BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION ATHYDERABAD
F.A.No.936 OF 2009 AGAINST C.C.No.695 OF 2008 DISTRICT FORUM-IIHYDERABAD.
Between:
S.K.Naima W/o late S.K.Abdul Rasool
1st Markapur-523316, Prakasham Dist.
A N D
1. India, Markapur
2. India, Divisional Office
3.
Counsel for the Appellant
Counsel for the Respondents
QUORUM:
AND
SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER
FRIDAY THE TWENTY FIFTH DAY OF FEBRUARY
Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)
1.
2. `4 lakh vide policy no.842769302 by paying premium amount of`14,158/-. On 3.11.2006 due to cerebral haemorrhage the husband of the complainant died and to that effect a death certificate dated 9.11.2006 was issued by the Municipal Commissioner. Guntur
3. Guntur.
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9. `4 lakh Guntur Hyderabad
10.
Answers given by the proposer to the two questions were “Sound Health” and “Nil” respectively. It would be beyond anybody’s comprehension that the insured was not aware of the state of his health and the fact that he was suffering from Diabetes as also chronic Renal failure, more so when he was stated to be on regular haemodialysis. There can hardly be any scope for doubt that the information required in the afore extracted questions was on material facts and answers given to those questions were definitely factors which would have influenced and guided the respondent – Insurance Company to enter into the Contract of Mediclaim Insurance with the insured. It is also pertinent to note that in the claim form the appellant had stated that the deceased was suffering from Chronic Renal Failure and Diabetic Nephropathy from 1stJune, 1990, i.e. within three weeks of taking the policy. Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was palpably untrue to his knowledge. There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent – insurer was fully justified in repudiating the insurance contract. We do not find any substance in the contention of learned counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated. Apart from the fact that at no stage the appellant had pleaded that the insured was not treated at Vijaya Health Centre at Chennai, where he ultimately died. It is more than clear from the said certificate that information about the medical history of the deceased must have been supplied by his family member sat the time of admission in the hospital, a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorises the insurer to seek information from any hospital he had attended or may attend concerning any decease or illness which may affect his health.
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KMK*
