Page 114 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 114

(e). For your ready reference, we are reproducing below the aforesaid question
and the reply thereto in the application for insurance:
(IX) Medical and Personal History of the Life to be Insured.
Lifestyle information
5 (a) Do you consume alcohol? ........................ No.
(D) MEDICAL INFORMATION
2 (a) Consulted any doctor or other health practitioner except for common
cold, influenza lasting less than 4 days?................ No.
(b) Submitted to ECG, X-rays, blood test or other tests? ......... No.
(c) Attended or been admitted/advised to be admitted to any hospital or other
medical facility? ................... No.
3 (e) Ulcer, colitis, chronic diarrhea, hepatitis or jaundice or other liver or di-
gestive disorders? ............................ No.
th
Further, in the Medical Examiner‘s Report dated 11 December 2008 (the
―MER‖), in connection with the aforesaid application for insurance dated
th
30 November 2008, the Life Assured had replied in negative to the following
questions:
3. (Of Part 1) within the past five years have you:
(a) Consulted any doctor or other health practitioner? ............... No.
(b) Submitted ECG, X-rays, blood test or other tests? ................No.
(c) Attended or been admitted to any hospital or other medical facility
................ No.
4. Have you ever had a or sought advice for
(e) Ulcer, Colitis, Chronic Diarrhoea, Hepatitis or Jaundice or other liver or
digestive disorder? ........................................................... No.
7. (a) Indicate your average weekly consumption of alcohol ......... No.
(b) Have you ever been advised to stop drinking alcohol or to drink less?
............................ No.
However, our investigations have established that the Life Assured was a
known alcoholic since long and that he was diagnosed of Alcoholic Liver Disease
and its complication for which he was admitted and treated in Hospital much prior
to the application for insurance. We also note that he died due to the complica-
tions of the same. Hence, the replies to the aforesaid questions in the application
as well as MER are false.
If the true and correct facts pertaining to Life Assured‘s Medical condition
and personal history were disclosed at the proposal stage, the company would not
have issued the policy at all.
We are, therefore, hereby repudiating out liability under the Policy; forfeit-
ing the premium paid thereunder.‖
2. Being aggrieved from the rejection of the claim, the complainant ap-
proached the concerned District Forum by way of a Consumer Complaint. Vide
order dated 03.05.2010, the District Forum allowed the complaint and directed the
insurer to pay an amount of Rs.15,10,250/- alongwith interest @ 9% per annum
and cost of litigation quantified at Rs.11,000/-. Being aggrieved from the order
passed by the District Forum, the insurer approached the concerned State Com-

INDEX