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Judgment
IN this case the complainant had taken a life insurance policy despite the fact that he was suffering from non-Hodgkin Lymphoma (Cancer) (hereinafter referred to as NHL), which is a deadly disease.
THE insured died on 27.2.1990. THE Insurance Company had repudiated the claim of the complainant on 23.3.91 as the deceased had given false answers to the various questions in the proposal form and that the LIC holds indisputable proof to show that before he proposed for the above policy he was suffering from the NHL for which he had consulted a doctor and had taken treatment etc. THErefore, the widow instituted a complaint before the District Forum on 24.4.93, which was dismissed by the forum on 2.11.1998. The State Commission, in appeal, after hearing the parties held as follows: There is no history on the record to show that the insured after taking the insurance policy was admitted in any Hospital and the insured had died after two years from the date of taking the insurance policy. It is also pointed out that the life is assured to ensure financial security and in case of demise of the policy holder, dependents of the insured dont suffer any financial hardship. In view of the above discussions, the impugned order is quashed and the complaint is allowed by directing the LIC to pay the sum assured of Rs. 1,00,000/- along with interest @ 10% per annum from the date of filing of the complaint till its realization. The appeal stands allowed accordingly.
Aggrieved by the order of the State Commission LIC has filed this revision petition. The medical text on cancer Principles & Practice of Oncology 7th Edition by Vincent T. D. DeVita, Jr. Samuel Hellman Steven A. Rosenberg mentions the following principles of management of non-Hodgkins Lymphoma
THE phases of patient management include obtaining an adequate biopsy for an accurate diagnosis, a careful history and physical examination, appropriate laboratory studies, imaging studies, and possibly further biopsies to determine an accurate stage and to plan therapy. Finally, taking into account factors related to the patient, type of lymphoma, and stage and pace of disease, a treatment recommendation must be made. Only after the various tests confirm the existence of non-Hodgkins Lymphoma, chemotherapy of different regimen is recommended.
IN this case the complainant had filled up proposal form on 29.1.88 in which he had given the answer No to the following questions :- Have you ever suffered from or are you suffering from Cancer, leprosy, rheumatism, gout enlarged glands or tumours? Have you consulted a medical practitioner, within the last five years for any ailments requiring treatment for more than a week? Have you remained absent from place of your work on ground of health during the last 5 years? Department of Radiotherapy Medical College and Hospital, Rohtak dt. 15.3.1991 certified as follows : This is certified that Vijay Chopra S/o Sh. Radhe Krishan 45 years Male reported us on 3.2.88 vide R.T. OPD No. 30/38 with diagnosis of Non-Hodgkin Lymphoma. He was given Radiotherapy and put on chemotherapy. He lastly reported us on 5.4.88 after that no whereabouts were known about the patient to us. Sd/- Deptt. Of Radiotherapy Medial College Hospital Rohtak. This certificate clearly indicates that when he reported at the said hospital he was already suffering from NHL. This means the diagnosis was done much earlier which itself is an elaborate process and a certificate given by Professor and Head of the Department of Radiology, P.G.I.M.E.R., Chandigarh has mentioned in the case summary that when the patient attended the radiotherapy OPD on 5.5.1988 he had made a complaint of swelling on both sides of neck and lump in the abdomen since five months which means at the time of filling up of proposal form he was suffering from the said disease.
IN view of the above analysis the revision petition is allowed and the order of the State Commission is set aside. There shall be no order as to costs.