IMPORTANT POINT
If life assured knowingly gave incorrect information on personal health claimant would not be entitled to benefit of Section 45 of Insurance Act, 1938

Suresh Chandra, Member—Delay of ninety nine days in filing the present revision petition is condoned for the reasons stated in the application for condonation of delay.

2. In this case, the complaint was filed by one Kamoda Devi, who is wife of Muni Dom. Muni Dom was an employee in SAIL Hospital at Bhawnathpur in Garhwa District and was working there till his death. During his service period, he had taken four policies bearing nos. 55238727, 552927537, 552959596 and 55391423 from LIC of India during the period from 28.1.1999 to 28.11.2003. He died on 3.3.2004. After his death, insurance claim was made by the complainant with the opposite parties and relevant documents were submitted along with the claim. The insurance claim was, however, repudiated by the OPs. The complainant, therefore, knocked the door of the Consumer Forum by filing Consumer Complaint No. 11 of 2005 against the OPs for payment of the insurance amount of Rs.5,31,000/- for the four policies plus compensation amounting to Rs. 20,000/- for mental agony and Rs. 5,000/- for economic loss.

3. According to the complainant, the life assured had been paying premium regularly and all the necessary papers in respect of the claim had been furnished to the OPs but according to her, the Legal Branch Manager of the LIC of India allegedly demanded an amount of Rs. 1,00,000/- to clear the payment of insurance amount but since she refused to fulfill the demand, her claim came to be repudiated.

4. On the other hand, according to the OPs, policy No. 552938727 for Rs 27,000/- commenced from 28.2.2000, Policy No. 552937537 for Rs. 50,000/- from 15.1.1999, Policy No. 552939596 for Rs. 50,000/-28.1.2002 and Policy No. 553914213 for Rs. 50,000/- from 28.11.2003. Thus, the total amount under the four policies was Rs. 1,77,000/-. It was submitted that the life assured had failed to deposit premium due in January, 2003 within time and hence first three policies lapsed but thereafter on 28.11.2003, three policies were revived and on the same day, 4th Policy bearing No. 553914213 for Rs. 50,000/- was taken. Since the life assured died within a period of three months five days from the date of revival/commencement of the policy it was treated as a case of an early death claim and hence investigation was carried out by the OPs as provided under Section 45 of the Insurance Act, 1938. During the course of investigation, OPs obtained the Medical Record, own Identity Book of the life assured from his employer and from these documents, they came to know that the life assured was an old patient of pulmonary T.B., but he had suppressed this material fact/information in the proposal forms of all four policies and answered the questions in paragraphs11(a) to (h) of the proposal forms in negative and in para 11(i) stated ‘Good’ about his usual state of health. The statements made by him regarding his personal history are reproduced below:-

Personal History Ans. Yes If yes, give

or No details

a) During the last five years did you No

consult a Medical Practitioner for any

ailment requiring treatment for more

than a week?

b) Have you been admitted to any Hospital No

or nursing home for general check up,

observation, treatment or operation ?

c) Have you remain absent from place of No

work on grounds of health during the last

five years ?

d) Are you suffering from or have you ever No

suffered from ailment pertaining to lever, stomach,

heart, lungs, Kidney, Brain or nervous system ?

e) Are suffering or have you suffered from diabetes, No

tuberculosis, high blood pressure, Low blood

pressure, Cancer, Epilepsy, Hernia, Hydrocele,

Leprosy or any other disease?

f) Do you have any bodily defect or deformity ? No

g) Did you ever have any accident or injury? No

h) Do you use or have ever used alcoholic drinks, No

narcotic or any other drugs. Tobacco in any form?

i) What has been your usual state of health? Good

5. Since the pr