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


APPEAL No. 1191/2008


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

..Appellant-OP



VS


Smt. Snehlata Agarwal W/o Late Sanjay Kumar Agarwal, C/o Gajanand Kantilal, Mahadeo ji ki Chhatri, Beawar, Distt. Ajmer.

..Respondent-Complainant

Before:

Mr. G.S. Hora, Presiding Member

Mr. Sikandar Punjabi, Member


Present:

Mr. Vizzy Agarwal, counsel for the Appellant

Mr. S.P. Gandhi, counsel for the Respondent


ORDER Dated:06/03/2009


PER Mr. G.S. HORA, PRESIDING MEMBER


This appeal has been filed against the order dated 1.3.2008 passed by the learned District Forum, Ajmer whereby the Appellant has been directed to pay to the Complainant a sum assured of Rs. 5 Lac along with benefits and sum assured of Rs. 50,000/- with benefits along with interest @ 9% per annum for the period from two months subsequent to the filing of insurance claims till the date of payment besides a sum of Rs. 1,500/- towards litigation expenses.


The Life Assured (LA) Late Shri Sanjay Kumar Agarwal on the basis of proposal dated 10.3.2003 obtained a policy for Rs. 5 Lac, the policy of which was issued on 19.3.2003. Thereafter Shri Agarwal again took a policy of Rs. 50,000/- which was issued on 5.8.2004. The earlier policy was lying in a lapsed condition because of non-payment of premium on 15.3.2004, The same was revived on 22.1.2005 on submission of declaration for good health. When the insured was admitted in Mumbai Hospital, he died on 25.5.2005 where he was under treatment for Tuberculosis (TB), meningitis with encepholitis, and HIV positive. The claim was filed by the Complainant being the nominee for grant of assured amount. Claims of both the policies were repudiated by two separate letters dated

2


31.3.2006 wherein it was mentioned that at the time of revival of earlier policy and the policy obtained on 5.8.200, the LA had been suffering from TB, RVD and HIV for which he had consulted a medical man and had taken treatment in a hospital. He did not disclose these facts in the declaration of good health and the proposal form. Instead he gave false answers therein.


The simple question for consideration is whether the LA had suffered from the aforesaid diseases before obtaining the second policy and revival of the earlier policy.


We have perused the entire record. Undoubtedly, when the LA was admitted in Mumbai Hospital, he was diagnosed as a patient of TB and HIV positive. The Appellant Corporation has relied upon the observations made in Bed Head Ticket (BHT) of the LA which was obtained from the Mumbai Hospital. The Appellant has also relied upon the medical attendant certificate which was given by Dr. Neeta Josh Kulkarni, MRO. Mumbai Hospital, Mumbai wherein the patient was shown to have been suffering from Retropositivity three months before 2.3.2005. He was also found to have been suffering from TB for the last three months, HIV positive for the last three and half months. A certificate of hospital treatment was also obtained from the Mumbai Hospital which also mentions the nature of disease, the LA had been suffering from. On being asked whether the history was reported by the patient himself, the answer was in negative. It was further clarified that history was reported by patient's relative as the patient was dis-oriented. We fail to understand as to how on the basis of history reported by a relative, it can be taken as a proof about the period from which the LA had been suffering from the said diseases.


The burden was on the Appellant Corporation to prove with cogent evidence that the LA had suppressed material facts at the time of making declaration about his health. The Appellant has not been able to prove that at the time of revival of policy and at the time of taking second policy, the LA suffered from any ailment as mentioned in the letter of repudiation.


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



Member Presiding Member



Hira Lal