The Complainant, Harjit Singh Padda had taken a Triple Accident Benefit Policy from the LIC in 2003. On 6.2.2005 he was admitted to Fortis Hospital with complaint of uneasiness and pain. He was diagnosed to have suffered a heart break. On 9.2.2005 heart surgery was performed, after which he was discharged on 19.2.2005. 2. His claim for reimbursement of expenditure under the policy was made in May 2006 and was repudiated by the OP/LIC of India in March, 2008. The letter of repudiation stated— “In response to the querry for claim under the policy, raised through an agency, we have to inform you that the competent authority has not find it possible to consider your claim under the policy and this decision has already been conveyed to you vide our letter dated 31.03.2007 and 10.05.2007. We, therefore, again inform you that in view of your failure to disclose to us material information as per details mentioned in our previous letter to you dated 15.10.2007 in terms of the declaration made by you at the foot of the Proposal for Assurance and the Policy contract the policy has become null and void and all moneys paid thereafter belong to us.” 3. In the consumer complaint filed against this repudiation, before the District Consumer Forum, UT of Chandigarh the matter was contested by the OP/LIC of India. In defence of the repudiation it was pleaded in the Written Statement before the District Forum that— “The life assured has taking a Jeevan Asha Policy for Rs.one lac. As per the case of life assured he has suffered a Heart Attack and was revealed Coronary Artery disease and subsequently Coronary Artery Bypass Graft (CABG) was done on Feb. 09.2005, whereas as per Clause 11(b) CABG is excluded and it is a well settled law that no claim can be considered beyond the terms and conditions of the Policy. As such the complainant is not entitled to the present claim.” 4. District Forum dismissed the complaint holding that the assured had suppressed material information about his health at the time of taking the policy. While doing so it relied upon the case history recorded in the report of the Fortis Hospital, which revealed that assured/Complainant was known case of hypertension for the last six/seven years. This information was deliberately concealed in the proposal form. 5. The State Commission allowed the appeal holding that the OPs have not raised any objection while issuing the insurance policy. The insured was examined by the doctor on the panel of the OPs, who had not raised any question about his health. As for the case history, in the records of the Fortis Hospital, the State Commission has observed:- “In this case, the case history and the discharged summary report from the Fortis Hospital, Mohali is neither supported by the affidavit of the doctor concerned nor he deposed before the District Forum/State Commission. History record filed by doctor and relied upon the appellant neither supported by any corroborative evidence in the form of affidavit or the deposition of doctor does not lead to suppression of material fact.” 6. LIC of India has challenged the above decision in this revision petition. It is important to note that the Written Statement of the Insurance Company before the District Forum claims, in paragraph 4, that CABG procedure was specifically excluded from the scope of the policy. Therefore, the complainant was not entitled to benefit under the policy, due to this exclusion. But significantly, the letter of repudiation makes no mention of this exclusion. Further, there is no explanation how this could it be made a ground in the pleadings of the insurance company, when the letter of repudiation itself does not mention it as a ground for repudiation. 7. The case of the revision petitioner has been argued by Mr. .B J. Singh, Advocate and of the respondent/complainant by Mr Mohit, Advocate. The records have been carefully perused. The Commission also observed that the Insurance Company had not placed on record the certificate of the doctors, who had examined the Complainant before the issue the policy. Therefore, the original file of the Insurance Company, on which the claim of the Complainant was processed, has been summoned and perused by us. 8. Report of medical examination, done by Dr Jasmer Singh on 2.10.2003 i.e. before the policy, does not show that the proposer/complainant was under any treatment. The record of the LIC, mentioned above, shows that before insurance the basic parameters of the proposer, like height, weight, chest, pulse and BP were all recorded and noted as being within standard parameters. Tests like ECG, PSB and Lipid Profile are also referred to. But, nothing adverse is recorded. More importantly, the LIC officer, who investigated the claim of 2006 under the Policy, has himself recorded that “On inquiry I am told that the proposer was having good health before the operation. He never took long leave for any illness during the last three years.” In this back ground, the observation of the State Commission, cited earlier in this order, acquires even greater significance. 9. The revision petition has gone into full details of the law on the subject of contract of insurance being one of utmost good faith and on the effect of wilful non-disclosure of information in the proposal form. But, it is completely silent on the question as to how did the OP/LIC prove the documents before the fora below, on which it had relied for repudiation of the claim. Learned counsel for the revision petitioner could also not point to any evidence which was led in this behalf and which has been ignored or misconstrued in the impugned order. 10. In view of the above, the revision petition is held to be devoid of any merit. It is dismissed for the same reason and the order of the State Commission Chandigarh in Appeal No 86 of 2009 is confirmed. |