Page 88 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 88

health condition in the proposal form, the petitioner categorically denied having been
suffering from Diabetes Mellitus. The aforesaid declaration of the insured is belied
by his medical treatment record. On perusal of prescription slip dated 11.04.2009
given by Dr. Prahlad Garg to the insured, it is recorded that patient is a case of DM (
Diabetes Mellitus) for the last 8-10 years. Similarly, on perusal of copy of the Dis-
charge Summary of the insured patient issued by the City Hospital, we find that it
records history of the petitioner insured as under:
“History 44 years old male patient known case of type-II DM for 20 years had
on episode of hypoglycemia 10 days back which was corrected. He later had loose
motion with fever about 4 days back. He took treatment at local hospital at Agra
and was relieved. However, he started developing pedal edema and deranged
RFT. He became drowsy since 2 days. No h/o chest pain, pain abdomen, cough,
burning micturition. No h/o CAD, TB HTN.”
9. On reading of the above, it is clear that the petitioner is known case of DM
for 20 years. From the above two documents, it is clear that petitioner was a known
case of DM since at least 8-10 years prior to filing of the proposal form, in which he
has denied that he was suffering from DM. Thus, we do not find any fault with the
finding of the State Commission to the effect that petitioner had obtained the insur-
ance policy by concealment of material fact regarding his medical condition. The
State Commission, therefore, was justified in holding that repudiation of insurance
claim of the petitioner for reimbursement of expenses incurred on the treatment of
Diabetes Mellitus was justified.
10. Learned counsel for the petitioner in order to wriggle out of the situation
has submitted that State Commission has committed a grave error in relying upon the
prescription slip of Dr. Prahlad Garg and Discharge Summary of City Hospital as
those documents have not been proved by the primary evidence i.e. by examining Dr.
Prahlad Garg or the witness from the City Hospital. We do not find merit in this con-
tention for the reason that proceedings before the consumer fora are summary pro-
ceedings in which strict technical rules of procedure and evidence are not applicable.
Otherwise also, the petitioner has not shown anything on the record that he in his evi-
dence denied correctness of prescription slip and the discharge summary. It is also
argued by learned counsel for the petitioner that recording of previous history of Dia-
betes Mellitus does not mean that aforesaid opinion was given by the petitioner or
that he was aware of his ailment. We do not find merit in this contention. Both doc-
tor Prahlad Garg and the concerned doctor of City Hospital have recorded about the
previous history of Diabetes Mellitus of the patient. This history obviously must have
been given by the petitioner himself or his friend / relative, who took him to the doc-
tor concerned or the hospital. Therefore, there is no reason to suspect that concerned
doctors of their own have recorded the previous history.
11. In view of the discussion above, we do not find merit in the revision peti-
tion. It is accordingly dismissed.

......................J
AJIT BHARIHOKE
PRESIDING MEMBER

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