CWP 11767 of 2007 1 IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH. C.W.P.No. 11767 of 2007 Date of decision 8 .4.2008 ICCI Prudential Life Insurance Company Ltd. ...Petitioner Versus Permanent Lok Adalat (Public Utility Services) and others ... Respondents. CORAM: HON'BLE MR. JUSTICE M.M. KUMAR HON'BLE MRS. JUSTICE SABINA Present: Mr. M.S.Cheema Advocate for the petitioner. M.M.KUMAR, J. This petition is directed against order dated 4.4.2007 (Annexure P.2) passed by the Permanent Lok Adalat (Public Utility Service) Union Territory, Chandigarh on an application filed by Smt. Inderjit Kaur, respondent no.2. On 31.3.2004 a policy bearing No.00862553 was issued by the petitioner in favour of respondent no.2 for a sum assured of Rs. 1,00,000/- It also covered Accident and Disability Benefit Rider “ABDR” and Critical Illness Benefit Rider “CIBR” each for a sum assured of Rs. 1,00,000/-. However, the claim of the petitioner was rejected vide letter dated 19.9.2005 (Annexure P.5) and 11.10.2005 ( Annexure P.11) being wholly unwarranted. The Lok Adalat has found that the requisition of policy was illegal because respondent no.2 had never made any mis-representation of facts regarding her health. Reliance of the petitioner on a copy of the report dated 1.4.2002 ( Annexure P.3) concerning Stress Myocardial Perfusion Study (thallium Stress test) was not accepted because the test was negative and it no where indicated that respondent no.2 was suffering from CWP 11767 of 2007 2 any heart ailment. The Lok Adalat held that the insurance company fell into grave error in concluding that the applicant suffer from heart illness or that the test was positive. Another issue raised by the petitioner was that respondent no.2 in the report dated 13.7.2005 ( Annexure P.4) has conceded in the resume of the history that she was suffering from chest pain radiating to the left arm alongwith shortness of breath on extortion of and on for about 15-20 days. In the history she stated that there were intermittent chest pain since six years. The reliance on the statement made by respondent no.2 that the applicant was suffering from heart trouble for the last over six years would show that there was suppression of information from the petitioner. However, the argument was rejected with the observation that the report makes is absolutely clear that ECG revealed Normal sinus rhythm, epicedial coronaries were normal. The patient had undergone Coronary Angiography and there was no post procedure complication. Even her stay in the hospital after procedure was without any problem. The final expression was described as normal coronaries and various coronary profiles were also described as normal. In these facts and circumstances, the Permanent Lok Adalat has found that there was no evidence on record showing that the respondent had history of heart disease and all the answers given by respondent no.2 in the proposal form were correct. The Permanent Lok Adalat also rejected the argument that angiography is not one of critical illness detailed in the policy. In the policy dated 31.3.2004 (Annexure P.1) Note I under clause ( c) states Coronary Artery bypass graft surgery and heart attack are critical illness. Heart ailment itself is one of the critical illness. Although angiography itself is not a disease but a significant test to diagnose the critical illness of heart which points to the narrowing or CWP 11767 of 2007 3 blockage of one or more coronary arteries leading to heart disease.Accordingly, Permanent Lok Adalat has concluded that repudiation of the claim made by respondent no.2 by letter dated 19.9.2005 ( Annexure P.9) and 11.10.2005 ( Annexure P.11) were wholly unwarranted. It has been further held that this constitute gross deficiency in service on the part of the petitioner.The application was allowed with costs and the petitioner was directed to pay the claim of respondent no.2 with interest @ 7% p.a. w.e.f. 19.9.2005 till the actual date of payment. After hearing learned counsel at a considerable length we find that the view taken by the Permanent Lok Adalat does not suffer from any legal infirmity warranting interference of this Court. Findings are based on acceptable evidence. Even otherwise, the award passed by the Permanent Lok Adalat is considered final as per the provisions of Section 22 (E) of the Legal Services Authoriies Act, 1987 and it has to be treated as decree of civil Court. For the reasons afore-mentioned this petition fails and the same is dismissed. (M.M.Kumar) Judge (Sabina) 8.4.2008 Judge okg