Ramakrishna Manjkrao Pusadkar       --- Petitioner
                 Vs.
L.I.C. of India                                    --- Respondent

Before: Hon'ble Mr. Justice D.P.Wadhwa, President, Hon'ble Mr. Justice J.K.Mehra, Member, Mrs. Rajyalakshmi Rao, Member, Mr. B.K.Taimni, Member.

J.K.Mehra, J. Member

     This revision Petition arises out of the order of the State Consumer Disputes Redressal Commission, Maharashtra, whereby the State Commission allowed the appeal and the order of the District Forum is set aside.

     The facts in brief are as under:

     The Complainant had taken an 'Asha Deep' Policy from the Opposite Party, M/s Life Insurance Corporation of India, on 27th November, 1993 for Rs. 50,000/-. In January, 1995 he got operated for heart ailment which cost him Rs.1,25,000/- and he made a claim to the Insurance Company for the payment of Rs. 50,000/- under the policy. The Insurance Company repudiated the claim on the ground that the complainant had concealed the fact of his having taken treatment for fistula prior to taking the policy. Challenging the repudiation, the Complainant approached the District Forum. The District Forum allowed the complaint with the following observations:

     "The ailment complained of by the appellant had no nexus with the heart treatment which the Complainant faced in the year 1995. The Judgment in Ajay Prakash Mittal case reported in 1997(5) CTJ 749 could not be relied upon as the flssures and flstula were not referred in the Insurance Manual so far as this case is concerned".

     Feeling aggrieved by the order of the District Forum, the Insurance Company went in appeal to the State Commission. The State Commission found that in Clause 11 (a)(b) and (c) of the insurance policy the assured had wrongly mentioned that he had not suffered from any illness during five years prior to the taking of the policy. The State Commission further held that the settled position of the law is that the contract of insurance is based on utmost faith and that the life assured must reveal all ailments. It is further held by the State Commission that fistula in ANO is one of the items contained in the written manual of the LIC empowered the LIC to refuse to accept or determine the date of commencement of the insurance policy. If that be so, the concealment of these facts by the complainant clearly amounts to breach of faith and calls for repudiation. While holding that the evidence regarding concealment of the ailment was not convincing which has lead to the breach of the terms of the policy, the State Commission allowed the appeal, set aside the order of the District Forum.

     Feeling aggrieved by the order of the State Commission the complainant has come in revision before us. On 3rd December, 2000, we passed the following order:

     "The case is regarding medical insurance claim which was denied and repudiated by the respondent LIC on the ground that there was concealment of material facts particularly relating to Clause 11 of the proposal form. Admittedly, earlier the complainant was suffering from Anal Fissures and Fistula, and he went for change of valve. District Forum held in favour of the complainant but on appeal State Commission reversed the order on the ground of concealment of the illness. The question arises for consideration is that if there is any nexus between the ultimate treatment and that which was concealed. LIC denied the claim. It is stated a similar case is coming up on 10.12.2002. Let this matter be listed on 10.12.2002."

     Heard the learned Counsel for the respondent. We have taken a view in the other similar matter, i.e. Revision Petition No. 1481 of 1997, which view we reiterate here that in order to avoid liability under the policy on the ground of suppression of facts it would be necessary to allege and prove that there was a nexus between the ailment suppressed and the ailment suffered by the complainant in respect whereof claim is made. This has not been proved. For this reason we do not find any reason to uphold the order of the State Commission and, therefore, set aside the same. 

     Consequently the order passed by the State Commission is set aside. In the fact and circumstances of the case there is no order as to costs.