IN THE DISTRICT CONSUMERS’ DISPUTES REDRESSAL FORUM AT MYSORE<br /> <br /> PRESENT: 1. Shri.D.Krishnappa<br /> B.A., L.L.B - President <br /> <br /> 2. Smt.Y.V.Uma Shenoi<br /> M.Sc., B.Ed., - Member<br /> <br /> 3. Shri. Shivakumar.J.<br /> B.A., L.L.B., - Member<br /> <br /> CC 350/08 DATED 19.02.2009<br /> ORDER<br /> <br /> Complainant Smt.Bhoodevi, <br /> W/o Late Srinivasa.T., Village Purohitha, No.14, Chamundeshwari Badavane, Nanjangud Town, Mysore District.<br /> (By Sri.B.S.Sidda Naika., Advocate)<br /> <br /> Vs. <br /> Opposite Parties 1. The Manager, SBI Life Insurance Company Ltd., State Bank of India, Nanjangud Branch, Nanjangud.<br /> 2. SBI Life Insurance Company Limited, Central Processing Centre, K.N.P. Bhavana, Flat No.3A, Sector No.10, CBD, Belapura, New Mumbai-400614.<br /> (By Sri.S.B.C. Advocate for O.P.1 and <br /> Sri.CMJ, Advocate for O.P.2)<br /> <br /> Nature of complaint : Deficiency in service<br /> Date of filing of complaint : 07.11.2008<br /> Date of appearance of O.P. : 16.12.2008<br /> Date of order : 19.02.2009<br /> Duration of Proceeding : 2 MONTHS 3 DAYS<br /> <br /> <br /> PRESIDENT <br /> <br /> <br /> <br /> MEMBER<br /> <br /> <br /> MEMBER<br /> <br /> Sri.D.Krishnappa,<br /> President<br /> <br /> 1. The grievance of the complainant in brief is, that her husband Late Srinivasa.T. Grama Purohitha had taken a Home Loan Insurance Master Policy from the opposite parties on 29.12.2007 for Rs.6,00,000/- by paying premium of Rs.41,893/-. That she is the nominee of the insured. That at the time of the inception of the policy, the opposite parties had taken medical fitness certificate showing the fitness of the insured. That her husband died on 27.05.2008, as the result she by furnishing all the necessary documents to the opposite parties claimed insurance amount of Rs.6,00,000/-. But, the opposite parties have not paid insurance amount and they went on giving one or the other reasons. Therefore, she on 23.09.2008 got issued a legal notice to the opposite parties, but is of no use and therefore has prayed for a direction to the opposite parties to pay her the insurance amount of Rs.6,00,000/- and also to award damages of Rs.50,000/- for mental agony besides cost of this complaint. <br /> <br /> 2. The opposite parties have appeared through their advocates and filed separate versions. The first opposite party in his version without disputing the issuance of the policy in favour of the deceased has only contended that he had forwarded the claim al of the complainant to the second opposite party for approval and they had no role in the issue of policy and honouring of the policy. In response to the forwarding of the claim of the complainant to the second opposite party, the second opposite party vide their letter dated 06.08.2008 informed him expressing their inability to meet the claim of the complainant, further informing that the insured deceased has signed a declaration of good health declaring as if he was having good health and was not suffering from any illness. But, as per the records, it was found that the insured was suffering from Ischaemic Heart Disease prior to the issue of the policy dated 14.12.2007 and he has suppressed the disease he was having and therefore stated that the claim of the complainant has been rightly repudiated and thus has prayed for dismissal of the complaint. <br /> <br /> 3. The second opposite party in his version has also stated that the insured deceased while giving a proposal for issue of a policy committed breach of principle of utmost good faith by suppressing the fact that he was diagnosed for Ischaemic Heart Disease and underwent angioplasty and stent implantation in the year 2004. That he was also suffering from diabetes for more than 6 years and thus contending that the insured has committed breach of good faith and given false information in the proposal form with a fraudulent intention by way of concealment. It is further detailed that the insured was hospitalized during February 2004 and was discharged on 25.02.2004 was again hospitalized during September 2004 and was diagnosed for diabetic cystopathy with bialateral grade-V refluxing non-obstructive mega ureter and was underwent MCU and cystoscopy under short GA and the insured had the history of anterior wall myocardial infraction and underwent angioplasty and diabetes mellitus for 6 years. But, the insured did not disclose this past history and the cause of death is shown as myocardial infraction directly associated with his pre-existing heart disease and therefore justifying their action in repudiating the claim have denied having had caused any deficiency in their service and thus has prayed for dismissal of the complaint.<br /> <br /> 4. During the course of enquiry in to the complaint, the complainant has produced a copy of the policy, death certificate of the insured and a copy of the legal notice she got issued to the opposite parties. The second opposite party has produced a copy of the Home Loan Insurance Master Policy, then general conditions of the policy, report of their investigator and copy of the case sheet of Vikram Hospital, Mysore, in which the insured had undergone treatment with discharge summary of the said hospital. Heard the counsel for both the parties and perused the records.<br /> 5. On the above contentions, following points for determination arise.<br /> 1. Whether the complainant proves that the opposite parties have caused deficiency in their service in repudiating her claim for payment of the insurance amount?<br /> 2. To what relief, the complainant is entitled to?<br /> <br /> 6. Our findings are as under:-<br /> Point no.1 : In the Negative.<br /> Point no.2 : See the final order.<br /> <br /> REASONS<br /> <br /> 7. Point no. 1:- As could be seen from the contentions of both the parties, the fact that the husband of the complainant had taken a Home Loan Insurance Master Policy for Rs.6,00,000/- by paying a premium of Rs.41,893/- with effect from 29.12.2007 is not in controversy. The fact that the insured died on 27.05.2008 leaving the complainant as his nominee is also not in dispute. Further the contention of the opposite parties that the insured died due to myocardial infraction is also not in dispute. But, the dispute started when the claim of the complainant as a nominee under the policy and wife of the insured for payment of the insurance amount came to be repudiated by the second opposite party by their repudiation letter dated 06.08.2008. The opposite parties in their repudiation letter and also in the version and affidavit evidence filed before this Forum have contended that the insured when moved for issue of that policy gave health declaration, declaring as if he was in sound health do not have any physical defect / deformity, performs his routine activities independently and that he never suffered or have been suffering, or have been hospitalized for any critical illness or a condition requiring medical treatment for a critical illness as on date. But, as verified from the records, the insured was in fact was suffering from heart disease from the year 2004 and thus have argued that the insurance which has been issued under utmost good faith has become vitiated in view of suppression of material fact by the insured.<br /> <br /> 8. The opposite parties to substantiate their contention of pre-existing disease that the insured had and that the insured had undergone treatment for his heart disease and that a false declaration has been given by the insured have produced the history sheet of the insured maintained with Vikram Hospital, Mysore and also a copy of the health declaration given by him. On perusal of the case sheet of the Vikram Hospital, it is found that the insured was admitted to that hospital on 17.02.2004 and was discharged from the hospital on 25.02.2004 in between, the doctors in that hospital diagnosed the insured as “IHD Anterior wall myocardial infraction (thrombolysed), post infraction angina, single vessel coronary artery disease, mild left ventricular systolic dysfunction, EF-45%, Type II diabetes mellitus with nephropathy”. Procedure done is shown on 19.02.2004 Angioplasty and stent implantation (3 x 18 Tristar) of mid LAD artery. With this procedure, the insured was discharge from the hospital with necessary advise with final diagnose as Acute anterior leptle wall (MI) – Type II DM. The complainant has not disputed the history sheet of the Vikram Hospital which discloses the ailment of the insured, diagnose reached there, and the procedure done. As against this factual aspects, the insured when he gave health declaration form on 08.12.2007 declared as if he was in sound health had not suffered any ailment as already stated above, and even further stated as if he was not taking treatment for heart disease. Further, the insured has declared at the bottom of the declaration form that what he has stated above is all true.<br /> <br /> 9. The counsel representing the complainant in his arguments submitted that treatment taken for heart ailment once and for diabetes cannot be construed as a chronic or serious disease for repudiating the claim of the complainant and further submitted even if the insured had suffered such an ailments at some stage that should not be take into consideration even after gap of some time or some years and therefore stated that repudiation of the claim by the opposite parties is illegal and submitted for allowing the complaint. We may to some extent agree with the arguments of the counsel for the complainant if the insured was only suffering some kind of diabetes for some period and that should not be construed as a serious ailment for all the time to come to deny the insurance amount. Because, the diabetes in the recent years is a common phenomenon in many of the people and if that is taken care of it may not affect the health of the patient totally, but in the case on hand as evident the insured had suffered heart disease warranting implantation of a stent with angioplasty. That being an admitted fact it cannot be said that the diabetes has not contributed to the heart disease and heart disease was arrested at that stage and that the insured later did not suffer any disability and was keeping sound health. Implantation and continuation of stent is nothing but a continuation of his ailment with chronic-diabetic mellitus is a cause for concern and that development diagnosed in the health of the insured cannot be turned as a short lived disease on that ended long back and that the insured later was keeping good health. These materials placed before us is evident of the fact that the insured was suffering from sever health problem and despite that he gave a declaration of his good health suppressing all the facts which were in his knowledge and thereby committed breach of good faith. That suppression in our view is a suppression of material facts, which vitiate the contract and that discharges the opposite parties from their obligation of meeting the insurance. Thus, we do not find any deficiency in the service of the opposite parties in repudiating the claim of the complainant and therefore the complaint is devoid of merits and is liable to be dismissed. With the result, we answer point no.1 in the negative and pass the following order:- <br /> <br /> ORDER<br /> <br /> 1. The Complaint is dismissed.<br /> 2. Parties to bear their own costs.<br /> 3. Give a copy of this order to each party according to Rules.<br /> <br /> (Dictated to the Stenographer, transcribed by her, transcript revised by us and then pronounced in the open Forum on this the day 19th February 2009)<br /> <br /> <br /> <br /> <br /> <br /> (D.Krishnappa) <br /> President <br /> <br /> <br /> <br /> (Y.V.Uma Shenoi)<br /> Member<br /> <br /> <br /> <br /> (Shivakumar.J.)<br /> Member<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />