DR. S. M. KANTIKAR, MEMBER

1.      The above said three first appeals have been filed under Section 19 of the Consumer Protection Act, 1986 against common order dated 11.12.2013 passed in Complaints case No. CC/12/15, CC/12/16 and CC/12/17 by Maharashtra State Consumer Disputes Redressal Commission, Mumbai ( in short, ‘the State Commission’) whereby the State Commission partly allowed the complaints.

2.      The relevant facts for the disposal of the appeals are that Shri Rajendra Chavan (since deceased), (hereinafter referred as ‘the life assured’), husband of the complainant, took several life insurance policies from LIC of India/OP although the present case relates to three of these policies only.  During the subsistence of the policies, the life assured died on 6.9.2010 due to oral cancer.  The death claim was submitted to the OP/LIC but the claim was repudiated by the OP/LIC on the ground that the life assured suppressed the material facts about the habit of Gutkha chewing for the last 14 years and also did not disclose dyspepsia which he was suffering prior to filling of the proposal form.

3.      Aggrieved by unlawful repudiation and the arbitrariness of the OP/LIC, the complainant filed three separate complaints before the State Commission.  The State Commission after considering the evidence, partly allowed the complaints No. CC/12/15, CC/12/16 and CC/12/17 and by a common order passed the following directions:-

1. In CC 12/15 OP is directed to pay to the complainant Rs.30,00,000/- (triple S. A.) with interest @6% p.a. from date of repudiation and cost of Rs.15,000/-

2. In CC 12/16 OP is directed to Complainant Rs.27,00,000 with interest @6% p.a. from the date of repudiation and cost of Rs. 15,000/-

3. In CC 12/17 OP is directed to pay to the Complainant Rs.25,00,000 with interest @6% p.a. from the date of repudiation and cost of Rs. 15,000/-

4.      Aggrieved by the impugned order, the OP/LIC of India filed three separate appeals before this Commission.

5.      We have heard the learned counsel for both the parties.

6.      Learned counsel for the appellant submitted that the life assured was a development officer in the LIC of India.  The policies were issued in the year 2009.  The counsel submitted that while filling the proposal form, all the answers to the clauses against question No. 11 were replied by the insured stating as “No”.  DLA was suffering from dyspepsia since many years with mouth ulcer for the last six years.  He was having trouble while opening the mouth since last five years.  He was habitual with chewing gutkha for the last 14 years.  The OP investigated the matter and brought the medical summary from the hospital where the insured has taken treatment prior to availing the policies and on the basis of medical record, the OP concluded that the DLA had suppressed the material information about his health, which ought to have been disclosed in the proposal form.  The counsel further submitted that the DLA also received medi-claim towards the expenses on account of his treatment.  The DLA has revived five policies and also purchased 7 new policies.  It itself indicates mala fide intention.

7.      The rival arguments on behalf of the complainant are that the policies were issued after due medical examination report, which was signed by panel of doctors of OP.  Prior to issuance of the policies, the DLA was thoroughly examined by the panel of doctors separately and nothing abnormal about the health of DLA was found.  The counsel submitted that on 27.9.2010, Dr. T. S. Jagtab issued one certificate mentioning that oral pain salivation and ulcer of the tongue.  The DLA was treated by Dr. Neve of Aditya Birla Hospital for difficulty in opening mouth and condition of the DLA.  Counsel for the complainant further submitted that the medical summary or certificate of Aditya Birla Hospital and the certificate issued by Dr. T. S. Jagtap nowhere shows about the diagnosis and treatment of oral cancer.

8.      We have perused the proposal forms submitted by the complainant.  The insured had submitted entire details in the proposal forms.  Also, there is a confidential report of the agent, which does not show any ambiguity.  To prove the contention of OP, the OP filed one document, annexure A-6 (115).  It is operative notes.  The date of operation was in handwritten as 22.1.2009 and the operation was started at 8.30 a.m. and completed at 8.30 p.m. whereas, there is another similar document the Discharge Summary issued on 13.1.2010, revealed the date of admission as “21.1.2010 and the patient was operated on 22.1.2010 for CA tongue and the operation was Hemiglossectomy plus RAFF”.  Therefore, Annexure A-6 and Discharge summary contradicts each other with respect to date and other details.  The date of surgery was 21.2.2010, it was not on 21.2.2009.  Such documents filed by OP create the element of suspicion in our mind that how OP managed to procure such document? and whether it was fraudulent intention.  It is pertinent to note that the insured diseased was Development Officer working in the LIC (OP’s office) for almost about two decades.  If he had habits of chewing tobacco, how the officers of OPs ignored such habit of tobacco chewing before issuing number of policies to the insured.  Therefore, the submission of OP about concealment about habit of tobacco chewing is not sustainable.  The person might have suffered oral ulcers and opening of jaw problems, but it should have been noted by the panel of doctors, who examined the complainant before certifying that he was fit for getting insurance policy.

9.         On the basis of foregoing discussion, we are of the considered view that the OPs failed to prove any cogent evidence or any medical record that the insured was suffering from oral cancer.  The available medical record clearly shows that he was suffering from oral ulcers and dyspepsia, which are common disease occur day to day.  Therefore, we do not find any merit in the instant appeals.  Accordingly, we dismiss all the three appeals.  The parties are directed to bear their own costs.