BEFORE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CIRCUIT BENCH, RAJASTHAN, JAIPUR


Appeal No. 532/2006


100.

Of India, through its Manager (LHPF), Divisional Office: “Jeevan Prakash, B.S. Road, Jaipur.

.

..Appellant-Opposite Party


vs


Smt. Savita Rathoria W/o Late Prakash Chand Rathoria, R/o 4-F-7, New Housing Board, Shastri Nagar Extention, Bhilwara (Raj.)

..Respondent-Complainant


Before:

Mr. G.S. Hora, Presiding Member

Mr. Sikandar Punjabi, Member


Present:

Mr. Vizzy Agarwal, counsel for the Appellant

Mr. Rajendra Sharma, counsel for the Respondent


ORDER Dated:15.07.2009


PER Mr. G.S. HORA, PRESIDING MEMBER


This appeal is against the order dated 7.2.2006 passed by the learned District Forum, Bhilwara whereby the Appellant has been directed to pay to the Complainant the assured sum of Rs. 1,00,000/- and benefits due under policy along with interest @ 9% per annum from the date of repudiation of the claim till the date of payment as well as a sum of Rs. 1,000/- towards litigation expenses.


Late Shri Prakash Chand Rathoria, Husband of the Complainant obtained a life policy for a sum of Rs. 1,00,000/- by submitting a proposal dated 2.10.2001 wherein he claimed himself healthy. The Life Assured (LA) died on 9.10.2003. On claim being filed by the Complainant, the Appellant Corporation inquired into the facts and circumstances surrounding the death of the LA. The inquiry revealed that LA was admitted in M.G. Hospital at Bhilwara on 7.10.2003 and was diagnosed to be suffering from IHD, hypertension and infarct in right frontle and left occipitle lobe cerebral vascular accident in November, 2002. The LA was discharged on 8.10.2003 and thereafter admitted in Maharana Bhupal Government Hospital at Udaipur. The history as revealed by the wife of the LA was recorded

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in Bed Head Ticket (BHT) which shows that LA had an accident five years back and was operated upon and a rod was put in right thigh. The LA had fallen four & half years back resulting in fracture of the hip. He was alcoholic for last 6-7 years, addicted to Bhang for last 7-8 years and a cigarette smoker. The claim was repudiated by the Insurance Corporation on the ground that the above facts were within the knowledge of the LA but he chose to give false and incorrect information while replying to the querries in the proposal form. The facts suppressed were material and if known to the Insurance Coroporation, the policy would not have been issued. By this suppression, the under-writing of the insurance by the Corporation was adversely affected.


The learned District Forum did not agree with the pleas raised by the Appellant, thus allowed the complaint as indicated above. Feeling aggrieved, this appeal has been filed by the Insurance Corporation.


We have given thoughtful consideration to the rival contentions and gone through the file.


The LA was admitted in M.G. Hospital, Bhilwara on 7.10.2003 and he was diagnosed as the patient of IHD, HT with CVA. He was referred to RNT Medical College, Udaipur. A BHT of Maharana Bhupal Govt.Hospital, Udaipur has been placed on record where the past history of the patient was recorded as given out by his wife. The patient was recorded as known case of hypertension since one and half year. It was also recorded that on two occasions, the LA had sustained bone injuries. He was found cigarette smoker, alcoholic till 6-7 years back, Bhang addict 7-8 years. On the basis of this history given by the wife, the claim was repudiated. We feel that there was hardly any justification for repudiating the claim of the Complainant. So far as the hypertension is concerned, the inception of the disease was one and half years before admission in the hospital, which shows that LA suffered from hypertension after policy was obtained by him. So far as the fracture of two bones are concerned, the incident took place four and half years back and therefore these fractures could not have been the reason for the death of the LA. The information about these fractures was not so material, the disclosure of which would have influenced the decision of the Insurance Corporation. To mention that LA was alcoholic till 6-7 years back goes to show that he had been taking alcohol much before the policy was obtained. Even otherwise, use of alcohol was not responsible for the death of the LA. Cigarette smoking and taking Bhang also did not affect the health of

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LA. Even if the history as disclosed by the wife of the LA is taken on its face value. The facts narrated are not such which would have influenced the decision of the Insurance Corporation whether to grant insurance or not. In our considered view, the repudiation of the claim by the Insurance Corporation was not justified. The order passed by the learned District Forum cannot be said to be erroneous.


For the forgoing reasons, we find no force in this appeal and the same is dismissed with cost on parties.



Member Presiding Member



Hira Lal