LIC OF INDIA Vs. BALUSAMI

JUDGEMENT

(1.) The complainant's wife had taken a money-back policy for Rs.50,000. When she died, the complainant herein being her husband, made a claim to the opposite party who repudiated the same and hence the present complaint. From the admitted facts, it is clear that the policy lapsed due to non-payment of certain premiums and was revived on 31.5.1997. The complainant's wife had given a declaration of good health on 20.5.1997 and on the basis of the same, the policy was revived. In the declaration of form she had answered the queries in the negative and further stated that she was keeping good health. From the records viz. , the discharge summary issued by AG Hospital, we find that the complainant's wife was suffering from diabetes for 13 years and hypertension for two years. She was also suffering from diabetic retinopathy with visual loss since 1995. We also find that she was an oral Glynase. From the discharge summary further we find that the Doctor has advised her dialysis. But the Lower Forum has ignored this document and has held that there is no proof that she was suffering from any disease. It is not disputed by the complainant that his wife was admitted in AG Hospital. The date of admission is given as 31.5.1997 and the date of discharge is given as 3.6.1997. The death had occurred on 10.6.1997 within a week of the discharge. There is sufficient evidence in the shape of discharge certificate viz. , Ex. B5 to show that the complainant's wife was suffering from diabetes for more than 10 years and she was hypertensive and she had diabetic retinopathy as well. Yet, when she gave a declaration for the purpose of revival of the policy, she did not choose to make a mention of this but answered the queries in the negative and gave the declaration to the effect that she was keeping good health. This definitely amounts to suppression. As held by the National Commisison in R. P. No.897/2001, reported in II (2003) CPJ 70 (NC), if the deceased once gives incorrect information knowingly concerning his personal health in the personal statement of health in the revival of the lapsed policy, the insurer will be justified in repudiating the claim. Here, we find that the insured had suppressed material facts concerning her health. Therefore, the repudiation of the claim was fully warranted and justified as held by the National Commission in the above case. The deceased gave incorrect information of personal health in the form for revival of the policy. The case is not covered under Sec.45 of the Insurance Act as the Insurance Company is justified in repudiating the same. In this case on hand, there is evidence to show that there was suppression of material fact relating to the health of the complainant's wife, the insured, and knowingly the insured gave incorrect particulars and, therefore, the repudiation was justified. Hence it follows that the order passed by the Lower Forum cannot be maintained and deserves to be set aside.

(2.) In the result, this appeal is allowed, but in the circumstances, without costs. The order passed by the Lower Forum is set aside. The complaint will stand dismissed, but in the circumstances without costs. Appeal allowed.