The present revision petition has been filed by one Vipin Gandhi, husband of late Sarita (hereinafter referred to as the ‘Petitioner’) against the order passed by the State Consumer Disputes Redressal Commission, UT Chandigarh (hereinafter referred to as the ‘State Commission’) which had dismissed the appeal filed by the Petitioner, in favour of Life Insurance Corporation (hereinafter referred to as the ‘respondent’). The facts of the case are that the petitioner’s wife Sarita who expired on 4.08.2006 had obtained three life insurance policies and out of these policies, the claim against one of the policies, i.e., Jeevan Plus Policy dated 13.01.2006 for an assured sum of Rs.5,00,000/- was repudiated by the respondent on 31.08.2008 on the ground that the deceased – life assured withheld the correct information regarding her health at the time of taking the policy. According to the petitioner, his wife died due to cardiac arrest on 4.08.2006 while she was admitted in Fortis Hospital from 13.07.06 and that she had not suppressed any material information or fact about her state of health because prior to her death, she had not suffered from any ailment. This is borne out by the fact that she had never availed of medical leave during the period of 5 years preceding her death nor was there any medical record or history with the respondent to prove that she was suffering from any disease prior to her death. In view of this there was no question of her suppressing any material fact of any pre-existing disease. Petitioner also stated that the respondent has taken similar objection in respect of an earlier policy for a sum of Rs.1,00,000/- which was later settled by making a payment of Rs.1,38,817.72p. to the life assured. Under the circumstances, repudiation of the genuine claim by the respondent insurance company amounts to deficiency in service for which the complainant / petitioner filed a complaint before the District Forum. The respondent, on the other hand, has denied the above contention and stated that the policy, in question, had run for less than 7 months when the life assured expired. The claim was, therefore, investigated by the Senior Branch Manager, who after due investigations on the basis of medical records obtained from Fortis Hospital brought to the notice of the respondent that the life assured was suffering from diabetes mellitus type-II for the past one year. She had a history of weight gain for the past 4 – 5 years and was also suffering from Pickwicknian Syndrome as well as breathlessness for the past two years. Obviously, these facts were known to her at the time of filing up the proposal form which she withheld. The insurance is a contract based on utmost good faith and as per the terms and conditions of the policy suppression of any such information is a justifiable ground for repudiation of the claim. Therefore, there is no deficiency in service on the part of the respondent in repudiating the claim. The respondent further stated that regarding the settlement of the earlier policy, this was before she had diabetes mellitus type-II and at that time she was suffering only from breathlessness (which is not a disease per se) and, therefore, the claim was settled. The District Forum after going through the record and hearing the parties dismissed the complaint. Aggrieved by this, the petitioner filed an appeal before the State Commission, which was also dismissed. The operative part of the order of State Commission reads as under:- “After minutely going through the documents on record including the medical record of Fortis Hospital brought on record of the complaint file separately before the learned District Forum by way of an interim application and particularly Annexure R-6 (Colly) at page 72 of the appeal file as well as annexed with the written statement, it is clearly brought out that the RBG of the patient (Life Assured) was recorded as 240 Mg / dl and not 140 Mg/dl. It seems that somebody has tried to make it 140 or it is a simple over writing while noting down this reading. Moreover, the treating doctor who had examined the Life Assured has also mentioned in the case history under the heading ‘short note’ as under:- “Type 2 DM – 1 yr on OHAS and diet control, history of weight gain – for last 4 – 5 years, Labelled outside – Pickwicknian Syndrome. Started her problems – 2 yrs with Breathlessness more at nigh while sleeping With ing frequency…..” It is apparent from this document, on which even the appellant has relied upon, that the Life Assured was a chronic patient of Diabetes Mallitus (Type II), which ailment she did not disclose at the time of filing up the proposal form. This clearly shows that there is a concealment of material information on the part of Life Assured, who had given wrong information as regards the status of her health while taking the insurance policy in question. Meaning thereby, that there is breach of terms and conditions of the Insurance Agreement by the Life Assured, which is termed as a contract of utmost faith between the parties. As regards Ground No. 1 of the appeal, we are of the view that the observation of the learned District Forum is not correct but does not affect the outcome of the appeal on merits. 11. At this stage, we may like to refer to the latest judgment of Hon’ble National Commission in the case of New India Assurance Company Limited Vs. Vishwanath Manglunia reported as 2010 CTJ 634 (CP) (NCDRC) wherein the Hon’ble National Commission has held that Insurance is a contract based on good faith and suppression of any material fact would be a breach of that contract. The Hon’ble National Commission further referring to the case of Satwant Kaur Sandhu (Supra) held that the insurer would, therefore, be justified to repudiate the insured’s claim once such a suppression is established. Thus, out view is fully supported by the law settled by the Hon’ble Apex Court and Hon’ble National Commission in the cases referred to above.” Hence the present revision petition. Counsel for the petitioner was present and he reiterated the fact that the patient was in good health prior to admission in Fortis Hospital and she had, therefore, not suppressed any relevant information from the respondent insurance company. The respondent insurance company wrongly repudiated the claim. We have considered the learned counsel for the petitioner and have gone through the evidence filed before the fora below. We agree with the learned fora below that there is adequate documentary evidence on record that the life assured was a chronic patient of diabetes mellitus type-II at the time of filing of proposal form for the Jeevan Plus Policy. Even prior to the onset of the disease, she had symptoms which indicated that she was not in good health which included history of weight gain and breathlessness. Under the circumstances, it is very clear that she suppressed material information regarding her health at the time of taking the insurance policy. As pointed out by the State Commission in its detailed and well-reasoned order, there are judgements of the Hon’ble Apex Court as well as of this Commission that insurance is a contract based on ut-most good faith and suppression of any material information is a breach of contract, justifying repudiation of the claim. Adverse inference can also be drawn from the fact that despite her having two earlier policies and after knowing about her present ailment, she took yet another policy just a few months before her death. Taking all these facts into consideration, we do not find any merit in the present revision petition and uphold the order of the State Commission. The revision petition is dismissed with no order as to costs. |
