Nawab Singh, President (Oral):
1. ICICI Prudential Life Insurance Company (hereinafter referred to as the appellant) has come up in appeal against the order dated October 24th, 2013 passed by the District Consumer Disputes Redressal Forum (for short District Forum), Jhajjar, whereby, death benefits of Lal Chand (since deceased) under the policy alongwith interest at the rate of 9% per annum from the date of death of life assured, that is, March 26th, 2009, till its realization, Rs.2000/- as litigation expenses was awarded to Roshni Devi-complainant (respondent No.1 herein).
2. Lal Chand (since deceased) husband of respondent No.1 obtained three insurance policies bearing numbers 11272099 dated March 13th, 2009, 11376953 and 10838390 dated February 23rd, 2009. He died on March 26th, 2009. The claim lodged by the complainant with the appellant, was repudiated on the ground that the life assured concealed material facts in his proposal form that he was suffering from Chronic Myeloid Leukemia for more than one year prior to his purchasing the policy.
3. Challenging the repudiation of her claim, the respondent No.1 filed complaint under Section 12 of the Consumer Protection Act, 1986 before the District Forum.
4. On appraisal of the pleadings of the parties and the evidence available on record, District Forum accepted the complaint.
5. Learned counsel for the appellant has urged that the life assured was suffering from Chronic Myeloid Leukemia for more than one year prior to his death and concealed this fact at the time of obtaining the insurance policies. He has placed on record treatment certificate issued by the doctor from All India Institute of Medical Sciences (AIIMS), New Delhi, indicating that the life assured was already suffering from Chronic Myeloid Leukemia much prior to the filling up of proposal form. The record of AIIMS is dated March 16th, 2009 giving history as under:-
œPast H/O diagnosed as CML (Chronic Myeloid Leukemia) 1 year ago and taking medication regularly.
Patient had regular complaints in the past. Since 3 months he had on or off.?
6. The history given by AIIMS clearly indicates that the life assured had been diagnosed as a case of Chronic Myeloid Leukemia one year prior to the issuance of certificate and he was regularly taking medicines. The certificate shows that the life assured had knowledge of being suffering from Chronic Myeloid Leukemia and still purchased the policy without disclosing this fact. Had the life assured disclosed the fact suffering from cancer, question of issuing the policy to the assured could not have arisen. It is well settled law that treatment record of hospital is sufficient evidence to prove that the patient was treated by the doctor/hospital and the same cannot be denied.
7. In view of above, District Forum has failed to appreciate the above stated evidence and erred in allowing the complaint because no relief can be granted to the complainant beyond the terms and conditions of the insurance policy. Hence, the impugned order under challenge cannot be allowed to sustain.
8. For the reasons recorded above, this appeal is accepted, the impugned order is set aside and the complaint is dismissed.
9. The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification, in accordance with the rules, after the expiry of period of appeal/revision, if any.