BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA<br /> <br /> PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President,<br /> <br /> 2. M.N.MANOHARA, B.A.,LLB., Member,<br /> <br /> <br /> ORDER<br /> <br /> Complaint No.MDF/C.C.No.141/2009<br /> <br /> Order dated this the 14th day of May 2010<br /> <br /> COMPLAINANT/S <br /> <br /> Smt.N.S.Padma W/o Late M.Mahadevappa, <br /> C/o Nandagopal, No.38/9, <br /> Balaji Nilaya, Shankar Nagar,<br /> Behind Water Tank, Mandya City.<br /> <br /> (By Sri.P.M.Somashekar., Advocate)<br /> <br /> -Vs-<br /> <br /> OPPOSITE PARTY/S<br /> <br /> The Manager,<br /> Bajaj Allianz Life Insurance <br /> Company Limited, Branch Office, <br /> Ashok Nagar, 1st Cross, <br /> Syndicate Bank Upstair, <br /> Mandya City.<br /> <br /> (By Sri.C.Thammanna., Advocate)<br /> <br /> Date of complaint 21.11.2009<br /> Date of service of notice to<br /> Opposite party 14.12.2009<br /> Date of order 14.05.2010<br /> Total Period 5 Months <br /> Result The complaint is dismissed. However, there is no order as to costs. <br /> <br /> Sri.Siddegowda,<br /> President<br /> <br /> 1. This complaint is filed under section 12 of the Consumer Protection Act, 1986 against the Opposite party Insurance Company claiming insurance amount of Rs.1,50,000/- with compensation of Rs.50,000/-.<br /> 2. The case of the Complainant is that her husband namely M.Mahadevappa submitting proposal form dated 21.07.2008 obtained a insurance policy bearing No.0104400272 for Rs.1,50,000/- for a period of 26 years, by paying half yearly premium of Rs.5,000/-. The Complainant is the nominee. Her husband was an young and energetic having very sound health and he was an engineer. The particulars furnished by her husband in the proposal form for obtaining insurance were true and correct. There was no occasion to furnish false information in the proposal form. The life assured was not at all having any health problem at any point of time. Suddenly her husband died on 15.10.2008 due to heart attack. Thereafter, on 21.01.2009 the Complainant submitted her claim with regard to the insurance policy amount. But, the Opposite party has not settled the claim, but repudiated the claim of the Complainant raising some untenable and unwarranted objections which are created and fabricated. Therefore, the Opposite party has committed deficiency in service.<br /> 3. The Opposite party has filed version admitting the obtaining the policy by the husband of the Complainant. After receiving the claim petition from the Complainant, the investigation was conducted since the claim is an early claim and the investigation report revealed that the death of the deceased was due to ischemic heart disease and it was known to the deceased since 3 years prior to the date of death and this fact has been evidenced by the investigation report of Narayana Hrudayalaya and Vikram Hospitals. The deceased had not disclosed his disease at the time of giving the proposal and at the time of obtaining the policy even though, he know the fact, he had not intimated his previous disease to the company subsequent to the date of policy which is clearly contrary to the terms of the policy and these facts are purposefully suppressed by the deceased only to gain unlawful profit and benefits from the Opposite party. The Opposite party is not liable to pay any amount as claimed by the Complainant. The other allegations are denied. The Opposite party has repudiated the claim properly. On these grounds, the Opposite party has sought for dismissal of the complaint with costs. <br /> 4. During trial, the Complainant has filed affidavit and produced the documents Ex.C.1 & C.2. On behalf of the Opposite party a Manager of the Opposite party Insurance Company and R.W.2 Dr.Keshavamurthy, examined and documents Ex.R.1 to R.7 are marked. <br /> 5. Both sides have filed written arguments.<br /> 6. We have perused the records. <br /> 7. Now the points that arise for our considerations are:-<br /> 1. Whether the deceased assured has suppressed the material fact for obtaining the policy though had the knowledge of heart disease?<br /> 2. Whether the Opposite party has committed deficiency in service by repudiating the insurance claim? <br /> 3. Whether the Complainant is entitled to the insurance claim?<br /> 8. Our findings and reasons are as here under:-<br /> 9. POINTS NO.1 TO 3:- The undisputed facts are that M.Mahadevappa, the husband of the Complainant has obtained insurance policy for Rs.1,50,000/- as per Ex.R.6 commencing from 28.07.2008. On the basis of proposal form Ex.R.1 dated 21.07.2008; the assured was an Engineer and date of birth is 01.06.1964. It is an admitted fact that on 15.10.2008, the life assured died due to heart attack. The death certificate Ex.C.2 is produced. It is also admitted that the complainant preferred the claim petition, claiming insurance amount to the Opposite party Company and the Opposite party Company after investigation, repudiated the claim as per Ex.C.1 dated 04.03.2009 intimating the Complainant about the repudiation due to the non-disclosure of materials facts that the deceased life assured was a known case of ischemic heart disease on treatment since 3 years and these facts known to the deceased life assured were not disclosed in the proposal form dated 21.07.2008.<br /> 10. The Complainant has challenged the same. The burden is on the Opposite party Insurance Company to prove that at the time of submitting the proposal for insurance, the deceased life assured had suppressed the heart disease he was suffering and treatment since 3 years.<br /> 11. It is pertinent to note that in the complaint, pleading that the life assured was hale and healthy and he was not at all having any health problem and there was no occasion or intention to submit the proposal with false information and complained that the allegations of the repudiation letter are false and concocted for the purpose of the letter.<br /> 12. To prove its defence, apart from its formal evidence through R.W.1 the Assistant Manager and investigation report Ex.R.7, the Opposite party has examined Dr.Keshavamurthy from Vikram Hospital, Mysore and relied upon Vikram Hospital record Ex.R.2 and the Ex.R.3 & R.4 report of the Narayana Hrudayalaya. Ex.R.4 the report from the Narayana Hrudayalaya, Bangalore clearly established that the deceased assured M.Mahadevappa was admitted to the Hospital on 14.10.2008 and he expired on the same day at 2.35 p.m. Before his death, as per Ex.R.2 and evidence of the Dr.Keshavamurthy, the life assured M.Mahadevappa was admitted to Vikram Hospital, Mysore on 02.10.2008 at 2.20 a.m. and discharged on 04.10.2008. The evidence of Dr.Keshavamurthy and the report Ex.R.2 proves that he was admitted with a history of chest pain since 10.30 p.m. on 1st October 2008 during micturation, mild and radiates to both upper limbs, associated with sweating and giddiness; known case of Ischemic hear disease since 3 years on treatment; known case of hypertension on treatment; not a known case of diabetes mellitus or asthma and 2D ECHO and Coronary Angiogram done and the diagnosis was;<br /> - Ischemic heart disease – Old anterior wall MI<br /> - Unstable Angina<br /> - Triple vessel coronary artery disease<br /> - Mild LV dysfunction. EF 40%<br /> - Hypertension,<br /> - Dyslipidaemia.<br /> <br /> This doctor has denied the suggestion that the patient informed that for the first time he was affected with heart problem. According to the doctor, the patient was conscious when he was brought to the hospital. The details of treatment since 3 years and the name of the doctor was not informed, but he gave the history of having heart problem since 3 years and was taking regular treatment. Though a person will not come to know the heart disease until he was affected by heart attack and examined by the doctor and disclosed to him, but in the present case, the doctor specifically deposed that the patient was conscious when he was brought to the hospital with a chest pain at midnight and gave the history of heart problem since 3 years and taking regular treatment. There is no reason to suspect and to reject the evidence of R.W.2 Dr.Keshavamurthy and the documents of Vikram Hospital Ex.R.2. It is pertinent to note that the Complainant has not whispered whether her husband died in Narayana Hrudayalaya Hospital or where he died, but simply stated that her husband died due to heart attack. She has gone to the extent of denying the suggestion that her husband was treated in Vikram Hospital and Narayana Hrudayalaya, Bangalore. Though, the address of her husband is clearly mentioned in the hospital records. In III (2003) CPJ page 15 the Hon’ble National Commission had held that even though a doctor is not examined, but we must give weight to a statement recorded in the normal course of discharge of once duty. In this case, the copy of the hospital record is not produced, but the original document is produced and the doctor has recorded the history by questioning the patient about his previous illness to start the examination and treatment. It is pertinent to note that the deceased obtained the policy by submitting the proposal form dated 21.07.2008 and he died on 15.10.2008. So, within 3 months from the date of policy, the insured died and therefore, the Opposite party has conducted the investigation as it was early claim and Opposite party has proved by acceptable evidence, both oral documentary evidence that the deceased life assured was suffering from heart disease since 3 years prior to obtaining the insurance policy from the Opposite party Company and has suppressed these material facts though he was having knowledge of the same and therefore, the contract of insurance between them becomes void and hence, the repudiation of the insurance claim by Opposite party is just and proper and the Complainant has failed to prove that the Opposite party has committed deficiency in service.<br /> 13. Since, the repudiation of the insurance claim is just and proper based on valid grounds, the Complainant is not entitled to the insurance claim.<br /> 14. In the result, we proceed to pass the following order;<br /> ORDER<br /> The complaint is dismissed. However, there is no order as to costs. <br /> <br /> (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 14th day of May 2010).<br /> <br /> (PRESIDENT) (MEMBER) <br />