Sri.Siddegowda,<br /> President<br /> <br /> 1. This complaint is filed under section 12 of the Consumer Protection Act 1986, for settlement of insurance claim with accidental benefit.<br /> 2. The facts of the complaint are as fallows; <br /> Late H.C.Shankaralingegowda, the father of the complainants had insured his life with the Opposite party Insurance Company for Rs.75,000/- with accident benefit under the policy No.0019436818 and said policy was issued after medical check up by the Doctor of the Opposite party. The insured H.C.Shankaralingegowda fell ill and admitted to Mamatha Nursing Home, Mandya on 19.07.2006 and took treatment and diagonised that he was having sugar complaint for the first time. He had taken follow-up treatment and on 10.08.2006 the assured due to chest pain, was admitted to Niveditha Nursing Home, Mandya, and after first aid treatment, he was shifted to Vikram Hospital, Mysore for better treatment at 8.00 a.m. on 10.08.2006, but died at 2.15 a.m. on 11.08.2006 due to cardio-respiratory arrest secondary to IHD, type-2 diabetes mellitus, hypertension. So, the complainants claimed the insurance amount from the Opposite party and as per the letter dated 22.09.2006, the complainants submitted all the relevant documents, but Opposite party repudiated the claim by a letter dated 29.11.2006 on the ground of non-disclosure of the material facts i.e. the life assured had not disclosed in the proposal form that he was suffering from type-2 diabetes mellitus and Bio-cardiac infection since 15 years. Even though, the Claim Review Committee of the Opposite party was approached with the certificate that at the time of admission entries are made mistakenly as 15 years, instead of 15 days, but the Opposite party has repudiated the claim and therefore the present complaint is filed.<br /> 3. The Opposite parties have filed version admitting that H.S.Shanakaralingegowda had insured his life with the Opposite parties and obtained the policy, but denied that after medical check up and obtaining all necessary particulars, polices was issued and prior to insuring the life of the insured had not suffered from any disease or ailment at any point of time. In fact, the deceased H.C.Shankaralingegowda was suffering from diabetes mellitus type-2 before obtaining the policy and the policy is a non-medical policy. Denying the other allegations made in the complaint, it is pleaded that deceased H.C.Shankaralingegowda died due to diabetes mellitus and hypertension and was suffering from MI and diabetes mellitus since 15 years and also hypertension since 2 months prior to admission to the Vikram Hospital and these material facts were not disclosed before taking the policy. Later on son and son-in-law of the deceased have won over the doctor of Vikram Hospital and managed to get the report in their favour that he was not suffering from any MI and diabetes mellitus. But the earlier report issued by the Vikram Hospital after thorough check up and investigation clearly strengthen that deceased was suffering from MI and diabetes mellitus. The Review Committee has not directed to produce the fresh death summary. It is purely concocted story of the complainants to lay false claim. Therefore, the repudiation is proper and the complainants are not entitled to any amount of insurance and the complaint is liable to be dismissed with cost. <br /> 4. During trail, the 1st Complainant was examined as CW.1 and Ex.C.1 to Ex.C.7 are marked. On behalf of the Opposite parties, the Doctor from the Vikram Hospital is examined as RW.1 and Ex.R.1 to R.3 are marked.<br /> 5. We have heard both the sides.<br /> 6. Now the points that arise for our considerations are:-<br /> 1) Whether the deceased H.C.Shankaralingegowda was suffering from MI and diabetes mellitus since 15 years and prior to his death and concealed these material facts at the time of obtaining the policy?<br /> 2) Whether repudiation by the Opposite party is proper?<br /> 3) What order?<br /> 7. Our findings and reasons are as here under:-<br /> 8. POINTS No.1 to 3:- The undisputed facts are that Sri.H.C.Shankaralingegowda, the father of the complainants had insured his life with Opposite party Company for a sum of Rs.75,000/- with accidental benefit from 28.03.2006 vide policy No.0019436818. It is also admitted fact that he was admitted to Vikram Hospital on 10.08.2006 at 8.00 a.m. due to chest pain, but died at 2.15 a.m. at night. When the claim of insurance was made by the complainants, the Opposite party rejected the claim on the ground that at the time of obtaining the policy, the insured had concealed the material facts about MI and diabetes mellitus type-2.<br /> 9. But, the contention of the complainant is that the deceased was hale and healthy, but he fell ill and so he was admitted to Mamatha Nursing Home, Mandya on 19.07.2006 and for the first time it was diagonised that the insured was having sugar complaint. The complainant has produced Ex.C.7 Biochemistry report, wherein the Fasting Blood Sugar was tested and sugar level was 115 mg, though the normal value is 65 to 95 mg and this report is dated 17.07.2006. But this report does not say whether he was an inpatient or out patient and Ex.C.7 reveals only the Blood Sugar level as on that date. As per Ex.R.1, the case sheet pertaining to the deceased produced by the witness Cardiologist from Vikram Hospital, the patient was brought and admitted by Dr.Anand who is the brother of the deceased on 10.08.2006 at 8.00 a.m. the deceased was examined by the Cardiologist and written all information given in the case sheet. The history is recorded as follows; “ Chest pain since 12.30.a.m. in the night retrosternal chest pain, non-radiating associated with profuse sweating. No H/o of giddiness, no history of vomiting. H/o of cough since morning associated with difficulty in breathing. H/o orthopnoea.”<br /> “Fast history – H/o MI 15 years back, patient was admitted to Jayadeva Hospital and evaluated details not available. H/o DM since 15 years on OHA’S – T Dibizid, H/o Hypertension since 2 months on T - Losar H. No h/o BA/Epilepsy/TB. Personal history – no habits”. This history is recorded in discharge summary Ex.C.6 also. The 2nd complainant the son of the deceased assured and one M.T.Prakash the son-in-law of the assured gave a letter stating that instead of 15 days, it is wrongly mentioned as 15 years and the entry of history of MI is 15 years and admission to Jayadeva Hospital and having diabetes since 15 years is not correct and thus requested to correct the statement in the death summery. Thereafter this RW.1 Cardiologist on the basis of these letters Ex.R.2 made entry in the death summery; “as per patient son and son-in-law declaration, there is no history of MI 15 years above, the patient was not admitted or seen at Jayadeva Hospital, is not a known diabetic”. Ex.C.6 is the copy of the death summery issued by the Vikram Hospital by RW.1 Dr. Keshava Murthy and according to his evidence on 16.09.2006 he has written in hand writing on death summery on the basis of the letter Ex.R.2. The contention of the complainants that their father was not having any MI and not treated at Jayadeva Hospital and was not having diabetes mellitus since 15 years and only for the first time it was noticed from 17.07.2006 cannot be believed at all, because the Dr.H.C.Anand, the brother of the deceased assured, admitted the assured to Vikram Hospital and gave the history and he has signed the consent letter for admission and treatment in CCU. So, it cannot be said that the cardiologist at the time of examining the patient has wrongly mentioned about the history of MI since 15 years and admission to Jayadeva Hospital and having diabetes mellitus since 15 years. At no stretch of imagination a Cardiologist would write such history without information and it cannot be said that the brother of the deceased who is running the Mamatha Nursing Home and who is a Doctor, has given false statement. Though the Cardiologist on 16.09.2006 made entries in his hand writing, it is only on the basis of letter Ex.R.2 given by the son of the complainant who was not present at the time of admission in the Vikram Hospital. So it is an afterthought to claim insurance. The complainants have not stated as to who gave history but suppressed that fact. The Cardiologist (RW.1) has filed affidavit about the entries made in the case sheet and death summery and there is no reason to disbelieve his evidence and the case sheet which reveal that the history of MI since 15 years and treatment at Jayadeva Hospital and further diabetes mellitus since 15 years and on medication for diabetes & blood pressure. Merely because the Doctor has later made entry at the pressure of the 2nd complainant by giving letter Ex.R.2 and R.3, later insertion in the death summery has no value at all. In fact, the Dr.Ananda H.C. who admitted the deceased at Vikram Hospital and gave history should have given letter to the Vikram Hospital for correcting the entries made and not the son of the complainant. So it proves that only for the purpose of claiming the insurance amount, the complainants got made an entry subsequently in the death summery Ex.C.6 in hand writing, though the case history and death report is recorded through computer. <br /> 10. Admittedly, the policy was obtained on 28.03.2006, the insured died on night of 10.08.2006 within 5 months. The evidence and records clearly establish that at the time of obtaining the policy and prior to obtaining the policy i.e., since 15 years prior to August 2006, the assured was suffering from MI and diabetes mellitus and taken treatment at Jayadeva Hospital and on medication and inspite of it, he has not disclosed the same at the time of obtaining the policy. The fact that the policy is a non-medical policy is not disputed, so in case of non-medical policy there is no question of examination by the Doctor of Insurance Company. Even if the Doctor of the Insurance Company examined the insured, but unless the heart disease and diabetes mellitus are disclosed a ordinary Doctor who is not a specialist will not be able to find out the heart disease and diabetes. In fact in the complaint the reason of death and illness complainants have stated. Therefore, the Opposite parties have proved that the deceased assured was having MI and diabetes mellitus type-2 since 15 years prior to obtaining the policy and in fact he was treated at Jayadeva Hospital prior to obtaining the policy and these material facts were not disclosed by the assured at the time of obtaining the policy and suppressed these material facts.<br /> 11. It is established that the contract of insurance is based on utmost good faith. If any statement given by the assured is false, the contract becomes voidabinitio. The non-disclosure of the information regarding state of health in the proposal form amounts to concealment of material facts. Therefore, the Opposite party has right to repudiate the claim for suppression of material facts about the health in the proposal form by the assured. Therefore, the opposite party is perfectly justified in rejecting the claim of the complainants as their father had obtained the policy by stating false facts and concealing the true facts. Therefore, the complainants are not entitled to the insurance claim. Further, it cannot be understood how the complainants have claimed accidental benefit also, because the death of the insured is not by any road accident, but only due to illness. Under these circumstances, the complainants are not entitled to the insurance claim. <br /> 12. In the result, we proceed to pass the following order;<br /> ORDER<br /> The complaint is dismissed. However, there is no order as to cost.<br /> <br /> (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 16th day of July 2008).<br /> <br /> (PRESIDENT)<br /> (MEMBER)<br /> (MEMBER)<br />