HIRALAL BHIMSEN SHARMA Vs. VIAST CORPORATION

JUDGEMENT

(1.) - The complainant is the widow of the insured who had taken an insurance policy on 13.3.90 for Rs.25,000/-. It appears that the husband of the complainant (insured) died on 24.7.90 and the last medical attendant's report submitted by the complainant to the Insurance Company states that the death of the insured was on account of cardio respiratory failure (preliminary cause) and Diabetec coma (secondary cause ). Column C para 4 states that C. D. H. Hospital admitted him. The admission card shows that he was admitted on 16.8.89 for pulmonary koch's and diabetes mellitius and on 21.7.90 he was admitted for fever, cough and burning. . . (illegible ). In clause (f) it is stated that the patient was under treatment at Bapunagar General Hospital since 21.7.90. Clause 11 states that this repairing is based on the indoor case papers of Rambhai Hargovinddas registration No.12935 dated 21.7.90 Bapunagar General Hospilal.

(2.) The Insurance Company has repudiated then claim by its letter dated 31.1.1991 staling that the proposal for assurance which was signed by the deceased on 13.3.90 to whom certain questions were asked and he had given incorrect reply i. e. he has made incorrect statement. The relevant portion reads as under: "we may, however, state that all these answers were false as we hold indisputable proof to show that since about 18 months before he proposed for the above policy, he had suffered from Diabetes Mellitis and Pulmonary Koch's for which he had consulted a medical man and had taken treatment from him in a hospital. He did not, however, disclose these facts in his proposal personal statement. Instead he gave false answers therein as slated above. It is, therefore, evident that he made incorrect statements and withheld correct information from us regarding his health at the time of effecting the assurance and hence in terms of the Policy Contract and the declarations contained in the forms of proposal for assurance and personal statement we hereby repudiate the claim and accordingly we are not liable for any payment under the above policy and all moneys that have been paid in consequence thereof belong to us. " The Insurance Company in support of their contention has produced several receipts signed by the deceased under which he had been given benefits of his sickness and those receipts show that the deceased has taken sufficient benefit for his sickness e. g. , certificate No.29384 shows that he had taken treatment for Koch's and diabetes and on that account according to the opinion of Dr. H. M. Desai he was unfit to resume work upto 5.10.88. Similarly the second certificate No.29389 shows the same disease and he was found unfit to attend the work for the days mentioned therein. This certificate is dated 6.10.88. The third certificate is in respect of sickness of 15 days for which he was given benefit of Rs.300/-. These benefits were given under E. S. I. Scheme. There is another certificate No.29395 which also shows that he had Koch's and diabetes signed by the Insurance Medical Officer giving opinion that he was not fit to resume work. One certificate No.183552 shows that he had Koch's and diabetes and was in the T. B. hospital for treatment. There are more certificates where he has taken benefits and in one certificate it is written that he was admitted for diabetes keto. (illegible) and was an indoor patient from 14.3.89 to 1.4.89 for which he has received Rs.360/-. Similarly there are other certificates also which we do not reproduce. All these certificates are for the treatment taken before the date of the proposal.

(3.) It is equally true that the insured has not disclosed these facts in the proposal form and the cause of his death appears to be associated with the diabetic coma and cardio respiratory failure.