AT HYDERABAD.

F.A. 356/2011 against C.C.  103/2009,   Dist. Forum, Chittoor

Between:

C. R. Vijaya, W/o. Chengalrayan Rajagopal

R/o. 2-988/1, Kamalamba Street,

Kongareddipalle, Chitoor Dist.                    ***                         Appellant/

                                                                                                Complainant

And

The Branch Manager

HDFC Standard Life Insurance Company Ltd.

D.No. 27/231/1, Kattamanchi Road

Chitoor Town & Dist.                                  ***                         Respondent/       

                                                                                                Opposite Party

Counsel for the Appellants:                         M/s.    Venkatachalapathi Reddy

Counsel for the Resp:                                  M/s.  S. Gopal Singh

CORAM:

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

                                        SRI R. L. NARASIMHA RAO, MEMBER

&

                                       SRI T. ASHOK KUMAR, MEMBER

MONDAY, THE TWENTY FIFTH DAY OF JUNE TWO THOUSAND TWELVE

Oral Order: (Per Hon’ble Justice D. Appa Rao, President)

                                                            ***

1)                Appellant is un-successful complainant. 

2)                The case of the complainant in brief is that her husband late Chengalrayan Rajagopal had taken  an insurance  policy commencing from  31.5.2008  to 31.5.2027 for a period of 20 years for a sum of Rs. 63,000/-.  While so, he died on 12.11.2008 due to sudden heart attack.  Before issuance of policy he was made to undergo   medical tests, and after  satisfying  with his health condition the policy was given.  The premium was collected on 9.5.2008 by way of demand draft.    She was nominee under the said policy.   When  death was intimated along with documents, her signatures were  obtained on various forms in order to sanction the claim.   Therefore she demanded the amount followed by legal    Therefore, she filed the complaint  claiming Rs. 63,000/- covered under the policy  with interest @ 18% p.a., together with compensation of Rs. 30,000/- and costs. 

3)                 The insurance company resisted the case.   While   issuance of policy it denied that the deceased underwent medical tests at its insistence.    It denied that her   or that of the insured were taken  on various blank forms.    The   under coloumn No. 13  ‘personal medical details’  he mentioned  ‘No’  to all the questions.    Basing on the information provided by him the policy was issued.   When investigation was   it was revealed that  he had suppressed  the pre-existing ailments.  The record maintained by  Appollo hospital shows that  he was admitted on 4.10.2004 and was discharged on 6.10.2004 wherein he was diagnosed  ‘Sub Acute- Antero-septal Infarction’ and he was directed to undergo angiogram he having suffered chest pain  on the left side radiating to left upper limb and throat associated with sweating  and vomiting since 17 days.    He was having diabetes and heart ailment much earlier to it.  He suppressed all these ailments and took the policy in the year 2008, and therefore the claim was repudiated on 13.3.2009 and the same was received by the complainant on 21.3.2009.  Since there   suppression of pre-existing ailments the complainant was not entitled to any amount by virtue of Section 45 of the Insurance Act, and therefore prayed  for dismissal of the complaint with costs. 

4)                The complainant filed rejoinder stating   at the time of obtaining policy signatures were taken enclosing the discharge summary.  It had conducted various tests on the deceased, and after   itself the policy was issued.     of the deceased were taken on blank forms.  The repudiation letter was not received, and therefore prayed that the complaint be allowed. 

5)                The complainant in proof  her  case filed  her  affidavit evidence and got Exs. A1 to  marked while the insurance company filed the affidavit evidence of its Zonal Manager and got Exs. B1 to B5 marked. 

6)                 The Dist. Forum after considering the evidence placed on record opined that the   had suppressed  his ailments evident from Ex. B2 discharge summary  which he had suffered  in October, 2004.   was admitted  as an in-patient  in Appollo hospital.  He   had  the ailments of diabetes and B.P. which he had suppressed in the proposal form.  Since the suppression was   the complaint was dismissed. 

7)                Aggrieved by the said order  complainant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective.    It ought to have seen that at the time when policy was   his previous medical record  was also given.    In fact he was made to undergo various medical tests, and only after satisfying with     the policy was given  after collecting the first premium.   The repudiation was never communicated, and therefore prayed that the complaint be allowed.

8)                The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?  

9)                 It is an undisputed fact that the deceased Chengalrayan Rajagopal

husband of the  complainant had taken the policy Ex. A1  for a sum of Rs. 63,000/- commencing from 31.5.2008  to 30.5.2027.  It is not in dispute that he died on 12.11.2008  from death certificate Ex. A3.  When the claim was made the same was repudiated on the ground of suppression of pre-existing ailments evidenced under Ex. B3.    The fact  repudiation was sent  evident  from proof submitted by the courier,   and the acknowledgement of the complainant vide Ex. B4.    The complainant did not deny that the deceased undergoing  in the Apollo hospital  on 4.10.2004.   He was discharged on 6.10.2004 vide   Ex. B2,   discharge summary wherein the following facts were mentioned:

Diagnosis :  Sub Acute – Anteroseptal  Infarction

                    History of the illness &   in the hospital:

                    Mr. C. Rajagopal, 53 years, male was admitted with history of left   chest pain radiating to left upper limb and throat associated with   sweating and vomiting since 17 days.  Treated at private hospital, Chitoor but   persisted.  Hence came   AAH.  His diabetic status was detected at Chitoor recently.   He is chronic smoker and alcoholic. 

                           ECG, ST segment elevation in V1, V2, V3, ST/II V5 suggestive  of sub-acute Antero-septal infarction. 

                    Echo diagram:      Regional wall motion abnormality, involving anterior wall, septum   apex anterolateral wall inferior  symptom  wall. LV normal in size with moderate   dysfunction.

                    After admission, he was treated   Asprin, Clopidegrel,  Captopril.  His diabetic   was controlled with insulin.  Hence his being discharged with advise to   angiogram at the earliest possible.

                    after 15 days. ”

It is   known whether the deceased  underwent angiogram as advised.      The fact remains that  after his discharge on 6.10.2004  he submitted the proposal form Ex. B1 wherein under coloumn No. 13  ‘Personal Medical Details’  he indicated that he was not suffering from  diabetes,  high B.P, heart ailment under sub-heading a,b, and q as ‘No’ ticking in the appropriate box.    The contention that signatures were   on blank forms etc., would not have been true  as all the coloumns  were filled.  His photo was also affixed on which   signed across  the photo.   

10)              The complainant contends that the entire discharge summary Ex. B2 was furnished to the insurance   before taking of  the policy  on which he was again made to undergo several tests, and after satisfying  with it policy was issued.    In proof of it, she relied on blood   enclosed to the proposal form.   This isolated report could not have been submitted along with proposal form.  The respondent while filing the discharge summary filed the said report.  May be it was dated 6.8.2007.    The fact remains that the insured while mentioning  under the coloumns  the particulars of pre-existing ailments  had denied having any ailment,  though admittedly he was admitted in Apollo Hospital  for the ailments which we have earlier mentioned.     It is not as   the deceased was an illiterate.  He was an Engineer   C.R. Turbo  Engineering  Services which he mentioned in his proposal form.    This   amounts to suppression which entails repudiation of the claim. 

11)               The learned counsel for the appellant/complainant relied the following decisions for the proposition   when there was no suppression of ailments, and there  was no nexus with the previous ailments  to the cause of death the repudiation was unjust. 

             i.        LIC   of India Vs.  Haridas Dey reported in  2011 ACJ 906

           ii.        Kunti Lata  Sahoo Vs. Senior Divional Manager, LIC  reported in 2011 ACJ 1001

          iii.        National Insurance Company Vs. P.R Narayana Kartha reported in  IV (2010) CPJ 200

          iv.        Oriental Insurance Company Ltd.  Vs.  A. Vijay Kumar reported in IV (2010) CPJ 272

            v.        New India Assurance Company Ltd. Vs., Jagrut Nagarik reported in IV (2010) CPJ 37

          vi.        LIC   of India Vs. Smt. Pankaj Pandey Reported in IV (2010) CPJ 189.

Those  are all cases where  non-mention of unrelated illness to the cause of death was held to be  not material.    It was held that ailment which the assured   does not have  any bearing  on the risk undertaken by the insurance company and non-disclosure  of the same cannot be said to be material, especially when  the same did not affect the life expectancy of the deceased.    It was held that the repudiation was unjust. 

12)              Since in the instant case, the insured having underwent treatment  and even admitted in the hospital  as an in-patient,  and the discharge summary discloses that he was suffering from ‘Sub Acute- Antero-septal Infarction’ besides diabetes and high blood pressure, and non-mentioning of the same in the proposal form amounts to material suppression. 

13)              It is settled proposition of law reiterated in P.C. Chacko & anr Chairman, Life Insurance Corporation of   reported in  III (2008) CPJ 78 (SC)  the Supreme Court held:

 “The purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression  was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law.”

When he did not inform the   which were existing for the last several years, it would amount to suppression of material fact which would entail insurance company to repudiate the policy.    Ex. B1 would itself show that he had suppressed all these ailments.    Therefore, we are of the opinion   the complainant is not entitled to the amount.  The Dist. Forum rightly considered the evidence on record and up-held the repudiation.   We do not see any mis-appreciation of fact or law by the Dist. Forum in this regard.  We do not see any merits in the appeal.

14)               In the result the appeal is dismissed.   

1)      _______________________________

PRESIDENT                 

2)      ________________________________

 MEMBER           

3)      ________________________________

 MEMBER           

25/06/2012

*pnr

UP LOAD – O.K.