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Judgment
This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the impugned order dated 27.11.2012 passed by Punjab State Consumer Disputes Redressal Commission, Chandigarh in first appeal No. 1281 of 2008.
The relevant brief facts to dispose of this revision petition are that the petitioner/complainant, Smt. Ranvir alias Ranbir Kaur''s husband Mr. Kamaljit Singh took an insurance policy covering death claim of Rs. 2 lakh from the LIC of India/the OP on 28.4.2002. The insured was hale and hearty, not suffering from any disease but unfortunately, he expired on 12.1.2004 during the hospitalization in Munni Lal Chopra Hospital, Amritsar. The wife as a nominee of the deceased life assured (DLA) filed a claim with the OP/LIC but it was repudiated on the ground that deceased life assured (DLA) was suffering from chronic liver disease for about 1 ? years prior to his death. He intentionally concealed it while taking the policy. Hence, against the unjust repudiation of claim, the complainant filed a complaint before the District Forum, Gurdaspur.
The District Forum after considering the pleadings and evidence allowed the complaint and directed the OP to pay insured sum alongwith interest from the date of due. The District Forum also awarded Rs.10,000/- towards mental agony.
Aggrieved by the order of District Forum, the OP approached the State Commission by way of an appeal. The State Commission allowed the appeal and dismissed the complaint wherein, it held that the insured concealed true facts about his health and the opinion of the doctors shows that he was a chronic alcoholic and suffering from alcohol related cirrhosis of liver. Hence, as per condition No. 5 of the policy, the claim was repudiated rightly by the OP. Aggrieved by the impugned order, the complaint filed the instant revision petition.
We have heard learned counsel for both the parties. Learned counsel for the petitioner/complainant made submission on delay of 13 days in filing this revision petition. For the reasons stated in the application for condonation of delay, the delay of 13 days is hereby condoned. He further argued that the deceased was admitted for the first time in the hospital on 16.11.2003 i.e. about 1 ? year after taking of the policy. He was a primary school teacher. He maintained his good health and he was a conscious person, who was getting his regular health check-up done during his lifetime. Moreover, the State Commission failed to appreciate the medical reports and tests of the deceased placed on record. However, the State Commission relied upon the baseless allegations and manufactured documents of OP. The fact is that the insured died in an accidental death, having no nexus with alcoholic cirrhosis of liver.
Learned counsel for the OP submitted that the life assured was a known case of chronic liver disease. He was consuming alcohol since a long time of 4 to 5 years and not keeping good health due to which, he suffered alcoholic cirrhosis. He did not disclose the same at the time of filing the proposal form on 28.04.2002. Therefore, the claim was rightly repudiated. The counsel brought our attention to the question No. 11(d), 11(h) and 11(i) of the proposal form. The insured declared that he was not taking alchohol and was not suffering from any disease pertaining to liver, stomach, heart, lungs, kidney, brain etc. Therefore, due to such false submission, as per condition No. 5, the policy became null and void. To support his contention, the counsel brought our attention to the certificate issued by Dr. Rajendra Kumar of Kumar Medical Centre, College Road, Guradspur, (Ex. R-5), and another certificate from Dr. Paramjeet Singh Dhaliwal, who had mentioned that the DLA remained under their treatment for chronic liver disease. The counsel further submitted that as per the certificate of hospital treatment of Muni Lal Chopra Hospital Amritsar, (Ex. R 7) and the medical attendance certificate, (Ex. R-2) the DLA was suffering from alcoholic liver disease.
We have perused the proposal form, the medical attendance certificate, the certificates issued by Dr. Rajendra Kumar and Dr. Paramjeet Singh. It is pertinent to note that the insured was a teacher. There is no evidence from any staff of the school that he was regularly consuming alcohol for the last 4 to 5 years and he was not healthy. On bare perusal of the certificate issued by Dr. Rajendra Kumar, it is clear that Dr. Rajendra Kumar is B.A.M.S. The certificate neither bears any reference number nor date. It is just hand written certificate. There is no treatment details or any investigation by which Dr. Rajendra Kumar arrived at the diagnosis of chronic liver disease of the patient (insured). Similarly, the medical certificate issued by Dr. Paramjeet Singh Dhaliwal under his seal appears to be written on the plain paper. He treated the patient on Out Door basis. The OP has placed another certificate/opinion dated 24.10.2004 issued by Dr. Yash P. Mehra from Amritsar. We do not accept the said opinion because it was given without any basis. In our view, it appears that the LIC and the doctors who have issued such certificates are working in cahoots with each other. We are rather surprised that how the LIC accepted and relied upon such vague certificates/opinions. We are saddened by such unfair practices of OP. Thus, in our considered view, the OP failed to prove that the deceased insured had concealed his health status, while filling the proposal form.
We have perused the medical record of PGI, Chandigarh. The patient was treated there from 16.11.2003 to 15.12.2003 under consultant by Dr. Chawla/Dr. R. K. Dhuman/Dr. V. Singh at Department of Hepatology. The patient was diagnosed as Liver Cirrhosis (alcohol related portal hypertension). There is no history suggestive of long standing alcoholic consumption. The patient was investigated and treatment was given in the PGI. The medical record clearly show the follow up notes as: "Due to uncertainty as to whether the liver disease can be attributed to alcohol ( due to the clearly short history of alcoholic consumption) , a liver biopsy was done."
Thus, it is clear that the doctors at PGI Chandigarh also have not confirmed the liver disease was due to alcohol as there was short history of alcoholic consumption.
Considering the facts and circumstances of the case, it is clear that for the want of repudiation, the OP took medical certificates from two doctors, who were not qualified in allopathic medicine, who mentioned the diagnosis of chronic liver disease without any confirmation from laboratory investigations or ultrasound sheets. Both the certificates/reports did not carry any importance as a medical certificate. The PGI also have not given definitive diagnosis of alcohol liver cirrhosis.
On the basis of aforesaid findings, there is no conclusive evidence to show that DLA was suffering from chronic liver disease due to long alcoholic consumption. Thus, the repudiation done by OP is unjustified. Therefore, we set aside the order of State Commission and restore the order of District Forum. As we have noted that the District Forum has not specified the rate of interest in its order, therefore, we direct the OP to pay insured amount with interest @ 9% per annum from the date of submission of claim to the complainant alongwith Rs.10,000/- towards mental agony within 90 days from the date of receipt of a copy of this order, failing which, the entire decretal amount will carry further interest @ 12% per annum from the date of pronouncement of this order till its realization.