F.A. No. 259/2006  against C.D. No. 38/2004,  Dist. Forum, Ongole  

Between:

Chalamani Narasa Reddy

S/o. Venga Reddy, Age; 58 years,

R/o. Lawyerpet, Ongole

Prakasham Dist.                                         ***                           Appellants/

            Complainant       

                                                                    And

The Branch Manager

New India Assurance Co. Ltd.,

Trunk Road, Ongole

Prakasham Dist.                                         ***                         Respondent/

Opposite Party

Counsel for the Petitioner:                         M/s. I. Koti Reddy

Counsel for the Respondent:                       M/s. Kota Subba Rao.

QUORUM:

HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.

    &

                                 SMT.M.SHREESHA, MEMBER.
                                                         

FRIDAY, THE TWENTY THIRD DAY OF JANUARY TWO THOUSAND NINE

ORAL ORDER:  (Per Hon’ble Sri Justice D.Appa Rao, President.)

***

Appellant is unsuccessful complainant.

The case of the complainant in brief is that  he had taken  hospitalization  and domiciliary hospitalization benefit policy with the insurance company valid from 10.7.2002 to 9.7.2003 after payment of premium of Rs. 4,206/-.   While so on 13.9.2002  when he got checked up  his health at Heart Foundation, Vijaya Hospital at Chennai  he was directed to undergo angiography operation  on 24.3.2003.  He was operated and discharged on  7.4.2003.   He spent Rs. 1,30,212.47  towards treatment.  When he claimed the said amount it was repudiated on the ground that he had concealed pre-existing ailment of  Coronary Artery Disease  he was not entitled to the amount.  Thereupon he filed the complaint for the said amount with interest and compensation of Rs. 1 lakh.

The insurance company resisted the case.   While admitting that it has issued the policy alleged by the complainant, it stated that when the claimant had claimed the amount towards treatment etc. an enquiry was conducted.   Dr.  C. G. Srinivas  at Vijaya Hospital, Chennai in his diagnosis report mentioned that the complainant underwent computerized stress ECG wherein there was  a mention that  CSA is positive.   Therefore, by 2.7.2002  the complainant was having chest pain.  After  evaluation and obviously after coming to know  he took  the  policy on 9.7.2002.  Since he suppressed the ailment, he was not entitled to the amount claimed.  Therefore it prayed for dismissal of the complaint with exemplary costs.

The complainant in proof of his case filed affidavit evidence and got Exs. A1 to A7  marked while the insurance company filed Exs. B1 proposal form and Ex. B2  diagnostic report  of computerized stress ECG Dt. 2.7.2002. 

The Dist. Forum after considering the evidence placed on record opined that the complainant had suffered pain in chest  on 2.7.2002  evidenced  from Ex. B2  and the said fact was suppressed while  taking the policy,   and therefore the  repudiation was just and consequently dismissed the complaint.  

Aggrieved by the said decision, the complainant preferred this appeal contending that he did not suppress the said ailment.  It ought not to have repudiated the claim basing on Ex. B2 report.

It is an undisputed fact that the complainant had taken  hospitalization  and domiciliary hospitalization benefit policy from the insurance company covering the period from 10.7.2002 to 9.7.2003 evidenced under Ex. A7 after submitting the proposal form  Ex. B1 Dt. 9.7.2002  wherein he mentioned that he was not having  diabetes, hypertension, chest pain or coronary insufficiency or myocardial infraction  

 It is also not in dispute that  on 13.9.2002  he complained chest pain, visited Vijaya Hospital at Chennai  wherein it was diagnosed  that he was having  Coronary Artery Disease, Class-II, Diabetes mellitus, positive TMT, angina vide Ex. A3 coronary angiography.   It was diagnosed that  he was having  coronary artery disease, triple vessel disease.  On that  Coronary Angiography was conducted on 13.9.2002.   He was admitted on 24.3.2003 and was  discharged on  7.4.2003 and he spent  Rs. 1,30,212.47 evidenced under bill Ex. A5. 

When he claimed the said amount the insurance company repudiated on the ground that even before taking the policy  he had chest pain  and got suppressed the ECG  Dt. 2.7.2002 about 7 days prior to his submitting the proposal form wherein  there was a mention that he was having inducible myocardial ischemia.  This is evident from Ex. B2.  He had pain on 2.7.2002.  He did not disown the facts mentioned  in Ex. B2.  He did not allege that it has nothing to do with the chest pain.   Obviously, having come to know positive for inducible myocardial ischemia,  he had taken the insurance policy  on 9.7.2002 suppressing the same.   When he was having diabetes as well as angina, he could not have taken the specific insurance policy for covering the hospitalization charges for the said ailments.  It is a clear case of  suppression of material fact which induced the insurance company to issue the policy.  Therefore the insurance company has rightly repudiated the claim.  We do not see any merits in the appeal.   The Dist. Forum has appreciated the facts in correct perspective. 

In the result the appeal is dismissed. However, in the circumstances of the case no costs.

PRESIDENT                                               LADY MEMBER           

                                     Dt. 23. 01. 2009.