IMPORTANT POINT
Suppression of pre-existing ailments may vitiate insurance cover.

V.K.Jain, Presiding Member—Late Sh. Subhash Chander Chopra, husband of the petitioner, Seema Chopra and the father of petitioners Mr. Ritesh Chopra and Mr. Chandan Chopra, obtained an insurance policy from the respondent on 22.06.2009, for a sum insured of Rs. 9,86,000/-. He having died on 17.08.2009, a claim was lodged by the complainants for payment in terms of the policy taken by the deceased. The claim, however, was repudiated by the respondent vide letter dated 20.11.2009, which to the extent it is relevant, reads as under:-

“The above policy was issued on the basis of your application for insurance dated 4th June 2009 on the life of Mr. Subhash Chander (the “Life Insured) in the said application signed by the Life Insured, question numbered Qs.nos. 5g, 7 & 9 of step 10 had been replied in the negative. For your reference we are reproducing below the aforesaid questions & the replied there to in the application for insurance.

Step 10 Health Details of Insured

5. Have you ever had any of the following:

g. Hepatitis (including hepatitis B carrier) live disorder, gall bladder disorder, ulcer, bleeding from the stomach or bowel, haemorrhoids or any other disorder of the digestive. Ans. No

7. In last 5 years, have you attended any doctor or any other medical facility for investigation or diagnostic test (such as X-ray, ultrasound, CT scan, biopsy, ECG, blood or urine, etc.)? Ans. No

9. Do you have any symptoms of condition for which you intend to consult a doctor in the future? Ans. No.

We may, however, state that our investigation established that the Life Insured had been suffering from Chronic Liver Disease, Portal ‘hypertension’ with Esophageal varices since prior to your application for insurance. According to our records, such information was not disclosed in reply to the specific questions in the application dated 4th June 2009 for the above policy. After careful evaluation of all facts, documents submitted and circumstances in this case, we have come to the conclusion that the replied to the aforesaid questions in the application form are false. Had such information been disclosed, our underwriting decision(s) would have been different.”

2. Being aggrieved from the repudiation of the claim, the complainants approached the concerned District Forum, by way of a complaint.

3. The complaint was resisted by the respondent on the same grounds on which the claim had been repudiated i.e. the deceased was suffering from chronic liver disease, hypertension and esophageal varices, which he had concealed at the time of taking the policy.

4. The District Forum, vide its order dated 06.06.2012, directed the respondent Company to make payment of Rs. 9,86,000/- to the complainant alongwith interest on that amount @ 9% per annum and cost of litigation quantified at Rs. 2,000.

5. Being aggrieved from the order of the District Forum, the Insurance Company approached the concerned State Commission by way of an appeal. Vide impugned order dated 22.12.2014, the State Commission allowed the appeal and consequently dismissed the complaint. Being aggrieved the complainants are before us by way of this revision petition.

6. The application form submitted by the deceased, available on the file of the State Commission, to the extent it is relevant reads as under:-

	Life Assured Yes/No	Proposer Yes/No
5. Have you EVER HAD any of the following: g) Hepatitis (including hepatitis B carrier), liver disorder, gall bladder disorder, ulcer, bleeding from the stomach or bowel, haemorrhoids or any other disorder of the digestive tract?	No
7) In the last 5 years, have you attended any doctor or any other medical facility for investigation or diagnostic tests such as X-ray, ultrasound, CT scan, biopsy, ECG, blood or urine etc.?	No
8) Have you had any other illness,