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


Appeal No. 1243/2006


Life Insurance Corporation of India, through its Manager (LHPF), Divisional Office: “Jeevan Prakash”, B.S. Road, Jaipur (Raj).

..Appellant-Non-applicant


VS


Smt. Shalini Shrivastava W/o Late Balram Shrivastava, R/o 53/156, Rajat Path, Mansarovar, Jaipur (Raj).

..Respondent-Complainant


Before:

Mr. G.S. Hora, Presiding Member

Mr. Sikandar Punjabi, Member


Present:

Mr. Vizzy Agarwal, counsel for the Appellant

Mr. Ashok Dubey, counsel for the Respondent


ORDER Dated: 06.07.2009


PER Mr. G.S. HORA, PRESIDING MEMBER


This is an appeal against the order dated 8.5.2006 passed by the learned District Forum, Jaipur-II, Jaipur whereby the Appellant Insurance Corporation was directed to pay to the Complainant a sum of Rs. 3,00,000/- with interest @ 9% per annum from the date when the claim was repudiated besides Rs. 2,000/- as litigation expenses.


The Husband of the Complainant Late Shri Balram Shrivastava obtained a policy under Jeevan Mitra (tripple cover endowment plan) with profit (with accident benefits) for a sum of Rs. 1,00,000/- by submitting a proposal on 24.10.2003. The policy was issued on 3.12.2003. The Life Assured (LA) died on 20.2.2004 in Saket Hospital, Jaipur. The claim was filed by the Complainant but after thorough inquiry, the same was repudiated on the ground that the LA before he proposed for the policy, had suffered from fever and SOB for which he had consulted a Doctor and have taken treatment but he did not disclose these facts in the proposal.




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The question for consideration is whether LA had suppressed the material facts about his health while filling the proposal form and therefore the Insurance Corporation was justified in repudiating the claim.


The learned counsel for the Appellant submitted that the LA was admitted in Saket Hospital, Jaipur on 12.2.2004 with history of breathlessness & fever and diagnosed to be suffering with Neumothorax and ILD (interstitial lung disease) and died on 20.2.2004. The learned counsel further submitted that the LA was suffering with severe respiratory distress and had been advised to keep oxygen saturation above 88% and oxygen inhalation – 3-4 ltrs/minute. He also referred to the treatment prescription dated 8.10.2003 and 9.10.2003 wherein strong medicines were prescribed to the LA. He further added that even ECG was advised which is done in cases of patient suffering from chronic obstructive pulmonary disease. It was further submitted that the LA had been on treatment continuously from 30.9.2003 till his death on 20.2.2004 which goes to show that he was not having good health but to secure the policy he mentioned wrong facts about his health in the proposal form. The learned counsel for the Respondent supported the judgement of the learned District Forum.


Undoubtedly the learned counsel Mr. Vizzy Agarwal has taken lot of pains in drafting the memo of appeal wherein the ailments the LA had suffered and the treatment given to him was eloborately mentioned. The question is whether such a material was placed before the learned District Forum. The claim was repudiated on the ground that the LA had suffered from fever & SOB before he proposed for the policy. It is said that the LA was admitted in Saket Hospital, Jaipur but no Bed Head Ticket has been placed on record. Certificate of hospital treatment given in Form No. 3816 has been produced wherein it has been mentioned that the patient had difficulty in respiration for the last 3-5 days. In para 10, the reply was negative to the querry whether he was treated in the hospital on any previous occasion either as 'in-patient' or 'out-patient'. Medical attendance certificate in Form No. 3784 has also been produced wherein primary cause of death has been shown. Symptoms of illness were SOB & cough with expectoration and fever. Duration of illness was 3-4 days. Again the answer was in negative to the querry in para 7 whether the deceased was treated during his last illness by any other medical practioner before he was consulted by treating Doctor. So far as these two certificates are concerned, they are in no way support the Non-applicant. The learned counsel for the Appellant heavily relied

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upon the Annexure R-6 which is a prescription dated 8.10.2003. If we look at Annexure R-5 and R-3 nowhere these certificates indicate that the patient was earlier treated on 8.10.2003. By whom this prescription was issued is still not known. Even the ailment the patient was suffering from has not been mentioned. In this regard, no Doctor has been examined nor any affidavit of the Doctor has been produced. Neither the IPD No. nor the HR No. has been given on this prescription. How long the treatment continued is not known from this document. The Appellant has relied upon the certificate of the Employer who had enclosed the statement of leave along with the certificate but that statement has not been produced. Even the prescription dated 8.10.2003 and the medical attendance certificate do not co-relate with each other. In any case, the Appellant Insurance Corporation has not been able to satisfy that the LA had been suffering from serious disease before he submitted the proposal form a for insurance.


In the result, we find no force in this appeal and the same is dismissed with cost on parties.



Member Presiding Member



Hira Lal