Reliance Life Insurance Co. Ltd. & Anr vs Marri Sujata

The present Revision Petition has been filed against the order dated 06.10.2017, passed by the Telangana State Consumer Disputes Redressal Commission at Hyderabad (hereinafter referred to as the State Commission), whereby the Appeal, preferred by the Petitioners herein, has been dismissed and the order passed by the District Consumer Disputes Redressal Forum at Warangal (for short the District Forum) has been affirmed.

We have heard Mr. A. Naveen Kumar, learned Counsel for the Petitioners, and Mr. K. Venkateswarlu, learned Counsel for the Respondent/Complainant, and have perused the impugned order dated 06.10.2017 passed by the State Commission as also the order dated 13.11.2013 passed by the District Forum and the other documents filed along with the Memo of Revision Petition and also by the Respondent/Complainant.

Briefly stated, the facts giving rise to the present Revision Petition are as follows:

The husband of the Respondent/Complainant, Marri Laxminarayana, during his lifetime obtained insurance policy bearing no. 13748755 for a sum of Rs.10,00,000/- commencing from 19.02.2009 on a yearly premium of Rs.49,130/-. The policy was issued after Insured was medically checked up under the supervision of the Authorized Medical Officer of the Petitioner, Dr. D. Mohan Das of Sri Sai Nursing Home, Hanamkonda. The Respondent/Complainant was the nominee.

The Insured died on 16.09.2010 while undergoing treatment of carcinoma tongue for a period of six months. The Insured took treatment at Yashoda Hospital, Secunderabad, and Prithvi Hospital, Subedari, Hanamkonda, and while undergoing treatment succumbed to injuries. The Respondent/Complainant being the nominee filed a claim on 01.12.2010, along with all relevant documents, which was repudiated by the Petitioners vide letter dated 26.05.2011 on the ground that the Deceased Insured had undergone treatment of carcinoma tongue for the last two years and, therefore, the claim was not maintainable.

The Respondent/Complainant approached the District Forum, which, vide order dated 13.11.2013, allowed the Complaint and directed the Petitioners to pay a sum of Rs.10,00,000/- under the insurance policy, along with interest @ 7.5% p.a. from the date of filing of the Complaint i.e. 01.08.2012 till realization and Rs.10,000/- towards compensation and Rs.1,000/- towards the costs, which order has been upheld by the State Commission.

Learned Counsel for the Petitioners submitted that as the Deceased Insured was having treatment for carcinoma tongue for more than two years, as per the prescription dated 10.08.2010 issued by Dr. Prem Sharma of Prithvi Hospital, which fact was not disclosed in the insurance proposal form, the Insured had concealed the material fact of his previous illness and the Petitioners were right and justified in repudiating the claim.

Learned Counsel for the Respondent/Complainant, however, submitted that mere mention of "hemimandilectomy done x Two years back" in the prescription form of Dr. Prem Sharma does not establish that the Insured was having carcinoma tongue for more than two years and was undergoing treatment and, therefore, the prescription which was issued by Dr. Prem Sharma cannot be taken note of. He further submitted that Dr. Prem Sharma did not appear as a witness and, therefore, the prescription issued by him cannot be relied upon.

Be that as it may, from the report submitted by M/s Zubair & Co., the Investigator, appointed by the Petitioners, we find that the Investigator visited the local hospitals at Warangal and Hyderabad and verified the available records in the hospitals but the name of the Deceased Insured was not available in the records. The Investigator had visited the following hospitals in Hyderabad:

Indo American Cancer Institute & Research Center;

Bibi Cancer Hospital;

MNJ Cancer Hospital;

NIMS Hospital;

Image Hospital; and

Care Hospital

The Investigator also visited following hospitals in Warangal District:

Nirmala Hospital;

Warangal Hospital;

Life Line Hospital;

Rohini Hospital; and

Government TB Hospital

Apart from it, the Investigator also verified the records from the Hospitals where the Insured was treated regarding carcinoma tongue but did not find any past history. The Hospitals visited by the Investigator were:

Prithvi Hospital, Hanamkonda;

Srilatha Nursing Home, Narsampet; and

Yashoda Hospital, Hyderabad

We may mention that Prithvi Hospital and Yashoda Hospital are the two Hospitals, from which, according to the Petitioner, the Insured had taken treatment. So far as Yashoda Hospital is concerned, there is no dispute. So far as the Prithvi Hospital is concerned, there was no record available regarding the Deceased Insured having taken the treatment of carcinoma tongue in the said Hospital. Mere mention of "hemimandilectomy done x Two years back" in the prescription of Dr. Prem Sharma, who was in the Prithvi Hospital, would not establish that the Deceased was undergoing treatment and was suffering from that disease for two years, to be taken from 10.08.2010.

That being the position, we are of the considered opinion that the Petitioners were not justified in repudiating the claim. The District Forum as also the State Commission have rightly allowed the claim.

The Revision Petition fails and is dismissed accordingly.

The amount, which has been deposited under the interim order dated 30.01.2019, shall be released in favour of the Respondent/Complainant.