JUDGMENT

JUSTICE SHRI. K.R. UDAYABHANU:   PRESIDENT

          The appellant is the complainant in OP 117/04 in the file of CDRF, Idukki.  The complaint stands dismissed.  It the case of the complainant that herself and her deceased husband was having medi-claim insurance policy with the opposite party/National Insurance Company Ltd. for a sum of Rs.50,000/- each for the period from 1-10-2002 to 30-09-2003.  Prior to the above policy they were having medi-claim policies continuously for the preceding 3 years from the Oriental Insurance Company.  On 24-06-2003 her husband felt chest pain and breathing difficulty and was taken to Mary Matha Hospital, Vazhithala and from there he was referred to Holy Family Hospital, Muthalakodam, Thodupuzha.  He was admitted therein and thereafter taken to AIMS, Kochi on 27-06-2003 and he was inpatient therein till 09-07-2003.  He died at the hospital on the same day.  The medical bills amounted to Rs. 56,847.80.  The claim was repudiated on the ground that her husband was having pre existing illness.

          2.          Her husband had not taken any treatment after the commencement of the first policy in 1999 and there was no claim during the above period.

          3.          The opposite party has contended that the policy was obtained suppressing material facts.  In the application for renewal dated 20-07-2002 it was declared that the complainant and her husband were free from all diseases.  The private investigator deputed has reported that the deceased was having pre existing diseases as on the date of the proposal and since the policy was obtained suppressing material facts, the same is void.

          4.          The evidence adduced consisted of the testimony of PWs 1, 2 and DW1 and Exts. P1 to P12 and R1 to R5.

          5.          The Forum dismissed the complaint as it appeared from the records produced that the deceased has suppressed material facts and that he was having illnesses before the inception of the policy.

6.          We find that the private investigator who was submitted Ext.R3 report was not examined nor was any doctor examined to establish that the deceased was having pre existing illness.  Ext.R1 is the copy of the application form for renewal of the medi-claim policy.  In Ext.R1 in the column as to the pre existing illnesses that included diabetes, hypertension etc. it is mentioned as ‘Nil’.  In Ext.P8 discharge summary from AIMS, Kochi it is mentioned that he was a known case of coronary artery disease and diabetes mellitus.  In Ext.P9 the discharge summary from Holy Family Hospital, Muthalakodam he is mentioned as known case of COPD and HTN.  In Ext. R4 produced by the opposite party captioned as Attending Doctor’s Report issued by the consulting physician of Holy Family Hospital the probable duration of illness is mentioned as one day.  In Ext. R5, the Attending Doctor’s Report from AIMS, Cochi the probable duration of illness is mentioned as one year.  As per Ext.P2 certificate issued from the Oriental Insurance Company Ltd. that  had issued policies to the diseased from 01-10-1999 up to 01-10-2002, it is mentioned that he has not made any claim during the period from 01-10-1999 onwards.  In the circumstances, we find that the probable duration of illness has to be treated as one year especially in view of Ext.R5 certificate produced by the opposite parties themselves.  The diseased died on 09-07-2003.  The period of coverage with the opposite party was from 01-10-2002 onwards and hence it is 9 months after the inception of the last policy that the assured died; the probable duration of illness being one year.  It has also to be established that the diseased was aware of the illness on the date of inception of the last policy.  Evidently, the deceased was having policy coverage from 01-10-1999 onwards.  In all the policies the coverage was for the same amount ie, Rs. 50,000/-.  The previous policy coverage was from the Oriental Insurance Company Ltd. which is one of the agencies of the General Insurance Company as in the case of the opposite party insurance company.  It is pertinent to note that the deceased has not enhanced the coverage amount.  In the circumstances, we find that nondisclosure if any would not change the position as it is not established that the illness was pre existing to the first policy that commenced from 01-10-1999.  In the circumstances, we find that the complainant is entitled for the policy amount.  The opposite parties/ respondents are directed to pay a sum of Rs. 50,000/- to the complainant with interest at 12% from today, the date of this order.

                                                JUSTICE K.R. UDAYABHANU:   PRESIDENT

Sr.