,00,000/- on a monthly premium of Rs. 1,975/-. The Policy was issued on the basis of the Proposal Form submitted by the Late husband of the Complainant, which was filled by the agents. The Policy was also accompanied with the Certificate of Medical Officer giving his recommendation for issuance of Policy. The Late husband regularly paid the premium amount and suddenly passed away on 18.06.2012. The Complainant being the nominee of the Policy filed her claim for the Insurance amount on 12.07.2012 and submitted requisite documents. The claim was rejected by the Respondents vide the letter dated 28.04.2014, i.e. one a half year later, on the basis of the Rule 39 of POLI Rule 2011 on the ground that there was concealment of facts. Aggrieved by the wrongful rejection of claim, she filed Complaint before District Forum, Barabanki.

3.      The District Forum vide its Order dated 18.02.2016 in Complaint No. 33 of 2014 allowed the Complaint and directed the Respondents to pay the Policy amount of Rs. 5,00,000/-  @9% p.a. from the date of filing of Complaint till its realization, Rs. 2,000/- for mental agony and Rs. 1,000/- towards the litigation cost. The Respondents filed an Appeal before the State Commission, which vide the impugned Order dated 14.03.2016 allowed the Appeal, set-aside the Order of the District Forum and dismissed the Complaint. The relevant extracts of the impugned Order are set out as below –

“The appellants/opposite parties produced the photocopy certified photocopy of the service book of the husband of the contesting/complainant, in which it is mentioned that the husband of the complainant namely Ravinder Pratap Nigam was on leave till 02.09.2011 to 18.11.2011. The contesting/complainant presented two medical certificate of late husband issued by the Dr. Jaswant Singh of the abovesaid leave period in the Divisional Account Office, Barabanki, in which is one medical certificate on 15.10.2011 and second medical certificate is on 18.11.2011. It is certified on the medical certificate dated 15.10.2011 that Sh. Ravinder Pratap Nigam is suffering from Hepatitis. Therefore, he gave bed rest advice from 02.09.2011 till 15.10.2011. The signature of Sh. Ravinder Pratap Nigam is also certified on the medical certificate. Dr. Jaswant Singh is also certified on the second medical certificate on 18.11.2011 that on 16.10.2011 till 18.11.2011 Sh. Ravinder Pratap Singh was illness due to burnt. Therefore, gave advice him for bed rest. The signature of Sh. Ravinder Pratap Nigam is also certified on the said certificate. The submit service book of husband of contesting/complainant Sh. Ravinder Pratap Nigam and the medical certificate produced before the Departmental competent officer for grant leave is oral evidence and contesting/complainant is not denied the signature of her husband namely Ravinder Pratap Nigam on the medical certificate dated 15.10.2011. Therefore, it is not liable to suitable and on the basis of containing relevant that Sh. Ravinder Pratap Nigam is on leave on 02.09.2011 till 15.10.2011 at about 43 days on the Hepatitis. The clause 15 of proposal of the insurance of husband of the contesting/complainant, in which mention the illness, gave the native reply and declare that his health is fine in the clause 16 and he disease free and he has no any serious disease on the past three years and nor any operate serious operation, while it is clear from the abovesaid representations that he was on leave for 43 days due to illness of Hepatitis on 02.09.2011 till 15.11.2011. Therefore, it is clear that the husband of the contesting/complainant concealed important facts relating to our illness in the proposal of the policy and obtained the policy on the basis of wrong information.

          Life Insurance Corporation of India and others Versus Nita Bhardwaj 1(2014) CPJ 409 (NC) in the petition National Commission is considered appropriate the claim is  liable  to be rejected on the basis of concealment of medical leave of 39 days by the policyholder. The Hon’ble National Commission is also stated in our decision that the concealment of illness of the Policyholder is concerned his death or not, it is very important. Satyawati Sharma Versus Life Insurance Corporation III (2013) CPJ 654 (NC) in the claim the Hon'ble National Commission considered appropriate the claim is liable to be rejected due to concealment of illness and leave 289 days. On the basis of the abovesaid deliberation we are reached at this conclusion that the husband of the contesting/complainant would be suffered from the illness of Hepatitis before proposal of the questioned Insurance Policy and due to which reason it is certified that remained leave for 45 days, but he concealed our disease in our Insurance Policy and in this reference the wrong declaration given in the Insurance Proposal clause no. 16. Hence, in that situation Insurance policy by the appellants/opposite parties and the claim of contesting/complainant is not suitable for repudiate and can not say valid.

          Hence, after considering the above said facts and circumstances we are doctrine that the District Forum is wrongly accepted the claim of the contesting/ complainant. Therefore, the present appeal accepted, the order and decision passed by the District Forum will be rejected and the claim of the contesting/complainant is liable to be rejected in law.”

4.      Ld. Counsel for the Petitioner has argued that the Policy was issued only after due satisfaction of the Respondents and their competent officer who certified the Policy Holder to be fit; That the allegation of the Respondents that the Policy Holder was on medical leave due to Hepatitis is wrong as the document dated 18.11.2011 relied upon by them is for treatment of burns; That it was not the husband of the Petitioner who filed the form but the agents of the Respondents, and further, Clause 16 of the Proposal Form does not provide for Hepatitis disease at all which clearly shows that the Hepatitis disease is not life threatening; Ld. Counsel for Petitioner has cited the cases of “LIC of India v. Panchfula Shriram Jadhav, RP No. 1785 of 2011”, “Sulbha Prakash Motegaonkar and Ors. v. LIC, CA No. 8245 of 2015” and “New India Assurance Co. Ltd. V. Usha Yadav and Ors., (MANU/PH/0517/2008)”.

5.      Ld. Counsel for the Respondents argued that the Policy Holder supressed the fact that he was suffering from Hepatitis and was under treatment in Shukla Clinic from 01.02.2012 to 12.04.2012; That the Policy Holder was mostly on medical leave before purchasing the policy and was suffering from fatal disease Hepatitis and with the aim of taking advantage of insurance, he concealed the fact of his illness on the Proposal Form; Ld. Counsel for Respondents placed reliance on the cases of “Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. and Ors. v. Dalbir Kaur, CA No. 3397 of 2020” and “P.C. Chacko and Anr. V. Chairman, LIC of India and Ors., CA No. 5322 of 2007”.

6.      This Commission has heard both the Ld. Counsel of the Petitioners and the Respondent; and perused the material available on record.    

7.      This Commission is to essentially consider whether the material on record indicates that the deceased life insured had wilfully suppressed any material information while submitting his Proposal Forum or not.   Contention of the Respondents is that he had actually made material suppressions by giving wrong answers to the questions put to him in Column 15 of the Proposal Form.  The entire contents of the aforesaid printed Column 15, as well as the answers given to the same by or on behalf of the DLA are re-produced as follows –

          “15.   Family History

Has any of your relatives living or dies/suffered from any hereditary/or infections disease………..

Epilepsy/Gash/Asthma/Tuber     /L    etc. if so give details:

…………NO…………………

……………………………….

Note:         The term ‘Family’ include, mother, father, brothers and sisters

Personal History:

Are you at present in sound health ……………Yes………..

Have you ever suffered from any of the following?

(i) Tuberculosis (ii) Cancer (iii) Paralysis (iv) Insanity (v) Any disease of the heart and lungs (vi) disease (vii) Any disease of brain (viii) Diabetes (ix) Hypertension (x) Any other serious ……No…… (xi)Any physical deformity or ……..No…….”

8.      It is, therefore, seen that there was no specific question to the proposer as to whether he had at any time suffered from “Hepatitis” in his life time.  Further, the queries “disease” in item (vi) and “Any other serious” in item (x), as are re-produced above, are exfacie incomplete.  It may however taken to mean that the proposer were being asked as to whether he had suffered from “any other serious disease”.  But, what constitutes a “serious disease” is not indicated anywhere in the said Form.

9.      Further, contention of the Respondents was that the DLA had been suffering from infective Hepatitis, for which he had been advised rest by Dr. Jaswant Singh of Barabanki for the period from 2.9.2011 to 15.10.2011 and the copy of the Certificate dated 15.10.2011 had been placed on record on behalf of the Respondents, which is Annexure-13 on Page 155 of the Paper Book.

10.    In the given circumstances, earlier on 28.8.2023, having taken note of the sketchy nature of the questionnaire contained in Col. 15 of the Proposal Form (already re-produced above) and the Declaration given by the DLA in response thereto, this Commission directed both sides to cite appropriate medical literature as to whether “Hepatitis” constitutes a “serious illness” or not.  Further, the Respondents’ side was also required to show the medical literature in relation to all the known forms/types of “Hepatitis” and to specify the kind of “Hepatitis” being suffered by the deceased, was a serious illness.

11.    In compliance of the aforesaid direction, certain medical literature pertaining to “Hepatitis” has since been placed on record by the Respondents, which was filed on 13.12.2023.  These happen to be articles on Hepatitis by Medical Authors- John P. Cunha, DO, FACOEP and Dr. Charles Patrick Davis, MD PhD.  Perusal of such medical literature reveals that Hepatitis is of five types being Hepatitis A, B, C, D & E virus (HAV, HBV, HCV, HDV, HEV). It is further seen from such medical literature that Hepatitis A & B are per se not serious diseases at all, and in respect of Hepatitis A, it is usually so mild that many people do not even know they are infected. The virus is eliminated by the body rapidly, and it does not cause long term damage.  Similarly, in case of Hepatitis B, it has been mentioned in the medical literature of Charles Patrick Davis that this disease has mild symptoms or no symptoms at all, and in a majority of adults the virus resolves spontaneously and only 5% of the people are not able to eliminate the Hepatitis B virus and develop chronic infection.  The other three types of Hepatitis (HCV, HDV and HEV) are stated to be comparatively more complicated and there is no vaccine for HCV.

12.    Now in the present case, it is on record that the deceased life insured had been advised to “take rest” for the period between 2.9.2011 to 15.10.2011.  He has not been shown to have been “hospitalised” and also there is nothing on record to show which type of Hepatitis he was suffering from.  As already seen, Hepatitis A & B virus related diseases are not at all serious or life threatening in the ordinary course. So in the given facts and circumstances, it cannot be said that the deceased life insured had consciously suppressed any material information or given any false answers to the questions put to him regarding his medical condition and background in the Proposal Form, as there was no specific question pertaining to “Hepatitis”, and also there is nothing on record to indicate that the kind of Hepatitis for which he had been prescribed rest in the year 2011 was of a dangerous or serious type.

13.    For the aforesaid reasons, this Commission is of the considered opinion that the Ld. State Commission had acted erroneously in setting aside the well-reasoned Order passed by the Ld. District Forum, and in dismissing the complaint. The Revision Petition is therefore allowed after setting aside the impugned Order passed by the Ld. State Commission,  and affirming the original decision of the Ld. District Forum.  Parties to bear their own costs.

14.    Pending application(s), if any, also stand disposed off as having been rendered infructuous.