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2008 (4) CPR 117
PUNJAB CONSUMER DISPUTES REDRESSAL COMMISSION, CHANDIGARH
S.N. Aggarwal, President and Jasbir Kapoor, Member
Sapna Arora —Appellant
versus
Life Insurance Corporation of India
and Ors. —Respondents
First Appeal No. 29 of 2003
Decided on 6.8.2008
Counsel for the Parties:
For the Appellant:Sh. Satinder Khanna, Advocate.
For the Respondents:Sh. Paramjit Batta, Advocate.
IMPORTANT POINT
Insured where suppressed material fact of the suffering disease of Diabetes Mellitus in proposal for life policy and died in eight months of taking policy repudiation of claim would not constitute deficiency in service.
Headnote:Consumer Protection Act, 1986—Sections 12 and 17—Claim under life insurance policy—Policy was taken on 28.3.2000 and insured died in hospital on 24.10.2000—Claim was repudiated on ground that material fact of deceased suffering from disease of diabetes mellitus-II was suppressed—District Forum dismissed complaint—Appeal—Onus was on respondents to prove that disease of insured was pre-existing—History of disease given to doctors in hospital as recorded showed deceased suffering from Diabetes Mellitus—Doctor who recorded history was not examined—Proceedings under the Act being summary in nature it did not involve lengthy trial of examining witnesses—Production of documents having authenticity and coming from hospital could not be said to be inadequate evidence—No reason to disbelieve the certificate from hospital—History of Diabetes Mellitus II was given by insured deceased himself—Suppression of disease in proposal was suppression of material fact and respondent was justified in repudiating the claim. (Paras 14 to 20 and 22 and 23)
Result: Appeal dismissed.
S.N. Aggarwal, President—Om Kumar Arora husband of Sapna Arora appellant had taken the life insurance policy from the respondents on 28.3.2000 for an amount of Rs. 2,00,000/-. He died in CMC Ludhiana on 24.10.2000 due to dengue disease. The appellant lodged the claim with the respondents. It was repudiated by the respondents vide letter dated 11.6.2001. Accordingly the appellant filed the complaint in the learned District Consumer Disputes Redressal Forum, Ludhiana (in short “District Forum”).
2. The respondents filed the written statement. Preliminary objections were pleaded and the case was also contested on merits. It was admitted that Om Kumar Arora had purchased life insurance policy under Table 75-20 (Money Back Policy) on 28.3.2000 and that he had died on 24.10.2000. It was pleaded that the said Om Kumar Arora was suffering from diabetes mellitus-II prior to the filling of the proposal form but he had suppressed these facts from being disclosed. Therefore, he had taken the life insurance policy with fraudulent intention. Repudiation was legal and valid. Hence dismissal of the complaint was prayed.
3. The appellant produced documents Ex.P-1 to Ex.P-4 while respondents proved documents Ex. R1 to Ex. R4.
4. On the basis of these pleadings and the documents, the learned District Forum dismissed the complaint vide impugned order dated 5.12.2002.
5. Hence the appeal.
6. Record has been perused. Submissions have been considered.
7. Om Kumar Arora had admittedly purchased the life insurance policy on 28.3.2000 for an amount of Rs. 2,00,000/-. He had filled the proposal form dated 24.3.2000 Ex. R1. The answers given to questions 11(a), 11(b), 11(c) and 11(i) are as under:-
11(a) During the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week? No.
11(b) Have you ever been admitted to any hospital or nursing home for general check up, observation, treatment or operation? No.
11(c) Have you remained absent from place of work on grounds of health during the last five years? No.
11(i) What has been your usual state of health? Good
8. It clearly reveals, therefore, that while filling the proposal form Om Kumar Arora had nowhere stated if he was suffering from any serious disease in general and from Diabetes Mellitus-II in particular.
9. Under Section 45 of the Insurance Act, 1938 the Insurance Company is entitled to repudiate the claim where the insurance policy was obtained by the assured by suppressing material facts and with fraudulent intention. It reads as under:-
“S. 45—No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that if suppressed facts which it was material to disclose.”
10. The provisions of Section 45 of the Insurance Act were interpreted by Hon’ble Supreme Court in the judgment reported as “Mithoolal Nayak v. Life Insurance Corporation of India”.1 Their Lordships were pleased to hold as under:-
“The three conditions for the application of the second part of S. 45 are:-
(a) the statement must be on a material matter or must suppress facts which it was material to disclose;
(b) the suppression must be fraudulently made by the policy-holder; and
(c) the policy-holder must have known at th
