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Judgment
THIS revision is directed against the order of the State Commission dated 25.10.2013 whereby the State Commission dismissed the appeal preferred by the petitioner /opposite party and confirmed the order of the District Forum Hissar.
BRIEFLY stated facts relevant for the disposal of the revision petition are that husband of the respondent / complainant had taken life insurance cover from the petitioner opposite party for a sum of Rs.5.00 lakhs. The life assured unfortunately died on 01.11.2009. Insurance claim of the complainant was repudiated on the ground that insurance policy was obtained by the life assured by concealing the fact that at the time of submitting proposal form, he was suffering from diabetes mellitus. The petitioner, however, refunded Rs.4651/ - as cash surrender value as ex gratia. Being aggrieved of the repudiation of the insurance claim, the respondent filed the consumer complaint.
THE District Forum Hissar on consideration of the pleadings of the parties and material on record allowed the complaint and directed thus: "Consequently, we partly allow this complaint and direct the opposite parties to pay claim amount with all consequential benefit to the complainant and further to pay compensation and litigation expenses of Rs.5000/ -. Order of this forum be complied within a period of 45 days from the date of receipt of copy of this order failing which opposite parties will pay the interest on the awarded amount @ 9% per annum from date of filing of the complaint. A copy of this order be supplied to both the parties free of cost as required under Sub Rule 10 Rule 4 of the Haryana Consumer Protection Rules, 1988. File be consigned to record room."
Counsel for the petitioner has contended that the impugned order of the fora below are based upon incorrect appreciation of facts. He has drawn my attention to the Medical Attendant''s Certificate pertaining to the treatment of the life assured till his death at Ravindra Hospital wherein it is recorded that the life assured Suraj Bali died on 01.11.2009 at 2.25 a.m. in the hospital. In the certificate, doctor concerned has recorded that he had been attending to the life assured for the last 5 -6 years and he treated him for diabetes mellitus. Learned counsel for the petitioner has also drawn our attention to the history recorded at Ravindra Hospital, wherein it is categorically mentioned that life assured had history of diabetes mellitus for the last 15 years. It is contended by learned counsel for the petitioner that the aforesaid aspect was concealed by the life assured while taking the insurance cover by wrongfully stating in the proposal form that he was not suffering from diabetes or sugar. Thus, learned counsel for the petitioner relying upon the ratio of the judgment of the Supreme Court in the matter of Satwant Kumar Sandhu Vs. New India Assurance Company Limited, 2009 8 SCC 316. has contended that in the instant case, the insurance policy was obtained by misrepresentation and concealment of material fact and as such insurance contract itself is invalid and thus, the repudiation of claim cannot be termed as deficiency in service.
LEARNED counsel for the respondent on the contrary has argued in support of the impugned order and submitted that the State Commission has rightly held that the insurance proposal was accepted by the petitioner opposite party after the medical examination of the life assured and now it is estopped from taking plea that the insurance contract was obtained by the life assured by concealing the material fact.
IN order to appreciate the contentions of the parties, it would be useful to see as to how and on what basis, the State Commission has rejected the plea of the petitioner regarding concealment of material fact by the life assured. Relevant observations of the State Commission is reproduced as under: "It has come on the record that the complainant was issued the above said policy on the basis of medical report of the doctor as well as laboratory. According to Lab Report the sugar level of the complainant was found within range. Meaning thereby the complainant was not suffering from diabetes mellitus as alleged by the opposite parties. The authenticity of the documentary evidence cannot be discarded on the oral version of the opposite parties. The complainant has placed on file the medical report of the doctor as well as lab report on the basis of which the complainant was supplied the policy at the instance of the Insurance Company. Since in the lab report, the sugar level of the life assured deceased was found within range, therefore, the opposite parties cannot say that the complainant was suffering from Diabetes Mellitus to disentitle the complainant from the compensation claimed by her. It has not been disputed that the Life Assured was subjected to medical examination at the instance of opposite parties and was examined by doctor of their panel. Therefore, opposite parties cannot challenge their medical report."
On reading of the above, it appears that the State Commission was persuaded to reject the plea of misrepresentation and concealment of previous ailment by the life assured because the life assured was put to medical test before issue of insurance policy and his sugar level was also tested at that time which was found within range. The above approach of the State Commission, in my view, is fallacious because even in a case of person suffering from diabetes, the sugar level can be kept under control by regulating the diet and taking medicine oral or injectable. Thus, the sugar level test by itself is not an assurance that the person is not suffering from diabetes.
FROM the medical record and the medical attendant certificate, it is clear that as on 2009, the life assured Suraj Bali was suffering from diabetes mellitus for the last 15 years. Undisputedly, this fact was concealed by the life assured by giving wrong answer in the proposal form. Thus, it is obvious that life assured Suraj Bali obtained the insurance policy by concealment of material fact, which would have impacted the decision of the petitioner whether to accept the insurance proposal or not. Thus, the foras below, in my considered view, have failed to appreciate the facts in true spirit. Therefore, orders of the foras below cannot be sustained.
IN view of the discussion above, I accept the revision petition, set aside the impugned orders of the foras below and dismiss the complaint.