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GUJARAT STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, AHMEDABAD
Hon’ble Mr. Justice R.C. Mankad, President & Dr. Jatin P. Vaidya, Member
SHANTABEN RATILAL PATEL—Complainant
versus.
LIFE INSURANCE CORPORATION OF INDIA—Opposite Party
Complaint No. 71 of 1993—Decided on 11.9.1995

Advocates:
Counsel for the Parties :
For the Complainant:Mr. D.C. Mehta, Advocate.
For the Opp. Party :Mr. H.J. Bhatt, Advocate.

Headnote:Consumer Protection Act, 1986 Sections 12 & 17 - Insurance claim - Life insurance policy for Rs. 1 lakh taken on 26th March 1988 - Insured died on 18th March 1991 - Claim repudiated on ground that insured gave false information about he suffering from diabetes - Certificate given by Resident Medical Officer of Hospital produced to show that insured had been admitted in Feb. 1990 & there was history of diabetes since 8 years - Nothing on record to show that such history was reported by patient himself or his relative - No evidence that cause of death was related to his disease of diabetes - Death not being connected with diabetes, insured could not be said to have suppressed material fact - Insurance Corporation is liable to pay insurance amount - Compensation of Rs. 20,000/- also awarded with interest at 18%. (Paras 4 to 6)

       Result : Complaint allowed.

       IMPORTANT POINT

       Where insured died due to heart attack & there is no evidence that cause of death was related to alleged disease of diabetes which insured was alleged to have suppressed, it could not be said that there was suppression of material fact & no liability arose under policy of Life Insurance Corporation.

       

ORDER

Mr. Justice R.C. Mankad, President—The complainant who is widow of Ratilal Popatlal Patel (deceased for short) has filed this complaint for recovery of insurance amount due under life insurance policy of the deceased and compensation from the opponent Life Insurance Corporation (Corporation for short).

2. The deceased made proposal for his life insurance for a sum of Rs. 1 lakh on March 26, 1988. In the form of proposal, the deceased was required to state whether he had suffered from any of the diseases or ailments mentioned at serial number 18. There were about 8 questions which tine deceased was required to answer in connection with the disease or ailment suffered by him. At serial No. 19 amongst other things the deceased was required to state whether he had suffered or was suffering from diabetes. The deceased answered all the questions in the negative. The Corporation’s doctor who examined the deceased certified him to be fit for insurance. The Corporation thereafter accepted the proposal and issued insurance policy for a sum of Rs. 1 lakh in favour of the deceased. The complainant, wife of the deceased was mentioned as nominee in the policy. The deceased died on account of massive heart attack on March 18, 1991. The complainant made claim for the insurance money under the policy. The Corporation, however, by its letter dated March 6, 1992 repudiated its liability to pay any amount under the policy on the ground that the deceased had given false answers to question Nos. 19,20 and 22 in the proposal form. According to the Corporation, the deceased suffered from diabetes mellitus since about 8 years before he made the proposal for insurance and this fact he had not disclosed in the proposal form. Thus, according to the Corporation, material facts were suppressed by the deceased at the time of making proposal for life insurance and, therefore, the Corporation was not liable to pay any money under the policy. The complainant has, therefore, approached this Commission claiming money due under the policy and compensation.

3. The Corporation has contested the complaint by filing written statement Exh. 10. The defence of the Corporation is that since the deceased had suppressed material facts regarding his state of health at the time of making proposal, it was not liable to pay any sum under the policy. It is contended that the deceased was suffering from diabetes mellitus at the time of making proposal and this fact has not been disclosed in the proposal form. It is submitted that the deceased had given false answers to the questions relating to his health at the time of making proposal. It is, therefore, prayed that the complaint deserves to be dismissed.

4. The main contention of the Corporation is that the deceased had suppressed the fact about his suffering from diabetes at the time of making proposal. We have already referred to question put at serial No. 19 in the proposal form in answer to which among other things the deceased was specifically required to state whether he suffered from diabetes. No arguments were advanced on the basis of the answers given by the deceased to question Nos. 20 and 22 to which reference is made in the letter repudiating the complainant’s claim and, therefore, we have not reproduced these questions at the earlier stage. At Sr. No. 20, the question which is formulated is to the effect whether the deceased had occasion to take treatment or medical advice for any illness for more than a week during preceding 5 years. At Sr. No. 22 the questions which the deceased was required to answer were :

(1) whether he was operated or met with an accident Or suffered injury;

(2) whether his electro cardiogram, x-ray or screening were taken or the blood, urine and stool were examined; and

(3) whether he was hospitalised or had to remain in asylum or sanitorium for examination, treatment or operation.

All the questions were answered by the deceased in negative. However, at the time of arguments, the learned A











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