Sri Medisetty Ramakrishna,
S/o Late Ramulu,
52 years, Residing at Revallapalem,
Vizianagaram District. …….Complainant.
1. M/s SBI Life Insurance,
Rep., by its Zonal Manager,
Flat No.101, D.No.6-2-46,
Moin Court, Opp:Saleem Function Palace,
2. State Bank of Hyderabad,
Rep., by its Branch Manager,
Kottam Branch, Vizianagaram District.
Andhra Pradesh. ……Opposite Parties.
O R D E R
1. This is a complaint filed under Section 12 of the Consumer Protection act, 1986 seeking for a direction to the opposite parties to (a) pay a sum of Rs.1,00,000/- being the claim made on policy No.82001002208 issued in favour of the deceased insured Gedela Demudamma, (b) to pay interest thereon at 24% per annum from 28-01-2006 the date of intimation till the date of realization, (c) to pay Rs.10,000/- towards compensation for the mental agony and hardship suffered by the complainant and (d) to pay costs.
2. Briefly, the complainant’s case is that he is brother of one Gedela Demudamma, W/o Swamy Naidu. She had availed credit vide crop loan Account No.01670862870 from the 2nd opposite party on 28-09-2005. The said loan had the benefit of Suraksha Group Insurance for Rs.1,00,000/- which is approved by opposite party No.1 through the 2nd opposite party vide policy No.82001002208. That the complainant is nominee of the insured. The insured was hale and healthy but she developed heart pain suddenly on 23-01-2006. She was shifted to the Community Health Centre, S.Kota where she died due to cardio respiratory arrest. The complainant submitted claim enclosing all the necessary documents but after a long lapse of seven months, opposite party No.2 rejected the claim on untenable grounds. That the deceased had no pre-existing disease and there is no suppression of any such disease. That the rejection of claim is deficiency of service.
3. Opposite party No.1 filed written statement admitting the fact that the deceased Gedela Demudamma had applied for S.B.H. Depositors Scheme under Master Policy, No.82001002208. Rest of the complaint allegations are denied. It is contended that she submitted a proposal form in that connection wherein she had declared that she was in good health but not suffering from any physical deformity or critical illness requiring medical treatment for a critical illness. Basing on the said declaration, she was covered under the S.B.H. depositors Scheme for a sum of Rs.50,000/-. That in fact the deceased Demudamma was suffering from Dilated Cardiomyopathy, PAH, Multiple Ventricular Ectopics, Ischemic Heart Disease since 1994 but suppressed the said fact. That the suppression of material information is fatal as such the contract of insurance is a nullity and void ab-initio. That the enquiry made by opposite party No.1 revealed, the deceased Demudamma had undergone treatment after several tests. That the repudiation of claim is fully justified and there is no deficiency of service. That the complaint is not maintainable. Therefore prayed to dismiss the complaint with costs.
4. Opposite party No.2 filed counter denying the material allegations. It is contended that the documents supplied by the complainant were sent to opposite party No.1 promptly by opposite party No.2. Basing on the material available, opposite party No.1 repudiated the claim since the insured gave a false declaration about her state of health by suppressing real facts. That there is no deficiency of service. Therefore, prayed to dismiss the complaint.
5. The complainant filed his evidence affidavit and marked Exs.A.1 to A.7. Opposite party No.1 filed affidavit and marked Exs.B.1 to B.6. Heard both sides. Perused the affidavits and documents. The point for consideration is: Whether there is deficiency of service?
6. POINT:- Admitted facts are that the deceased G.Demudamma herein after referred to as the insured, was covered under the Master Policy and the complainant is shown as her nominee. So also there is no dispute the policy was in force when the insured died. The reason for rejection of the claim as per Ex.A.6 is, “Late Gedela Demudamma was suffering from Dialted Cardiomyopathy i.e., heart ailment prior to the date of enrolment of policy. That the life assured had concealed material facts at the time of entry into the scheme. The cause of death is directly attributable to the pre-existing medical condition of the deceased at the time of enrolment under the scheme and since the policy does not cover deaths due to pre existing illness, the claim has been rejected”.
7. The burden is on the 1st opposite party to prove that the insured having known that she was suffering from Dialated Cardiomyopathy, PHA, Multiple Ventricular, Ectopics and Ischemic a heart disease from 1994 but suppressed the said fact by giving a false declaration that she possessed good health and never suffered any critical illness. In this context it is relevant to peruse Ex.B.2 letter dated 25-09-2005 which is addressed by the insured to the 2nd opposite party. The insured made declaration that “I am in sound health and that I am not suffering from any physical deformity, mental disorder, critical illness or any condition requiring medical treatment for a critical illness as on date.
I have not been hospitalized for a period of more than fifteen consecutive days in the last twelve months”. Therefore, the statement made by the insured is clear that she possessed of sound health and never suffered critical illness prior to 25-09-2005, when the above statement was made. The opposite parties have produced Exs.B.3 to B.6 to substantiate the plea that the insured had undergone treatment for critical illness before obtaining the policy. Ex.B.3 is Xerox copy of Diagnostic Report from the Mediplus Diagnostic Services, Visakhapatnam.
It shows, on 22-12-1994 one Smt G.Demudamma was examined by the said diagnostic services on being referred by one Dr.G.S.R.Murthy, M.D., D.M. The impression of the diagnostic services is that it is a case of Dialated Cardiomyopathy Moderate Mr., and etc. Ex.B.4 is Xerox copy of the observations made by the said Doctor and also mentioned the prescriptions. Ex.B.5 is electrocardiogram report dated 23-12-1994 pertaining to Smt G.Demudamma. This Ex.B.5 is from Dr., Rao’s X-ray Clinic and Nursing Home, Vizianagaram. The impression stated is Antero Lateral Myocardial Insufficiency. These reports Ex.B.3 to B.5 mentioned the name of patient as G.Demudamma. More particulars such as surname, name of the village and name of the husband of the patient are not available. Further the opposite parties have not chosen to file any affidavit of the treating Doctor G.S.R.Murthy or that of Dr.K.Tirumala Prasad who referred the patient to Dr.G.S.R.Murthy. But there is one document which is Ex.B.6 an investigation report from Phantom Detective Agency on the treatment undergone by G.Demudamma. In this report it is mentioned the Detective Agency happened to meet one G.Krishna, S/o Late Swami Naidu.
The deceased insured is G.Demudamma who is Wife of Late Swamy Naidu. Therefore, the said Mr., Krishna who is shown as an advocate at Buchchayapalem, Visakhapatnam made a statement to the Investigating Agency. According to that statement, the insured was staying in his house during the year 1994. She consulted both at Visakhapatnam and Vizianagaram. It is also mentioned that the deceased was treated by Doctors for the Cardio Myopathy. We are of the sincere opinion, that Mr.G.Krishna who is a practicing advocate is a material witness. He is no other than one of the sons of the insured. He could have filed his affidavit denying the observations made in Ex.B.6 by the Detective Agency. But the complainant did not choose to file any affidavit of the said G.Krishna. We are also doubtful about the personal knowledge of the complainant about the details of the health problems of his sister which is the insured since he is not a member of the family of the insured. Added to this, Ex.A.5 Medical Attendant’s Certificate shows that the primary cause of death was heart failure. The insured had heart complaint during the year 1994 and later she died of the same complaint. Thus from the material available on record, we hold that it is a case of suppression of true state of health by the insured at the time of the proposal. Accordingly we hold there is no deficiency of service. Accordingly this point is answered.
8. In the result, the complaint is dismissed. Each party to bear its own costs.