Page 130 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 130

dated 24.10.2004 issued by Dr. Yash P. Mehra from Amritsar. We do not accept the
said opinion because it was given without any basis. In our view, it appears that the
LIC and the doctors who have issued such certificates are working in cahoots with
each other. We are rather surprised that how the LIC accepted and relied upon such
vague certificates/opinions. We are saddened by such unfair practices of OP. Thus,
in our considered view, the OP failed to prove that the deceased insured had con-
cealed his health status, while filling the proposal form.
8. We have perused the medical record of PGI, Chandigarh. The patient was
treated there from 16.11.2003 to 15.12.2003 under consultant by Dr. Chawla/Dr. R.
K. Dhuman/Dr. V. Singh at Department of Hepatology. The patient was diagnosed as
Liver Cirrhosis (alcohol related portal hypertension). There is no history suggestive
of long standing alcoholic consumption. The patient was investigated and treatment
was given in the PGI. The medical record clearly show the follow up notes as:
―Due to uncertainty as to whether the liver disease can be attributed to alcohol
(due to the clearly short history of alcoholic consumption), a liver biopsy was
done.‖
9. Thus, it is clear that the doctors at PGI Chandigarh also have not confirmed
the liver disease was due to alcohol as there was short history of alcoholic consump-
tion.
10. Considering the facts and circumstances of the case, it is clear that for the
want of repudiation, the OP took medical certificates from two doctors, who were not
qualified in allopathic medicine, who mentioned the diagnosis of chronic liver disease
without any confirmation from laboratory investigations or ultrasound sheets. Both
the certificates/reports did not carry any importance as a medical certificate. The PGI
also have not given definitive diagnosis of alcohol liver cirrhosis.
11. On the basis of aforesaid findings, there is no conclusive evidence to show
that DLA was suffering from chronic liver disease due to long alcoholic consump-
tion. Thus, the repudiation done by OP is unjustified. Therefore, we set aside the
order of State Commission and restore the order of District Forum. As we have noted
that the District Forum has not specified the rate of interest in its order, therefore, we
direct the OP to pay insured amount with interest @ 9% per annum from the date of
submission of claim to the complainant alongwith Rs.10,000/- towards mental agony
within 90 days from the date of receipt of a copy of this order, failing which, the en-
tire decretal amount will carry further interest @ 12% per annum from the date of
pronouncement of this order till its realization.

......................
DR. B.C. GUPTA
PRESIDING MEMBER
......................
DR. S.M. KANTIKAR
MEMBER

INDEX