Sri Shyamal Gupta, Member

The complaint case since been allowed by the Ld. District Forum, aggrieved with such decision, this Appeal is moved by the Life Insurance Corporation of India.

The complaint case was filed by one Sabita Singh over repudiation of her insurance claim by the Appellants.  Husband of the Respondent No. 1 took one LIC Policy bearing Policy No. 577648969.  During subsistence of the said policy, the said policyholder died.  In the death certificate, the cause of death was subscribed to “Septic shock – Pneumonia”.  Following such death, necessary claim was lodged with the Appellants which however was repudiated alleging suppression of pre-existing medical condition of the policyholder.  Following a contested hearing, the complaint case was decided in favour of the Respondent No. 1 which prompted the Appellants to move this Appeal.

We have heard both sides in the matter and gone through the material on record thoroughly.

It is claimed by the Appellants that the policyholder, since deceased, was suffering from various ailments like Diabetes Mellitus, Chronic obstructive Pulmonary disease and drawing the attention of this Bench to a list containing details of leaves being availed of by the policyholder at his workplace, Ld. Advocate for the Appellants tried to impress that the policyholder, since deceased, took sick leave on several occasions from his workplace before commencement of the policy in question.  However, concealing such serious medical condition, the policyholder, since deceased, obtained the policy and thus, he was guilty of suppression of material fact and therefore, the subject claim was rightly repudiated by the Insurer.

It appears that the policyholder, since deceased, took the subject policy on 19-11-2012 and he died in a hospital on 03-01-2015. According to the treatment sheet, the patient was known case of Bronchial Asthma, Type II DM. However, no specific time is mentioned in the said certificate in order to come to a definite conclusion that the above mentioned medical conditions developed before inception of the insurance policy in question.

It transpires from the Certificate of Employer that the policyholder, since deceased, took leave from his workplace on several occasions.  However, the nature of leave being not mentioned therein, there is no way to find out as to whether, he took leave on medical ground or for any other reason.   

No other proof is advanced from the side of the Appellants in support of their contention.  Thus, on overall scrutiny of the documentary proof on record, we are unable to satisfy ourselves about the veracity of the allegations being made by the Appellants.

The facts and circumstances of the citation referred to by the Appellants, viz., Reliance Life Insurance C