REKHA GUPTA, PRESIDING MEMBER

                The present revision petition has been filed against the judgment dated 03.10.2016 of the Punjab State Consumer Disputes Redressal Commission, Chandigarh (‘the State Commission’) in FA No. 1252 of 2015.

2.     The brief facts of the case as per the petitioner-complainant are that the petitioner had filed a complaint under section 12 of the Consumer Protection Act, 1986, wherein the petitioner has averred that Bhsuhan Kumar her husband had obtained an insurance policy bearing no. 20664379 for a period of five years with effect from 21.10.2011 to 20.10.2016 having annual premium of Rs.1.00 lakh. After completion of five years the insured was to get maturity amount of Rs.13 lakh. In case the insured died during the subsistence of the policy, the nominee was entitled to get the insured amount of Rs.13 lakh. Bhushan Kumar (now referred as DLA) paid two annual premiums of Rs.1.00 lakh each, i.e., in the year 2011 and in the year 2012. Unfortunately, the assured expired on 08.04.2013. After the death of the DLA, petitioner being the nominee was entitled for the sum assured. The petitioner lodged the claim with the respondent/ insurance company for disbursement of sum assured of Rs.13 lakh and also submitted the relevant documents including insurance policy as well as receipts of paid premiums. The respondent – insurance company assured the petitioner that her claim would be settled within a short period, but vide letter dated 13.06.2013 her genuine claim was rejected on the ground that DLA was suffering from Hypertension since three years and Diabetes Mellitus since 10 to 12 years and that fact was not disclosed at the time of obtaining the insurance policy. She averred that the DLA had never suffered from any such alleged disease and the respondent rejected her claim on a false plea. DLA was medically checked by the empanelled doctors of respondent before issuing the insurance policy and DLA was found fit and healthy. Hence, repudiation of her genuine claim amounted to unfair trade practice and deficiency in service on the part of the respondent/ insurance. Therefore, the petitioner filed the complaint before the District Forum seeking following directions against the respondent:

1. To pay Rs.13 lakh as insured amount along with interest @ 18% per annum from the date of lodging of the claim till payment;

2. To pay Rs.50,000/- as compensation for mental tension and harassment.

3.     The complaint was contested by the respondent/ insurance company who filed the written reply and took the preliminary objection that DLA, after understanding the terms and conditions of the policy had submitted the proposal form on 21.10.2011. He had filed the proposal form, which was attested by one witness Mr Sanjeev Kumar, and the insured was explained the contents of the proposal form in vernacular language. It was admitted that the petitioner was the nominee/ beneficiary under the policy. The proposal form was filled on the basis of the information furnished by DLA and thereafter, the policy in question was issued. Petitioner had informed this respondent that the insured had died on 08.04.2013 due to sudden cardiac attack. Petitioner submitted the death claim and other documents with the respondent. The claim of the petitioner was investigated by investigating agency, i.e., Eagle Eye Consultant Private Limited. During investigation it was revealed that DLA was suffering from Hypertension (HTN) since three years and Diabetes Mellitus (DM – II) for the last 10 to 12 years and was on insulin prior to applying for the said policy. DLA took treatment from Smt Parvati Devi Hospital, Ranjit Avenue, Amrtisar. DLA was well aware about his health condition before filling up the proposal form but he did not disclose the fact in the proposal form. Further, even if the DLA had undergone a medical examination with the doctors appointed by the respondent he was bound to disclose the treatment taken by him. However, the DLA had suppressed the material facts and therefore, the respondent had rightly repudiated the claim of the petitioner on the ground of concealment of disease. The contract of insurance is based upon good faith and thus the respondent was not liable to pay any compensation as there was no deficiency or unfair trade practice adopted by it. Prayer was made for dismissal of the complaint with costs.

4.     The District Consumer Disputes Redressal Forum, Amritsar vide its order dated 09.11.2015 while allowing the complaint held as under:

“Consequently, we allow the complaint with costs and the opposite party is directed to pay the insured amount of Rs.13 lakh to the complainant within one month from the date of receipt of copy of this order failing which the complainant shall be entitled to interest @ 9% per annum on this amount from the date of filing of the complaint till the payment is made to the complainant. Opposite party is also directed to pay litigation expenses to the complainant to the tune of Rs.2,000/-.”

5.     Aggrieved by the order of the District Forum, the respondent opposite party/ insurance company filed an appeal before the State Commission. The State Commission while allowing the appeal set aside the order of the District Forum. The State Commission observed as under:

“The question for consideration is whether DLA Bhushan Kumar was suffering from any pre-existing disease before taking the policy bearing no. 28664379 for a period of five years with effect from 21.10.2011 to 20.10.2016. The relevant documents are is the history sheet from Smt Parvati Devi Hospital dated 06.04.2013 wherein it has been referred the history of past illness K/C/O of DM type II for the last 10-12 years and hypertension for the last three years. In the discharge summary wherein it was mentioned that past history K/C COL Esophageal Varices. Whether we can rely upon the history recorded in the history sheet. A reference can be made to the judgment ‘Satwant Kaur Sandhu vs New India Assurance Company Ltd., - IV (2009) CPJ 8 (SC) observed in paragraph no. 22 of that judgment as under:

‘We do not find any substance in the contention of learned counsel for the appellant that reliance could not be place on the certificate obtained by the respondent from the hospital where the insured was treated. Apart from the fact that at no stage had the appellant pleaded that the insured was not treated at Vijay Health Centre at Chennai, where he ultimately died. It is more than clear from the above said certificate that information about the medical history of the deceased must have been supplied by his family members at the time of admission in the hospital a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorities the insurer to seek information from any hospital he had attended or may attend concerning any disease or illness which may affect his health.

From the above said judgment it is clear that information regarding the history of the deceased must have been supplied by his family members at the time of admission in the hospital which is a normal practice. The District Forum had relied upon the judgment of Life Insurance Corporation of India & Ors. Vs Kunari Devi IV (2008) CPJ 89 (NC) in that case no document was produced in support of allegation of suppression of disease at the time of taking the policy.

Further, in judgment of Sahara India Life Insurance Co. Ltd., (supra) opposite party has failed to produce on record any evidence to show that deceased insured ever consulted doctor for taking the treatment of heart disease. In that case sufficient evidence was not referre,d therefore, the plea of the opposite party to repudiate the claim of the insured was rejected. Here the counsel for the complainant was unable to rebut the judgment Satwant Kaur Sandhu vs New India Assurance Company Ltd., IV (2009) CPJ 8 (SC) wherein Supreme Court has mentioned in unequivocal terms that normally the history is given by the patient or its attendant.

We accept the appeal, the order of the District Forum is set aside. Consequently the complaint is hereby dismissed”.

6.     Hence, the present revision petition.

7.     I have heard the learned counsel for the petitioner and have gone through the record. Learned counsel for the petitioner admitted that the petitioner’s husband Late Bhushan Kumar was suffering from Diabetes Mellitus and Hypertension but contended that this life style disease is common to most people and hence, the DLA had not considered it necessary to mention the same. She has further contended that no evidence had been produced by the respondent/ opposite party to prove the suppression of material facts, i.e., the pre-existing condition of the insured.

8.     The claim of the petitioner was repudiated by the respondent vide letter dated 15.06.2013 on the grounds that Late Bhushan Kumar was a known case of hypertension since three years prior to his death on 08.04.2013 and was a diabetes mellitus for the last 10-12 years and was on insulin dependent. However, these facts were not disclosed in his application form dated 21.10.2011. I have seen the application form which reads as under:

1.     High Blood Pressure, chest pain, Angina, Heart Attack or any other ailment pertaining to the heart or circulatory system? (Y/ N) - NO

7.     Ulcers or ant Stomach or intestinal Disorder?

        Diabetes, thyroid or any other Gland Related Disorders? (Y/N) - NO   

9.     I have also seen the investigation report of the death claim by Eagle Eye Consultant Pvt Ltd.  During investigation they came to know that DLA was not keeping well prior to purchase of the policy.

“Medical documents – During investigation we have come to know that LA was keeping ill prior to purchase of this policy. He was suffering with DM II and HTN. He was admitted at Srimati Parvati Devi Hospital on 02.03.2013 and discharged on 13.03.2013. LA was again admitted at the same hospital on 06.04.2013 but could not revive and died at the same hospital on 08.04.2013.

We have also collected the treatment copies of the said hospitals. As per the entire collected medical papers it has been confirmed that LA was suffering with DM II and HTN prior to purchase of this policy.

Others – During investigation we have come to know that LA was keeping ill prior to purchase of this policy. He was suffering with DM II and HTN. We also have collected the treatment copies for confirmation. The given age proof and occupational details found to be genuine.

During investigation we have come to know that LA was keeping ill prior to purchase of this policy. He was suffering with DM II and HTN. He was admitted at Srimati Parvati Devi Hospital on 02.03.2013 and discharged on dated 13.03.2013. LA was again admitted at the same hospital on 06.04.2013 but could not revive and died at the same hospital on 08.04.2013.

We also have collected the treatment copies of said hospitals. As per entire collected medical papers it has been confirmed that LA was suffering with DM II and HTN prior to purchase of this policy. As per the collected medical records of Paravati Hospital LA was suffering with DM II since last 10-12 years and was on insulin and also had history of HT Since last 3 years”.

10.    I have also gone through the medical report placed in the file pertaining to the period the DLA received treatment at Smt Parvati Devi Hospital. In the history of illness it is clearly recorded that he was suffering from Diabetes Mellitus for the last 10-12 years and was on insulin and that he was a known case of Hypertension for the last three years. He was also known case of Cirosis of Liver with Esophageal Varices.

11.    The statement of Jitender Kumar, Store In-charge and record keeper of the Smt Paravati Hospital reads as under:

“I have brought the summoned record, i.e., the original treatment file of patient Bhushan Kumar son of Kedar Nath, VPO Khalra, Tehsil Patti, District Tarn Taran. The said patient was got admitted in our hospital on 02.03.2013. As per the record the witness was brought to the hospital by Manoj Kumar son of Bhushan Kumar and due to the chief complaint of injury on left leg due to slip followed by pain in leg difficulty in moving leg and as per the diagnosis of Dr J P S Chinna and G S Chinna and J S Sidhu the patient is known case of cirrhosis of live, Esophageal Varices and hypertension and DM on regular on insulin. As per the record brought by Manoj Kumar son of Bhushan Kumar patient also disclosed the above said history of the patient. The patient was also diagnosed HCV+ve (Hepatitits C Virus). The patient was treated in the hospital by the above referred doctor and was discharged on 13.03.2013. I have brought with me the original treatment file. Again on 06.04.2013 said patient Bhushan Kumar was brought to our hospital by the son of patient namely Manoj Kumar due to the complaint of Cirrhosis of live, Esophageal Varices, DM Type II and HCV Positive.  As per the history of post illness got recorded by the son of patient namely Manoj Kumar, the patient was diabetes mellitus Type II (DM –II) for the last 10-12 years and was on insulin, since them left femur one month back. Cirrhosis of liver, DM Ii HCV positive, Esophageal varices and hypertension for the last three years and on regular RX on the medicines of such diseases since then. The patient was diagnosed by Dr J S Sidhu of such ailments and was treated in the hospital but the patient could not be survived and was died on 08.04.2013 due to such ailments. I have brought the original treatment file with me in court. I have not brought the treatment record of the patient prior to 02.03.2013 due to shortage of time. (At this stage further examination in chief is deferred and witness is directed to bring the relevant summoned record on the next date of hearing)”.

12.    From this it is clear that the history of Late Bhushan Kumar was given by none other than his son Manoj Kumar.

13.    In view of the forgoing, I find that there is, no jurisdictional or legal error or misrepresentation of facts have been shown to us to call for interference in the exercise of powers under Section 21 (b) of Act.  The order of the State Commission does not call for any interference nor does it suffer from any infirmity or erroneous exercise of jurisdiction or material irregularity. Thus, the present revision petition is dismissed and the order of the State Commission is upheld.