IMPORTANT POINT
Acute Stress Reaction is of temporary nature and not a serious life threatening disease.

Ajit Bharihoke, Presiding Member—This revision is directed against the order of the State Commission dated 18.07.2012 whereby the State Commission accepted the appeal of the respondents against the order of the District Forum and dismissed the complaint of the petitioner.

2. The facts relevant for the disposal of this revision petition are that Shishpal purchased a postal life insurance No.APS-720183-L from the respondents for Rs.2,00,000/-. The insurance was to mature on 29.05.2024. Unfortunately, Shishpal died on 19.04.2009. The complainant being the mother and nominee of the deceased submitted insurance claim. The respondents opposite parties repudiated the claim on the ground of concealment of material information regarding medical condition and paid a sum of Rs.23,750/- to the petitioner. Challenging the repudiation of the insurance claim, petitioner filed consumer complaint in District Consumer Forum Fatehgarh.

3. Upon notice, opposite parties filed written statement justifying the repudiation of the claim on the ground of concealment of material information by the insured. It was alleged that on verification of document, medical category of the insured at the time of acceptance of proposal was S2 (T-24) with diagnosis ‘Acute Stress Reaction’ which was not disclosed. It was also alleged that the insured died of ‘Massive Pulmonary Oedema’ leading to Cardio Pulmonary Arrest on 19.04.2009 whereas the life assured had mentioned his category in the proposal form as Aye /Shape-I.

4. Learned District Forum on consideration of the pleadings of the parties and the evidence accepted the complaint and directed thus:

“For the reasons and finding above, we accept the complaint of the complainant with cost of Rs.1000/- and direct the Ops who are jointly and severely liable to release the remaining insured amount of the life assured to the tune of Rs.1,76,250/- in favour of the complainant alongwith interest @ 9% per annum from the date of repudiation i.e. 19.03.2010 till actual payment. The compliance of this order be made within a period of two months failing which the complainant is at liberty to initiate the legal proceedings against the Ops”.

5. Being aggrieved of the order of the District Forum, respondents opposite parties preferred an appeal and the State Commission on consideration of material on record accepted the appeal, set aside the order of the District Forum and dismissed the complaint by observing thus:

“As a sequel to our aforesaid discussions, it has been established on the record that the life assured had concealed the true and material facts with respect to his state of health before purchasing the postal life insurance policy and for that reason the appellants-opposite parties cannot be held liable to pay any insurable benefits as per terms and conditions of the insurance policy. District Consumer Forum has failed to appreciate the above stated evidence. Hence the impugned order cannot be allowed to sustain”.

6. Mr. Pradeep Sharma, Advocate, for the petitioner has contended that impugned order of the State Commission is contrary to the facts. In support of this contention, he has drawn our attention to the proposal form submitted by the assured Shishpal for obtaining the insurance and contended that truthful information about the medical / personal history of the assured was given in the proposal form which was also certified to be correct by the superior officer of the insured. Thus, there is no question of mis-information on the part of the assured. As such, order of the State Commission setting aside the order of the District Forum is not sustainable.

7. Mr. Roshan Lal Goel, Advocate, learned counsel for the respondents on the contrary has argued in support of the impugned order. He has contended that undisputedly the life assured was suffering from ‘Acute Stress Reaction’ disease which fact was not disclosed in the proposal form. Therefore, the State Commission was right in concluding that