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Judgment
THIS revision petition impugns the order dated 02.07.2010 of the Maharashtra State Consumer Disputes Redressal Commission, Mumbai (in short, ''the State Commission'') in First Appeal no. 7 of 2010. By this order, the State Commission allowed the appeal filed by the opposite party (OP)/respondent Life Insurance Corporation of India Ltd. (LIC) (and consequently dismissed the cross appeal of the petitioner/complainant) against the order dated 31.10.2009 of the District Consumer Disputes Redressal Forum, Thane (in short, ''the District Forum'').
THE petitioner was the complainant before the District Forum as the widow and nominee of the deceased life assured (DLA) Babulal N Punamiya, alleging deficiency in service on the part of the LIC in repudiating her claim for the three life insurance policies that the DLA had obtained from the LIC during his life time. Policy no.981227308 for Rs. 1 lakh obtained by the DLA was effective from 27.09.2000 for which the premium had been paid upto September 2006. Two other policies no 922847647 and 922847648, each for Rs.4 lakh, were also been obtained by the DLA on 05.02.2004 and the premia therefor had been paid upto March 2006. The DLA was admitted to Pramila Hospital, Kalwa, Thane on 06.09.2005 with complaint of chest pain and died on 14.09.2005 while still under treatment at that Hospital. The complainant''s claim for the insurance amounts were, however, repudiated by the LIC by its letter dated 14.02.2006 for the two policies of Rs. 4 lakh each and letter dated 17.03.2006 for the policy of Rs. 1 lakh. Aggrieved by this action, the complainant represented to the LIC which only led to reiteration of the earlier decision. As a result, the complainant filed a consumer complaint before the District Forum.
THE LIC filed its written statement before the District Forum admitting several of the statements in the complaint but reiterating that it had repudiated the insurance claims on the ground that the answers given by the DLA in reply to questions 11(a), 11(b), 11(d), 11(e) and 11(i) of the proposal form were false because the "LIC had undisputable proof to show that he was suffering from hypertension for 20 years and diabetes mellitus for 10 years, i.e., prior to the date of death and date of proposal for which he consulted "a medical man and had taken treatment". Thus, he failed to disclose material facts in his proposal entitling the LIC to repudiate the claim for the three policies mentioned above.
ON consideration of the pleadings, evidence and documents of the parties, the District Forum held that the DLA did not disclose his pre-existing disease but directed the LIC to refund the amount of premia for the two policies of Rs. 4 lakh each (Rs.35,976/- ~ Rs. 36,000/-) with interest @ 9% per annum and Rs.5,000/- towards cost within 30 days from the date of the receipt of the order.
IN separate appeals by both the parties, the State Commission, as already noticed, allowed the appeal of the LIC and dismissed that of the complainant/petitioner, setting aside the order of the District Forum and dismissing the complaint.
WE have heard Mr. Mahaling Pandarge, learned counsel for the petitioner/complainant and Mr. Nikhil Jain, learned counsel for the respondent/OP/LIC.
LEARNED counsel for the petitioner has filed copies of the relevant medical records that were produced before the District Forum in support of his principal contention that in obtaining the policies of Rs.4 lakh each, the DLA was subjected to detailed medical examination and the records of this examination show that he had disclosed both his diseases, namely, hypertension and diabetes mellitus and it was only after the LIC had satisfied itself on the basis of these medical records that it issued the two insurance policies of Rs.4 lakh each. Therefore, it was clear deficiency in service on the part of the LIC to repudiate the insurance claims not only of these two policies but also that of Rs.1 lakh taken on 27.09.2000 on the ground of non-disclosure of material facts relating to the status of his health by the life assured at the time of his submitting the respective proposals. He further urged that the LIC had relied entirely on one medical record by a Doctor at the Bombay Hospital where the DLA had gone for treatment in March 2004. This observation (dated 23.03.2004) recorded, inter alia, "A 55 year old male, K/C/O DM since 10 years and is on insulin now. Pt. is also hypersensitive since 20 years and is on (illegible) and Envas. He was admitted for Femoropoplitieal bypass. Bypass done on 13.03.2004 .. .. .." As against this, the Doctor who had been the usual medical attendant of the DLA for approximately 8-10 years had recorded in his Medical Attendant''s Certificate to the LIC to the LIC that the DLA was diabetic (within normal limits) and he also suffered from hypertension with CRF for roughly 11/2 years. Further, the special bio-chemical tests undergone by the DLA in the process of obtaining the insurance policies in February 2004 as well as the LIC''s Medical Examiner''s confidential report clearly showed that the DLA did not suffer from any abnormalities of his eyes, ears, nose, throat or mouth, had no signs of externally visible swelling of lymph glands, joints or other organs and did not suffer from any abnormality of cardiovascular system, respiratory system, central or peripheral nervous system, abdomen or pelvis. Finally, the Medical Examiner also recorded that on examination he appeared healthy. Thus, on the basis of LIC''s panel Doctors report, bio-chemical reports of tests undergone by him as well as the Medical Attendant''s certificate, it would be clear that at the time of making the proposal in February 2004 for the life insurance policy the DLA did not withhold any material information about his health. This was so because his hypertension as well as diabetes mellitus developed about 11/2 years prior to his death in September 2005 which was after he had submitted the proposals for the two insurance policies in February 2004. Equally, he didn''t suffer from any of the diseases when he submitted the proposal for the insurance policy of Rs.1 lakh in 27.09.2000.
ON the other hand, learned counsel for the respondents has argued that from the medical record of the Bombay Hospital (March 2004) it would be clear that the DLA was suffering from hypertension as well as diabetes mellitus for several years prior to February 2004; otherwise, he could not have developed the kind of diseases (chronic renal failure, occlusion of the politeal arteries of the thigh and legs requiring femoropoplitieal bypass surgery and gangrene of the toes) Bypass.
WE have carefully considered the medical records produced by the learned counsel for the petitioner. His contention is based entirely on the attempt to infer from the Medical Attendant''s Certificate dated 06.10.2005 that at the time of submitting the proposal/s for the two insurance policies for Rs. 4 lakh each in February 2004, the DLA was not suffering from either hypertension or diabetes mellitus because, according to the said Certificate, he had had these diseases only for about 11/2 years prior to September 2005 (i.e., since sometime in March 2004). This contention is simply not acceptable because the deceased required Femoropoplitieal Bypass in March 2004. The underlying disease (atherosclerosis, i.e., plaque formation in the femoral and popliteal arteries leading to partial blockage thereof, attributable to diabetes mellitus and hypertension) could not have developed in a matter of less than a month. The note dated 23.3.2004 of the Doctor at the Bombay Hospital showed that the DLA underwent angiography which showed Femoropoplitieal block with left renal artery stenosis. DLA''s serum creatinine reading as on 21.03.2004 was as high as 5.6 mg%, showing severe renal distress (caused by hypertension). Therefore, the observation recorded by that Doctor on 23.03.2004 that the DLA was a known case of diabetes mellitus for 10 years and hypertension for 20 years acquires far more credibility than that of the Medical Attendant''s Certificate dated 06.10.2005 regarding that the DLA suffered from diabetes mellitus and hypertension for roughly 11/2 years. This would be too convenient an explanation and obviously tailored to enable the DLA to claim that he developed these two diseases soon after he had submitted the proposal for the two life insurance policies in February 2004.
IN view of the foregoing discussion, we do not see any reason to interfere with the concurrent findings of both the Fora below that there was enough documentary evidence to show that the DLA had not disclosed the true status of his health at the time of making the proposal for obtaining the life insurance policies in September 2000, much less in February 2004. The impugned order of the State Commission is accordingly upheld and the revision petition is dismissed, leaving the parties to bear their own costs.