Khusbu Singh vs Life Insurance Corporation Of India Ltd

V.K. Jain, J

The deceased husband of the complainant purchased an insurance policy from the respondent insuring his life to the extent of Rs.1,04,32,864/-

which included Rs. 50.00 lacs payable in case of an accident and Rs.50.00 lacs in case of his death due to other cause. The husband of the

complainant having died on 08.3.2014 within three years of having taken the policy, a claim was submitted by the complainant and her father-in-law

also submitted another claim. The claim was rejected by the insurer primarily on the ground that the insured had suppressed the true medical facts

while obtaining the insurance policy. Being aggrieved from the rejection of the claim, the complainant approached the concerned State Commission b

way of a consumer complaint.

The complaint was resisted by the respondent which inter-alia pleaded that the deceased had died due to chronic alcoholic liver disease and he had

suppressed his health related issues while submitting the proposal form for insurance. It was also stated in the reply filed by the State Commission that

the insured had also been admitted in Apollo hospital Bilaspur for the period from 08.1.2011 to 28.1.2011 for treatment of the chronic pancreatitis etc.

and instructed not to take alcohol. It was also alleged that despite the aforesaid instructions, the insured continued taking alcohol and at the time of

taking the insurance he was suffering from several pre-existing ailments of liver besides high blood pressure etc. and was consuming alcohol.

The State Commission having dismissed the consumer complaint, the complainant / respondent is before this Commission by way of the present

Appeal.

A perusal of the proposal form submitted by the deceased insured while seeking the insurance cover, to the extent it is relevant, shows that the

questionnaire contained in the proposal form was required him to disclose as to whether he was taking alcoholic drinks and he had replied in negative

to the aforesaid question. The questionnaire also required him to disclose whether he was suffering from ailment pertaining to liver, stomach etc.

Again, the answer given by him was in the negative. He was required to disclose whether he had ever been admitted to any hospital for general

check-up, observation, treatment or operation. The answer given by him was in the negative.

A perusal of the impugned order would show that the insurer had obtained a certificate form the Apollo hospital Bilaspur which would show that he

was admitted in the aforesaid hospital on 08.1.2011 and was discharged on 28.1.2011. He was suffering from PHT with SBP chronic pancreatitis and

was a chronic alcoholic known case of ALD. The aforesaid admission and treatment had taken place in the year 2011, much before the proposal form

was submitted by the insured. Therefore, he ought to have disclosed the aforesaid ailment and the admission and treatment in the Apollo hospital

Bilaspur in the proposal form.

The insurer also obtained record from Rama Krishna Care Hospital which revealed that the insured had remained admitted in the said hospital from

05.2.2011 to 16.2.2011 and he had given previous history of being a chronic alcoholic and known case of ALD. This was yet another material fact

concealed by the insured while submitting the proposal form dated 07.8.2012.

Since the insured concealed material facts with regard to the state of his health from the insurer and thereby influenced the decision of the insurer

on the question as to whether to accept the proposal for insurance or not, the insurer was fully justified in repudiating the claim. Had the true state of

his health, including his previous treatment and his being an alcoholic been disclosed by the insured to the insurer, either the proposal would have been

rejected or he would have been subjected to further advanced investigations before accepting the proposal.

Such an opportunity was denied to the insurer by concealment of material fact with respect to the state of the health of the insured.The view taken by

the State Commission therefore, does not call for any interference by this Commission in exercise of its appellate jurisdiction. I find no merit in the

appeal and the same is hereby dismissed with no order as to costs.