Page 125 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 125

cate
Mr. R.L. Syngal, Advocate
Ms. Madhuri Narula, Ad-
vocate

For the Respondent :

Dated : 31 Jan 2017
ORDER
JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL)
1. Late Sh. Haridaya Narain Singh obtained an insurance policy from the re-
spondent company, the benefit payable to his nominee under the said policy being
Rs.2,50,000/-. He died on 21.09.2008, within two years of taking the policy, alleg-
edly due to shunt infection with intraventicular haemorrhages and DIC septicemia.
The insured had undergone a surgery of right VP shunt with right frontal burrhole in
April 2005, as he was suffering from Hydrocephalous. On his death, a claim by the
petitioner/complainant was lodged with the respondent company. The claim was re-
jected on the ground that the deceased, while taking the insurance policy, had con-
cealed a material fact of his having undergone a surgery in April 2005. Being ag-
grieved from the rejection of the claim, the complainant/petitioner approached the
concerned District Forum by way of a consumer complaint. The complaint was re-
sisted by the respondent primarily on the same ground on which the claim had been
rejected.
2. The District Forum having allowed the complaint, the insurer approached
the concerned State Commission by way of an appeal. Vide impugned order dated
16.08.2016, the State Commission allowed the appeal and consequently, dismissed
the complaint. Being aggrieved from the dismissal of the complaint, the peti-
tioner/complainant is before this Commission.
3. It is not in dispute and is an admitted position that the deceased insured had
undergone the above referred surgery in April 2005. The insurance policy was taken
by him on 12.03.2007, more than one year after the said surgery was performed. It is
also not in dispute that while applying for the policy, the insured was asked whether
he had ever been treated or was currently under treatment for the following condi-
tions:
(m) injured, sick, operated, given a medical consultation, given a medical ad-
vice on health, care in any hospital.
Admittedly, the aforesaid question was answered by the insured in the nega-
tive, meaning thereby that he represented to the insurer that he had never been oper-
ated nor had any medical consultation or care in any hospital. The insured thus, con-
cealed the material fact with respect to his health from the insurer. An information
which would influence the decision of the insurer as to whether it should accept the
proposal or not and whether it should grant the insurance policy or not, would be a
material fact, which a person seeking to obtain an insurance policy must necessarily
disclose to the insurer that he had undergone a surgery in April 2005. Had he dis-
closed the said information, the insurer might or might not have accepted the proposal

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