Karnataka

Bangalore 4th Additional

CC/12/2146

Smt. Hemalatha H. N. W/o. Late Sri. lVenugopalachari - Complainant(s)

Versus

Bajaj Allianz Life Insurance Company Ltd - Opp.Party(s)

Sri. Karthikeyan

24 Apr 2018

ORDER

Complaint filed on: 30.10.2012

                                                      Disposed on: 24.04.2018

 

BEFORE THE IV ADDL DISTRICT

CONSUMER DISPUTES REDRESSAL FORUM, BENGALURU

 1^ST FLOOR, BMTC, B-BLOCK, TTMC BUILDING, K.H.ROAD, SHANTHINAGAR, BENGALURU – 560 027       

 

 

CC.No.2146/2012

DATED THIS THE 24^th APRIL OF 2018

 

PRESENT

 

 

SRI.S.L.PATIL, PRESIDENT

SMT.N.R.ROOPA, MEMBER

 

Complainant/s: -                           

Smt.Hemalatha.H.N

W/o Late Sri.Venugopalachari, No.109, 8^th cross, Near Govt. School, Murugesh Palya, Nanjareddy Colony,

HAL Post,

Bengaluru-17.

 

Since deceased represented by her legal heirs:

 

1. Gitanjali Venugopalachari

Aged about 30 years,

W/o Varun R Gowda,

R/at no.613, 10^th A cross,

4^th E Main, West of Chord Road, Bengaluru-86.

 

2. Priyadarshini Venugopalachari, Aged about 27 years,

W/o Rajesh S,

R/at no.P172, 7^th main,

11^th cross, LIC colony,

Jeevan Bhima Nagar, Begnaluru-75.

 

By Advocates

M/s.Shree Mukhi Associates     

V/s

Opposite party/s

Respondent/s:-

 

1. Bajaj Allianz Life

Insurance co., ltd.,

GE Plaza airport road,

Yerawada, Pune – 411006.

Rep. by its Branch Manager

 

2. Bajaj Allianz Life insurance company ltd.,

Branch office, no.19/8,

3^rd and 4^th floor, Hindustan complex, BVK Iyengar Road, Bengaluru-09.

Rep. by its Branch Manager

 

By Advocates Sri.J.R.Jagadish & Smt.K.N.Hemalatha

 

3. TLC Insurance (India) Pvt. ltd., ‘Srinivasan’, 1B, 1^st floor, 2B,

2^nd floor, No.15, 1^st cross,

Pampa layout, Kempapura, Hebbal, Bengaluru-24.

Rep by its Branch Manager

 

Ex-parte

 

 

PRESIDENT: SRI.S.L.PATIL

 

 

            This complaint is filed by the deceased Complainant against the Opposite party no.1, 2 & 3 (herein after referred as Op.no.1, 2 & 3 or Ops) seeking issuance of direction to pay a sum of Rs.1,25,000/- being the sum assured under the policy with interest at 10% p.a. from 28.05.10. Further direct them to pay Rs.10,000/- towards deficiency of service, Rs.10,000/- towards mental agony and cost and to grant such other reliefs deem fit for which the Complainant is entitled to.

          2. The brief facts of the case of the deceased Complainant are that she is the legally wedded wife of Late Sri.Venugoapalchari. Sri.Venugoapalchari was approached by Op.no.3 who is a channel partner with proposal to take up a like insurance policy. Thereafter the life assured paid a premium of Rs.12,500/- and submitted the proposal form for availing a life insurance policy vide plan Bajaj Allianz New Unit Gain (hereinafter referred as the said policy). The Op.no.1 & 2 on scrutiny of the proposal form and on satisfaction of the health condition of the life assured issued policy bearing no.116889681 and date of commencement of risk being 31.12.2008 and the sum assured under the policy is Rs.1,25,000/-.  Deceased Complainant further submits that, the insured died on 28.05.10 due to a massive heart attack. Subsequently a death claim was registered with Op.no.1 & 2 claiming the sum assured under the policy and furnished all necessary documents as requested for processing the death claims. The deceased Complainant further submits that, to the utter shock and surprise, without appreciating the documents on record and to enrich themselves illegally Op.no.1 & 2 repudiated the claim on 06.08.10. Op.no.1 & 2 on the presumption that the insured had not disclosed the material facts that he was suffering from Diabetes Mellitus repudiated the legitimate claim of the Complainant. The deceased Complainant further submits that, the insured was not suffering from any form of disease much less from diabetes mellitus, as on the date of the submission of proposal form. The act of the Op.no.1 & 2 repudiating the genuine claim of the Complainant on the basis of pre-existing disease and for concealment of the material facts at the time of availing the policy by the Op.no.1 & 2 amounts to unfair trade practice and deficiency of service with a malicious intention. The Op.no.1 & 2 had accepted the proposal on satisfaction of health condition of the life assured. Deceased Complainant further submits that, Op.no.1 & 2 in connivance with Op.no.3 have repudiated the valid claim of the Complainant and has caused deep misery and mental agony to the grieving Complainant by baselessly averring that the insured was suffering from diabetes mellitus. Deceased Complainant further submits that, the cause of action for this complaint arose on 06.08.10, when Op repudiated the legitimate claim, thus indulging in providing deficient service. The Complainant aggrieved by the repudiation had approached the Claims Review Committee, to consider the claim on 20.09.10, but till date the said representation remained unanswered. The complaint is well within time, but the Complainant is filing an application u/s.24A seeking condonation of delay if any as the order of repudiation was on 06.08.10. Hence prays to allow the complaint.

 

3. On receipt of the notice, Op.no.1 & 2 did appear and filed version denying the allegations made in the complaint. Inspite of notice served on Op.no.3 it did not appear, hence placed exparte. The sum and substance of the version filed by Op.no.1 & 2 are that, the deceased life assured has not disclosed the fact that he was suffering from ailment prior to making the proposal. The deceased life assured was under an obligation to mention the same in the proposal from at the time of applying for the insurance policy from the insurance company. Had he disclosed the same, the company would not have insured the life assured under the said policy or would have certainly called for more documents and the medical tests. It is further submits that, breach of providing information by the life assured entitles the insurer to avoid the contract of insurance so long as he can show that the non-disclosure induced the making of the contract on the relevant terms. The Ops further submit that, the claim of the Complainant also stands repudiated on the ground that this fact amounts to non-disclosure of material facts, and hence the present complaint is not maintainable on the grounds of ‘suggestio vari supprestio falsi’. The life assured had knowledge that he was suffering from the disease and undergoing medical treatment even at the time of making the proposal to the opponent company. The life assured is guilty of suppressing the material facts at the time of making proposal for his insurance. The insurance policy is based upon contract whereby the proposal form along with the first insurance premium is received from the proposer, who intends to take the insurance policy from the insurance company. The proposer who intends to procure a insurance policy has to fill in the material details in the proposal form, amongst which the medical, income details, as well nomination details have to be provided. The same is as per the Insurance Act. The Ops further submit that, when the deceased had has knowledge of his pre-existing disease and ailment, he is obliged to disclose it particularly while answering questions in the proposal form. In the absence of such non-disclosure or in case of any inaccurate answer will entitle the insurer to repudiate its liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering in to a contract of insurance. The Ops further submit that, the various investigation reports, issued with respect to deceased life assured, clearly establish that, the policy was obtained by suppressing material facts, and also by fraudulent manner, the policy was obtained only with malafide motive and intention, under those circumstances, the Op.no.1 & 2 has rejected the claim and this act will not amount to any deficiency of service or unfair trade practice, needless to say the complaint deserve to be dismissed. Hence on these grounds and other grounds prays for dismissal of the complaint.

         

          4. The deceased Complainant to substantiate her case filed affidavit evidence and got marked the documents as Ex-A1 to A3. The South Zonal Legal manager of Op.no.1 & 2 filed affidavit evidence and got marked the documents as Ex-B1 to B11. The Medical Record Officer of Fortis Hospital ltd., filed his affidavit evidence. Written arguments filed by Complainant only. We have gone through the available materials on record. Heard both side.

  

5. The points that arise for our consideration are:

1. Whether the application dtd.30.10.12 filed by the deceased Complainant u/s.24A of CP Act to condone the delay of 83 days in filing the complaint is to be allowed ?
2. Whether the LR’s of the deceased Complainant proves the deficiency of service on the part of Ops, if so, whether they entitled for the relief sought for ?  
3. What order ?

                   

           

 

6.  Our answers to the above points are as under:

 

Point no.1: In the Affirmative  

Point no.2: In the Affirmative 

Point no.3: As per the final order for the following

 

REASONS

 

          7. Point no.1:  In the affidavit filed by the deceased Complainant Smt.Hemalatha.H.N in support of the application filed u/s.24A of CP Act, stated that, her husband died on 28.05.10, due to a massive heart attack and his life was assured and he had nominated her as the nominee as per Sec.39 of the Insurance Act, 1938, under the said life insurance policy bearing no.116889681. She further stated that, subsequently a death claim was registered with the Op.no.1 & 2 claiming the sum assured under the policy by furnishing all necessary documents as requested by them. Further stated that, Op.no.1 & 2 on the presumption that the insured had not disclosed the material facts that he was suffering from diabetes mellitus, repudiated the legitimate claim on 06.08.10. She further stated that, she was hospitalized between 21.06.12 up to 26.06.12 for amputation of little right 2^nd toe and subsequently, she approached the Claims Review Committee, to reconsider the claim on 20.09.10, but till date the said representation remained unanswered. She has a good case on merits, she submits that, no prejudice would be caused to Ops if the said application seeking condonation of delay is allowed, where as she would suffer grave, serious and irreparable loss, harm and prejudice if the delay in filing this complaint is not condoned. The delay in filing this complaint is due to bonafide reasons and not intentional. Hence, she requested this forum to condone the delay in filing this complaint.

 

          8. It appears that this application is not seriously opposed by the Ops by way of filing the objections. Any how we placed reliance on the contents of the affidavit filed in support of the said application. We find there are reasonable grounds to condone the delay as the Ops did not respond to the representation given by the deceased Complainant to the Claim Review Committee. Further we are of the opinion that, the said delay neither intentional nor deliberate. If the said application is allowed, no prejudice will be caused to Ops. In this view of the matter the delay in filing the complaint is condoned. Accordingly we answered the point no.1 in the Affirmative.

 

9. Point no.2: During the course of arguments, learned counsel for the Complainants/LRs submit that, the main contention of Op.no.1 & 2 is that, deceased life insured who is the husband of the deceased Complainant has suppressed the material facts with regard to the pre-existing disease. Hence repudiation of the claim by Ops is just and proper. To prove this fact, Ops have failed to produce any documents to show that deceased insured was having pre-existing disease and the same was suppressed. Further Complainants submit that, all the allegations regarding the suppression of material facts and suppression of pre-existing disease are all false and the same amounts to deficiency of service and unfair trade practice, since there is no volition of utmost good faith by the deceased insured. In this context, he placed reliance on the observation of Hon’ble Apex court in United India Insurance co. ltd., v. MKJ Corpn (1996 6 SCC 428) wherein it was held that “It is a fundamental principle of insurance law that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing (non-disclosure) what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, “Similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured. Referring to this, submits that, though the insured was examined medically by the prescribed doctors of Op company, approved by the Development officer and the Branch manager, the Op is failing to fulfill its obligation of making the payment on unsustainable grounds. Hence, the version of the Ops are entirely misleading and false made to cover up their deficiency of service and unfair trade practice of the Ops.

 

          10. The learned counsel for the Complainants/LRs further submit that, very document produced by Ops marked as Ex-B4 which is the copy of the letter written by the deceased Complainant Smt.H.N.Hemalatha to the insurance company goes against the plea taken by the Op.no.1 & 2. For better appreciation, we would like to extract the said letter, which reads thus:

I have been married to Sri.Venugopalachari for 28 years now and have two daughters named Gitanajali.V and Priyadharshini.V. My husband has been working for BOSCH (MICO) since 24 years. He was healthy and fit, very conscious about his health. He was a responsible man towards us. We have been residing at the above mentioned address for more than 40 years. My husband suffered his first attack on 12.11.09 with no prior symptoms and was admitted at Wockhardt, Bannerghatta road. His daily activities started from freshening up, having breakfast, going to the market, chatting with daughters, going to short walks in the neighborhood and going to work, later getting back home having dinner and off to sleep. His diabetes was detected when he was admitted at Wockhardt after his first attack. He has always been hard working for the family and even after leaving me and my kids he has financially helped us by getting his life insured through your company. Kindly disburse the assured amount.

 

Emphasis supplied by us

 

11. If the above contents of the said letter are strictly construed, one thing is clear that, her husband suffered his first attack was on 12.11.09 with no prior symptoms and was admitted at Wockhardt, Bannerghatta road. It is also evident that, his diabetes was detected when he was admitted at Wockhardt hospital after his first attack. It is not in dispute that, the deceased life insured Sri.Venugopalachari availed the insurance policy from Op.no.1 & 2 under policy no. no.116889681 and date of commencement of risk being 31.12.2008 and the sum assured under the policy is Rs.1,25,000/-. This fact is not denied by Op.no.1 to 3. If the contents of the letter marked as Ex-B4 referred with the contents of the para 4 of the complaint as we stated above, one thing is clear that as on the date of taking the policy in the year 2008, the deceased life insured Sri.Venugopalachari never diagnosed any kind of the disease much less the heart attack and also the diabetes.

 

          12. The learned counsel for the Ops submit that, in discharge summary marked as Ex-B2, wherein, the past history shown as “known case of diabetes mellitus since 3 years, No h/o hypertension”. In this context, submits that, at the time of availing the policy deceased life insured Sri.Venugopalachari has suppressed the pre-existing disease. Hence, the claim repudiated by the Ops is just and proper. We have already stated that, the contents of letter Ex-B4 disclose that the husband of the deceased Complainant suffered his first attack on 12.09.09 and the diabetes was detected when he was admitted at Wockhardt hospital on the said date. Hence question of suppressing the alleged pre-existing disease does not arise.  The Hon’ble Supreme Court as well as Hon’ble National Commission categorically ruled that, as to how the insurance companies are technically repudiating the claim in genuine cases. The said important decisions are:

 

1. Hon’ble Supreme Court, MANU/SC/0804/ 2000, AIR 2001 SC page 549, in the case of LIC of India & ors., v. Smt.Asha Goel and Anr, wherein at para 16 it is held that: In course of time the corporation has grown in size and at present it is one of the largest public sector financial undertakings. The public in general and crores of policy-holders in particular look forward to prompt and efficient service from the corporation. Therefore the authorities in-charge of management of the affair of the corporation should bear in mind that is credibility and reputation depend on its prompt and efficient service. Therefore, the approach of the corporation in the matter of repudiation of a policy admittedly issued by it should be one of extreme care and caution. It should not be dealt with in a mechanical and routine manner.
2. Hon’ble National Commission,1 (2008) CPJ 501 NC, in the case of National Insurance company ltd., v. Raj Narain, dtd.15.01.2008, wherein at para 7 it is held that: In Revision Petition no.1696/2005, Praveen Datnani v. Oriental Insurance co. ltd., IV (2006) CPJ 189 (NC) this commission has held that:

The District forum also relied on clause 4.1 of the policy which states that it is not material whether the insured had knowledge of disease or not, and even existence of symptoms of the disease prior to effective date of insurance enables the insurance company to disown the liability.

If this interpretation is upheld, the insurance company is not liable to pay any claim, whatsoever, because every person suffers from symptoms of any disease without the knowledge of the same. This policy is not a policy at all, as it is just a contract entered only for the purpose of accepting the premium without the bonafide intention of giving any benefit to the insured under the garb of pre-existing disease. Most of the people are totally unaware of the symptoms of the disease that they suffer and hence they cannot be made liable to suffer because the insurance company relies on their clause 4.1 of the policy in a malafide manner to repudiate all the claims. No claim is payable under the mediclaim policy as every human being is born to die and diseases are perhaps pre-existing in the system totally unknown to him which he is genuinely unaware of them. Hindsight everyone relies much later that he should have known from some symptom. If this is so every person should do medical studies and further not take any insurance policy. Even on the facts on record, there is no material to show that the petitioner had any symptoms like chest pain, etc., prior to 11.08.2000. Since, there were no symptoms, the question of linking up the symptoms with a disease does not arise. In any case, it is the contention of the Complainant that he was thoroughly checked up by the doctors who were nominated by the insurance company and at that time he was found hale and hearty. In such set of circumstances, it would be difficult to arrive at the conclusion that the insured had suppressed the pre-existing disease.

In view of the above discussions and from the records available before us, in our opinion, the Complainant has proved that he was unaware of the disease at the time of taking the policy and hence the complaint is allowed.

3. Hon’ble State Commission, Puna, dtd.10.12.13, in the case of Mr.Ashok M Ahuja v. United India Insurance co. ltd., in first appeal no.A/12/822 arisen out of order dtd.30.05.12 in case no.519/2010 of District forum, Pune, wherein at para 10 & 11 it is held that: There is another aspect to the matter. The Complainant seems to have sought some cashless facility in the year 2008 and hand undergone MRI scan as recommended by Dr.Parasnis on 09.10.2008. Now, report of this MRI scan was with the insurance company because the Complainant had sought cashless service. If this report was with the insurance company, insurance company could have discovered while renewing the insurance policy that there was something amiss and the Complainant had suppressed certain things from the insurance company and the insurance company could have refused to renew the insurance policy. Insurance company, without any hesitation, collects premia from the persons, who approach the insurance company with the hope that the insurance company will help them in times of difficulty, but later on insurance company feels no compunction when it declines to fulfillment of its commitments and raises all sorts of defence. This is extremely tragic.

Since in our view the Complainant could not at all have known when he submitted the proposal form that he was suffering from any disorder of nervous system, it cannot be said that the Complainant was suffering from pre-existing ailment/disease which entitled the insurance company to repudiate his claim. We, therefore, answer the point in the affirmative and hold that the District forum was not justified in holding that repudiation of the Complainant’s claim by the insurance company was proper.

 

4. Hon’ble National Commission Decision reported in II (2005) CPJ 78 NC, in the case of LIC of India Vs. Joginder Kaur & Ors, where in it is held that: Consumer Protection Act 1986 – Section 21(b) – Life insurance – Repudiation of claim – concealment of material facts alleged – contention, deceased suffering from diabetes mellitus, was chronic alcoholic and had an attack of jaundice, not acceptable in absence of any evidence in support – complaint rightly allowed by State Commission – no interference required in revision.

5. Hon’ble National Commission Decision reported in I (2005) CPJ 41 (NC), in the case of Life Insurance Corporation of India & Ors Vs. Dr.P.S.Aggarwal, where in it is held that: Consumer Protection Act 1986 – Section 21(b) – Life insurance – Repudiation of claim – Onus on company to prove material concealment of disease which directly proved fatal – alleged, deceased suffering from cough, expectoration, breathlessness, not recorded in proposal form – information collected from hospital not primary piece of evidence – Doctor who prepared discharge summary not produced – Deceased admitted in hospital or met with accident few years before death not proved – Extraordinary suspicious approach without pleading and without proof could not be justified – Death has no direct nexus with bronchitis – Nature of ailment not known to doctor of company despite detailed examination – material concealment not proved – Repudiation unjustified – Issuance of policy after 4 months itself amounts to deficiency of service – complaint allowed by State Commission setting aside order of Forum – No interference required in revision.

6.  Hon’ble National Commission (Circuit Bench at Hyderabad) Decision reported in II (2005) CPJ 9 (NC), in the case of Life Insurance Corporation of India Vs. Badri Nageswaramma (deceased) & Ors, where in it is held that: Consumer Protection Act 1986 – Section 21 – Life insurance – Repudiation of claim – Deceased an old T.B patient, having diabetes, not known on date of proposal – burden to prove false representations and suppression of facts on insurer – Doctor’s certificate without affidavit in support no basis for repudiating the claim – No conclusive evidence produced to suggest suppression on part of deceased – company liable under policy.

7.  Hon’ble National Commission Decision reported in I (2004) CPJ 91 (NC), in the case of LIC of India Vs. Smt.Promila Malhotra, where in it is held that: Consumer Protection Act 1986 – Section 21 – Insurance Act 1938 – Section 45 – Insurance - Repudiation of claim – Suppression of material fact – more than 2 years elapsed between date of policy and date of death – policy not to be called on ground of mis-statement after two years – Onus to prove fraudulent suppression not discharged by company – contention of 14 years history remained unproved – company liable under policy.

8. Punjab SCDRC, Chandigarh decision reported in I (2001) CPJ 53 in the case of LIC of India Vs. Charanjit Kaur, wherein it is held that: Consumer Protection Act, 1986 – Section 15 – Appeal – Life insurance – repudiation of claim – suppression of material facts – onus of proving that deceased made false statement lies on insurance company – death due to hypertension and abdomen pain not proved – Complainant entitled to get policy amount along with interest.

 

9.  III (2017) CPJ 553 (NC) in the case of Arunkumar vs. New India Assurance co., ltd.,

Consumer Protection Act, 1986 – Sections 2(1)(g), 14(1)(d), 21(b) – insurance (mediclaim) – degenerative joint disease in both knees – treatment taken – medical reimbursement – suppression of pre-existing disease alleged – claim repudiated – deficiency of service – District Forum allowed complaint – State Commission allowed appeal – hence revision – opinion given by panel doctors is based on presumption only that Complainant would have been suffering from degenerative joint disease for the last 4 to 5 years atleast – said presumption has not been supported by any medical evidence or record – Complainant has been taking the insurance policy since the year 1997 -  It was the bound duty of insurance company to have verified information given in proposal form by obtaining suitable expert opinion – However, when claims are filed, minute scrutiny starts at that stage and claims are repudiated, even for minor lapses on part of proposer – Complainant had difficulty in waling for a long time and history of borderline hyper tension, but not on any medication – non-disclosure of such conditions in proposal from cannot be blown out of proportion, so as to disentitle Complainant from claim amount from insurance company – repudiation not justified.

 

13. In the light of the decisions cited supra, we come to the conclusion that, doctor who has prepared and issued discharge summary marked as Ex-B2 is not examined by way of filing affidavit. Further heart attack was after one year from the date of obtaining the policy. When such being the fact, question of suppressing material facts, in respect of the diabetes does not arise. Even if assuming for a moment that, the deceased life insured Sri.Venugopalachari was suffering from diabetes which is noway related to the sudden heart attack in the light of the decisions cited supra. Hence, we come to the conclusion that, the claim repudiated by the Ops is unjust, illegal and against the settled principles of law as laid down in the decisions which we have already extracted in the foregoing paragraphs. In this context, we are of the opinion that, there is a deficiency of service on the part of Ops. Under such circumstances, the LR’s of the deceased Complainant Smt.Hemalatha.H.N are entitled for the relief of Rs.1,25,000/- which is the assured amount covered under the said policy with interest at 6% p.a. from the date of repudiation till the date of realization. With regard to the compensation is concerned, deceased Complainant stated that, she is entitled for an amount of Rs.10,000/-. Soon after the death of the deceased Complainant, her LRs are brought on record who are nothing but children of the deceased life insured Sri.Venugopalachari and deceased Complainant Smt.Hemalatha.H.N. The LRs are being sufferer in respect of the legitimate claim repudiated by the Ops. Under such circumstances if an amount of Rs.10,000/- is being awarded as compensation, ends of justice would met sufficiently. With regard to the cost of litigation, Rs.5,000/- is fixed. In this context, we direct Op.no.1 to 3 are jointly and severally liable to pay the said amounts. Anyhow the liability is fastened on Op.no.1 & 2 to realize the said amounts. Accordingly we answered the point no.2 in the affirmative.

 

14. Point no.2: In the result, we passed the following:

 

ORDER

 

          The complaint filed by the deceased Complainant is hereby allowed.

 

2. We direct Op.no.1 to 3 who are jointly and severally liable to pay an amount of Rs.1,25,000/- covered under the policy no. 0116889681 with interest at the rate of 6% p.a. from the date of repudiation of the claim till the date of realization to the LRs of the deceased Complainant.

 

3. Further we direct Ops to pay compensation of Rs.10,000/- and cost of litigation of Rs.5,000/- to the LRs of the deceased Complainant.

4. We fastened the liability on Op.no.1 & 2 to realize the said amount within six weeks from the date of receipt of this order, failing which the LRs of the deceased Complainant are at liberty to have the redress as per law.

 

          Supply free copy of this order to both the parties.

 

          (Dictated to the Stenographer in the open forum and pronounced on 24^th April 2018).

 

 

 

(ROOPA.N.R)     MEMBER

(S.L.PATIL)  PRESIDENT

                                                                        

1. Witness examined on behalf of the complainant/s by way of affidavit:

 

Smt.Hemalatha.H.N/deceased, who being the complainant was examined. 

Copies of Documents produced on behalf of Complainant/s:

 

Ex-A1	Original receipt for having paid the premium dtd.06.02.12
Ex-A2	Letter of authorization dtd.01.07.12
Ex-A3	Original repudiation letter dtd.06.08.10

 

2. Witness examined on behalf of the Opposite party/s Respondent/s by way of affidavit:

 

Sri.M.Arvinda, who being the South Zonal Legal Manager of Op.no.1 & 2 was examined.

Sri.Ravkumar.C, who being the Medical Record Officer of Fortis Hospital Ltd., was examined.

 

Copies of Documents produced on behalf of Opposite partis no.1 & 2

 

Ex-B1	Policy of life assured Venugopalachari
Ex-B2	Discharge summary issued by Wockardt hospital
Ex-B3	Repudiation letter dtd.06.08.10
Ex-B4	Letter given by the deceased Complainant
Ex-B5	Authorization letter by Wockardt hospital
Ex-B6	Admission profile of life assured Venugopalachari
Ex-B7	Admission history and physical assessment form
Ex-B8	Physical examination
Ex-B9	Coronary angio report
Ex-B10	Discharge summary of Wockardt hospital
Ex-B11	Discharge slip

 

 

 

 

(ROOPA.N.R)     MEMBER

(S.L.PATIL)  PRESIDENT