IMPORTANT POINT
Where insured was suffering from hypertension and dysphasia prior to taking policy and suppressed information regarding that deceased and died within 4 months of taking policy, insurance was justified in repudiating the claim.

Sunil Kumar Garg, President —This appeal has been filed by the appellants LIC against order dated 20.3.2006 passed by the District Forum, Ajmer in complaint No. 260/2005 by which the complaint of the complainant was allowed in the manner that the appellants were directed to pay a sum of Rs.1,00,000 the amount of the LIC policy along with interest @ 9% p.a. w.e.f. 28.5.2004 and further to pay a sum of Rs.1,000 as costs.

2. It arises in the following circumstances:

That the deceased complainant respondent had filed a complaint before the District Forum, Ajmer on 12.9.2006 inter alia stating that his wife Smt. Pramila, now deceased had taken a life insurance policy for a Sum of Rs. 1,00,000 from the appellants on 15.2.2004 bearing policy No. 0184948417 and that policy was to come into force w.e.f. 28.11.2003. It was further stated in the complaint that on 28.5.2004 the deceased had died suddenly and after the death of the deceased claim was preferred by the complainant-respondent being the husband and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 9.11.2004 on the ground that at the time of taking the policy in question on 15.2.2004 the deceased had filled in up a declaration form regarding her health in which she had not mentioned that she was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to that, the deceased was suffering from hypertension shock and had consulted the medical man and had taken the treatment from him and since these facts were not disclosed by the deceased in her declaration form on 15.2.2004 at the time of taking the policy, therefore, the deceased was guilty of suppression of material facts regarding her health. Thereafter the present complaint was filed.

A reply was filed by the appellants on 7.2.2006 and they have taken the same pleas which were taken by them in the repudiation letter dated 9.11.2004. It was further stated in the reply that since a specific question was asked by the appellants at the time of filling in up the declaration form on 15.2.2004 whether she was a patient of hypertension, etc. and since she had given the answer of these questions in negative but from the record of the Government Hospital, Beawar it is very much clear that the deceased was admitted in that hospital on. 2.1.2004 and the diagnosis which was made by the doctors was hypertension and when the deceased was admitted in the Hospital, it was found that she was feeling difficulty in speech and further she was suffering from vertigo and on clinical examination it was found that it was a known case of hypertension and further on the same day the deceased had left the hospital against the medical advice of the doctors, therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.

After hearing the parties the District Forum, Ajmer through impugned order dated 20.3.2006 had allowed the complaint inter alia holding that:

(i) That since the deceased was admitted in the Government Hospital, Beawar on 2.1.2004 only for the purpose of investigation and since there is nothing on record to prove the fact that prior to filling in up the declaration form regarding her health on 15.2.2004, the deceased had ever taken treatment from any hospital, therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.

(ii) That the appellants were not justified in repudiating the claim of the complainant-respondent and it had amounted to deficiency in service on the part of the appellants.

Aggrieved from that order dated 20.3.2006 passed by the District Forum, Ajmer, this appeal has been filed by the appellants.

3. In this appeal the main contention of the counsel for the appellants is that before issuance of policy in quest