DR. S. M. KANTIKAR, MEMBER

1.       The present revision petition is being preferred by the petitioner under Section 21(b) of the Consumer Protection Act, 1986 assailing the validity of impugned order dated 22-11-2013 passed by Rajasthan State Consumer Disputes Redressal Commission, Jaipur in First Appeal No.623 of 2013.

2.       The brief facts are that the complainant’s husband, Shri Shyam Sunder Heda obtained a life insurance policy for a sum of Rs.2,50,000/- on 27-07-2009 from the OP, Life Insurance Corporation of India, Ajmer. The insured died on 15-10-2010 at SMS Hospital, Jaipur. The complainant filed an insurance claim and completed all the formalities but the claim was repudiated by the OP on 04-01-2012 on the ground that her husband was suffering from Systemic Sclerosis with Silico Tuberculosis, ILD, Arthritis, Hypothyroid since 1½ months prior to the date of acquiring the insurance policy i.e. 27-07-2009.

3.       The complainant filed a complaint before the District Forum, Ajmer against the OP alleging deficiency in service by repudiating her claim.

4.       After considering the pleadings and evidence of both the parties, the District Forum allowed the complaint and directed the OP to pay insurance claim of Rs.2,50,000/- along with interest @ 9% per annum and Rs.2,500/- as cost.

5.       Aggrieved by the order of the District Forum, the OP filed the first appeal before the State Commission. The State Commission dismissed the appeal.

6.       Hence, this revision petition.

7.       We have heard the counsel for both the parties.  The learned counsel for LIC, Mr. U.C. Mittal, Advocate vehemently argued that the insured/patient was initially admitted in SMS Hospital on 10-12-2008. The insured was again admitted in SMS Medical College and Hospital from 04-06-2009 to 14-06-2009. He was diagnosed for ILD, Arthritis and Hypothyroidism. As per history, he was a known case of Systemic Sclerosis with Silico Tuberculosis and was taking treatment since four months.  Also, there is a past history of tuberculosis and he was treated for the same.  Therefore, repudiation of claim is justified.  He further submitted that the State Commission has not given any findings and it was not a speaking order which is passed arbitrarily. 

8.       Learned counsel for the complainant submitted that the burden heavily lies on the insurance company to prove the allegation of deliberate concealment and misrepresentation. The OP/petitioner failed to discharge the burden. Mere presumption never make any proof.

9.       We have perused the medical record of SMS Hospital. It clearly revealed the treatment aspects of the deceased/insured. The patient/insured was treated and investigated for Upper Gastro Intestinal bleeding. He was a known case of ILD with Systemic Sclerosis.  It is clearly established that he was suffering from chronic diseases which are not of short duration. Also there was clear history of the patient undergone treatment for Tuberculosis for nine months.

10.       Considering the entirety, in our view, it was a material concealment done by the insured. Thus, LIC is justified in repudiating the fraudulent claim. Accordingly, we allow this revision petition and dismiss the complaint. The parties are left to bear their own costs.