K.D. Mandappa vs Metlife India Insurance Co. Ltd.

THIS revision is directed against the order of the State Commission dated 31.10.2011 whereby the State Commission allowed the appeal of the respondent insurance company against the order of the District Forum Madikeri in Complaint No. 77/09, set aside the order and dismissed the complaint.

BRIEFLY put facts relevant for the disposal of this revision petition are that Shri K.D. Mandappa son of the petitioners complainants obtained a Unit Linked Insurance Policy from respondent insurance company on annual premium of Rs. 12000/ -. The sum assured was Rs. 2,40,000/ -. During the currency of the insurance policy, K.D. Mandappa died on 31.03.2009 because of kidney failure. The petitioners being parents of deceased insured submitted the insurance claim but the claim was repudiated by the respondent insurance company on the ground that deceased insured had obtained the insurance policy by concealing the fact that he was suffering from "Diabetes Mellitus". Being aggrieved by repudiation of the claim, the petitioner filed the consumer complaint in District Forum Madikeri. The District Forum after considering the pleadings and evidence produced by the parties allowed the complaint and directed the insurance company to pay a sum of Rs. 2,40,000/ - together with 100 per cent of the fund value in the unit account to the complainants. It was also directed that the aforesaid amount shall carry future interest @ 10% per annum from the date of the complaint till realization.

BEING aggrieved of the order of the District Forum, the respondent insurance company preferred an appeal. The State Commission Karnataka on perusal of record particularly the Discharge summary of the deceased insured issued by Vikram Hospital Mysore came to the conclusion that deceased insured had obtained the insurance policy by concealing the material fact regarding his previous ailment i.e. Diabetes Mellitus. Thus, the State Commission took the view that the repudiation of the claim was justified. Accordingly, the State Commission allowed the appeal and dismissed the complaint while setting aside the order of the District Forum.

LEARNED counsel for the petitioner has contended that the impugned order of the State Commission is not sustainable for the reason that the State Commission has failed to appreciate that there was no concealment of previous ailment on the part of the insured. It is contended that the State Commission has failed to appreciate that it was only on 25.08.2008, the deceased was admitted with the complaint of stomach ache in Vikram Hospital Mysore when it was found that the deceased was suffering from diabetes and one of his kidney was not properly functioning. It is further contended that the State Commission has fallen in error in relying upon the discharge summary purported to have been issued by Vikram Hospital Private Limited without there being a proper proof of discharge summary on record. It is further contended that the insured or his parents were not aware of any previous ailment of the insured. Thus, learned counsel has urged us to allow the revision, set aside the order of the State Commission and restore the order of the District Forum. On perusal of record we do not find merit in the contention of the petitioners. In para 4 of the complaint filed before the District Forum, the petitioners took the stand that the deceased insured K.D. Mandappa was admitted at Vikram Hospital Mysore on 25.08.2008 and discharged on 27.08.2008. Thereafter he was admitted in Vivus Hospital Madikeri for kidney treatment. In para 6 of the revision petition, petitioners have alleged that deceased insured was admitted in the hospital on 25.08.2008 and there for the first time, it was noticed that he was suffering from diabetes and functioning of one of his kidney is impaired. From the above allegations in the complaint, it stands established that the deceased insured was admitted in Vikram Hospital on 25.08.2008. The State Commission while deciding the appeal has relied upon the discharge summary issued by Nephrology Department of Vikram Hospital Private Limited where the deceased had admittedly gone for treatment. In the aforesaid discharge summary, in the column of History, it is recorded: Patient admitted with the complaints of puffiness of face and dysuria. Known case of Diabetes Mellitus since 8 years on treatment.

THE aforesaid history obviously must have been given by the patient himself or the person who accompanied him to the hospital. Therefore, the correctness of the fact recorded in the discharge summary cannot be doubted. From this document, it is clearly established that the deceased was a known case of diabetes mellitus for the last eight years and was on treatment for the said disease. On perusal of the application for Life Insurance policy submitted by the deceased insured (annexure R1), we find that in response to a query whether applicant/insured was suffering from diabetes, the insured had answered in ''negative''. Thus, this is clear case of concealment of material information regarding the medical condition of the insured. We may note that diabetes is a serious disease and it can adversely impact the functioning of vital human organs. Therefore, in our opinion, the insurance contract was obtained by the insured by concealing the material information which could have impaired the decision of respondent insurance company to accept or reject the insurance proposal. Thus, the order of the State Commission accepting the appeal and dismissing the complaint cannot be faulted. (Reference be made to the judgments of the Supreme Court in the matter of P.C. Chacko & Anr. Vs. Chairman, LIC of India : (2008) 1 SCC 321 and Satwant Kaur Sandhu Vs. New India Assurance Company : (2009) 8 SCC 316).

IN view of the discussion above, we are of the opinion that petitioner has not been able to point out any jurisdictional error or material irregularity in the impugned order in exercise of revisional jurisdiction of this Commission. Revision petition is, therefore, dismissed.