KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
VAZHUTHACAD, THIRUVANANTHAPURAM
APPEAL NO.273/2006
JUDGMENT DATED: 23 .11.2010
PRESENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
SRI.M.K.ABDULLA SONA : MEMBER
1.Life Insurance Corporation of India Ltd., : APPELLANTS
Divisional Office, Ernakulam,
Rep. by the Manager (Legal & HPF),
LIC of India,
Jeevan Prakash, M.G.Road, P.B.No.1133,
Ernakulam-682 011.
2. Branch Manager, LIC of India,
Muvattupuzha Branch, Muvattupuzha,
Rep. by the Manager, (Legal & HPF),
LIC of India, Jeevan Prakash,
M.G.Road, P.B.No.1133,
Ernakulam – 682 011.
(By Adv.G.S.Kalkura)
Vs.
Molly Paulose,
Panichikudy House, : RESPONDENT
Parayithottam Road, Kuthukuzhy.P.O.,
Kothamangalam, Ernakulam District.
ORDER
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
The appellants are the opposite parties/LIC of India in CC.556/05 in the file of CDRF, Ernakulm. Appellants are under orders to pay a sum of Rs.50,000/- and cost of Rs.2000/- to the complainant.
2. The case of the complainant is that her husband had availed the LIC policy for a sum of Rs.50000/-. He died on 27.7.04 on account of cardiac arrest due to peri operative mio cardial infarct. In the post mortum report the reason for the death mentioned is coronary insufficiency. The claim was repudiated. It is denied that there was any material suppression. It is further alleged that the proposal form was filled up by the agent of the opposite party. It is after medical check up that the proposal was accepted . The reason mentioned in the post mortum report for the death has no nexus with the disease such as “episodes of right sided facial pain”. Hence he has sought for the assured amount of Rs.50000/- with interest and cost.
3. The opposite parties have filed version admitting the policy but contended that the averments in the proposal form dated 12.2.2002 were false. It is pointed out that within a short period of 2 years and 5 months death took place. The death was occasioned consequent to the surgery done for trigeminal neuralgia. It is also mentioned in the medical certificate that the deceased had repeated episodes of right sided facial pain since 1996. In the certificate of the Neuro Surgeon dated 28.7.04 it is mentioned that the deceased had recurrent attacks of lancinating pain starting from the bridge of the nose on the right side and spreading towards vertex on the right side along upper eye lid. It is also mentioned therein that since 1996 deceased used to get pain initiated with activities like sudden opening or closing of eyes, sudden opening of mouth, chewing food on right side, swallowing cold water etc. The deceased was taking various combinations of medicines like zen retard, zeptol, Gafaptin etc. since 1996. He was diagnosed as having leukopenia at Sree Chitira Thirunal Medical Institute and also underwent treatment therein. He was advised R.F. Lesion but agreed for M U D after fully being informed of the risk involved. The insured was duty bound to disclose of all material facts relating to his health, ailments and hospitalization etc. He has filled the proposal form on 12.2.2002 fully aware to his past ailments of recurring attack of lancinating pain from 1996. He has replied as to the colums with respect to the ailments, treatment, hospitalization etc in the negative and has stated that his state of health is good. He has signed the above declaration in the proposal form. He has suppressed the illness which is sufficient ground for repudiation evenif there is no nexus between the cause of death and concealed fact.
4. The evidence adduced consisted of the testimony of PW1, DW1; Exts.A1 to A5, B1 to B4.
5. The cause of death mentioned in Ext.A5 post mortum certificate is death due to coronary insufficiency. Ext.B1 is the copy of the proposal form wherein the colums with respect to the illness and habits like drinking etc and as to whether he has ever been admitted to a hospital etc are all answered in the negative. The state of health is mentioned as good. Ext.B2 is the medical attendant’s certificate issued by the Consultant Neuro surgeon of Medical Trust Hospital, Ernakulam. The cause of death is mentioned as acute pre operative mio cardiac infarct . It is mentioned that the patient was operated for ® trigeminal neuralgia. Ext.B3 is another certificate issued by the same doctor wherein the date of admission is mentioned as 18.7.04 and death as on 27.7.04. The history of the patient is mentioned as repeated episodes of right sided facial pain since 1996. The diagnosis is ® V I trigeminal neuralgia. Ext.B4 is the copy of the treatment details at Medical Trust Hospital. It is mentioned that he was having a history of sudden onset of recurrent attacks of lancinating pain starting from the bridge of nose on the right side and spreading towards vertex on the right side along upper eye lid since 1996. Pain gets initiated with activities like sudden opening or closing of eyes, sudden opening of mouth, chewing food on right side, swallowing cold water. Pain lasts for less than a minute and resolves completely without a sequelae . There was no history of trauma/® facial weakness/ ® facial numbness, not a known diabetes mellitus /hypertension/ ischaemic heart disease. He was on various combination of medications (Zen retard,Zeptol, Carbamozepine, Gabaptin, Eptoin, Tryptomed, analgesics, steroids) since 1996. He was found to be Leukopenic at Sree Chitra Thirunal Medical Institute (drug induced) for which he was consulted by Hematologist and treated accordingly. Patient was advised RF lesion at Sree Chithra Thirunal Medical Institute but agreed for MUD. He was admitted for observation and management of Leukopenia and ® trigeminal neuralgia. He underwent microvascular decompression of right trigeminal neuralgia on 27.7.04. Peri-operatively abberent vessels (superior petrosal vein tributary and S.C.A loop) were identified in close proximity to the right trigeminal nerve. These vessels were separated and Teflon sheet placed between trigeminal nerve and the surrounding vessels after coagulation and division of all superior petrosal vein tributaries. After adequate haemostasis dural closure was started. Patient developed ST changes followed by cardiac arrest due to peri-operative myocardial infarct. Cardiologist was consulted and appropriate measures taken. Cardio pulmonary resuscitation was started and continued in post operative ward after wound closure. His cardiopulmonary status continued to deteriorate in spite of active resuscitation measures. He died at 9.30PM on 27.7.04.
6. Leukopenia is an abnormal decrease in the number of white blood cells due to adverse drug reaction, pathological condition etc. The complainant has not produced any previous treatment records. It is seen from Ext.B4 treatment record of Medical Trust Hospital that the deceased was having right sided trigeminal neuralgia since 1996. It is mentioned that he was having sudden onset of recurrent attacks of lancinating pain on the right side of the face from the upper eye lid. It was for the above illness that he underwent surgery and it was during the surgery that he developed cardiac arrest. Cardiac arrest due to perioperative myocardial infarct cannot be disassociated from the surgery that he underwent for right trigeminal neuralgia. It was during the surgery for the trigeminal neuralgia that the deceased had the cardiac arrest. Hence the contention of the complainant and the finding of the Forum that there is no nexus between cardiac arrest and the ® trigeminal neuralgia cannot be sustained. Being a contract based on good faith the deceased was bound to disclose the trigeminal neuralgia that he was having. The above illness cannot be treated as a minor one. Treatment for the above illness that included surgery is a major one. Hence we find that the contention that there was no nexus between the illness that he was having and the illness on account of which he died cannot be upheld. Hence we find the order of the Forum can not be sustained. The order of the forum is setaside. The appeal is allowed.
Office will forward the LCR along with the copy of this order to the Forum.
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
SRI.M.K.ABDULLA SONA : MEMBER
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