ORDER
K.S. Gupta, J. (Presiding Member)
1. This revision is directed against the order dated 30.3.1999 of Consumer Disputes Redressal Commission Haryana, Chandigarh summarily dismissing appeal against the order dated 9.2.1999 of a District Forum whereby petitioner/opposite party – Insurance Company was directed to pay the claim under Policy No. 170715682 with interest to the respondent/ complainant.
2. Complaint was filed by the respondent alleging that his wife had obtained policies of Rs. 30,000on28.3.1982,Rs. 50,000 on 28.12.1985, Rs. 1,00,000 on 25.10.1990 and Rs. 2,00,000 on 20.9.1993 from the petitioner. Wife of respondent died of heart failure on 20.2.1994. Respondent being nominee filed claims under the said policies but claim under the last policy of Rs. 2,00,000 was repudiated by the letter dated 30.3.1995 by the Insurance Company on ground of deceased having withheld information regarding her health at the time of purchase of said policy. It was further alleged that deceased was medically examined by the authorised doctor of Insurance Company who had certified that she was enjoying good health. Reason given in repudiation letter was that the deceased had been suffering from bronchitis etc. She was treated for such ailment and discharged from the hospital. Moreover, that ailment could not be the cause of death by heart failure. It was denied that deceased had concealed any material fact regarding her health. Repudiation of claim by the Insurance Company was mala fide. In the written version obtaining of policy in question was not denied. However, it was alleged that deceased was a chronic patient of asthma and allergic bronchitis before proposing for the policy in question. She had taken treatment in hospital from 28.5.1992 to 9.6.1993 and 28.7.1993 to 12.8.1993. In proposal form the deceased gave wrong declaration as under in reply to answer to question Nos. 11(a), (b), (c) and (d):
(a) During the last five years did
you consult a Medical practi-
tioner for any ailment requir-
ing treatment for more than
a week? (No)
(b) Have you ever been admitted to
any hospital or nursing home
for g eneral check up
observation, treatment or
operation1 (No)
(c) Are you suffering from or have
you ever suffered from ailment
pertaining to liver, stomach,
heart, lungs kidney, brain or
nervous system? (No)
(d) What has been your usual state
of health (Good)
3. It was further stated that medical examination by the doctor of Insurance Company is a routine check up which is based on the replies given by the life assured. It was asserted that claim had been rightly repudiated by the letter dated 30.3.1995.
4. On enquiry how the orders passed by Fora below are legally sustainable, Mr. R. Venkataramani, Sr. Advocate for respondent contended that burden to prove that life assured was suffering from allergic bronchitis and asthma etc. before purchasing the policy in question was on Insurance Company and the petitioner had not filed the affidavit or examined as witness the treating doctor. In support of the contention, reliance was placed on the decision in Life Insurance Corporation of India v. Narmada Agarwalla and Ors. ; Life Insurance Corporation of India v. Ambika Prasad Pandey . As part of submission it was urged that deceased had died due to heart failure which had no nexus with the ailments she was allegedly suffering from. To be only noted that as policy in question had not run for two years, Section 45 of Insurance Act would not be attracted. Said decisions are, thus, not of any assistance to the respondent. On the other hand, it was pointed out by Mr. S.P. Mittal, for petitioner that nonfiling of affidavit and/or non-examination of treating doctor of the deceased is not fatal. In para No. 8 of the complaint as also by way of ground No. 2(iii) of the response filed to revision petition it is admitted by the respondent that deceased was treated for allergic bronchitis etc. in a hospital. He invited our attention to the claim inquiry report (Copy at pages 22 to 26) and certificate issued by N.C. Jindal Hospital, Hissar (copy at pages 27 to 30). Against Column Nos. 16 and 33 in claim inquiry report it is mentioned that deceased remained admitted in the said hospital from 23.5.1992 to 9.6.1992, 28.7.1993 to 12.8.1993 and l.l2.1993 to 26.12.1993 as she was seriously ill because of asthma and allergic bronchitis. It is further mentioned that treatment files were in personal custody of Dr. Ravinder Gupta. It is not in dispute that respondent is also a doctor by profession. After said certificate was issued by the above hospital with reference to admission of the deceased from 23.5.1992 to 9.6.1992. In view of said pleadings and evidence, we are in agreement with Mr. Mittal, Advocate that non-filing of affidavit and/or non-examination of treating doctor is not ruinous. In our view, certificate of the medical officer of petitioner certifying the deceased as enjoying good health would not be of much consequence. Ultimate cause of death of the deceased has no relevance whatsoever to the disclosing of information regarding health as required by aforementioned Clauses (a), (b), (d) and (i) of Clause 11 of the proposal form. Obviously, the answers given by the deceased who was suffering from asthma and allergic bronchitis etc., to these questions were false to her knowledge and petitioner-Insurance Company was, thus, justified in repudiating the claim by the said letter dated 30.3.1995. Orders passed by Fora below being legally erroneous, deserves to be set aside.
5. Accordingly, while allowing revision, aforesaid orders passed by Fora below are set aside and complaint dismissed. No order as to cost.