BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
OF 2008 AGAINST C.C.NO.132 OF 2007 DISTRICT CONSUMER FORUM KADAPA
Between
K.Suresh Kumar S/o K.Venkatapathi
aged about 39 years, Occ: Business
R/o D.No.7/132, Ammavari Sala Street
Badwel Town, Badwel, Kadapah District
Appellant/complainant
A N D
1. Claims Review Committee
Bajaj Allianz Life Insurance Co., Ltd.,
5th Floor, Ashoka Plaza, Corporate
Software Park, S.No.32/3, Nagar Road
Viman Nagar, Pune-411 006
2. The Manager,
Bajaj Allianz Life Insurance Co., Ltd.
D.No.22/468, B.S.Complex, Gandhi Road
Proddatur Town, Kadapah District
Respondents/opposite parties
Counsel for the Appellant Sri G.V.Raghava Reddy
Counsel for the Respondents Sri Srinivas Karra
QUORUM: SRI SYED ABDULLAH, HON’BLE MEMBER
&
SRI R.LAKSHMINARSIMHA RAO, HON’BLE MEMBER
TUESDAY THE NINETH DAY OF NOVEMBER
TWO THOUSAND TEN
Oral Order ( As per R.Lakshminarsimha Rao, Member)
***
1. The complainant has filed the appeal challenging the order of the District forum whereby his complaint was dismissed on the ground that the deceased Smt K.Renuka suppressed the material facts of her earlier cancer at the time of submitting the proposal form.
2. The factual matrix of the case is that the complainant’s wife Karnati Renuka during her life time had taken a policy bearing No.18574201 on 28.3.2006 for an assured sum of `2,50,000/-. The complainant’s wife died on 9.5.2007 while the policy was in subsistence. The complainant being the nominee of his deceased wife submitted the claim form by enclosing thereto all necessary documents, claiming the sum assured. The opposite party by its letter dated 1.9.2007 repudiated the claim of the complainant on the ground that the complainant’s wife died on account of carcinoma of her left breast which fact was not disclosed in the proposal form. The opposite party has issued a statement dated 31.5.2007 showing the account value to the extent of `98,050.31 which includes the premiums paid by the deceased policy holder. The complainant submits that his wife died due to acute myocardial infarction which fact was supported by the duty doctor who also issued certificate to that effect. The opposite parties though enquired with the lady doctor as regards the cause of death, repudiated the claim. The complainant got issued notice dated 5.10.2007 to the opposite parties and filed the complaint before the District forum seeking direction to the opposite parties to pay `2,50,000/- being the sum assured along with interest, `98,050.31 being the account value during the time of claim, compensation and costs.
3. The opposite parties resisted the case contending that the complaint is bad for misjoinder of party i.e., opposite party no.1 who neither issued the policy nor made repudiation of the claim of the complainant. After enquiry by the opposite parties revealed that the deceased was already suffering with carcinoma left breast and was taking treatment at Jakka Sujathamma Cancer Center, Podalakur Road, Nellore from 7.11.2005 till the 1st week of May 2007 and was operated on 8.6.2006. In May 2007 the life assured reported in a morbid condition with severe pleural affusion and multiple metastatic in the right lobe of liver and the hospital offered only supportive and symptomatic treatment. Later, the life assured was taken back to Badvel where she died at home. The death of the life assured was due to cancer and not heart attack. The deceased life assured even though was aware of the fact did not disclose the same in the proposal form. Therefore the opposite parties justified their action of repudiation of claim of the complainant.
4. The complainant filed his affidavit and documents Exs.A1 to A7. The opposite parties filed documents Exs.B1 to B7.
5. The appellant filed the appeal contending that in the absence of any supportive evidence by the opposite parties in regard to the suppression of material fact the dismissal of the complaint by the District Forum is not justified.
6. The point for consideration is whether there was any suppression of material facts by the deceased wife of the complainant?
7. The dispute in a narrow compass is in regard to the material fact relating to the health condition of the wife of the complainant at the time of her submitting the proposal for obtaining the insurance policy. It is the contention of the complainant that his wife died of myocardial infarction and she did not suffer from carcinoma of her left breast nor did she suppress any material fact in the proposal form submitted to the opposite parties. Whereas it is the contention of the opposite parties that the wife of the complainant suffered from carcinoma of left breast and she was treated in cancer hospital Nellore which fact was suppressed by her in the proposal.
8. The complainant’s wife was treated on 8.5.2007 as seen from the copy of hospital treatment certificate issued by Dr.J.Laxmi of Sri Laxmi Durga Hospital, Badwel. The doctor has replied to the questionnaire furnished by the opposite parties. The questionnaire forms part of the medical attendant’s certificate issued by the doctor. She has stated that the patient was “not absolutely hospital admission but kept under observation for 3-4 hours” with her bed head ticket no.4 for treatment of retosckeletal chest pain accompanied by vomiting and sweating reportedly the patient suffered for about 10 to 14 hours prior to the time she was taken to the hospital. The doctor has stated that the patient was under her treatment since 25.12.2005 and she had visited for follow up treatment on 10.4.2006, 15.10.2006, 21.12.2006, 4.2.2007, 26.4.2007 and 8.5.2007. Relying upon the conclusion arrived at by Dr.J.Laxmi, it was contended by the complainant before the District Forum that his wife suffered from myocardial infarction i.e., the heart failure was cause of her death. He relied upon the Hon’ble National Commission in “New India Assurance Ltd., and Others Vs. Rajkumar Chuchra” reported and LIC of India Vs. Sajitha Begum at page no.442 and 443 respectively in S.C. & National Commission Consumer Law Cases (2005-2008).
9. The opposite parties had relied upon the certificate issued by Dr.T.lakshmi of Indian Red Cross Society of Cancer Hospital, Nellore wherein the doctor has certified that the complainant’s wife was diagnosed to have suffered from carcinoma of left breast and she was given pre-op.RT and CT (FEC.6 cycles) + Radio Castration and she had undergone surgery on 8.6.2006 performed by Dr.Aruna Chandrasekharan. Further the certificate indicates that the patient was free of disease till October 2006 and the CT scan done on 17.12.2006 revealed multiple cystic lesions involving vertebral bodies and posterior elements for which she was started on palliative Radio Therapy to the spine along with 2 cycles of Inj. Docetaxol and Zyfoss and the patient reported in morbid condition with severe pleural effusion and multiple metastatic lesions in the right lobe of liver in the month of May 2007 for which she was offered only supportive and symptomatic treatment. The doctor has diagnosed the patient basing on the pathology report issued by IRCS Jakka Sujathamma Cancer Detection Centre which had shown that the smears of the patient sent for cytological study indicated the features suggestive of duct cell carcinoma. The pathological report coupled with certificate issued by Dr.T.Lakshmi amply establish that the complainant’s wife suffered from Carcinoma of left breast and she had undergone surgery as well as radiation in the cancer hospital, Nellore.
10. The diagnosis of the patient as found by Dr.J.Lakshmi of Sri Lakshmi Durga Hospital that she suffered from Myocardial Infarction and the heart failure was cause of her death has to be read in conjunction with the findings of Dr.T.Lakshmi of the Cancer Hospital, Nellore. The cause for acute myocardial infarction as found out by Dr.J.Lakshmi was due to sedentary life style and this finding has to be considered in consonance with the morbid condition of the patient as reported by Dr.T.Lakshmi in her certificate dated 14.6.2008 which gives a clear picture that the patient suffered from carcinoma of left breast. Dr.J.Lakshmi had suppressed the fact that the patient was suffering from carcinoma of left breast and she has only stated that the cause of death of the patient was acute myocardial infarction for which the secondary cause was sedentary life style. She has not explained how the sedentary life style was concluded to be the cause for acute myocardial infarction in the absence of any postmortem examination of body of the patient. Therefore, we do not find any merit in the appeal.
11. The decisions relied upon by the complainant were rendered relating to the circumstances where the insurance company failed to prove treatment rendered to the insured in regard to the diabetes mellitus. The facts and circumstances o those cases and those of the present case are completely different and as such the principle laid down in the said cases is not applicable to the facts of case on hand. The deceased wife of the complainant had suppressed in the proposal form that she suffered from Carcinoma of left breast and was treated in cancer hospital prior to the date of obtaining the insurance policy. We are of the considered opinion that the appeal is devoid of any merits and the impugned order does not suffer from any infirmity of misappreciation of fact or law.
12 In the result the appeal is dismissed confirming the order dated 1.7.2008 of the District Forum. No costs.
MEMBER
MEMBER
Dt.09.11.2010
KMK*
