Page 55 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 55

icy was obtained and proposal form for the same was filled. In this way, there had
been no suppression of material facts by the deceased insured. The learned counsel
has referred to the record from the Kidney Hospital, Jalandhar, saying that the de-
ceased was admitted in the said hospital on 28.04.2006, but he was discharged on the
very next day, i.e., 29.04.2006. In the consultants‘ notes in that hospital recorded on
28.04.2006, he was stated to have been suffering from ARF. Keeping all these facts
into consideration, the allegation of suppression of material information was not
proved against the deceased insured.

5. Per contra, the learned counsel for the respondent/Insurance Company ar-
gued that no valid grounds had been mentioned in the application for condonation of
delay, based upon which, the huge delay of 224 days could be condoned. The medi-
cal documents produced by the complainant in her favour are not relevant because she
was never advised any bed-rest or immobilisation etc. The learned counsel has drawn
attention to an order passed by the Hon‘ble Supreme Court in ―Post Master General
& Ors. vs. Living Media India Limited & Anr. [(2012) 3 SCC 563]‖, saying that the
condonation of delay should be made only, if there is any valid explanation for doing
the same.

6. The learned counsel further argued that a simple perusal of the proposal
form for obtaining the insurance policy indicated that the deceased had given answers
as ‗No‘ to all the questions mentioned in the proposal form. The deceased had cate-
gorically stated that he had not been treated for any disease or disorder in the past. It
was the duty of the insured to have disclosed about the treatment taken for the ARF
and also for other problems like diabetes mellitus and hypertension etc. The learned
counsel argued that vide their letter dated 18.08.2010, they had asked for the case-
sheets and treatment details of 2006 related to CRF from the complainant. It was evi-
dent from the medical record of the Kidney Hospital pertaining to the year 2006 as
well as 2009 that the insured was suffering from ARF. The learned counsel has fur-
ther drawn attention to copy of consultants‘ notes made on 08.07.2009 in the Kidney
Hospital, where it was stated that the insured was diagnosed as CRF in the year 2006.
It is also stated that he had been suffering from diabetes mellitus for the last 23 years
and had hypertension for the last 4 – 5 years. In the medical attendant certificate
given by Dr. Ajay Marwah, he had been shown suffering from diabetes mellitus and
hypertension besides other ailments. In the certificate of hospital treatment given by
Kidney Hospital as well, there is mention of these diseases. It was evident, therefore,
that there had been suppression of material information from the insurance company
on the part of the complainant. The learned counsel argued that ARF and CRF were
interchangeable terms. It was wrong to suggest, therefore, that the patient had been
cured from kidney ailment at the time of filling the proposal form. The learned coun-
sel has drawn attention to the order passed by this Commission in ―Life Insurance
Corporation of India vs. Mamta [I (2015) CPJ 670 (NC)]‖, saying that concealment
of material fact regarding previous ailment by the life assured was fatal and the Insur-
ance Company was well within their rights to repudiate the claim. The learned coun-
sel has also drawn attention to order passed by the Hon‘ble Supreme Court in
―Mithoolal Nayak vs. Life Insurance Corporation of India [AIR 1962 SC 814]‖,

INDEX