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Judgment
THIS appeal has been directed by the complainant against order dated 15.3.2007 passed by Consumer Disputes Redressal Forum-II, U.T. Chandigarh (hereinafter to be referred as District Consumer Forum), whereby his complaint was dismissed as meritless.
BRIEFLY stated the facts are that wife of the complainant namely Santosh Duggal got herself insured from opposite party vide proposal form No. 300 (C-1) on 19.10.2003 for a sum of Rs. one lac and paid premium of Rs. 6,946. The opposite party issued insurance policy No. 162426838 for a period of 16 years which started from 28.4.2003. However, his wife died on 15.2.2004 and certificate of her death is Annexure C-2. Appellant submitted all the documents required by OP for payment of the claim but the same was rejected vide letter dated 2.2.2005 (Annexure C-3). Alleging deficiency in service, the complaint was filed for compensation.
Opposite party contested the complaint and stated that on receipt of information regarding death of the policy holder, an inquiry was conducted and it was found that she had fraudulently suppressed material facts in the proposal form dated 15.11.2003 and as such that there was no deficiency on their part.
PARTIES adduced their evidence by way of affidavits and documents. After hearing Counsel for the parties, District Consumer Forum vide order dated 15.3.2007 dismissed the complaint being merit less.
AGGRIEVED by the said order, complainant has field the present appeal. We have heard Mr. Munish Goel, Advocate for appellant and carefully gone through the file. It is an admitted fact that Smt. Santosh Duggal wife of appellant/complainant got herself insured for Rs. one lac on making payment of Rs. 6,946 vide proposal form Annexure C-1/OP-1. Accordingly respondent had issued insurance policy OP/2/1 and also issued receipt for having received the premium Ex. OP/2. The date of commencement of policy was 28.4.2003 but Santosh Duggal died on 15.2.2004. The appellant had informed the respondent regarding the death of his wife vide letter dated 15.3.2004 Annexure OP-3. The death certificate is Annexure OP-3/1. Smt.Santosh Duggal had made applications for leave on medical grounds OP -5/1, OP-5/2 and OP-4/5 is form of leave account showing the leave taken on medical ground. Smt. Santosh Duggal had filled proposal form dated 15.11.2003 in which she had stated that she was not suffering from ailments pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system and further she had not suffered from diabetes, tuberculosis, high blood pressure, cancer, epilepsy, hernia and other diseases.
THE death certificate OP-3/1 does not disclose the cause of death but as per claimant''s statement OP-4/1, immediate cause of death of Smt. Santosh Sudan was cardiac respiratory arrest. She died in Inscol Hospital, Sector-34, Chandigarh. As per certificate of hospital treatment OP-4/2, at the time of admission Smt. Santosh Sudan had symptoms of chronic renal failure, diabetic nephropathy and uncontrolled high blood sugar. In this certificate, diagnosis arrived at in the hospital at the time of admission was type-II diabetes mellitus, triopathy with hypertension, CRF, end stage renal disease and high blood sugar and diabetes since many years. Thus, certificate of hospital treatment categorically showed that Smt. Santosh Sudan was suffering from diabetes etc. for many years. This fact had not been mentioned in the proposal form and on the other hand, she had stated in the proposal form that she had not been suffering from such diseases. It is true that Smt. Santosh was employed as a teacher and she had obtained leave on medical ground on a number of times. In the certificate of hospital treatment of Dr. Mrs. Kumpally Aruna Kumari, it is mentioned that the date of first admission was 25.1.2004 to 29.1.2004, the second admission for the period from 10..2.04 to 11.2.2004 and third admission from 12.2.2004 and she expired on 15.2.2004. It is further mentioned that Smt. Santosh was a known case of diabetes since the age of 20 years and later on she suffered from chronic renal failure and was on intermittent haemodialy. Thus, at the time of admission Smt. Santosh had symptoms of chronic renal failure, diabetic, nephropathy and uncontrolled high blood sugar. THEse diseases show that at the time of taking policy, she was suffering from the same and did not disclose the same in the proposal form and thus there was breach of condition of the policy. THEse facts were material to be disclosed. If the diseases had been disclosed, perhaps the insurance company would not have issued the insurance policy.
IT has been observed by Hon''ble Supreme Court in Mithu Lal Nayak v. LIC of India, AIR 1962 SC 814 that policy holder was clearly guilty of a fraudulent suppression of material facts when he made his statement, which he must have known were deliberately false and hence the policy issued to him relying on those statements was vitiated. Since, insurance company has rejected the claim after applying its mind to all the relevant aspects and as such there is no deficiency on its part. Counsel for appellant contended that immediate cause of death of Smt. Saroj was cardiac respiratory arrest and it had got no nexus with diabetes mellitus type-II, triopathy with hypertension, CRF, renal disease and blood pressure. In our opinion, certainly existing disease had nexus with her cause of death i.e. cardiac respiratory arrest.
It has been observed by the National Commission in the case titled Lic Of India & Ors. v. Smt. Shashi Bala, IV (2003) CPJ 91 (NC), that since the deceased was suffering from diabetes and further allegation of concealment of material facts was made by the insurance company and there was nexus between diabetes mellitus and heart attack, so, repudiation of claim was justified.
THEREFORE, in view of the discussion above, there is no force in the appeal. Consequently, the same is dismissed. Copies of this order be communicated to the parties, free of charge. Appeal dismissed.