Rajasthan High Court - Jodhpur
Life Insurance Corporation Of India vs Damodar Bagdi on 6 March, 2025
[2025:RJ-JD:12242]
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 6359/2024
Life Insurance Corporation Of India, Divisional Office, 1 West
Patel Nagar, Circuit House Road, Jodhpur through its Manager
(Legal) and Authorized Signatory Mr. Subhash Chandra Sharma.
----Petitioner
Versus
Damodar Bagdi S/o Shri Ghanshyam Bagdi, resident Of 307 B,
Laxmi Nagar, Paota, Jodhpur.
----Respondent
For Petitioner(s) : Mr.Sheetal Kumbhat, Adv.
For Respondent(s) : Mr.Anil Kumar Bhandari, Adv.
HON'BLE MR. JUSTICE MUNNURI LAXMAN
Judgment
Judgment Reserved on : 04/03/2025
Judgment Pronounced on : 06/03/2025
1) Heard both the counsel on final disposal.
2) The present writ petition challenges the award dated
28.02.2024 passed by the learned Permanent Lok Adalat, Jodhpur
Metropolitan in Public Utility Service Case No.183/2019,
whereunder the claim of the respondent for coverage of Rs.16
lacs, was allowed.
3) Aggrieved by the said award, the petitioner-Insurer has
filed the present writ petition.
4) The case of the respondent-claimant was that the
deceased had obtained a policy being the Cancer Cover Plan
No.905-30 for 30 years coverage for Rs.16 lacs and the said policy
[2025:RJ-JD:12242] (2 of 5) [CW-6359/2024]
was issued on 22.01.2018. The deceased succumbed to the cancer
after 180 days of issuance of the policy. The Insurance Company
on knowing the discovery of the first diagnosis of cancer within the
waiting period of 180 days repudiated the contract of insurance.
The claimant had preferred a claim before the Permanent Lok
Adalat, Jodhpur Metropolitan. The Permanent Lok Adlat after
conducting summary proceedings has overruled the repudiation of
contract and granted the assured amount with interest @ 8% per
annum.
5) The learned counsel appearing for the petitioner-
Insurance Company has submitted that the terms of policy
particularly Part 'C' of 8(G) entitle the Insurance Company to
repudiate the contract if the first diagnosis of "any stage" of
cancer is diagnosed within 180 days from the date of issuance of
policy or the date of arrival of the risk cover, whichever is later.
This means if the stages of cancer is diagnosed within 180 days,
the Insurance Company is entitled to repudiate the contract of
insurance.
6) The learned counsel for the Insurance Company further
contended that as per the investigation done by them, a Positron
Emission Tomography (PET) Test was conducted on 19.07.2018
and the said PET test discloses that the deceased diagnosed with
the cancer and such a discovery was made within 180 days of
commencement of the policy. Since the cancer was detected
within waiting period, as per the terms of the policy, the insurer is
entitled to repudiate the contract of insurance, which is rightly
done. Therefore, the Permanent Lok Adalat was not correct in
allowing the claim for assured amount under the policy in spite of
[2025:RJ-JD:12242] (3 of 5) [CW-6359/2024]
valid repudiation of contract. The learned counsel has submitted
that on this ground only, the impugned award is required to be
interfered.
7) Per contra, the learned counsel appearing for the
respondent-claimant has submitted that the PET Test was not
conducted on 19.07.2018 and in fact, the soft tissue was collected
on 24.07.2018 and the discharge summary also indicates that the
stage of cancer was detected only on 29.07.2018 and treatment
was started from 30.07.2018. According to him, the PET Test only
shows areas of the body where the cells are more active than
normal and such a test is not exclusive to the cancer and it can
also be used for heart diseases and brain conditions. By such a
test, the stage of cancer cannot be detected. It can only be done
by biopsy based on the soft tissue collected.
8) In the back ground of the above contention, this Court is
required to appreciate whether the findings of Permanent Lok
Adalat suffer from any perversity or any finding was made without
any evidence.
9) There is no doubt that the Insurance Company is entitled
to repudiate the contract if it is established that within the waiting
period of 180 days, if the first diagnosis of any stage of cancer is
detected. This means if any medical report of diagnosis, which
indicate any stage of the cancer within 180 days, the Insurance
Company is entitled to repudiate the policy. In the present case,
the policy was issued on 22.01.2018 and 180 days comes to an
end on 21.07.2018. The evidence on record show that the PET
Test was conducted on the deceased on 19.07.2018 and the soft
tissue for biopsy was taken from the deceased on 24.07.2018. The
[2025:RJ-JD:12242] (4 of 5) [CW-6359/2024]
PET scan only indicates areas of body where cells are more active
than normal. This test do not furnish diagnosis of stage of cancer.
It is a pre-indicative test to proceed for the biopsy. The biopsy is
the test for cancer, which could only give the stages of the cancer.
The policy terms only indicate the first diagnosis of any stage of
the cancer. If the PET test is not the first diagnosis of
determination of any stage of the cancer then the case of the
insurer must fail. In the present case there is no material to show
that when the report of the PET Test was furnished. Even
assuming that the same was furnished within 180 days, that test
results do not satisfy the requirement of first diagnosis of any
stage of cancer. As adverted herein-before, such a test is only
indicative of areas where cells are more active and not more than
that. The biopsy is the only test, which could give the first
diagnosis of any stage of cancer and admittedly & indisputably,
the soft tissue for biopsy was collected on 24.07.2018, which is
subsequent to 180 days and the test results were prior to
30.07.2018. The treatment of the cancer was commenced from
30.07.2018. This means the stage of the cancer was detected
basing on the biopsy result, which material was collected
subsequent to 180 days. Therefore, the case of the claimant do
not fall within the waiting period. This is the only ground which is
urged in the present writ petition.
10) This Court on appreciation of the facts and evidence on
record finds that there is no perversity in the award impugned,
which requires no interference.
11) In the result, the writ petition is dismissed.
[2025:RJ-JD:12242] (5 of 5) [CW-6359/2024]
12) Pending interlocutory applications, if any, shall stand
disposed of.
(MUNNURI LAXMAN),J
NK/-
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