LIFE INSURANCE CORPORATION OF INDIA vs GURVINDER KAUR

THIS revision petition has been filed by the petitioner/opposite party against the order dated 20.2.2008 passed by the State Consumer Disputes Redressal Commission, Delhi (in short, ''the State Commission '') in Appeal No. FA/2008/45 - LIC Vs. Smt. Gurvinder Kaur by which, while dismissing appeal, order of District Forum allowing complaint was upheld.

BRIEF facts of the case are that complainant/respondent ''s husband Kanwaljit Singh obtained policy of Rs.1,00,000/- on 12.6.2001 from OP/petitioner. It was further alleged that in the year 2004, her husband fell ill and some problem was detected in right kidney and he underwent treatment for the same, but expired on 8.8.2004. It was further alleged that OP was explained about the illness of the disease who suffered right renal calculi after September, 2003, but had no other illness since last 8 years. Complainant submitted claim, which was repudiated by the petitioner on flimsy grounds; hence, complainant filed complaint before District Forum. OP filed written statement and resisted claim and submitted that policy issued in favour of deceased lapsed due to non-payment of half yearly premium due on 14.6.2003 and it was again revived on 1.11.2003. At the time of revival, diseased submitted personal statement of his health, which contained false statement in respect of his health. As he was operated on 8.9.2003, but this fact was not disclosed in his statement; hence, claim was repudiated and prayed for dismissal of complaint. Learned District Forum after hearing both the parties allowed complaint and directed petitioner to pay policy amount along with 9% p.a. interest and Rs.5,000/- as compensation and Rs.2,000/- as cost of litigation. Appeal filed by the petitioner was dismissed by learned State Commission vide impugned order against which, this revision petition has been filed. Heard learned Counsel for the petitioner and respondent in person and perused record.

LEARNED Counsel for the petitioner submitted that at the time of revival, the assured suppressed fact of undergoing treatment and also falsely answered the questions in personal statement regarding his health; even then, learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal; hence, revision petition be allowed and order of State Commission be set aside and complaint be dismissed. On the other hand, respondent submitted that at the time of revival, every fact was disclosed to the concerned agent and fact of previous ailment was not suppressed and in such circumstances, order passed by learned State Commission is in accordance with law, which does not call for any interference; hence, revision petition be dismissed.

COMPLAINANT has suppressed fact of lapse and revival of policy in his complaint. Complainant simply mentioned in para 11 of the complaint that petitioner was explained about the true facts regarding the illness that the deceased suffered right renal calculi only after September, 2003. In the complaint it has not been mentioned that these facts were disclosed by the deceased to petitioner. During course of arguments, respondent submitted that at the time of revival of policy, these facts were disclosed to the agent of the petitioner, but agent has filled wrong answers in the personal statement regarding health. This fact cannot be believed because this declaration dated 1.11.2003 given at the time of revival of the policy has been signed by the deceased and answers to question no. 2 are in negative which runs as under: Q.No.2 a) Have you suffered from any illness/ Disease requiring treatment for a week or more? : No b) Did you ever have any operation, accident or injury? : No. c) Did you ever undergo ECG, X-ray Screening, blood, Urine or stool Examination? : No

Apparently, these answers are wrong in the light of admissions in the complaint itself in which complainant has mentioned that deceased suffered right renal calculi in September, 2003. Record furnished by petitioner clearly proves that decease was admitted in Jeevan Mala Hospital on 8.9.2003, operated on the same day on account of right non-functioning Kidney secondary to right renal calculi and right ureteric calculi and was discharged on 11.9.2003. As per deceased ''s previous treatment summary recorded by Sir Ganga Ram Hospital, deceased underwent treatment in September, 2003. Admittedly, this fact does not find place in personal statement regarding health submitted on 1.11.2003 at the time of revival which amounts to suppression of material facts. It was held by me in R.P. No.3848 of 2007 - LIC Vs. Smt. Kempamma decided on 24.1.2013 that at the time of revival of policy, new contract comes into existence and if assured suppresses material fact or gives false declaration regarding his health, Insurance Company is entitled to repudiate claim.

IN the present case, admittedly, assured had suppressed material facts regarding his previous treatment and operation and has furnished false answers regarding his health, operation, X-ray, etc. petitioner has not committed any deficiency in repudiating claim and learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal and in such circumstances, revision petition is to be allowed.

CONSEQUENTLY , revision petition filed by the petitioner is allowed and impugned order dated 20.2.2008 in Appeal No. FA/2008/45 - LIC Vs. Smt. Gurvinder Kaur is set aside and complaint is dismissed. There shall be no order as to costs.