BHARTI AXA LIFE INSURANCE LTD Vs. AMRIK KAUR

JUDGEMENT

(1.) This revision petition under the Consumer Protection Act, 1986 (in short, the 'Act') assails the order dtd. 1/9/2017 in Appeal No. 341 of 2017 of the State Consumer Disputes Redressal Commission, Punjab, Chandigarh (in short, the 'State Commission') arising out of order dtd. 27/3/2017 in Consumer Complaint No. 320 of 2016 of the District Consumer Disputes Redressal Forum, Amritsar (in short, the 'District Forum'). This order will also dispose of RP No. 3295 of 2017 which arises from the same order.

(2.) The facts, in brief, according to the revision petitioner/opposite party, are that the late husband of the respondent/complainant had obtained a life insurance policy from the petitioner on 31/10/2012 for an assured sum of Rs.25,00,000.00. On 3/11/2012 the insured expired suddenly. A claim was preferred by the respondent on 23/4/2014 after which the petitioner investigated since the death of the insured had occurred within 2 years of the policy being taken. During investigations it came to notice that the Deceased Life Assured (DLA) had concealed material evidence at the time of filling the proposal form relating to his hospitalization in Sri Guru Ramdas Hospital, Amritsar from 6/9/2012 to 7/9/2012 for Diagnostic Laparoscopy Biopsy prior to the issuance of the policy. It was also ascertained that the DLA was diagnosed with Sub Acute Intestinal Obstruction and that he was a known case of Non-Hodgkin Lymphoma. The claim was therefore repudiated on 16/7/2014. The respondent filed a consumer complaint no. 320 of 2016 which came to be decided on contest on 27/3/2017 with the District Forum upholding the complaint. The appeal before the State Commission against this order in Appeal No. 341 of 2017 was dismissed on 1/9/2017. This order is challenged in the instant petition.

(3.) The petitioner's case is that the DLA had deliberately not disclosed the fact of his hospitalization prior to the taking of the policy as per the proposal form which constituted suppression of a material fact. It is argued that the report of the medical examination done prior to the policy cannot be accepted in view of suppression of material evidence. Therefore, the claim had been rightly repudiated. The respondent has contended that the proposal form relied upon was unsigned and, therefore, not reliable. The fact of hospitalization is not denied although it was for a minor reason and that no evidence of the doctor concerned had been brought on record. According to the respondent, the affidavit of Ms Sunita Yadav, Associate Manager (Legal) relied upon by the petitioner could not be considered since she did not have first-hand knowledge of the facts. It is also contended that the policy was approved after the conduct of a medical examination which did not reveal any pre-existing illness.