1990 MarsdenLR 1248
LC VOHRAH
HIGH COURT (JOHORE BAHRU)
KATHIRVELU - Appellant
Versus
PACIFIC & ORIENT INSURANCE CO SDN BHD - Respondents
CIVIL SUIT NO 841 OF 1985
Decided On : 06/07/1990
N Jegatheeson for the plaintiff.
RA Kumar for the defendant.
This is a claim under a personal accident insurance policy issued by the defendant for repayment of a liquidated sum of $ 200,000 for total disablement and also indemnity in respect of medical expenses amounting to $ 2,250.
The defendant has denied liability on the ground that there was non-disclosure of material facts, that there was a breach of condition of the policy and that the plaintiffs condition does not fall within the ambit of the policy.
The plaintiff, now aged 54 years, until he was medically boarded out at the instance of the state government on 1 December 1984, was a superscale technical assistant in the Jabatan Kerja Raya in the state of Johor having technical charge of the hospitals and markets in Muar and responsibility for the construction of the ammunition depot in Kluang. Since 1977 he had been taking out personal accident policies on a yearly basis with the defendant. The policy ABD 1-4 on which the present claim is founded was issued by the defendant on 17 June 1983 and it covered the period 19 June 1983 to 18 June 1984 and provided, inter alia, for the payment to the plaintiff of the sum of $ 200,000 for bodily injury caused by violent accidental external and visible means which injury shall solely and independently of any other cause result in permanent disablement occurring within 24 calendar months of such bodily injury and of a sum up to $ 5,000 by way of indemnity for expenses incurred for medical and surgical treatment for the injury in respect of any one accident. The said policy was issued pursuant to the proposal form D1 signed by the plaintiff on 14 June 1983, question no 10(a) of which required an answer as to whether the plaintiff to the best of his knowledge suffered from any of the diseases listed therein or any other disease and the answer was no. All the answers and other particulars in D1 were entered by an agent of the defendant after the plaintiff had signed the blank form. During the currency of the said policy the plaintiff met with two accidents -- the first occurring on 29 October 1983 when he fell down the stairs at the Johore Bahru General Hospital and suffered a swelling in his right hand and the second on 19 November 1983 when he was involved in a motor vehicle accident whereby he sustained an injury also to the same hand. In respect of the first accident the plaintiff was treated at the Johore Bahru hospital and given medical leave for a fortnight until he reported for work on 12 November 1983. In respect of the second accident he was given medical leave for 6 days. Despite the medication prescribed for his injured right hand the swelling did not subside. Then by letter dated 27 December 1983 (ABD 13), written 38 days after the second accident, the plaintiff informed the defendant of the two accidents. The defendant by letter dated 11 January 1984 (ABD 14) acknowledged its receipt and forwarded a three-page claim form (ABD 19) for completion and return within 14 days by the plaintiff; the last page entitled Medical Certificate required the answers to the questions therein to be furnished by a registered medical practitioner and question no 7 in particular required the doctor to state whether the plaintiff sustained any permanent disability. In the meanwhile the plaintiffs condition worsened and he was admitted to the Johore Bahru hospital as an inpatient on three separate occasions -- on 17 April 1984, 19 June 1984 and 17 July 1984. On 30 August 1984, the claim form duly completed was returned to the defendant with the answer of the orthopaedic registrar to question no 7 as still in the ward under treatment. None of the three specialists at the Johore Bahru hospital who attended upon the plaintiff was able to diagnose the plaintiffs ailment until 30 October 1984 when they certified that he was suffering from, inter alia, Sudecks osteodystrophy after a meeting convened at the instance of the state government whereat he was recommended to be boarded ou