IMPORTANT POINT
Presence of any ailment in body does not mean that person concerned is aware of it.

Rekha Gupta, Presiding Member—The present revision petition has been filed against the judgment dated 17.08.2016 of the Haryana State Consumer Disputes Redressal Commission, Panchkula (“the State Commission”) in Appeal no. 528 of 2016.

2. The facts of the case as per the respondent/ complainant are that the respondent requested for compensation on account of death of her son Ravi Kumar who obtained a policy no. 179603061 for Rs.5.00 lakh. At the time of issuance of the policy he was examined by the doctors of the petitioner/ opposite party and no abnormality was found. Unfortunately he fell ill and expired on 16.07.2013 in PGI MS Chandigarh. Her claim was repudiated on 31.03.2014 without any reasonable ground.

3. In reply, the petitioner admitted the policy but alleged that medical examination of the deceased life assured (DLA) was not conducted by any doctor at the time of obtaining the insurance policy. As per form no. 3816 which was received from PGI Chandigarh, the DLA was suffering from Idiopathic Dilated Cardiomyopathy since February 2013, whereas the insurance policy commenced from 28.05.2013. He remained admitted to PGI MS, Chandigarh from 06.05.2013 to 28.05.2013 for this treatment. As the previous disease was not disclosed his claim had been rightly repudiated.

4. The District Consumer Disputes Redressal Forum, Rohtak (‘the District Forum’) vide its order dated 25.04.2016 while allowing the complaint observed as under:

“After going through the file and hearing the parties it is observed that the claim of the complainant has been repudiated by the opposite parties on the ground that at the time of proposal of policy, the life assured was suffering from Idiopathic Dilated Cardiomyopathy. But to prove its contention opposite parties have placed on record only copy of certificate of hospital treatment, but the alleged document is not supported with the affidavit of the doctor concerned. Moreover there is no proper address of the life assured on the alleged document and there are so many over writings/ cuttings on the dates and other particulars, i.e., name of doctor to whom history was reported and in the case summary column and the cuttings are not attested by the doctor concerned. Hence, the same cannot be read into evidence. No other treatment record of life assured prior to taking the policy has been placed on record by the opposite parties.

In view of the facts and circumstances of the case it is observed that opposite parties shall pay the sum assured under the policy no. 179603061, i.e., Rs.5.00 lakh along with interest 9% per annum from the date of filing the present complaint, i.e., 23.05.2014 till its actual realisation, other benefits under the policy, if any, and shall also pay an amount or Rs.3500/- as litigation expenses to the complainants maximum within one month from the date of decision failing which the awarded amount shall carry further interest @ 12% per annum from the date of decision. Complaint is allowed accordingly.”

5. Aggrieved by the order of the District Forum, the petitioner/ opposite party filed an appeal before the State Commission. The State Commission while dismissing the appeal has observed as under:

“This argument is of no avail. There is no cogent evidence to prove that he (DLA) was suffering from any ailment before obtaining the insurance policy. As per history of the DLA, it cannot be presumed that he was having this ailment keeping in view expressed by Punjab State Commission, Chandigarh in Joginder Kaur and Others vs Life Insurance Corporation of India and Another – 2001 (3) CLT) 633 and Life Insurance Corporation of India and Anr. Vs Raj Kumar Sharma – II (2013) CPJ 60. When OP has failed to prove that DLA was suffering from above said ailment the claim cannot be repudiated. Impugned order passed by the District Forum is well reasoned, based on law and facts and cannot be disturbed. Hence, the appeal fails and the same is hereby dismissed.”

6. Hence, the present revision petit