IMPORTANT POINT
Pre-existing disease – life assured has deliberately concealed the true facts about his state of health and suppressed his pre-existing disease.

ORDER

Kumkum Rani, President—This appeal under Section 15 of the Consumer Protection Act, 1986 has been directed against the impugned judgment and order dated 13.09.2019 passed by learned District Consumer Disputes Redressal Forum, Haridwar (hereinafter to be referred as “The District Commission”) in consumer complaint No. 46 of 2015, styled as Smt. Roopa Vs. Manager, Life Insurance Corporation of India and another, wherein

and whereby the consumer complaint was allowed.

2. The facts giving rise to the present appeal, in brief, are, as such that late Nathi Ram, the deceased husband of respondent/complainant - Smt. Roopa, during his lifetime, had purchased a life insurance policy bearing No. 273119859 on dated 04.11.2010 for assured sum of Rs.3,00,000/-. The life assured expired on 07.12.2010 and intimation regarding death of the life assured was given to the insurance company. The complainant submitted the claim form along with all requisite documents in the office of the insurance company, but after expiry of long time, the claim amount was not paid to the complainant and the same was avoided, saying that the claim papers are under investigation and after conclusion of investigation, the cheque of the claim amount shall be sent to the complainant, but after waiting for a long time, the amount was not paid. Therefore, the insurance company had committed deficiency in service by not paying the claim amount to the complainant. The complainant also sent a registered notice dated 18.12.2014 to the insurance company, in reply whereof, it was stated that the claim of the complainant has been repudiated on 26.12.2012, but no information regarding repudiation of the claim was given to the complainant. Thus, the insurance company has resorted to unfair trade practice. Therefore, the consumer complaint was submitted by the complainant before the District Commission.

3. The appellants/opposite parties filed joint written statement before the District Commission, pleading therein that the life assured had expired on 07.12.2010 after only one month of purchasing the policy and there was suppression of material facts relating to his health, when the policy was purchased. On investigation, it came to the knowledge of the insurance company that the said policy was purchased by deliberate concealment of material facts and also about ailments which the life assured suffered prior to his purchasing the policy. It also came to the knowledge of the insurance company that the deceased life assured had undergone operation for “Transurethral restation of Prostate” and for that, he had been admitted in Himalayan Institute Hospital, Dehradun from 10.08.2010 to 20.08.2010. It is only after that the life assured had underwent said operation that he opted to purchase the policy and gave false answers as to his state of health in the proposal form dated 31.10.2010. There was also false declaration given in the proposal form dated 31.10.2010 regarding queries asked therein. The declaration tantamounts to a guarantee and since it has been breached, the claim has rightly been repudiated vide letter dated 26.12.2012, hence there was no deficiency in service on the part of the insurance company. It was also averred that the consumer complaint is barred by time because the life assured expired on 07.12.2010 and the insurance company had informed the complainant about repudiation of the claim through letter dated 26.12.2012 sent through speed post and the consumer complaint was filed on 15.01.2015, after expiry of about four years’ and two months’ from the death of the life assured and after two years’ twenty days’ from the date of repudiation of the claim. Therefore, the consumer complaint is not legally maintainable and the same is liable to be dismissed.

4. Learned District Commission after hearing both the parties and after taking into consideration the material available on record, passed the impugned judgment and order dated 13.09.2019, thereby allowing the