(Delivered on 13/12/2016)

Per Mr. S.B. Sawarkar, Hon’ble Member

1. The instant appeal is filed  against the order of the District Forum, Bhandara passed in CC No. 57/2008, dated 9/9/2008, partly granting the complaint and directing the OP Nos. 1 to 3 to provide the claim in five policies with all benefits with the interest at the rate of 9 percent  per annum from 12/11/2007 i.e. from the date of death of insured husband of the complainant, with Rs. 10,000/- as compensation for physical and mental harassment with Rs. 4,000/- as cost of the complaint and the order to be complied severally or together by all three OPs, in the span of 30 days from receipt of the order.
2. The complainant had filed the claim application in case of five policies taken by her deceased husband between 2001 to 2005 after his death on 12/11/2007. However the opposite party (in short  OP) repudiated the claim vide letter dated 24/03/2008 on the ground that the deceased life assured (DLA) during revival of the policy on 5/6/2007, suppressed the vital information about his health that he was suffering from IHD with HT (Ischimic Heart Disease with Hypertension. Hence the complainant filed the complaint claiming deficiency with a prayer to provide her the claim amount of Rs. 4,05,000/-, Rs. 1,000/- as notice charges, Rs. 10,000/- for agony and Rs. 10,000/- for agony, Rs. 3,000/- as litigation expenses, totaling to Rs. 4,19,000/- with interest at the rate of 12 percent from 12/11/2007, i.e. from death day of DLA
3. The  complaint was filed against OP Nos. 1 to 3 who are The various officers of the life insurance corporation. On notice the OPs appeared and with common written version, countered the complaint stating that the DLA while taking the policy suppressed  the information that he was being medically treated for his ailment and also while reviving the policy on 5/6/2007 again suppressed the information of his ailment. Hence breach of the conditions of policy of atmost faithfulness. Therefore  the repudiation to be  justifiable with no deficiency. The OP filed the chart of medical leave, taken by the DLA from his service from the year 2004 to 2007 with treatment documents of the DLI and the death papers with post  mortem examination report showing that the DLA had died due to Cirrhosis of liver  with heavy amount of alcohol in the blood and to have taken treatment for IHD in Government Hospital in 22/10/2003.
4. The learned Forum heard both the parties and on the ground that the treating doctor of the DLA wrote in the report that the symptoms were observed by him on 8/11/2007 after the revival of the policy though he was treating the DLA from  the year 2004 till his death. The learned Forum held that the repudiation being unjustifiable passed the order as above.
5. Aggrieved against the order, the OP filed the appeal. Hence are called as appellant. Advocate Mr. Gedam remained present for the appellant. The complainant  is referred as respondent who remained absent but filed written notes of arguments.
6. The advocate for the appellant relied on the following judgments.

1. National Commission Judgment passed in Divisional Manager LIC Vs. Anupama and others, published at legal digest April 2012, page 96, wherein the Hon’ble Commission held that it is medically well established that cirrhosis of lever is not an overnight phenomen on and that one of the most common causes is alcoholism.  Mere absence of an affidavit from the treating the doctor cannot be a valid reason to reject the evidence produced.
2. National Commission Judgment, passed in Revision petition No. 3848/2007 between LIC of India Vs. Kempamma and others, published in Legal Digest April 2013, page 103 where in the Hon’ble Commission held that it is clear that at the time of revival of policy, a new contract comes into existence and the insurance company is entitled to repudiate claim if life assured suppresses material fact or gives false declaration regarding his health.
3. National Commission Judgment passed in Revision Petition No. 4875/2012, published in Legal Digest, April 2013, page 107, in case of Usharani Gupta Vs. Life Insurance Corporation of India where in it is held that at the time of revival DLI denied the fact of having undergone treatment for more than a week. He is under obligation to give correct answers pertaining to his health at the time of revival of lapse policy whether cause of death has any nexus or not with the decease suffered by life assured, revival of insurance policy tantamount to a fresh policy.
4. Supreme Court Judgment passed in Satwan Kaur Sandhu Vs.  New India Assurance Company, published at IV (2009)CPJ 8 (SC), wherein the Hon’ble Supreme Court held that suppression of material fact proved  and repudiation of claim is justified.
5. National Commission Judgment, passed in revision petition No. 602of 2009, between LIC of India Vs. Morala Shiva Parvati where in it is  held that ultimate cause of death has no relevance to the disclosing of information related to death and thus allowed the revision petition.

7. The advocate for the appellant based on the ratios held by the above judgments submitted that the deceased life assured was taking a treatment for IHD from  the year 2003 and had remained absent on various durations throughout the period till his death as can be seen from the certificate given by his employer. He had died of cirrhosis  of lever indicating that he was suffering with IHD with HD at the time of taking the policy and also at the time of revival of the policy. However he suppressed the information by giving false replies of good health in the form and thus committed the breach of the policy condition. However the learned Forum did not appreciate the evidence and passed the erroneous order which needs to be set aside by allowing the appeal.
8. The respondent with written notes of arguments claimed that the deceased life assured was examined by the panel doctor of the appellant who did not find  any disease or ailment  also at the time of revival. He was examined and hence the DLA did not suppress the information. Also the treating doctor Mr. Vairagade who later on became the panel doctor of the appellant  submitted that the DLA came  to know of the symptoms on 8/11/2007 after the revival. Hence no suppression of information and therefore the order of the Forum being correct needs to be confirmed.
9. We considered the contentions of both the parties and perused the report given by doctor Shrikant Vairagade who gave the certificate that he treated the DLI from 28/5/2004 till 8/11/2007 but wrote in the column  that the deceased came to know of the symptoms on 8/11/2007 of viral hepatitis. We find that there has to be some mistake in the certificate as the doctor certified that he treated the patient from 28/5/2004 till 8/11/2007 and the certificate is given in respect of viral hepatitis of which the symptoms were noted on 8/11/2007. We do not find any relevance of this certificate to the present complaint as the certificate is for viral hepatitis and the repudiation is for IHD with HT. The DLA also died on 12/11/2007 after four days of being infected with viral hepatitis with cirrhosis of lever. Hence the certificate has no relevance with the repudiation of the claim which is based on the suppression of information of medical treatment and the ailment. We find that the learned Forum committed mistake by relying on above certificate which is not concerned with the claim and overlooked the evidence about leave taken by DLA on medical ground and evidence showing  that the DLA took treatment in the District Hospital in the year 2003 for  severe ischemia  and IHD in  the year 2003 before taking the policy and getting them revived. This clearly shows that the DLA  had dishonestly suppressed material information of his medical treatment while taking the policy. When the information suppressed is proved by the filing of documents of medical treatment by the appellant and leaves taken by him from office on medical ground, we have no doubt in accepting the appeal and holding the order of the learned Forum to be erroneous based on unsupported presumption. We also find no reason to provide cost to the appellant while passing the order as below.

ORDER

1. The appeal is allowed.
2. The order of the learned Forum is set aside in the event the complaint stands dismissed.
3. Parties to bear their own cost.
4. Stay  order if any stands vacated.
5. Copy of the order be given to both the parties, free of cost.