UNITED INDIA INSURANCE CO. LTD. vs BIMAN KRISHNA BOSE

UNITED India Insurance Co. Ltd. who was Opposite Party in the complaint filed by the present respondent Biman Krishna Bose, has filed this Revision Petition against the order dated 5th April, 1993 passed by the State Commission, West Bengal in Appeal No. 994/A/93. That appeal had been filed by the Complainant. By J the impugned order, the State Commission accepted the said appeal and directed the Insurance Company to pay Rs. 8,243 being the claim amount plus Rs. 500/- towards harassment, mental agony and cost of the proceedings. The facts are that the Complainant Biman Krishna Bose alongwith his wife Smt. Alaka Bose took a Medi-claim aim Policy of insurance from the Petitioner� Insurance Company on 12th December, 1990. The proposal form was signed by Biman Krishna Bose. It was valid up to 11th VM December, 1991, In July, 1991 Smt. Alaka Bose fell ill and she was admitted in Kothari Medical Centre on 7th August, 1991. She was discharged from the nursing home on 14th August, 1991. Rs. 8,243 was paid to the nursing home. The Complainant lodged the claim for that amount with the Insurance Company along with all necessary papers. In spite of several reminders, the Insurance Company did not make payment of the claim. Therefore, the Complainant filed a complaint before the District Consumers Disputes Redressal Forum at Calcutta.

THE complaint was contested by the Insurance Company on the ground that material facts were suppressed by the Complainant while taking out the Policy and thus the policy was void abinitio. The District Forum found that Smt. Alaka Bose was suffering from hypertension for five years but it was not disclosed in the proposal form. Relying upon the term under the policy that any incorrect and untrue statement may disentitle the insured from the benefit of the policy, the Forum held that the Insurance Company was not liable in the present case. Accordingly, the complaint was dismissed. The complainant filed an appeal before the State Consumer Disputes Redressal Commission, West Bengal at Calcutta. The State Commission held that the non-disclosure of hypertension will not amount to suppression of material fact. Temporary or casual suffering from hypertension not being a permanent illness need not be required to be disclosed in the proposal form. Further, there was no evidence to show that Smt. Alaka Bose was suffering from hypertension It was also held that the treatment of Smt. Alaka Bose was mainly concentrated for pathological aspects and ENT treatment associated with hypertension. Consequently, the appeal was allowed. The Insurance Company has now come before this Commission by way of this Revision Petition.

THE learned Counsel for the Petitioner argued that in the present case there has been suppression of material facts under the terms of policy and, therefore, the claimant is not entitled to claim any benefit under the policy in respect of treatment of his wife. We are of the opinion that this argument has force. Columns 10 and 11 of the proposal form relating to personal history read as follows:� 10. Details of any knowledge of any positi existence or presence of any ailment, sickness or injury which may require medical attention in immediate future. 11. Details of Medical treatment/ Surgical Operation during preceding 12 months� Nature of treatment Period of treatment Doctor/ Hospital If fully cured, a certificate from treating medical practitioner/ Surgeon to be attached.

AGAINST both the columns the Complainant wrote the word "NO" for himself and on behalf of his wife. The medical documents produced by the Complainant show that Smt. Alka Bose had history of hypertension of 5 years. As noted by the State Commission the treatment of Smt. Alka Bose was mainly concentrated for pathological aspects and ENT treatment associated with hypertension. In our opinion the non-disclosure of the fact that Smt. Alka Bose was suffering from hypertension at the time of the proposal form for Medi-claim policy was submitted is fatal to the Complainant''s case. We are clearly of the view the State Commission was not right in saying that no-disclosure of hypertension is not suppression of material facts and temporary or casual suffering of hypertension not being a permanent deceased need not be required to be disclosed, nor it was fatal for acceptance of the insurance policy. There is nothing to show that hypertension of Smt. Alka Bose was temporary or casual. As noticed earlier, she gave her history of suffering from hypertension for 5 years before the Doctor who treated her.

IN the light of the above discussion, we, accept the present revision petition and set aside the impugned order of the State Commission and the order of the District Forum is restored. We make no order as to costs.