Reva Odak v. Manager, Life Insurance Corporation of India
2009-09-08
NEERJA SINGH, PRAMILA S.KUMAR, S.K.KULSHRESTHA
body2009
DigiLaw.ai
JUDGMENT : Neerja Singh.:- Thisappeal is by the complainant, aggrieved by the order dated 23-12-08 , passed by the District ConsumerDispute Redressal Forum, Gwalior , dismissing her complaintof deficiency on the part of the respondent-Insurance Company. 2.The facts in brief are that the appellant's husband had taken a Bima Plus Policy with accident benefit on 28-3-05 for Rs . 1,00,000/-. On 2-1-06 ,while on a trip to Hyderabad , hesuddenly developed stomach ache. He was taken to the Asian Institute of Gastroentology at Hyderabad ,where it was diagnosed that he was suffering from liver cirrhosis with portalhypertension. He recovered, but 3 months later, on 17-4- 06 , he suffered from a brain haemorrhage at Indore and died. 3. The respondent-Insurance Company states that theappellant's husband was suffering from liver cirrhosis 4 years to his death. Asthere was suppression of material fact at the time of taking the policy, theclaim was repudiated. 4.We have heard the learned Counsels for the parties and perused the documentsfiled on record. 5.There is ample evidence on record to demonstrate that prior to taking the policy, the appellant's husband was suffering from cirrhosisof the liver. The discharge summary of CHL Apollo Hospital , Indore ,is filed on record, wherein the history, as mentioned by the brother of theinsured, states that he developed pyrexia 4 years ago, and ascites 2 years ago. The medical attendant's certificate also states that the insuredwas diagnosed with liver cirrhosis 4 years back, and that the primary cause ofdeath was liver cirrhosis. These facts were suppressed by the insured in theproposal form, which has been filed on record. 6.The insured died within 2 years of taking the policy. The principle of UtmostGood Faith states that there should be a full and true disclosure of all material facts without any concealment, misrepresentation orfraud. The insured should have revealed that he was suffering from livercirrhosis, and the respondent-LIC could have decided whether or not to offer orto accept such risk, and if the risk is acceptable, then on what terms andconditions such risk should be accepted. Full and true disclosure of thesefacts should have been made. As there was suppression of material facts, we donot see any deficiency in service on the part of the Insurance Company inrepudiating the claim.
Full and true disclosure of thesefacts should have been made. As there was suppression of material facts, we donot see any deficiency in service on the part of the Insurance Company inrepudiating the claim. 7.The appellant has placed reliance on the judgment of the Rajasthan StateCommission, 2009 (1) CPR 135 , wherein it was held that there was no evidencethat the insured had taken treatment for heart problem prior to taking thepolicy or that he was aware of the disease. The facts of the case in hand aredistinct. Here the brother of the insured has stated that the insured was diagnosedwith liver cirrhosis 4 years back, and had been treated for the same. By nostretch of imagination can it be said that the insured was not aware of thedisease. 8.In the result, the appeal fails and is dismissed. No order as to costs.