Page 129 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 129

of due. The District Forum also awarded Rs.10,000/- towards mental agony.
4. Aggrieved by the order of District Forum, the OP approached the State
Commission by way of an appeal. The State Commission allowed the appeal and
dismissed the complaint wherein, it held that the insured concealed true facts about
his health and the opinion of the doctors shows that he was a chronic alcoholic and
suffering from alcohol related cirrhosis of liver. Hence, as per condition No. 5 of the
policy, the claim was repudiated rightly by the OP. Aggrieved by the impugned or-
der, the complaint filed the instant revision petition.
5. We have heard learned counsel for both the parties. Learned counsel for the
petitioner/complainant made submission on delay of 13 days in filing this revision
petition. For the reasons stated in the application for condonation of delay, the delay
of 13 days is hereby condoned. He further argued that the deceased was admitted for
the first time in the hospital on 16.11.2003 i.e. about 1 ½ year after taking of the pol-
icy. He was a primary school teacher. He maintained his good health and he was a
conscious person, who was getting his regular health check-up done during his life-
time. Moreover, the State Commission failed to appreciate the medical reports and
tests of the deceased placed on record. However, the State Commission relied upon
the baseless allegations and manufactured documents of OP. The fact is that the in-
sured died in an accidental death, having no nexus with alcoholic cirrhosis of liver.
6. Learned counsel for the OP submitted that the life assured was a known
case of chronic liver disease. He was consuming alcohol since a long time of 4 to 5
years and not keeping good health due to which, he suffered alcoholic cirrhosis. He
did not disclose the same at the time of filing the proposal form on 28.04.2002.
Therefore, the claim was rightly repudiated. The counsel brought our attention to the
question No. 11(d), 11(h) and 11(i) of the proposal form. The insured declared that
he was not taking alchohol and was not suffering from any disease pertaining to liver,
stomach, heart, lungs, kidney, brain etc. Therefore, due to such false submission, as
per condition No. 5, the policy became null and void. To support his contention, the
counsel brought our attention to the certificate issued by Dr. Rajendra Kumar of
Kumar Medical Centre, College Road, Guradspur, (Ex. R-5), and another certificate
from Dr. Paramjeet Singh Dhaliwal, who had mentioned that the DLA remained un-
der their treatment for chronic liver disease. The counsel further submitted that as per
the certificate of hospital treatment of Muni Lal Chopra Hospital Amritsar, (Ex. R 7)
and the medical attendance certificate, (Ex. R-2) the DLA was suffering from alco-
holic liver disease.
7. We have perused the proposal form, the medical attendance certificate, the
certificates issued by Dr. Rajendra Kumar and Dr. Paramjeet Singh. It is pertinent to
note that the insured was a teacher. There is no evidence from any staff of the school
that he was regularly consuming alcohol for the last 4 to 5 years and he was not
healthy. On bare perusal of the certificate issued by Dr. Rajendra Kumar, it is clear
that Dr. Rajendra Kumar is B.A.M.S. The certificate neither bears any reference
number nor date. It is just hand written certificate. There is no treatment details or
any investigation by which Dr. Rajendra Kumar arrived at the diagnosis of chronic
liver disease of the patient (insured). Similarly, the medical certificate issued by Dr.
Paramjeet Singh Dhaliwal under his seal appears to be written on the plain paper. He
treated the patient on Out Door basis. The OP has placed another certificate/opinion

INDEX