STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA :
At HYDERABAD
FA 344 of 2017
AGAINST
CC No. 67/2013, DISTRICT FORUM, WARANGAL
Between :
Kothapalli Jyothi,
W/o Late Mohan Rao,
Age : 39 years, Occ: Household
Q.No.D-40, Pilot colony
Badarigudem (p), Manuguru Mandal
Khammam District – 507 117 .. Appellant/complainant
And
- The Branch Manager, LIC of India,
Bhadrachalam Branch Office
Govt. Hospital Road, Bhadrachalam Post and Mandal
Khammam District – 504 251.
- The Sr. Divisional Manager,
Life Insurance Corporation of India,
Divisional Office, Jeevan Prakash,
Near Dr. B.R. Ambedkar Statue,
Balasamudram, Hanamkonda ( P & M ),
Warangal District.
- The Chief Public Information Officer,
LIC of India, Divisional Office,
Jeevan Prakash, Near Dr. B.R. Ambedkar Statue,
Balasamudram, Hanamkonda ( P & M ),
Warangal District – 506 001. … Respondents/opposite parties
Counsel for the Appellant : M/s. K. Karunakar
Counsel for the Respondents : Sri Srinivasan S. Rajan
Coram :
Honble Sri Justice B. N. Rao Nalla … President
And
Sri Patil Vithal Rao … Member
Tuesday, the First Day of May
Two Thousand Eighteen
Oral order : ( per Hon’ ble Sri Justice B.N.Rao Nalla, Hon’ble President )
***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the complainant praying this Commission to set aside the impugned order dated 22.08.2017 made in CC 67 of 2013 on the file of the DISTRICT FORUM, Warangal.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainant, in brief, is that her husband, Mohan Rao, while working in Singareni Collieries Co. Ltd at Manuguru of Khammam District has obtained Endowment Assurance Policy bearing No. 688158441 for the assured sum of Rs. One lakh commencing from 28.03.2010 under Salary Savings Scheme from the opposite parties by paying the monthly premium amount of Rs.640/- for 15 years and the deductions were commenced from May, 2010 on authorizing their employer and she is the nominee. After death of her husband on 11.08.2010, when she submitted the claim in the month of September, 2010, repudiated the claim vide letter dated 31.03.2011. The opposite party no. 3 did not furnish any document under RTI Act. The acts of the opposite parties amount to deficiency in service. Hence the complaint to direct the opposite parties to pay the assured sum of Rs. One lakh along with bonus, interest @ 9% pa from 31.03.2011 to 24.12.2012, further compensation for mental agony, travelling expenditure, legal expenditure and costs
4). The opposite parties opposed the above complaint by way of written version, while admitting the policy in question was taken by the husband of the complainant, contended that the life assured suppressed the material facts regarding his ailment in proposal on 30.03.2010, hence they repudiated the claim of the complainant, there is no deficiency in service on their part and hence prayed to dismiss the complaint.
5). During the course of enquiry before the District Forum, in order to prove her case, the complainants filed her evidence affidavit and got marked Ex.A1 to A6. The opposite parties have filed their Evidence affidavit and got marked Ex. B1 to B7. The District Forum got marked Ex. X-1 to X-4.
6) The District Forum, after considering the material available on record, dismissed the complaint.
7) Aggrieved by the said order, the complainant preferred this appeal before this Commission.
8). Both sides have advanced their arguments reiterating the contents in the grounds of appeal, rebuttal thereof along with written arguments.
9) The points that arise for consideration are,
(i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner?
(ii) To what relief ?
10). Point No. 1 :
There is no dispute that the husband of the appellant/complainant while he was working in Singareni Collieries Limited obtained policy in question under Salary Savings Scheme to deduct the premium amounts from his salary and pay the same by his employer after giving his authorization vide Ex. A2. There is no dispute that her husband died on on 11.08.2010. There is no dispute that the claim submitted by her to the respondents/opposite parties in the month of September, 2010 was repudiated vide letter dated 31.03.2011.
11). The main contention of the appellant/complainant is that the claim submitted by her was repudiated on the ground that her deceased husband/insured life assured intentionally suppressed the material fact that he was suffering from Hypertension for ten years at the time of proposal vide Ex.A1 and obtained the said policy which is false.
12). The District Forum observed that Ex.X-1 to X-4 Medical record of Kamineni Hospitals, Hyderabad, shows that the deceased Life assured had taken treatment from 05.05.2010 until his death i.e., 11.08.2010 and that he was suffering from Hypertension for ten years with irregular treatment. Diagnosis was made as ( R ) Capuloganglionic Bleed with mass effect which was supported by Ex. B-5 Medical Attendants’ Certificate. The District Forum further observed that the report of the CT Scan under Ex.X-1 to X-4 reveals that the deceased life assured was having the Hypertension and the impression says the same, i.e., “ LARGE ACUTE HYPERTENSIVE HAEMOTOMA RIGHT CAPSULO – GANGLOINC RFEGION WITH SEVERE MASS EFFECT AND EDEME” and came to the conclusion that the deceased policy holder suppressed the ailment and justified the repudiation.
13). Counsel for the appellant/complainant argued that there is no evidence on record of the doctor who treated the life assured for ten years. Mere filing of Ex. X-1 to X-4, i.e, Case Sheet of Kamineni Hospital is not sufficient to hold that there was suppression of material fact and as such there is no suppression of ailment of Hypertension and further held hypertension is not a disease to repudiate the claim.
14). Section 45 of the Insurance Act stipulates that : ‘ not to 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 from 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 and that it was fraudulently made] by the policy-holder and that the policy‑holder knew at the time of making it that the statement was false 2[or that it suppressed facts which it was material to disclose]: 2[Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.].
The deceased policy holder submitted the proposal form vide Ex.A1 on 30.03.2010. The policy holder died on 11.08.2010. The claim submitted by the nominee/complainant was repudiated vide Ex. A-6 on 31.03.2011. i.e. in one year the respondents’ insurance company repudiated the claim. Hence Section 45 is not applicable to the facts of the case on hand.
15). High blood pressure, or hypertension, occurs when your blood pressure increases to unhealthy levels. Your blood pressure measurement takes into account how much blood is passing through your blood vessels and the amount of resistance the blood meets while the heart is pumping.
Narrow arteries increase resistance. The narrower your arteries are, the higher your blood pressure will be. Over the long term, increased pressure can cause health issues, including heart disease.
Hypertension typically develops over the course of several years. Usually, you don’t notice any symptoms. But even without symptoms, high blood pressure can cause damage to your blood vessels and organs, especially the brain, heart, eyes, and kidneys.
Treatment for hypertension includes both prescription medication and healthy lifestyle changes. If the condition isn’t treated, it could lead to health issues, including heart attack and stroke.
What are the symptoms of hypertension?
Hypertension is generally a silent condition. Many people won’t experience any symptoms. It may take years or even decades for the condition to reach levels severe enough that symptoms become obvious. Even then, these symptoms may be attributed to other issues.
Symptoms of severe hypertension can include:
- headaches
- shortness of breath
- nosebleeds
- flushing
- dizziness
- chest pain
- visual changes
- blood in the urine
What causes high blood pressure?
There are two types of hypertension. Each type has a different cause.
Primary hypertension
Primary hypertension is also called essential hypertension. This kind of hypertension develops over time with no identifiable cause. Most people have this type of high blood pressure.
A combination of factors may play a role. These factors include:
- Genes: Some people are genetically predisposed to hypertension. This may be from gene mutations or genetic abnormalities inherited from parents.
- Physical changes: If something in your body changes, you may begin experiencing issues throughout your body. High blood pressure may be one of those issues. For example, it’s thought that changes in your kidney function due to aging may upset the body’s natural balance of salts and fluid. This change may cause your body’s blood pressure to increase.
- Environment: Over time, unhealthy lifestyle choices like lack of physical activity and poor diet can take their toll on your body. Lifestyle choices can lead to weight problems. Being overweight or obese can increase your risk for hypertension.
Secondary hypertension
Secondary hypertension often occurs quickly and can become more severe than primary hypertension. Several conditions that may cause secondary hypertension include:
From the above literature, it is to be inferred that the Primary Hypertension develops over time with no identifiable cause and the Secondary hypertension often occurs quickly and since the deceased was diagnosed as capsuloganglionic hemorrhage, which means hemorrhage into the basal ganglia and internal and external capsule of the brain, the death might have occurred due to Hypertension.
16). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, we do not want to interfere with the impugned order. The point framed at para 9, supra, is answered accordingly.
17). Point No. 2 :
In the result, the appeal is dismissed confirming the impugned order dated 22.08.2017 made in CC 67/2013 on the file of the DISTRICT FORUM, Warangal. There shall be no order as to costs.
PRESIDENT MEMBER Dated : ORDER DATE : 01.05.2018.
