Page 93 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 93

argued that the insured was not entitled to any accidental benefit or dreaded disease
benefit at all. The consumer fora below, therefore, had taken an erroneous view in
allowing the claim of Rs. 3,52,728/- to the complainant. The learned counsel has also
filed his written submissions alongwith copies of the following judgments in support
of his arguments:-
(1) Mithoo Lal Nayak vs LIC, AIR 1962 SC 814
(2) P.C. Chacko vs. Chairman, LIC & Ors., (2008) 1 SCC 321
(3) Satwant Kaur Sandhu vs. New India Assurance Co. Ltd., (2009) 3 UC
1718
The learned counsel argued that keeping in view the above judgments, the
consumer complaint in question deserved to be dismissed.
7. We have examined the entire material on record and given a thoughtful
consideration to the arguments advanced before us.
8. From the material on record, it is clear that the insured had taken an En-
dowment Participating Insurance Policy from the OP Insurance Company on
23.03.2004 for a sum insured of Rs. 1,52,728/- with riders of personal accident
benefit and dreaded disease for a sum insured of Rs. 1 lakh each. In the grounds of
Revision Petition, the petitioner Insurance Company has stated that the sum assured
was an amount of Rs. 1,52,728/- only and under no circumstances, the personal ac-
cident benefit or dreaded disease rider clause of Rs. 1 lakh each could come into play
in the present case. A perusal of the orders passed by the District Forum as well as
the State Commission reveals that they have not given any justification as to how the
personal accident benefit or dreaded disease rider could be awarded to the complain-
ant. The orders passed by these consumer fora are, therefore, perverse in the eyes of
law, as these fora failed to take into account this material aspect, regarding the policy
in question.
9. The main issue for consideration in the matter is whether there has been any
concealment or non-disclosure of material information on the part of the insured from
the Insurance Company. It has been stated by the complainant that the deceased had
no health problem at the time of obtaining the insurance policy in question. There is
no evidence on record to belie the version of the complainant. It is true that as stated
in the medical documents after his death, he was reported to be a chronic alcoholic
with hypertension, ALD, Cirrhosis etc., but there is no material to establish that any
of these conditions were occurring at the time of issuance of the policy. It has also
been stated in the said documents that the deceased was suffering from hypertension
for the last one year. However, any basis for mentioning this period of one year, has
not been indicated. The basic issue for consideration is whether at the time of submit-
ting the proposal form, the deceased was aware that he was suffering from hyperten-
sion. In the absence of any evidence to the contrary, it cannot be stated that there was
deliberate non-disclosure of information on this issue on the part of the deceased.
10. A perusal of the proposal form indicates that the insured disclosed in the
same that he used to take 100 ml of alcohol per week for the last 15 years. It has not
been clarified anywhere if such an intake shall qualify him to be called a ‗chronic
alcoholic‘. In any case, the deceased disclosed the fact about his intake of alcohol in
the proposal form and hence, it was upon the Insurance Company to decide whether
to issue the policy to him or not. The insured could not be accused of providing any

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