IMPORTANT POINTS
(1) Unless and until the insured is hospitalized or operated upon, in the near proximity of obtaining the policy his claim should not be repudiated unless he has concealed such hospitalization or operation.
(2) Any malady, which is controllable with medication and does not involve such a treatment that needs hospitalization for days together or needs operation to cure is not a ‘disease’ for the purpose of insurance policy.
(3) Unless a person is hospitalized for the treatment or operated upon as discussed above, he cannot be held to be suffering from a ‘pre-existing disease’ as he undertakes day-to-day activities and attends to daily chores and duties.

J.D. Kapoor, President—On account of having wrongfully repudiated the claim of the respondent for Rs. 1.5 Lac, towards the death claim of her husband Shurveer Singh who was holder of policy No.121558651 issued by .the appellant-insurance company, by invoking Sec. 45 of the Insurance Act, the appellant-company has been vide impugned Order dated 13-12-2007 directed to pay the aforesaid amount with interest @9% from the date of repudiation till its realization and to pay Rs. 5,000/- as compensation besides Rs. 2,000/- as cost of litigation. Feeling aggrieved the appellant has preferred this appeal.

2. The case of the respondent before the District Forum in brief was that she is the widow of Late Shurveer Singh who was holding policy No.121558651 issued by the appellant-insurance company for an assured sum of Rs. 1.5 Lac. The policy started from 19-12-2000. The husband of the respondent died on 07-09-002 due to high fever. After his death the respondent filed a claim before the appellant-company for the sum assured. However, the appellant-company repudiated the claim. Feeling aggrieved the respondent filed the present complaint before the District Forum seeking payment of benefits under the policy alongwith cost and compensation.

3. On the contrary, while justifying the repudiation of the claim, the appellant-insurance company, contended that the Death claim requirements were received by the LIC on 9-12-2002 and after review further requirements were called from the respondent on 30-12-2002 by the appellant-company and that since the death of the insured occurred within three years from the date of effecting policy, it was a case of early death claim and as such investigation was mandatory to find out the exact cause of death and genuineness of the death claim. The leave record of the deceased life assured was called for from his employer- MTNL and after scrutiny and due consideration the claim was rightly repudiated by the competent ,authority and the respondent was informed accordingly and hence there was no deficiency in service on its part.

4. The appellant-company referred to the leave register of the deceased to argue that the insured was suffering from “pre-existing disease” which he did not disclose at the time of signing of proposal form. However, in this regard, the District Forum—observed that the appellant-company referred to leave register from 5-1-1998 to 2-8- 2002 showing the leave availed by the deceased; however, no leave was taken on medical ground by the deceased from 1-6-1998 to 2-8-2002.

5. We have taken a view that unless and until the insured is hospitalized or operated upon, in the near proximity of obtaining the policy his claim should not be repudiated unless he has concealed such hospitalization or operation.

6. Let us deal as to the import, concept and scope of exclusion clause or plea of concealment of a fact by the consumer as to a ‘pre-existing disease’. To get teeth more deeply into reality we have to first know as to what is the meaning of word ‘disease’. Dictionary meaning of ‘disease’ is “illness, a serious derangement of health or malady, a bodily disorder”. Ordinarily ‘disease’ or ‘malady’ refers to a deep-seated chronic disease, frequently, one that is ultimately fatal; whereas any other ailment or even chronic disorder like diabetes, hypertension, pain in limbs or body, or even arthritis that are controllable by day-to-day medication are generally present in the people in their middle age, say above forty or fifty. This is internationally accepted dogma of health as ordinarily even medical insurance of people below forty does not require any blood test or test for hypertension or ECG or any other test for even cardiac ailment.

7. As is apparent, any malady, which is controllable with medication and does not involve such a treatment that needs hospitalization for days together or needs operation to cure is not a ‘disease’ for the purpose of insurance policy. If medication of any su