BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. M.N.MANOHARA, B.A.,LLB., Member, 3. A.P.MAHADEVAMMA, B.Sc., LLB., Member, ORDER Complaint No.MDF/C.C.No.23/2010 Order dated this the 26th day of May 2010 COMPLAINANT/S Smt.H.S.Nirmala W/o Late V.Venkatakrishnaiah, R/o Door No.319, 1st Main, 3rd Cross, Leelavathi Extension, Maddur. (By Sri.D.G.Niranjanamurthy., Advocate) -Vs- OPPOSITE PARTY/S 1.The Post Master, Post Office, Maddur. 2.The Superintendent of Posts, District Post Office, V.V.Road, Mandya. 3.The Deputy Divisional Manager, Postal Life Insurance, Karnataka Circle, Bangalore-560001. (By District Government Pleader) Date of complaint 17.02.2010 Date of service of notice to Opposite parties 01.03.2010 Date of order 26.05.2010 Total Period 2 Months 25 Days Result The complaint is dismissed. However, there is no order as to costs. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act, 1986 claiming insurance amount of Rs.1,50,000/- with interest against the Opposite parties. 2. The case of the Complainant is that V.Venkatakrishnaiah, the husband of the Complainant had insured his life with 1st Opposite party under PLI Policy No. KT 248046-R, dated 01.03.2005 for Rs.1,50,000/- and he died on 22.07.2006 due to heart attack on the way to the General Hospital, Maddur and before that he was hale and healthy. Being the nominee, the complainant submitted the claim to the 1st Opposite party and the Opposite party has not settled the legal claim, instead the 3rd Opposite party had issued an endorsement dated 10.09.2008 by repudiating the claim with untenable ground that the deceased V.VenkataKrishnaiah had suppressed the fact of his diseases namely diabetes, hypertension at the time of taking the policy. The claim is repudiated under false pretext with untenable grounds and shows the negligence to settle the claim. Therefore, the present complaint is filed. 3. The Opposite parties were served with notices and 2nd Opposite party has filed version. Admitting that V.VenkataKrishnaiah had insured his life with 1st Opposite party under PLI Policy of Rs.1,50,000/- and upon his death on 22.07.2006 claim was made by the Complainant as a nominee, it is pleaded that as per rules, enquiry was conducted, since the death occurs within 3 years of acceptance of the policy and thorough examination of the case and as per the confidential report and discharge summary issued by the Hosmat Hospital, Bangalore, the insured was a known diabetic. However, the deceased V.Venkatakrishnaiah, while applying for the policy has suppressed this fact of diabetes, even though, he was a known case of diabetes since 2002 and so, the Opposite parties have repudiated the claim and issued a endorsement dated 10.09.2008 to the Complainant. The other allegations are not accepted. There is no deficiency in service on the part of the Opposite parties. The Complainant is not at all entitled to receive the insured amount. Therefore, the complaint is liable to be dismissed with costs. 4. During trial, the Complainant is examined and the Complainant has produced the documents Ex.C.1 to C.4. On behalf of the Opposite parties, one witness is examined and documents Ex.R.1 & Ex.R.2 are produced. 5. We have heard the both sides. 6. Now the points that arise for our considerations are:- 1. Whether the life assured V.Venkatakrishnaiah had suppressed the fact of diabetes while applying for the policy, even though he was a known case of diabetes since 2002? 2. Whether the Opposite party has committed deficiency in service in repudiating the insurance claim? 3. Whether the Complainant is entitled to the insurance amount? 7. Our findings and reasons are as here under:- 8. POINTS NO.1 & 2:- The undisputed facts are that V.Venkatakrishnaiah, the husband of the Complainant had obtained insurance policy from the Opposite party Department on 01.03.2005 for Rs.1,50,000/- and Complainant is the nominee and insured died on 22.07.2006 and the Complainant preferred the claim and the Opposite party repudiated the claim on the ground of suppression of material fact of disease namely diabetes mellitus and hypertension at the time of taking the PLI policy as per Ex.C.3. 9. The Complainant has questioned the same contending that her husband was hale and healthy before his death, but died due to heart attack. 10. Now, we are not concerning with the case of death. The ground on which the Opposite party has repudiated of the claim is the suppression of material fact of disease namely diabetes mellitus, hypertension at the time of taking the PLI policy by the life assured. So, the burden is on the Opposite party to prove the same. In this regard, on behalf of 2nd Opposite party, one Official is examined by filing affidavit and the Opposite party has relied upon the document Ex.R.1 & R.2. Ex.R.1 is the certified copy of the proposal form for postal life insurance by the life assured V.Venkatakrishnaiah. Ex.R.2 is the copy of the discharge summery issued by Hosmat Hospital. 11. In Ex.R.1 proposal form, the life assured has given answer No for question No.16(b); have you ever suffered from any of the following diseases. The diseases include diabetes, hypertension and he answered No to the question 16(c), which states during the last three years, have you ever consulted a Medical Practitioner for any ailment regarding treatment for a week or more. As per Ex.R.2, the discharge summary of Hosmat Hospital, V.Venkatakrishnaiah was admitted to hospital on 08.06.2002 as inpatient and discharged on 15.06.2002 and as per this document, he was admitted with a history of road traffic accident in Maddur while going in two wheeler, which was hit by four wheeler and while giving history it is given as known diabetic on treatment and even treatment for diabetic was given and diabetic management was also advised. 12. On the basis of these documents, it is contended by the learned counsel for the Opposite parties that this document clearly proves that the deceased life assured was suffering from diabetes as a known case of diabetic since 2002 and in spite of it, at the time of submitting the proposal form in 2005, he has suppressed the same giving false answer to the question No.16 (b & c). 13. On the other hand, the learned counsel for the Complainant contended that the Opposite parties have settled other two claims and Ex.R.2 discharge summery is not proved by examining doctor who treated the insured and the insured was not admitted to the hospital for the treatment of diabetes or hypertension, but on account of road traffic accident and the Complainant has denied disease of diabetes to her husband and treatment for diabetes at Hosmat Hospital and contended that the repudiation is illegal and has relied upon the decision reported in IV(2009) CPJ page 140 in case of L.I.C. Vs- Tripti Kana Sadhu by West Bengal State Commission and also III(2009) CPJ page 51 in case of L.I.C. Vs- Arati Chatterjee by Delhi State Commission. In the case of L.I.C. Vs- Tripti Kana Sadhu, West Bengal State Commission has held that when the earlier policy purchased by assured was settled, the contention of assured having diabetes, the same was not possible if assured was a patient of alleged disease for past 8 to 10 years. Photocopies of prescriptions never produced as evidence by Opposite party. The doctor who allegedly treated by assured was not examined. Certificate and bed head ticket of the hospital are also not proved. On these grounds, the West Bengal State Commission has held that the suppression of material fact is not proved and the deficiency in service is proved and upheld the order of the District Forum. In the case of L.I.C. Vs- Arati Chatterjee, the Delhi State Commission has held that contention that the deceased suffering from diabetes mellitus at the time of taking the policy is not acceptable, unless a person is hospitalized/undergone operation/admitted for treatment for particular disease in rear proximity of obtaining the policy, the insured is not supposed to disclose about day to day problem. On these grounds, when the insured died due to cardiac arrest, the contention of suppression of material fact was not accepted by the District Forum and also Honble State Commission. 14. Now, coming to the facts of the present case, the insured obtained PLI policy for Rs.1,50,000/- on 01.03.2005 and he died on 22.07.2006. So, within 1 ½ year of the taking policy, the assured died due to heart attack according to the Complainant. According to the Opposite party, when the claim was made, the Opposite party conducted a investigation as it is early claim and as per the confidential report and discharge summary issued by the Hosmat Hospital, Bangalore he was a known diabetic since 2002. But, he had suppressed the fact of his diabetes while applying for the policy in the year 2005. 15. The Complainant in her evidence has admitted that on 08.06.2002 her husband met with an road traffic accident and sustained injury and he was treated in Hosmat Hospital, Bangalore. She has admitted that Hosmat has issued discharge summary document. Of course, she has denied that at the time of treatment in Hosmat Hospital her husband was subjected to test for diabetes and he was treated for diabetes and prescribed continuous treatment for diabetes. According to the affidavit of the 2nd Opposite party Officer, the Complainant submitted the true copy of the discharge summary of late V.Venkatakrishnaiah issued by the Hosmat Hospital. This evidence of Opposite party side is not questioned by the Complainant side. According to the Opposite party, Ex.R.2 is the true copy of the discharge summary issued by Hosmat Hospital and it was furnished by the Complainant. Under these circumstances, though the Opposite party has not examined the doctor who treated the insured V.Venkatakrishnaiah, but the fact remains unchallenged that the deceased assured was admitted to Hosmat Hospital on 08.06.2002 due to road traffic accident and he was treated. So, where the entire treatment was mentioned in the discharge summary, it is not just to accept part of the discharge summary and to reject the part of the discharge summary with regard to the history of known diabetic treatment and treatment for diabetic and advise by Dr.Karunesh Kumar for diabetic management and also evaluation after one week with reports. There is no reason to suspect the discharge summary of Hosmat Hospital Ex.R.2 since, the Complainant has admitted that her husband was admitted to Hosmat Hospital on 08.06.2002 for road traffic accident. So, when treating the insured due to road traffic accident, he gave history of known diabetic treatment and further, at the time of treatment, treatment of diabetic was also given and further, diabetic management was advised by Dr.Karunesh Kumar for review with Dr.Karunesh Kumar after one week with the FBS and PPBS reports. Even though, as contended by the learned counsel for the Complainant hypertension and diabetes are common in these days and a person will not come to no of this ailment, unless he is admitted to hospital and diagnosed and treatment is given, but in the present case, though the deceased insured was admitted to Hosmat Hospital on account of road traffic accident in 08.06.2002, but the doctor would enquire about the previous history and the patient would give details of treatment he had undergone and medication about his health and then on investigation the disease of diabetes will be revealed and treatment would be given to such patient. So, the decisions cited by the learned counsel for the Complainant are not applicable to the facts of the case and not helpful to the Complainant. This has happened in the present case also. In the decision reported in III (2003) C.P.J Page 15, the Honble National Commission has held that even though the doctor is not examined, we must give a statement recorded in the normal course of discharge of ones duty. In the present case also even though the doctor who treated the insured in Hosmat Hospital is not examined, but the evidence clearly proves that the Hosmat Hospital issued the discharge summary to the Complainant and according to the Opposite party, the Complainant submitted the true copy of the discharge summery of V.Venkatakrishnaiah. Under these circumstances, there is no reason to discard Ex.R.2 discharge summery and not to give any credence to the contents of Ex.R.2. There is no evidence that Opposite party has settled other policy claims to say that repudiation on the ground of suppression of material fact by Opposite party is not acceptable. 16. In view of the proof of Ex.R.2 and the evidence of the Complainant, it is proved by the Opposite party that the deceased assured was a known patient of diabetes since 2002 and having knowledge of treatment in 2002 itself for diabetes, has suppressed the said material facts at the time of giving proposal for Postal Life Insurance as per Ex.R.1 and therefore, the Opposite party is justified in repudiating the claim, since within two years of the policy, the insured died. Therefore, the Complainant has failed to prove that Opposite party has committed deficiency in service in repudiating the claim and therefore, we answer points No. 1 and 2 against the Complainant and infavour of the Opposite party. 17. POINT NO.3:- Though the Complainant has claimed insurance amount. But, in view of our findings on point No.1 and 2, the Complainant is not entitled to the insurance amount as claimed. 18. In the result, we proceed to pass the following order; ORDER The complaint is dismissed. However, there is no order as to costs. (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 26th day of May 2010). (PRESIDENT) (MEMBER) (MEMBER)
