PANCHAL RAMABHAI MOTIBHAI Vs. LIC OF INDIA

JUDGEMENT

(1.) The present revision petition has been filed by one, Panchal Ramabhai Motibhai (hereinafter referred to as the 'Petitioner') being aggrieved by the order of the State Consumer Disputes Redressal Commission, Gujarat (hereinafter referred to as the 'State Commission') in favour of Life Insurance Corporation of India (hereinafter referred to as the 'Respondent').

(2.) The facts of the case according to the Petitioner was that he had taken an insurance policy in the name of his wife, Geetaben from the Respondent Insurance Company for Rs. 50,000 on 15.5.1995. The wife of the Petitioner suddenly died on 18.12.1995 when the policy was still in force. Since, this was a natural death and covered under the insurance policy, the Petitioner filed a claim before the Respondent Insurance Company along with necessary documents. But the claim was not settled despite a legal notice. Petitioner thereafter filed a complaint before the District Forum requesting that the Respondent be directed to pay Rs. 50,000 of the insurance policy along with interest @ 18% from the date of presenting the claim as well as other admissible benefits.

(3.) The Respondent on the other hand stated that since the Petitioner's wife died within six months of her taking the insurance policy, as per the required procedure an inquiry was conducted into the cause of death and it came to light that at the time of filling the proposal form, the life assured had concealed the facts about her health and physical condition in response to questions at Paras 11(e) and 13(a) of the policy which sought information as to whether she had T.B. and had undergone a caesarean Section respectively to which the reply given was 'No'. On the other hand, investigations revealed that she had T.B. and that she also had undergone three caesarean operations prior to filling the insurance form. This was confirmed by an affidavit of the doctor who had performed the caesarean operations on the deceased. It was also stated that the patient was suffering with Cox (T.B.) with Anaemia for which she was treated as an indoor patient by Dr. Dilip Shah, M.D. from 11.10.1995. According to medical science, patients with T.B. and anaemia for which the patient was treated as an in-patient two months prior to her death, are long existing diseases and, therefore, it would be reasonable to presume that she was suffering from these diseases at the time when she took the insurance policy. Under the circumstances it is clear that apart from suppressing material facts, the death of the deceased was not due to natural causes but due to old diseases. This makes it clear that Petitioner had not come with clean hands before the Forum and therefore, the claim was rightly repudiated.