IMPORTANT POINT
Production of a document is different from proof of the same.

Mrs. Vineeta Rai, Member—These two revision petitions (R.P. No.10/2007 and RP No.11/2007) have been filed by the Life Insurance Corporation of India & another (hereinafter referred to as the ‘Petitioners’) being aggrieved by the order of the State Consumer Disputes Redressal Commission, Punjab(hereinafter referred to as the ‘State Commission’) in favour of Ashok Manocha and another, respectively (hereinafter referred to as the ‘Respondents’).

2. Since the facts and points of law involved are common in both cases, we propose to dispose of these revision petitions through a single order by taking into consideration the facts of Revision Petition No.10 of 2007.

3. The facts of the case according to the Respondent, Ashok Manocha, are that his brother Pawan Kumar had purchased a life insurance policy on 28.06.2004 for a sum of Rs.2 lakhs under the Plan and Term 150-121 and the Respondent was his nominee in this policy. Unfortunately, Pawan Kumar died in an accident within a period of 4 months on 25.10.2004 and after his death Respondent filed a claim with Petitioner/Insurance Company as the nominee of the deceased, after completing all the required formalities and submitting the required documents. Petitioner/Insurance Company repudiated the claim on 30.03.2005 on the grounds that deceased had concealed and suppressed material information regarding his health status because he was admitted in B.B.M.B. Hospital, Nangal on 13.03.2003 with congestive heart failure and non-insulin dependent diabetes mellitus. Respondent denied this contention and stated that cause of his death was the accident and not because of any pre-existing disease. Further there was no affidavit filed in evidence of the doctor who attended the deceased and treated him to support Petitioner’s contention. Moreover, the deceased had been examined by doctors of Petitioner/Insurance Company at the time of taking the policy and the post-mortem also clearly indicated that his cause of death was not due to any heart problem. Respondent, therefore, filed a complaint before the District Forum on grounds of deficiency in service and requested that Petitioner be directed to pay him Rs.4 lakhs i.e. double the insured amount as per the terms of Policy along with interest @ 18% and Rs.10,000/- as costs.

4. Petitioner/Insurance Company have denied the contentions of the Respondent and stated that there is credible documentary evidence that the deceased had suffered from diabetes mellitus and heart problems which he did not disclose at the time of effecting the insurance and that a policy being a contractual agreement between an insuree and the insurer in utmost good faith, suppressing material information would entitle the insurer to reject the claim. The District Forum after hearing both parties and considering the evidence on record accepted the complaint on the grounds that there was no credible proof of the fact that the deceased Pawan Kumar was suffering from any disease as contended by the Petitioner/Insurance Company and the nexus between cause of death and the alleged illness was not established. The operative part of the order of the District Forum reads as follows:

“There is no evidence worth the name in the form of affidavit of some doctor to the effect that treatment was actually and factually taken from him by the insured. Nexus between the alleged illness of the insured and the cause of death has not at all been established. Admission of the insured on account of illness (which is alleged to have been suppressed by the insured from the insurer) was just for one day and the death of the insured in this case was not on account of that illness or any other illness but the death of the insured admittedly had taken place on account of accident and it is not the set up case of the O.P. that the illness with which the insured was allegedly suffering had contributed to his death. In view of the discussion made above, we reach the conclusion that repudiate of the claim