DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  16^th day of December, 2022

Present      :   Sri.Vinay Menon V.,  President

                  :  Smt.Vidya A., Member             

                  :  Sri.Krishnankutty N.K., Member                                 Date of Filing: 16/03/2018    

     CC/45/2018

Krishnaprabhu,

S/o.Krishnan,

Anjali Gardens,

Pallipuram, Palakkad                                                              -           Complainant

(By Adv. P. Sreeprakash)  

                                                                                    Vs

Manager,

Bajaj Allianz Life Insurance Company Ltd.,

1^st Floor, Surumi Plaza, Fort Maidan,

East Fort Road, Palakkad – 678 001               -                       Opposite party

            (By Adv. Sachindas P.)

O R D E R

By Sri. Vinay Menon V., President

1. Gist of pleadings is that the complainant is the legal heir one deceased Krishnan, a beneficiary under a policy issued by the opposite party. Father of the complainant died after suffering from a heart attack while on a visit to Thirupathy temple. Claim raised by the complainant and other legal heirs before the opposite parties for death benefits were repudiated on the ground that the deceased was suffering from pre-existing cardiac issues. There is no merit in the ground for rejection. Late Krishnan was not suffering from and pre-existing disease. The complainant sought for sum assured with interest and compensation.

Incidentally, complainant is one of the legal heirs of the deceased Krishnan. Deceased Krishnan’s other legal heirs, his wife, mother and daughter have issued a letter stating they have no objection in the dispute and the same is filed along with the memorandum of complaint.  

2.         The opposite party contested the complaint pleadings on the grounds that one Thankamani C.K., brother of deceased Krishnan is the nominee and he alone can contest the proceedings against the opposite parties. The opposite party further alleged that a perusal of records show that the life assured had not disclosed the treatment / diagnosis undertaken by him during 2006. The deceased had failed to disclose his actual illness in the proposal form at the time of filling the same. Had the deceased disclosed the PED, this policy would not have been issued. Hence, the claim was repudiated on the ground of non disclosure of material fact. 

3. The following issues arise for consideration:

1. Whether the complainant is competent to prosecute this proceeding?
2. Whether the deceased  suffered from any pre-existing disease ?

3.         Whether there is any deficiency in service on the part of Opposite party?

4.         Whether the complainant is entitled to any of the reliefs sought for?

5.         Reliefs, if any?

4.         Evidence comprised of Exhibits A1 & A2 on the part of complainant and testimony of DW1 and Exts.B1 to B5 on the part of opposite parties.  Medical record from treating hospital at Thirupathi is marked as Exts.X1. Death Summary forming part of Ext. X1 is marked as  Ext. X1(a). DW1 is the doctor who treated the deceased at Thirupathi.

                                    Exts.A1, A2 and B2 to B5 were objected to by the respective counsels on the opposite sides on the ground these documents were photocopies of originals. Since this Commission is not bound by strict procedures contemplated under The Evidence Act and since neither contesting parties have any complaint that the documents produced and marked in evidence by respective opposite sides were concocted or forged, the said documents are taken as evidence over-looking the objections.

Issue No.1

5. Opposite party has raised an objection with regard to the competency of complainant in proceeding with this complaint. Their allegation is that since one Thankamani, brother of the deceased, was the nominee, he alone could file a complaint as against the opposite party. 

It is well settled in law that a nominee is a person to whom the insurer can hand over a cheque in the case of the death of life assured. That does not make him a beneficiary. A nominee, who is not a legal heir, is not at par with a legal heir unless the deceased has executed a will in favour of the nominee. Herein the legal heirs have filed this complaint. We do not find any legal impediment  in the complainant proceeding with the dispute.

Issue No.2

6.         Next question to be answered is whether the deceased suffered from and PED. The claim was rejected as the complainant did not willfully disclose the cardiac problems suffered by him. Ext. B1 is the proposal form. In the said form, deceased Krishnan has stated that he is not suffering from any cardio-vascular issues (2^nd page, Answer to Question 5(f)).

The opposite party vouches on Ext. X1(a) Death Summary as the source of this information. Relevant portion of Ext. X1(a) reads as follows:

“Course in Hospital : Pt is a known case of coronary artery disease, PTCA done in 2006.  They advised CABG, but the patient denied”.

7.         DW1 is the doctor who treated the deceased Krishnan at Thirupathy. He has stated in his chief examination as follows:

Page 1 line 1 to line 7 in Page 2 : “ Mr.Krishnan was my patient and I had examined him on 23^rd Jan 2017. He came to DBR & SK hospital at 7.30 pm with complaints of severe breathlessness which was suggestive of heart failure. I asked him for past history. He told that he had undergone PTCA in 2006 and later he got repeated hospitalization. On the day of admission, his condition worsened”.

Eventhough counsel for the complainant tried his best to refute the testimony of DW1 that the complainant had underwent PTSA (Percutaneous Translumini Coronary Angioplasty) as early as 2006, the doctor stuck to his guns. Nothing solid could be brought out to discredit the testimony of the witness. It was the effort of the counsel for the complainant to make the DW1 admit that the source of information regarding coronary angioplasty was unreliable, if not imaginary. We do not understand, in the absence of any cogent evidence, why DW1, who has no prior relationship to the deceased, should fabricate such an information with regard to his patient or that Ext.X1(a) death summary be prepared showing that the deceased suffered from coronary issues. We therefore hold that the testimony of DW1 is made after appreciation of the facts and circumstances in its right perspective and that Ext. X1(a) reflects the correct picture.

8.         We therefore hold that the deceased Krishnan was suffering from pre-existing disease which material information was not disclosed in Ext.B1.

             Issue No.3

9.         Pursuant to the findings in the preceding issue we hold that there is no deficiency in service or unfair trade practice on the part of opposite party.

The complaint is dismissed accordingly.

            Issue Nos. 4 & 5

10.       Resultantly we hold that the complainant is not entitled to any of the reliefs sought for.

11.       In cases where there is non-disclosure of material facts, interest of justice dictates that the complainant be loaded with costs payable to the opposite party. But herein it is not the complainant who had suppressed material facts, but the deceased. It is not clear whether the complainant had any part in it. It is also not clear, either from pleadings or evidence, whether the complainant had any role in committing fraud of the opposite parties. Hence cost is not imposed on the complainant.

Parties are directed to suffer their respective costs.

                        Pronounced in open court on this the 16^th  day of  December, 2022.          

                                                                                                      Sd/-

                                                                                             Vinay Menon V

                                                      President

                                                              Sd/-

   Vidya.A

                       Member     

           Sd/-                                                                 Krishnankutty N.K.

                                                                                                      Member

APPENDIX

Exhibits marked on the side of the complainant

Ext.A1   -   Copy of certificate of insurance bearing No.5060324251310

Ext.A2  –   Copy of rejection of claim  

Exhibits marked on the side of the opposite party:

Ext.B1 -  Original application for group credit protection plus

Ext.B2 –  Same as Ext.A1

Ext.B3 –  Copy of death claim

Ext.B4 –  Copy of Death Summary dated 23/1/17

Ext.B5 –  Same as Ext.A2

Court Exhibit:   

Nil

Third party documents: 

Ext.X1 – Treatment records  maintained in M/s.DBR & SK Super Speciality Hospital

Ext.X1(a) – Same as Ext.B4

 Witness examined on the side of the complainant:

 Nil

Witness examined on the side of the opposite party:  

DW1  - Dr.Vasudeva Chetty

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.