HDFC STANDARD LIFE INSURANCE COMPANY LIMITED Vs. KAILASH CHANDRA AGARWAL

JUDGEMENT

(1.) THIS appeal arises out of order dated 30.4.2008 passed by the District Consumer Forum (DCF), Ajmer whereby while accepting the complaint, the Appellant Insurance Company was directed to pay to the Complainant a sum of Rs. 5,00,000 within a period of two months failing which the Appellant was further directed to pay interest @ 9% per annum after expiry of said period along with Rs. 1,500 as cost of litigation.

(2.) THE Complainant had taken "HDFC Unit Linked Endowment Policy" from the Opposite Party (OP). The yearly premium of which was Rs. 50,000. As per the policy, in case of open heart surgery, the insured amount was payable. It is an admitted position that the Complainant had undergone angiography test and it was found that there were severe blockages in the main coronary arteries and the Complainant was advised to go for by -pass surgery. On the basis of this report, the claim was filed but the same was repudiated on the ground that the Complainant had been suffering from diabetes for the last eight years and had taken insulin mixtard also. This fact was known to him but he did not disclose this fact at the time of taking the policy and thus suppressed the material information from the Insurance Company. The only evidence on record is exhibit R -4 which is a copy of Bed Head Ticket (BHT) of Tongia Heart and General Hospital, Jaipur. Under the caption 'Past History' the following observations have been made: "He is a known case of DM - last 8 years Taking insulin mixtard 10(M) 8(E)"

(3.) THE learned Counsel for the Appellant submitted that exhibit R -4 is sufficient to prove that the insured had been suffering from diabetes and had been taking treatment also and therefore on the ground of suppression of material fact by the Complainant, claim was rightly repudiated. As per the learned Counsel, diabetes is a serious disease which affects vital organs of the body. It damages kidney, heart, and eyes, etc. If the Complainant had disclosed this fact to the Insurance Company, he would have been put to other tests to assess whether insurance cover should be granted or not.