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Judgment
MR. Justice J.D. Kapoor, President-The appellant is aggrieved of the order dated 27.5.2002, passed by the District Forum (Central) whereby it has been directed to pay Rs. 1,18,000/- on account of medical expenses against life insurance policy. The impugned order has been assailed mainly on the premise of term 11(b) Sub-clause (1) which is a benefit clause and reads as under: "Benefit (B)-If any one of the contingencies given in paragraph 11(b), subject however to the conditions mentioned in paragraph 11(a) of the ''Conditions and Privileges'' when referred to occurs during the term of the policy, then the following benefits will be available: (i) Immediate payment of 50% of the sum assured. (ii) Payment of balance 50% of the sum assured along with vested bonuses, if any, in the event of the life assured surviving the stipulated date of maturity or at his death or earlier. (iii) Payment of an amount equal to 10% of the sum assured, every year, commencing from the policy anniversary falling on or immediately after the date of eligibility for benefit (B) and ending with the policy anniversary preceding the stipulated date of maturity or the date of death of the life assured which is earlier. (iv) Waiver of premium, if any (including accident premium) due from the policy anniversary falling on or immediately after the date of eligibility for Benefit (B)."
ADMITTEDLY the sum assured was Rs. 1,00,000/- and in terms of the aforesaid term of the policy the respondent was entitled to a minimum payment of 50% of the sum assured amounting to Rs. 50,000/-. However, this legitimate claim of the respondent was repudiated on the ground that the respondent has suppressed or concealed the pre-existing disease that he was suffering from diabetes for the last 10 years and hypertension for the last 4-5 years as disclosed by him in the medical history of the Apollo Hospital where he was admitted for by-pass surgery. No party can be allowed to take undue advantage of its own acts of omission and commission. It was the bounden duty of the appellant-company to get the person medically examined before insuring him. Unless and until there is a direct nexus and connection with the death of the assured and the disease alleged to have been concealed such concealment if any is of no significance or value. In modern times almost every one is prone to a high tension life and, therefore, hypertension and diabetes are not such disease for which a person gets a set treatment to keep them under control that concealment of which may render the contract null and void. These are normal diseases. A person is insured for life or medical treatment when his general condition of health is normal and satisfactory.
If the concealent of diabetes and hypertension was of such an importance and significance, nothing prevented the appellant from getting the medical examination of the assured by prescribing certain tests. They did not do so either because of their overzealousness to assure the people by supplementing their income through premiums or due to their cavalier and careless approach in insuring a person on the basis of self-declaration. While providing information, assured may not deem it necessary to treat hypertension or diabetes such a disease which may deprive him of mediclaim policy as he may be keeping them under control. He ordinarily insures himself for those eventualities or diseases that may develop or be detected suddenly necessitating hospitalization or life saving treatment. Whenever a person is assured for mediclaim policy minimum precaution the Insurance Company is expected to take is to get his general examination as well as blood examination or any such examination like ECG, etc. done from their own doctors.
IN the instant case the concealment of hypertension or diabetes does not fall within such pre-existing diseases which were the direct reason for the disease which the assured suffered and underwent treatment. The reliance upon the decision of the National Commission entitled LIC v. Smt. Minu Kalita, III (2002) CPJ 10 (NC)=Consumer Cases 1986-2002 Part IV 6829 (NS), wherein the assured had given false statement regarding age as well as income rendering the insurance null and void is misplaced. Similarly the ratio of the case of Mithoolal Nayak v. LIC of INdia, AIR 1962 Supreme Court 814, is again not applicable as suppression of the condition of health or such a disease which has no important bearing on the subsequent disease which does not make him fit for policy for the life is not suppression or fraudulent concealment. Foregoing reasons persuade us to dismiss the appeal. However, we feel inclined to reduce the rate of interest on amount of damages and compensation to 9% from 12% w.e.f.,November, 1997 as the respondent was supposed to decide the claim within 3 months of its preference by the assured. Apart from this we also award damages of Rs. 25,000/- on account deficiency in service and mental harassment the respondent has suffered. Appeal is disposed of in above terms. A copy of this order, as per the statutory requirements, be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to record room. Appeal disposed of.