Meenaben Ashok Kumar Patel vs Life Insurance Corporation of India

COMPLAINANT/Petitioner has filed this Revision Petition against the impugned order dated 21.10.2005 passed in appeal No. 1217/04 by the State Consumer Disputes Redressal Commission, Gujarat (in short, ''the State Commission'') by which the State Commission reversing the order dated 18.8.2004 passed in complaint No. 50/97 by the District Forum, has dismissed the complaint filed by the Petitioner.

COMPLAINANT''s husband had taken two insurance policies mentioned in the complaint from the Life Insurance Corporation of India filling the proposal forms on 31.7.1993 and 26.11.1993 respectively for the said policies. He died on 29.8.1996. On the death of her husband, Petitioner lodged the claims under the said policies with the Respondent which were repudiated on 12.12.1996 on the ground that the policy holder had suppressed material facts about his health and medical leaves taken for getting the treatment. Aggrieved by the repudiation of the claims, Petitioner filed the complaint before the District Forum.

DISTRICT Forum allowed the complaint and directed the Respondent to pay to the complainant the sum of Rs. 1,50,000 with interest @ 9% p.a. from the date of repudiation till realization, Rs. 2,500 were awarded as costs. Respondent preferred an appeal before the State Commission which allowed the same and set aside the order of the District Forum. The State Commission held that the policy holder had suppressed material facts about his illness while filling up the proposal form and the LIC was justified in rejecting the claims.

THE only question which falls for consideration in this Revision Petition is, whether the policy holder at the time of filling up the proposal form had suppressed the material facts about his illness of hypertension and chronic renal failure or not?

RESPONDENT had produced the certificate and affidavit of Dr. Anil Ganju who was treating the policy holder. The said doctor in his affidavit has clearly mentioned that the policy holder consulted him on 25.9.1992 and was suffering from chronic renal failure. The relevant portion of the affidavit reads as under: "(1) That Shree Ashokbhai L. Patel had consulted me on 25.9.1992 and was advised further investigations at that time. I had gone through pathological reports of Shri A.L. Patel of dated 28.9.1992 which shows: Test Result Normal 1. Urine Proteins 2336.0 mg/day 130.0 2. Blood Urea 42.0mg 45.0 3. S. Creatinine 4.7mg/day 0.5-1.6 (date 1.1.1993) The above reports suggest that patient had chronic renal failure since September, 1992."

DR. Anil Ganju was cross-examined by the Petitioner before the District Forum and in his cross-examination he was confronted with the reports dated 23.3.1995, 27.3.1995, 30.3.1995, 1.5.1995 and 8.5.1995 of Muljibhai Patel Urological Hospital with which he was associated showing that the kidneys of the policy holder were functioning normally. Doctor Ganju admitted that he has not referred to the reports given by Muljibhai Patel Urological Hospital. These reports have not been placed on record. In the absence of reports, it is not possible for us to give an opinion regarding the nature or contents of the reports. Moreover, these reports are subsequent to the transplantation of kidney in February, 1995.

IN the cross-examination, a suggestion was put to the Dr. Anil Ganju that he had given a false certificate because of the heated arguments he had had with the relatives of the policy holder. Suggestion put to him was denied. Mere suggestion put to the doctor that he had given a false certificate because he had heated arguments with the relatives of the policy holder, cannot be accepted in the absence of any other supporting evidence to that effect.

MEDICAL Attendant''s certificate and certificate of hospital treatment produced by the Petitioner herself shows that the policy holder was suffering from hypertension for the last five years and he was detected of renal failure in December, 1994 and had also undergone the kidney transplantation in February, 1995. In the proposal form filled in, the policy holder had replied in negative to the question, whether he was suffering from major illness like hypertension or any other life threatening disease, etc. The Policy holder had withheld the fact about his suffering from hypertension, swelling of body for the last two years as well as that he was taking treatment for kidney failure from Dr. Anil Ganju. It is a clear case of suppression of material facts and the State Commission has rightly dismissed the complaint. The contract of insurance is contract of uberrima fides and there must be complete good faith between the life assured and the Insurance Company. If a contract is entered into by withholding the material fact the Insurance Company is not liable to pay the insured amount.

FOR the reasons stated above, we do not find any merit in this Revision Petition and dismiss the same with no order as to costs. Revision Petition dismissed.