1.      Heard Ms. Gurmeet Bindra, Advocate, for the appellant and Mr. K. Maruthi Rao, Advocate, for the respondent. 

2.      Above appeal has been filed against the order of State Consumer Disputes Redressal Commission, Andhra Pradesh, dated 19.08.2015, passed in Consumer Complaint No.214 of 2014, allowing the complaint and directing the appellant to pay Rs.3000000/- with interest @9% per annum from 23.12.2013 till the date of payment as the insurance claim, refund Rs.16860/- as realized as insurance premium and Rs.10000/- as litigation costs, within three months from the date of judgment.

3.      Mrs. M. Krishna Veni (the respondent) filed CC/214/2014, for directing Aviva Life Insurance Company India Limited (the appellant) to pay (i) Rs.3000000/- with interest @12% per annum from 21.10.2013 till the date of payment, as insurance claim; (ii) refund Rs.17381/- realized towards insurance premium; (iii) Rs.one lakh, as compensation for mental agony and harassment; (iv) litigation costs; and (v) any other relief, which is deemed fit and proper in the facts of the case.

4.      The complainant stated that her husband Late Mallidi Srinivas Reddy had obtained “Aviva Life Shield Advantage” Insurance Policy No.10010732, from Aviva Life Insurance Company India Pvt. Limited on 06.05.2013. The term of the policy was 30 years and annual premium was Rs.17381/-. Late Mallidi Srinivas Reddy (the DLA) was partner in Sri Vaishnavi Rice Mill, Pedaparthi Revu, which was under construction. The DLA went at the site of above rice mill on 14.09.2013. At about 17:00 hours, the DLA went to attend the call of nature towards irrigation canal side. While returning, as soon as, he reached on the road, lorry bearing Regd. No. AP 16 TU 4983, coming from the side of Machavaram towards Mandapet and being driven by Syed Javed Baba rashly and negligently, run over the DLA. In this accident, the DLA received crush injury in his right leg, severe injury in left leg with multiple injuries and profuse bleeding on the body and he had become unconscious. Millidi Appa Reddy, his relative admitted him to Safe Emergency Hospital, Kakinada at 17:30 hours on 14.09.2013, where he remained till 02.10.2013. On 02.10.2013, he was shifted to Medicare Hospital, Rajahmundry, from where he shifted to Naveen Trauma & Emergency Centre on 05.10.2013 and again shifted back to Medicare Hospital on 13.10.2013 and remained there till 19.10.2013. On 19.10.2013, he was again shifted to Naveen Trauma & Emergency Centre, where he expired on 21.10.2013 at 23:15 hours. On the information given by Safe Emergency Hospital, FIR of Crime No.136/2013, under Section 338 IPC was registered on 15.09.2013 at 10:00 hours at Police Station Mandapet Town, which was converted under Section 304-A IPC on 22.10.2013 at 5:00 hours, after death of the DLA. The police conducted investigation and submitted charge sheet against Syed Javed Baba on 10.11.2013. The complainant incurred Rs.100000/- in treatment of the DLA, during this period. The complainant set up insurance claim before the opposite party on 18.12.2012. The opposite party, vide letter dated 23.12.2013, repudiated the claim on the ground that the DLA was known diabetic since 6 years and known pulmonary tuberculosis since March, 2013, but he had concealed his diseases in Proposal Form filled up on 30.04.2013, for obtaining policy, giving liberty to file a review application. The complainant, through letter dated 13.01.2014 submitted all the relevant documents for review and gave reminders on 20.01.2014, 14.02.2014 and 07.04.2014. Along with reminder dated 07.04.2014, the complainant filed Affidavit of Karri Koteswar Reddy, stating that at the time of admission of the DLA in Safe Emergency Hospital, Kakinada at 17:30 hours on 14.09.2013, he replied the attendant of the hospital in nervousness. The DLA was neither diabetic nor suffering from pulmonary tuberculosis. The complainant also filed certificates of the family doctor of the DLA, Dr. G. Suryanarayanan, Safe Emergency Hospital and Medicare Hospital stating that the DLA had never been treated by them for diabetic or pulmonary tuberculosis. But the opposite party, vide letter dated 26.06.2014, rejected the representation. Stating that the DLA neither suffered from diabetic or pulmonary tuberculosis nor took any treatment from anywhere for these diseases and the claim was wrongly rejected, the complaint was filed on 01.08.2014.

5.      The appellant filed its written reply and contested the complaint. The facts relating to issue insurance policy on 06.05.2013 and accident of the DLA on 14.09.2013, his treatment in Safe Emergency Hospital, Medicare Hospital and Naveen Trauma & Emergency Centre and his death on 21.10.2013, due to accidental injuries, have not been disputed. The appellant stated that in the medical record of Safe Emergency Hospital, it has been noted as “patient is a known diabetic since 6 years”. In the medical records of Medicare Hospital and Naveen Trauma & Emergency Centre, it has been noted as “patient is a known diabetic since 6 years and known pulmonary tuberculosis, diagnosed 5 months back”. The DLA concealed his diseases in Proposal Form filled up on 30.04.2013. Proposal Form contained queries at Point 6.2 relating to “Health & Activities Section” and Point 8 “Insurance Details”. These queries were answered as “No”. The DLA had taken one insurance policy from Cholamandalam and 5 insurance policies from Life Insurance Corporation of India. Due to concealment of material facts and obtaining insurance policy by misrepresentation, the policy was vitiated and the claim was rightly repudiated on 23.12.2013 and representation was rejected on 26.06.2014. There is no deficiency on the part of the Insurer.    

6.      State Commission, in the impugned order found that the Insurer raised plea that the DLA was suffering from diabetes and pulmonary tuberculosis prior to taking insurance policy but Investigator appointed by the Insurer failed to find out any evidence in this respect. So far as medical records of Safe Emergency Hospital, Medicare Hospital and Naveen Trauma & Emergency Centre are concerned, entries in these records have been controverted by the certificates issued by Dr. G. Suryanarayanan, Safe Emergency Hospital, Medicare Hospital and Naveen Trauma & Emergency Centre stating that the DLA had never been treated by them for diabetic or pulmonary tuberculosis, as well as Affidavit of Karri Koteswara Reddy, stating that at the time of admission of the DLA in Safe Emergency Hospital, Kakinada at 17:30 hours on 14.09.2013, he replied the attendant of the hospital in nervousness. As such concealment of diseases by the DLA in proposal form has not been proved. The claim was repudiated on irrelevant consideration. On these finding the complaint was allowed. Hence this appeal has been filed.

7.      We have considered the arguments of the counsel for the parties and examined the record. Proposal Form for taking insurance policy was filled up on 30.04.2013. By the letter dated 23.12.2013, the appellant repudiated the insurance claim on the ground that that the DLA had concealed previous ailments although he was suffering from diabetes from 6 years and pulmonary tuberculosis from March, 2013, in the Proposal Form filled up on 30.04.2013. These ailments were noticed by the appellant from medical records of Safe Emergency Hospital, Medicare Hospital and Naveen Trauma & Emergency Centre. In Discharge Summery of the DLA of Safe Emergency Hospital, it was noted that “patient is a known diabetic since 6 years”.  In General Condition and In Condition at Discharge –“Lungs clear” have been noted. In the Information given to police, brought by Karri Koteswara Reddy had been noted. Karri Koteswara Reddy filed his Affidavit, stating that at the time of admission of the DLA in Safe Emergency Hospital, Kakinada at 17:30 hours on 14.09.2013, he replied the attendant of the hospital in nervousness and the DLA was not suffering from any disease prior to his accident on 14.09.2013. Admittedly, the patient was unconscious at that time as such endorsement “patient is a known diabetic since 6 years” as noted was made on the information of Karri Koteswara Reddy, which had been controverted by him by filing his Affidavit.       

8.      In Discharge Summery of Medicare Hospital and Treatment Summary of Naveen Trauma & Emergency it has been noted as “patient is a known diabetic since 6 years and known pulmonary tuberculosis, diagnosed 5 months back”. In the hospital medicines of diabetes were given to the DLA. But it is not proved that any medicine for pulmonary tuberculosis was given, particularly when in Discharge Summery of Safe Emergency Hospital it has been mentioned that “lungs clear”. It is not clear that information relating to “pulmonary tuberculosis, diagnosed 5 months back” has come from which source.      

9.      In order to find out the previous diseases of the DLA, the appellant appointed an Investigator, who made inquiry from Anganwadi worker, Auxiliary Nurse Midwifery, Panchayat Secretary, Medical Stores in the locality of the DLA as well from the resident of the locality of the DLA but could not find that the DLA had ever used medicines of diabetes or tuberculosis. In these circumstances, the certificates issued by Dr. G. Suryanarayanan, Safe Emergency Hospital, Medicare Hospital and Naveen Trauma & Emergency Centre stating that the DLA had never been treated by them for diabetic or pulmonary tuberculosis prior to this incident have been relied upon by State Commission for recording findings that the appellant had failed to find out any evidence in respect alleged pre-existing diseases of the DLA. We do not find any reason to take contrary view as taken by State Commission. So far as other insurance policies of the DLA are concerned, a perusal of written reply of the appellant shows that these policies were obtained subsequent to the present policy. The noting of the hospitals, which had been proved to be incorrect by the complainant. Repudiation of the claim was based upon these noting was illegal. The impugned order of State Commission does not suffer from any illegality. The appeal has no merit and is liable to be dismissed.

                                                    O R D E R

In view of the aforesaid discussions, the appeal is dismissed.