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2010 (4) CPR 49
ANDHRA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HYDERABAD
Mrs. M. Shreesha & Syed Abdullah, Members
Life Insurance Corporation of India
and Ors. —Appellants
versus
M. Vijaya Laxmi and Ors. —Respondents
F.A. No. 1120 of 2008
Decided on 19.1.2010
Counsel for the Parties :
For the Appellants:Mr. N. Mohana Krishna, Advocate.
For the Respondent No.2:Mr. P. Veerraju, Advocate.
For the Respondent Nos. 1 and 3:Mr. V. Gourisankara Rao, Advocate.
IMPORTANT POINT
Suppression of material facts relating to the health condition amounts to breach of terms and conditions of Insurance Contract.
Headnote:Consumer Protection Act, 1986—Section 12 and 17—Life insurance policy claim—Policy was taken on 11.6.2002 and insured died on 13.2.2003 due to massive cardiac arrest—Claim was repudiated on ground of suppression of material facts relating to health of insured—Record was produced showing that insured had taken treatment for cancer in Apollo Hospital from 17.6.2002 to 19.6.2002 for second cycle chemotherapy—District Forum allowing claim holding that Xerox copies in absence of affidavit of doctor concerned could not be taken into consideration—Appeal—Ex. B5 letter had been written by complainant No. 2 containing all those facts and appellant filed Xerox copy of that letter—Complainant had not challenged or disputed said letter as forged or fabricated—Factual aspects about suppression of health condition and medical treatment pleaded by appellant in its version were not challenged by filing rejoinder—District Forum erred in not taking such material into consideration—Suppression of medical treatment for serious ailment at the time of taking policy was suppression and repudiation was justified—Appellant was justified in repudiating claim. (Para 6)
Result: Appeal allowed.
Syed Abdullah, Member— This appeal is filed against the order dated 29.1.2008 passed in CD 159/2006 by the District Forum, Nellore directing the OPs LIC of India to pay compensation of Rs.18,75,000 with interest thereon and compensation of Rs.50,000 and costs. The impugned order is assailed by the OPs questioning it as erroneous both on question of fact and law and sought to be set aside.
2. In nutshell, the complainants are the legal heirs of the deceased policy holder Bhaskara Rao who had taken two policies for Rs.6,00,000 each on 11.6.2002 and according to the complainants the policy holder was healthy at the time of taking policy but died due to massive cardiac arrest on 13.2.2003. After investigation of death of the policy holder the complainants have preferred a claim to OP 1 but the same was repudiated on 20.10.2003 informing that they may appeal to Zonal Office. The Zonal Office in turn informed that as the claim was more than Rs.2,00,000 he has no jurisdiction and advised to appeal to the Chairman but the said authority failed to reconsider it. OP 1 filed the counter denying the factual aspects and justified its stand in repudiating the claim on the ground that since the contract is a contract of utmost good faith, the facts relating to the health of insured are false and there was suppression of true facts as such the insurer has no liability to pay the insurance claim. It is stated that the claim was an early claim. So as per the guidelines, the Corporation had taken up the investigation to find out the actual cause of the death and the mala fides involved in taking the policies. As per the hospital record secured, the insured had taken treatment for cancer in Apollo Hospital on 17.6.2002 to 19.6.2002 for second cycle chemotherapy. Again from 9.7.2002 to 11.7.2002 for third cycle. Again from 2.8.2002 to 4.8.2002 for 4th cycle and from 27.8.2002 to 29.8.2002 for 5th cycle from which it is evident that the insured was suffering from cancer and especially it is clear that prior to 17.6.2002 he had taken treatment for first cycle. Thus he was suffering from cancer two years prior to the proposal itself. During that period he had taken treatment from Jakka Sujatamamma Cancer Hospital, Nellore also. Apart from it, the insured had fallen from the steps of the first floor and sustained injuries resulted in fracture on 13.1.1999 for which he was admitted in Govt. Hospital, Nellore and underwent surgery. The said fact was not revealed in the proposal. Had these facts been revealed in the proposal, they would not have issued the policy at all. The insured had signed the declaration also about the facts mentioned therein the proposal. As there was misstatement and suppression of the facts with regard to health condition of the insured the claim was not considered and the Corporation has no liability to pay the amount claimed for. During the enquiry the complainant had filed evidence affidavit along with Exs.A1 to A11 so also OPs have filed Exs.B1 to B11 along with evidence affidavit of OP1.
3. After going through the evidence on record the District Forum held that the OP had filed Xerox copies of Ex. B5 without producing the affidavits of the concerned hospital to prove that the insured had taken treatment there, so its contents cannot be accepted as true. Consequently held that the complainant had proved deficiency on the part of the OPs in not allowing the claim covered by the two policies which were issued.
4. The District Forum made observation that Ex. B 11 is Xerox copy of the case record of Cancer Detection Centre and PPR charts, and they have not taken any steps to file the affidavits of the concerned doctor who prepared the same or treated. That mere filing of documents does not amount to proof of document and thereby held that Exs.B5 to B 11 filed by the OPs remained unproved. So it concluded that the insured had misrepresented or concealed the actual facts with regard to health condition in obtaining the
