Page 92 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 92

policy-holder from the OP Insurance Company. There was, therefore, a violation of
the terms and conditions of the policy and breach of utmost good faith between the
parties. The OPs stated that in response to all 17 questions regarding his health con-
dition, the insured gave the answers as ‗NO‘, indicating that he was not suffering
from any of these medical problems. He specifically stated that he was not suffering
from hypertension or high blood pressure. The Insurance Company, acting in good
faith, issued a 20 years Endowment Participating Insurance Policy, bearing no.
243679834 on 23.03.2004 for a sum insured of Rs. 1,52,728/- with accrued bonus and
with the riders, (1) personal accident benefit and (2) dreaded disease for a sum as-
sured of Rs. 1 lakh each. After the death of the insured, the Insurance Company re-
ceived the claim documents including the Attending Physician‘s Statement in form
‗C‘ and Hospital Treatment Certificate in form ‗D‘, in which, it was stated that the
deceased suffered from hypertension for the last one year. It was also stated that as
per the diagnosis at the Hospital, he was a chronic alcoholic with hypertension, ALD
Cirrhosis, ARF, Hepatitis, UGI Bleed, with Cardiorespiratory Arrest‘. Since the in-
sured had not disclosed material information about his health condition to the Insur-
ance Company, they repudiated his claim vide their letter dated 20.10.2005, a copy of
which is on record. Before that, they had sent another letter dated 06.09.2005 to the
complainant, indicating their inclination to deny the death claim due to the non-
disclosure of true facts therein.
4. The District Forum, after taking into account the averments of the parties, al-
lowed the consumer complaint and directed the OP Insurance Company to pay a sum
of Rs. 3,52,728/- alongwith interest @ 9% per annum w.e.f. the date of death includ-
ing the amount on account of accidental death and dreaded disease claimed. Being
aggrieved against the order of the District Forum, the OP Insurance Company chal-
lenged the same by way of an appeal before the State Commission. The said ap-
peal having been dismissed vide impugned order, the OP Insurance Company is
before this Commission by way of the present Revision Petition.
5. Notice of the Revision Petition was issued to the respondent/complainant,
who put in appearance through counsel. The said counsel appeared till hearings held
on 09.09.2015, but thereafter, there was no appearance for the respondent. In the in-
terest of justice, notice was issued to the learned counsel for the respondent for ap-
pearance on the next date of hearing, but due to her failure to put in appearance de-
spite service, the respondent was proceeded against ex-parte.
6. At the time of hearing before us, the learned counsel for the petitioner Insur-
ance Company has drawn attention to the Attending Physician‘s Statement for death
claim on form ‗C‘ and Hospital Treatment Certificate on form ‗D‘, stating that as per
the information contained therein, the deceased was suffering from hypertension for
the last one year. Moreover, the conditions referred in the said documents could not
have developed within a short span of about 8 months. The insured died only 3 to 4
months after obtaining the policy in question. It was evident, therefore, that there had
been concealment of material information on the part of the insured from the Insur-
ance Company and hence, the claim had been rightly repudiated by the Insurance
Company. The learned counsel has drawn attention to the entries made in the pro-
posal form, in which the insured had given answers to all questions as ‗no‘, indicating
that he had not been suffering from any previous disease. The learned counsel further

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