Judgment:
Oral Order ( As per the Smt Merla Shreesha, Member)
Aggrieved by the order in C.D.No.94 of 2006 on the file District Forum Kurnool opposite parties preferred this appeal.
The brief facts as set out in the complaint are that the complainants husband S.Krupakar insured his life with opposite parties under policy bearing Nos.651591662 for Rs.25,000/-, 651616062 for Rs.50,000/-, 651616098 for Rs.20,000/- and 651615853 for Rs.25,000/-. The policy holder S.Krupakar died on 24.5.2002 due to chest pain and the death is a natural one. Thereafter the complainant submitted claim form as nominee to opposite parties but the opposite parties did not pay the policy amount inspite of several representations. On 20.3.2003 the opposite party no.3 repudiated the complainants claim on the ground that the policy holder suppressed the material fact regard his health. Hence the complaint seeking directions to the opposite parties to pay the policy amounts along with interest, compensation and costs.
Opposite party no.3 filed counter and opposite parties no.1 and 2 adopted the same. Opposite parties submitted that the policy holder admitted in the hospital with acute palpitation, breathlessness and died on 24.5.2002 which was intimated to opposite parties by the nominee. After intimation of the death of the policy holder an investigation was conducted which raveled that the deceased was a chronic smoker and known diabetic and hypertension for past five years and was admitted in Govt. General Hospital, Kurnool under i.P.No.34434 and the policy holder visited the hospital frequently till his death. The policy holder did not disclose his sickness prior to the date of proposals. As the policy holder suppressed the material facts, the contract was declared null and void and repudiated the claims under the said policies on 20.3.2003. Hence, there is no deficiency in service on the part of opposite parties.
Based on the evidence adduced i.e., Ex.A1, Exs.B1 to B7 and X1, the District Forum allowed the complaint directing the opposite parties to pay the claim amounts of Rs.50,000/- under policy no.651616062, Rs.20,000/- under policy no.651616098, Rs.25,000/- under policy no.651591662 and Rs.25,000/- under policy no.651615853 with interest at 9% per annum from the date of filing of the complaint till the date of realization together with costs of Rs.5000/-.
Aggrieved by the said order the opposite parties preferred this appeal.
The learned counsel for the appellants/opposite parties submitted that the District Forum having accepted written version, affidavits and marked documents and having allowed IA filed for calling the hospital records and marked as Ex.X1 and that having recorded the evidence of the RW1 committed apparent error in holding that the opposite parties are not properly represented.
We have gone through the material on record.
It is not in dispute that the appellants were issued four policies dated 7.6.2000 for Rs.25,000/-, dated 28.12.2001 for Rs.25,000/-, dated 28.3.2002 for Rs.20,000/- and dated 28.3.2002 for Rs.50,000/-. It is the case of the complainant that the policy holder died on 24.5.2002 due to chest pain and that death is natural one and after the death of the life assured, the complainant made a claim with the opposite parties and submitted several representations but on 20.3.2003 opposite partyno.3 repudiated the claim on the ground that the policy holder suppressed diabetes and hypertension and hence he is not entitled for the amounts. It is the case of the opposite parties that the deceased life assured was chronic smoker and known case of diabetes and hypertension for the past 5 years and to substantiate their case they rely on the case record of the Govt. General Hospital and submitted that the policy hodler was admitted in the hospital with acute chest pain and died on 24.5.2002. The deceased did not declare about his actual health conditions and therefore their repudiation is justified. We observe from the record i.e., case sheet of Govt. General Hospital, Kurnool that the policy holder was admitted on 24.5.2002 with chest pain which he has been suffering since one month. The case record also reveals that the policy holder died on the same day i.e., 24.5.2002 on account of chest pain. The Cardiologist who has cross examined stated that he did not treat the said patient and that the particulars in Ex.X1 were noted by the duty Postgraduate doctor and that he is not an LIC panel doctor and that he issued Ex.B1 on the basis of Ex.X1. When the Cardiologist mentioned the said patient was never under his treatment in his cross examination and state that only on the basis of X1 notes, he is stating that the patient was known diabetic and hypertensive, the opposite parties ought to have filed his affidavit tot hat effect. Opposite parts failed to establish that the life assured was in the knowledge of his disease i.e., diabetes and hypertension and willfully and wantonly suppressed it prior to issuance of the policy. As per Sec.45 of the Insurance Act:
â45. Policy not be called in question on ground of mis-statement after two years:- No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the Policy, was inaccurate or false, unless the insurer shows that such statement 1[was on a material matter or suppressed facts, which it was material to disclose..]
Note:- Material shall mean and include all important, essential and relevant information in the context of under-writing the risk to be covered by the corporation.â
It is stated that it is the duty of the Insurance Company to establish that the policy holder had willfully and fraudulently suppressed facts whether material to his case. In the instant case four policies were taken and the proposals were dated 25.5.2000, 31.1.2001, 30.3.2002 one more dated 30.3.2002 and the policy holder died on the very date of admission in the hospital i.e., 24.5.2002 due to chest pain. The appellant/opposite party ought to have filed the affidavit of the doctor who has treated the patient to establish their case of the material suppression if any. Even otherwise it is held by the National Commission in New India Assurance Co.Ltd. v. Lalit M.Bhambani and Anr., I(2002) CPJ 23(NC) that Diabetes and Hypertension are not chronic disease and their suppression, if any, cannot be a sole ground for repudiation unless their nexus for cause of death would establish which in the instant case has not been done.
Now we address ourselves to the ground to the ground of the appellants that the District Forum erred in raising an objection that the authorized officer did not file any authorization letter without considering the merits of the case.
We are of the considered view that the District Forum ought not to have raised the technical objection and having considered the facts and circumstances of the case and the merits in its entirety we are of the considered opinion that the appellants/opposite parts committed an act of deficiency in service in repudiating the claims. Therefore, we confirm the order of the District Forum.
In the result this appeal is dismissed confirming the order of the District forum. No costs. Time for compliance four weeks.