Page 87 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 87

an appeal before the State Commission. The State Commission on re-appreciation of
evidence came to the conclusion that insurance policy was obtained by the complain-
ant by concealment of material fact i.e. he was suffering from Type II Diabetes Melli-
tus. The State Commission, therefore, took the view that insurance claim was rightly
repudiated by the opposite party. As a consequence the appeal was allowed and or-
der of District Forum was set aside.
5. Learned counsel for the petitioner has contended that State Commission
has fallen in error in failing to appreciate that opposite party has failed to produce any
cogent evidence that the petitioner at the time of answering the questionnaire regard-
ing his health condition in the proposal form was aware that he was suffering from
Diabetes Mellitus. It is argued that if the petitioner was not even aware of his medical
condition, he cannot be said to have obtained the insurance policy by concealing the
material fact.
6. We do not find merit in the contention of the petitioner. On perusal of
copy of the proposal form, we find that in response to the health questions, insured
has answered all the questions in the negative. Question no. 23 h (i) is reproduced as
under:
“Have you ever suffered or are suffering from any of the following
Diabetes / High Blood Sugar”
7. This question has been answered by the insured in the negative. At the
end of the proposal form, the petitioner has signed the following declaration:
“I/We declare that I/We have fully answered the questions in the proposal
form after being explained by the advisor of the ICICI Prudential Life Insurance
Co.Ltd. (hereinafter referred to as Company) and have fully understood the na-
ture of the questions including health related questions and the importance of
disclosing all material information while answering such questions. I/We further
declare that the answers given by me/us to all the questions in the proposal form
and the information given to the Medical Examiner of the Company as to the state
of health and habits of the Life Assured are true and complete in every respect and
that I/We have not withheld any material information or suppressed any material
fact. I/We have made no statement to the Insurance Advisor, Medical Examiner,
or any other person associated with ICICI Prudential Life Insurance Company
Limited which in any way modifies the answers and statements on this application.
I/We undertake to notify the Company of any change in the state of health of the
Life Assured or as to his occupation subsequent to the signing of this form and be-
fore the acceptance of the risk by the company. I/We also understand that in case
of any mis-statement or suppression of material information the company has the
right to repudiate the claim under this policy. The policy shall become void where
it is found that the policy was issued on the basis of fake/tempered documents
and/or proofs. I/We also certified that I/We have read and understood the benefits
illustration as published by the Company that were handed over to me/we along-
with this proposal form. I also understand that terms and condition including the
premium and benefits under the policy are subject to taxis/duties/charges in ac-
cordance to the applicable laws. I confirm that all premium will be paid from
bonafide sources.
8. On reading of the above, it is clear that while giving information about his

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