Life Insurance Corporation of India v. Damodar Bagdi
2025-03-06
MUNNURI LAXMAN
body2025
DigiLaw.ai
JUDGMENT : MUNNURI LAXMAN, J. 1) Heard both the counsel on final disposal. 2) The present writ petition challenges the award dated 28.02.2024 passed by the learned Permanent Lok Adalat, Jodhpur Metropolitan in Public Utility Service Case No.183/2019, whereunder the claim of the respondent for coverage of Rs.16 lacs, was allowed. 3) Aggrieved by the said award, the petitioner-Insurer has filed the present writ petition. 4) The case of the respondent-claimant was that the deceased had obtained a policy being the Cancer Cover Plan No.905-30 for 30 years coverage for Rs.16 lacs and the said policy was issued on 22.01.2018. The deceased succumbed to the cancer after 180 days of issuance of the policy. The Insurance Company on knowing the discovery of the first diagnosis of cancer within the waiting period of 180 days repudiated the contract of insurance. The claimant had preferred a claim before the Permanent Lok Adalat, Jodhpur Metropolitan. The Permanent Lok Adlat after conducting summary proceedings has overruled the repudiation of contract and granted the assured amount with interest @ 8% per annum. 5) The learned counsel appearing for the petitioner- Insurance Company has submitted that the terms of policy particularly Part ‘C’ of 8(G) entitle the Insurance Company to repudiate the contract if the first diagnosis of “any stage” of cancer is diagnosed within 180 days from the date of issuance of policy or the date of arrival of the risk cover, whichever is later. This means if the stages of cancer is diagnosed within 180 days, the Insurance Company is entitled to repudiate the contract of insurance. 6) The learned counsel for the Insurance Company further contended that as per the investigation done by them, a Positron Emission Tomography (PET) Test was conducted on 19.07.2018 and the said PET test discloses that the deceased diagnosed with the cancer and such a discovery was made within 180 days of commencement of the policy. Since the cancer was detected within waiting period, as per the terms of the policy, the insurer is entitled to repudiate the contract of insurance, which is rightly done. Therefore, the Permanent Lok Adalat was not correct in allowing the claim for assured amount under the policy in spite of valid repudiation of contract. The learned counsel has submitted that on this ground only, the impugned award is required to be interfered.
Therefore, the Permanent Lok Adalat was not correct in allowing the claim for assured amount under the policy in spite of valid repudiation of contract. The learned counsel has submitted that on this ground only, the impugned award is required to be interfered. 7) Per contra, the learned counsel appearing for the respondent-claimant has submitted that the PET Test was not conducted on 19.07.2018 and in fact, the soft tissue was collected on 24.07.2018 and the discharge summary also indicates that the stage of cancer was detected only on 29.07.2018 and treatment was started from 30.07.2018. According to him, the PET Test only shows areas of the body where the cells are more active than normal and such a test is not exclusive to the cancer and it can also be used for heart diseases and brain conditions. By such a test, the stage of cancer cannot be detected. It can only be done by biopsy based on the soft tissue collected. 8) In the back ground of the above contention, this Court is required to appreciate whether the findings of Permanent Lok Adalat suffer from any perversity or any finding was made without any evidence. 9) There is no doubt that the Insurance Company is entitled to repudiate the contract if it is established that within the waiting period of 180 days, if the first diagnosis of any stage of cancer is detected. This means if any medical report of diagnosis, which indicate any stage of the cancer within 180 days, the Insurance Company is entitled to repudiate the policy. In the present case, the policy was issued on 22.01.2018 and 180 days comes to an end on 21.07.2018. The evidence on record show that the PET Test was conducted on the deceased on 19.07.2018 and the soft tissue for biopsy was taken from the deceased on 24.07.2018. The PET scan only indicates areas of body where cells are more active than normal. This test do not furnish diagnosis of stage of cancer. It is a pre-indicative test to proceed for the biopsy. The biopsy is the test for cancer, which could only give the stages of the cancer. The policy terms only indicate the first diagnosis of any stage of the cancer. If the PET test is not the first diagnosis of determination of any stage of the cancer then the case of the insurer must fail.
The biopsy is the test for cancer, which could only give the stages of the cancer. The policy terms only indicate the first diagnosis of any stage of the cancer. If the PET test is not the first diagnosis of determination of any stage of the cancer then the case of the insurer must fail. In the present case there is no material to show that when the report of the PET Test was furnished. Even assuming that the same was furnished within 180 days, that test results do not satisfy the requirement of first diagnosis of any stage of cancer. As adverted herein-before, such a test is only indicative of areas where cells are more active and not more than that. The biopsy is the only test, which could give the first diagnosis of any stage of cancer and admittedly & indisputably, the soft tissue for biopsy was collected on 24.07.2018, which is subsequent to 180 days and the test results were prior to 30.07.2018. The treatment of the cancer was commenced from 30.07.2018. This means the stage of the cancer was detected basing on the biopsy result, which material was collected subsequent to 180 days. Therefore, the case of the claimant do not fall within the waiting period. This is the only ground which is urged in the present writ petition. 10) This Court on appreciation of the facts and evidence on record finds that there is no perversity in the award impugned, which requires no interference. 11) In the result, the writ petition is dismissed. 12) Pending interlocutory applications, if any, shall stand disposed of.