State Consumer Disputes Redressal Commission
M/S Star Health And Allied Insurance Co. ... vs Ashish Rana on 8 January, 2013
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH First Appeal No. : 336 of 2012 Date of Institution : 08.10.2012 Date of Decision : 08.01.2013 M/s Star Health and Allied Insurance Co. Ltd., SCO 257, IInd Floor, Sector 44-C, Chandigarh, through its Zonal Manager Sh. Pradipta Chandra Tripathy, its duly constituted Attorney. Appellant/Opposite Party V e r s u s Ashish Rana s/o Sh. Ashok Kumar Rana, R/o H.No.101, GH-31, Sector 5, Mansa Devi Complex, Panchkula. ....Respondent/Complainant Appeal under Section 15 of the Consumer Protection Act, 1986. BEFORE: JUSTICE SHAM SUNDER (RETD.), PRESIDENT. MRS. NEENA SANDHU, MEMBER.
Argued by: Sh. Gopal Mittal, Advocate for the appellant.
Sh. Sandeep Bhardwaj, Advocate for the respondent.
PER JUSTICE SHAM SUNDER (RETD.), PRESIDENT This appeal is directed against the order dated 31.08.2012, rendered by the District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (hereinafter to be called as the District Forum only), vide which, it accepted the complaint, filed by the complainant (now respondent) and directed the Opposite Party (now appellant), as under:-
In the light of above observations, we find a definite deficiency in service on the part of the Opposite Party. The present complaint of the Complainant succeeds against the Opposite Party, and the same is allowed qua it. Hence, the Opposite Party is directed:-
[a] To pay 70% of the claim of Rs.97,523/-, as per Clause 5 of Exclusions of the Policy;
[b] To pay Compensation of Rs.25,000/- towards mental agony and harassment;
[c] To pay Cost of litigation amounting to Rs.10,000/-;
The above said order shall be complied within 45 days of its receipt by Opposite Party; thereafter, Opposite Party shall be liable for an interest @18% per annum on the amount mentioned in sub-para [a] & [b] of para 8 above, from the date of authorization rejection letter i.e. 19.09.2011, till it is paid.
2. The facts, in brief, are that, the father of the complainant (now deceased), took Health Insurance Policy namely Senior Citizens Red Carpet Insurance Policy for a sum of Rs.2 lacs, by paying a sum of Rs.9,326/-, as premium, for the period from 28.12.2010 up to 27.12.2011. According to the complainant, at the time of taking the aforesaid Policy, by his father (now deceased), they were made to understand by the Opposite Party, he (his father) could avail of the benefits of (a) in patient hospitalization expenses (b) ICU expenses per day (c) Nursing expenses
(d) Surgeons fee, Consultants fee, Anesthetists and Specialists fee (e) Cost of blood, Oxygen, pacemaker (f) Cost of drugs and diagnostic tests and (h) Emergency ambulance charges. It was stated that the father of the complainant had supplied all the information, demanded by the Opposite Party, prior to taking the Policy. After getting completed the formalities, and satisfying itself, the Opposite Party issued a cover note, in the name of Ashok Kumar Rana (father of the complainant), for the sum assured of Rs.2 lacs. It was further stated that the detailed terms and conditions of the Policy, were to reach the address of the deceased, which according to complainant, he never received.
3. It was further stated that the father of the complainant was very much healthy, at the time of purchase of the Policy. On 16.9.2011, father of the complainant, was admitted in Alchemist Hospital, Panchkula, due to fever, and pain in abdomen, for the last 8 to 10 days. He was shifted to Intensive Care Unit (ICU), on the same day, but, unfortunately, he passed away, on 18.9.2011, due to multi-organ failure, and severe metabolic acidosis, as reported by the Alchemist Hospital. The Opposite Party was duly informed, about the admission of the father of the complainant, in the aforesaid hospital on 16.9.2011 itself. The complainant was told that the charges of Hospital, would be paid by the Opposite Party, as the benefits of Policy were of cashless nature. It was further stated that 17.9.2011 and 18.9.2011, were Saturday and Sunday respectively. The Opposite Party, informed the complainant, that he should bear the expenses, of his fathers treatment, from his own pocket, as it was holiday on Sunday, and assured to indemnify him, later on.
4. It was further stated that during the course of treatment of the father of the complainant, he (complainant) paid an amount of Rs.900/-, at Government Medical College and Hospital, Chandigarh, and Rs.3,144/- at Fortis Hospital, on 17.9.2011. Believing the promise, made by the Opposite Party, the Complainant also paid an amount of Rs.97,523/-, through credit card, to the Alchemist Hospital vide bills and receipts Annexures C-2/1 to C-2/6. It was further stated that the complainant completed all the formalities, with the Opposite Party, by supplying each and every document, as and when asked for by it. On 22.11.2011, the complainant inquired about the status of the claim of his father, submitted by him, to the Opposite Party. The Opposite Party handed over a computer generated repudiation letter, without any seal/ stamp, on the ground, that there was misrepresentation of material facts, by the insured i.e. father of the complainant, with regard to the disease i.e. Hairy Cell Leukemia, with which, he was suffering from, at the time of signing the proposal form.
5. It was further stated that the certificate, from the treating doctor dated 24.10.2011 (Annexure C-4), copy of which was also supplied to the Opposite Party, specifically mentioned that there was no evidence of Hairy Cell Leukemia, during investigation, at the time of treatment of the father of the complainant. It was further stated that, thus, the Opposite Party illegally and arbitrarily, repudiated the claim of the complainant, on flimsy grounds. It was further stated that the Opposite Party was many a time, asked to withdraw the illegal and arbitrary repudiation letter Annexure C-3, and settle the claim of the complainant, but to no avail. It was further stated that the aforesaid acts of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Party to pay a sum of Rs.97,523/-, i.e. the expenses incurred towards the treatment of his father, alongwith interest @18% p.a., from the date of payment; compensation, in the sum of Rs.1,00,000/-, on account of mental agony and physical harassment; and cost of litigation to the tune of Rs.21,000/-.
6. The Opposite Party, in its written version, pleaded that the complaint was not maintainable, on the ground, that the complainant had not approached the District Forum with clean hands; that no cause of action accrued to the complainant, to file the present complaint, against it; and that the contract of insurance being based on the principle of Uberrima Fide i.e. utmost good faith, the father of the complainant, having concealed the material facts, regarding his diseases, at the time of filling up and signing the proposal form, he could not claim any benefit, under the same. It was stated that the Medical Officer, who visited the ALCHEMIST Hospital, and had gone through the records of the deceased (insured), had submitted his report, mentioning therein, that the complainant was a known case of Hairy Cell Leukemia, had a history of PTCA, in the year 2000, and had taken treatment for the same, in the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. It was further stated that, at the time of submission of the proposal form, the insured intentionally gave wrong answers, to the questions that he had not suffered from any disease(s), at any point of time. It was admitted that the father of the complainant (now deceased), took the Health Insurance Policy namely Senior Citizens Red Carpet Insurance Policy for a sum of Rs.2 lacs, by paying a sum of Rs.9,326/-, as premium, for the period from 28.12.2010 to 27.12.2011. The treatment of the father of the complainant and expenses incurred thereon, was also not denied. It was further stated that repudiation of the claim aforesaid, was legally and validly made by the Opposite Party, as the contact of insurance stood vitiated, being based on fraud, which was played by the father of the complainant, upon the Opposite Party, at the time of signing and submission of the proposal form.
It was further stated that neither there was any deficiency, in rendering service, on the part of the Opposite Party, nor it indulged into unfair trade practice. The remaining averments, were denied, being wrong.
7. The Parties led evidence, in support of their case.
8. After hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, accepted the complaint, in the manner, referred to, in the opening para of the instant order.
9. Feeling aggrieved, the instant appeal, has been filed by the appellant/Opposite Party.
10. We have heard the Counsel for the parties, and, have gone through the evidence, and record of the case, carefully.
11. The Counsel for the appellant/Opposite Party, submitted that the contract of insurance, being based on utmost good faith, it was the duty of the insured, to disclose, as to whether, he was suffering from, or had suffered from any disease(s), at the time of signing and submission of the proposal form. He further submitted that, since it was an Insurance Policy, which was purchased by a Senior Citizen, additional questions were attached with the proposal form, to be answered by the insured. He further submitted that the additional questions, were put to the insured i.e. father of the complainant, as to whether, he had ever suffered from/was suffering from any of the diseases i.e. Cancer, Chronic Kidney Disease, CVA/Brain Stroke, Alzheimer Disease and Parkinsons Disease. He further submitted that, he (father of the complainant), answered all these questions, in negative, by tick marking, the word No, written against each disease, referred to above, at page 151 of the District Forum file, and crossing/cutting the word Yes, mentioned against these diseases. He further submitted that, as per Annexure R-3 and Annexure R-6, the father of the complainant had been suffering from PTCA since 2000 and took treatment for Hairy Cell Leukemia, in 2002. He further submitted that even, at the time of admission of the father of the complainant, in ALCHEMIST Hospital, the treating Doctor, in clinical notes Annexure R-7 mentioned that he took treatment for Hairy Cell Leukemia in 2002 and PTCA in 2000, in Post Graduate Institute of Medical Education and Research, Chandigarh. He further submitted that Hairy Cell Leukemia is a type of rare cancer. He further submitted that since these diseases were concealed/suppressed by the insured, at the time of furnishing the additional information, when the proposal form was filled up and submitted, the contract of insurance, being based on fraud, stood vitiated, and the insured was not entitled to any benefit, thereunder. He further submitted that the claim submitted by the complainant, was rightly repudiated by the appellant/Opposite Party.
12. On the other hand, the Counsel for the respondent/complainant, submitted that no affidavits of the treating Doctor, or the Doctors, who recorded the information, in Annexures R-3, R-6 and R-7, were produced, on record, by the Opposite Party. He further submitted that the medical history recorded in the clinical reports, in the absence of being supported by the affidavits of the treating Doctor(s), could not be taken into consideration. He further submitted that even if, the father of the complainant was suffering from PTCA or Hairy Cell Leukemia, and took treatment for the same from the Post Graduate Institute of Medical Education and Research, Chandigarh, he had recovered from the same, as is evident, from Annexure C-4, copy of the certificate, issued by Dr. Vikas Bhadu, Consultant Physician, ALCHEMIST Hospital. He further submitted that there was no suppression or concealment of material facts, at the time of filling up the proposal form, by the insured. He further submitted that the claim submitted by the complainant, was thus, illegally and arbitrarily repudiated by the Opposite Party. He further submitted that the order of the District Forum, being legal and valid, is liable to be upheld.
13. After giving our thoughtful consideration, to the rival contentions, advanced by the Counsel for the Parties, and the evidence, on record, we are of the considered opinion, that the appeal is liable to be accepted, for the reasons to be recorded hereinafter. It has been repeatedly held that the contract of insurance falls in the category of contract of UBERRIMAE FIDEI meaning thereby, a contract of utmost good faith, between the parties. When information on a specific aspect, is asked for, in the proposal form, the insured is under a solemn obligation, to make a true and full disclosure of the information, on the subject, which is within his knowledge. Of course, obligation to disclose, extends only to the facts, which are known to the applicant, and not to what he ought to have known. The Hon`ble Supreme Court of India in United Insurance Co. Ltd. Vs. M.K.J. Corporation, III (1996) CPJ 8 (SC)= (1996) 6 SCC 428, laid down the principle of law, that it is a fundamental principle of Insurance Law that utmost good faith must be observed by the contracting parties. Good faith forbids either party from non-disclosure of the facts, which the party privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing to the contrary. To the similar effect, the principle of law, was laid down in Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd., II (2000) SLT 323 = I (2000) CPJ 1 (SC) . In P.C. Chacko and Anr.
Vs. Chairman, Life Insurance Corporation of India and Ors, III(2008) CPJ 78 (SC), it was held as under:-
12.
Section 45 postulates repudiation of such policy within a period of two years. By reason of the aforementioned provision, a period of limitation of two years had, thus, been specified and on the expiry thereof the policy was not capable of being called in question, inter alia on the ground that certain facts have been suppressed which were material to disclose or that it was fraudulently been made by the policy holder or that the policy holder knew at the time of making it that the statement was false. Statute, therefore, itself provides for the limitation for valid repudiation of an insurance policy. It takes into account the social security aspect of the matter.
13.There are three conditions for application of Second Part of Section 45 of the Insurance Act which are:
(a) the statement must be on a material matter or must suppress facts which it was material to disclose;
(b) the suppression must be fraudulently made by the policy-holder; and
(c) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose.
14. The purpose of taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security, but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated, if a fraudulent act is discovered. The proposer must show that his intention was bonafide. It must appear from the face of the record. In a case of this nature, it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered, may lead to the policy being vitiated in law.
15. In Rampreeti Yadav Vs. U.P.Board of High School & Intermediate Education & Ors, V(2003) SCT 394= JT 2003 (Supplt.I) SC 25, the principle of law, laid down, was to the effect that it is well settled law that mis-representation itself amounts to fraud in some cases.
16. Keeping in view the principle of law, laid down, in the aforesaid cases, now let us see, as to whether, in the instant case, the insured(now deceased), at the time of taking the Insurance Policy, suppressed the material facts by answering the additional questions aforesaid, in the negative, or had made a wrong declaration or not. Copy of the proposal form is at page 149 of the District Forum file and the additional questions, which were attached with a copy of the proposal form, by the Opposite Party, as the Policy was proposed to be taken by the Senior Citizen, are at page 151 of the District Forum file. The insured was put the following additional questions, to which he answered as under:-
Have you ever suffered from/Are you suffering from any of the following:-
Cancer No Chronic Kidney Disease No CVA/Brain Stroke No Alzheimer Disease No Parkinson`s Disease No
17. He also signed the additional information, aforesaid furnished by him. From the perusal of the answers to the additional questions, furnished by the insured, it is evident, that he, in clear-cut terms, replied that he had not suffered or was suffering from any of the diseases like Cancer, Chronic Kidney Disease, CVA/Brain Stroke, Alzheimer Disease and Parkinson`s Disease. On the other hand, it is evident from Annexure R-3, containing the medical history of the father of the complainant, that he took admission in ALCHEMIST Hospital on 16.09.2011 and that he had been suffering from Diabetes, for the last10 years. It is further evident from Annexure R-3 that that he suffered from heart disease CAD and PTCA had been done in 2000. It is further evident from Annexure R-3 that he was suffering from pre-existing disease of Hairy Cell Leukemia. It is further evident, from this document that he expired on 18.09.2011. Not only this, Dr. K.R. Dhawan of the Opposite Party, visited the ALCHEMIST Hospital and went through the admission and treatment record of the father of the complainant, wherein, he, in clear-cut terms, vide report Annexure R-6, stated that he had undergone PTCA in 2000 and suffered from Hairy Cell Leukemia. Even from the clinical notes Annexure R-7, of ALCHEMIST Hospital, it was proved that the father of the complainant, took treatment for Hairy Cell Leukemia, in 2002 and for heart disease in 2000, from the Post Graduate Institute of Medical Education and Research, Chandigarh. This clinical report was signed by Dr. Gurpreet Singh on 16.09.2011. These notes were recorded by the treating Doctor, of ALCHEMIST Hospital, where the father of the complainant, took admission with complaint of fever and abdominal pain, for the last three to four days. It means, that the father of the complainant very well knew that he had suffered from the aforesaid diseases, but even then, he intentionally gave wrong answers, to the additional questions, attached with the proposal form. The clinical notes (Annexure R-7), were recorded by the Doctor, on the information supplied by the father of the complainant or the complainant and not, on his own. From the documents Annexures R-3, R-6 and R-7, it was, thus, proved that there was suppression of material facts, with regard to diseases, with which the father of the complainant had suffered, at the time of answering the additional questions, attached with the proposal form. Since, the father of the complainant had obtained the Insurance Policy, by suppressing the material facts, with regard to the diseases, with which he had suffered, the contract of insurance, being based on fraud, stood vitiated. Under these circumstances, the Opposite Party legally and validly repudiated the claim of the complainant. The District Forum was wrong, in holding otherwise.
18. The next question, that falls for consideration, is, as to whether, in the absence of the affidavits of the Doctors, Annexures R-3, R-6 and R-7 could be taken into consideration or not. In Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., IV (2009) CPJ 8 (SC), in para 22, the Apex Court held as under:-
Answers given by the proposer to the two questions were Sound Health and Nil respectively. It would be beyond anybodys comprehension that the insured was not aware of the state of his health and the fact that he was suffering from diabetes as also chronic renal failure, more so, when he was stated to be on regular haemodialysis. There can hardly be any scope for doubt that the information required in the afore-extracted questions was on material facts and answers given to those questions, were definitely factors, which would have influenced and guided the respondent - Insurance Company to enter into the Contract of Mediclaim Insurance with the insured. It is also pertinent to note that, in the claim form, the appellant had stated that the deceased was suffering from Chronic Renal Failure and Diabetic Nephropathy from 1st June, 1990, i.e. within three weeks of taking the policy. Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was palpably untrue to his knowledge. There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent - insurer was fully justified in repudiating the insurance contract. We do not find any substance in the contention of learned Counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated. Apart from the fact that at no stage the appellant had pleaded that the insured was not treated at Vijaya Health Centre at Chennai, where he ultimately died. It is more than clear from the said certificate that information about the medical history of the deceased must have been supplied by his family members, at the time of admission, in the hospital, a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorises the insurer to seek information from any hospital he had attended or may attend concerning any disease or illness which may affect his health.
19. In the said case, the Apex Court, without insisting on the affidavit, in support of the certificate, issued by the Doctor, and by relying upon the same held that the insured was guilty of suppression of material facts, in disclosing the disease, she was suffering from. Similar principle of law, was laid down, in Puspha Chauhan Vs. Life Insurance Corporation of India, II (2011) CPJ 44 (NC). In view of the principle of law, laid down, in the aforesaid cases, the documents Annexures R-3, R-6 and R-7, could be taken into consideration, even without the affidavits of the Doctors, who prepared the same. The submission of the Counsel for the respondent/complainant, therefore, being without merit, must fail, and the same stands rejected.
20. The next question, that falls for consideration, is, as to whether, even if, the death of the father of the complainant had not allegedly taken place, on account of Hairy Cell Leukemia or heart disease, but, on account of some other disease(s), his claim could be legally and validly repudiated or not. In Kokilaben Narendrabhai Patel Vs. Life Insurance Corporation of India, IV (2010) CPJ 86 (NC) deceased husband of the complainant, took an Insurance Policy for Rs. 1 lac, on 28.03.1993. He died on 21.06.1996, due to heart attack. At the time of filling up, and signing the proposal form, he gave false answers, to the questions and, thus, suppressed material facts. The claim of the complainant was repudiated, by the Insurance Company, on the ground, that it was not disclosed that 11 months prior to taking the Insurance Policy, the insured, suffered from typhoid (Enteric fever), remained admitted, in the hospital, for one day and was advised complete bed rest. He took 17 days leave, from the bank, where he was working. In these circumstances, the National Consumer Disputes Redressal Commission, New Delhi, held that though, the disease, on account of which, the insured died, had no nexus, with the false answers to the questions, given by him, yet, as he suppressed the material facts, at the time of filling up the proposal form, he was not entitled to any benefit, under the Policy, and repudiation of his claim was rightly made by the Opposite Party/Insurance Company. The principle of law, laid down, in the aforesaid case, is fully applicable to the instant case. Under these circumstances, the factum, that the father of the complainant was admitted, in ALCHEMIST Hospital, as he complained of fever, was, ultimately, diagnosed as a case of Dengue, and his death resulted, on account of multi organ failure, did not mean that consequences of the suppression or concealment of material facts, made by him, while falsely answering the additional questions, aforesaid, at the time of filling up the proposal form, could not ensue. Under these circumstances, the submission of the Counsel for the respondent/complainant, being devoid of merit, must fail, and the same stands rejected.
21. No doubt, the respondent/complainant submitted that vide certificate Annexure C-4, the treating Doctor of the father of the complainant, stated that during investigation, he did not find any traces of Hairy Cell Leukemia, as the same had been treated, and, as such, the answers to the questions, given by him, to the additional questions, put to him, were not at all relevant, for the purpose of repudiating the claim, in question. The submission of the Counsel for the respondent/complainant, in this regard, does not appear to be correct. Here, we are concerned with the factum, as to whether, there was a suppression or concealment of material facts, and, as such, the Policy was obtained by a fraudulent act or not. Since, it has been proved that the Policy had been obtained, by intentionally giving wrong answers, to the additional questions aforesaid, by the father of the complainant, and, thus, he suppressed the material facts, the contract of insurance being based on fraud, stood vitiated. Under these circumstances, Annexure C-4 had no effect, whatsoever, with regard to the suppression/concealment of material facts, by the father of the complainant, at the time of answering the additional questions, at page 151 of the District Forum file. The submission of the Counsel for the respondent/complainant, in this regard, being devoid of merit, must fail, and the same stands rejected.
22. The Counsel for the respondent/complainant also placed reliance on L.I.C. of India and Ors. Vs. Surekha Rameshrao Mankra, 2012 (1) CPC 295 and National Insurance Company Limited Vs. Mona Ohri and Another, First Appeal No.1583 of 2005, decided by the State Consumer Disputes Redressal Commission, Punjab, Chandigarh, on 25.03.2011, to substantiate his claim, that since the death of the insured, did not take place, on account of Hairy Cell Leukemia or heart disease, his claim could not be legally and validly repudiated. In L.I.C. of India and Ors. case (supra), the claim of the complainant was repudiated, alleging that material fact of serious disease Herpes Zoster was suppressed. In that case, the insured suffered from viral infection and was cured, as per the documents on record. It was held, in that case, that the said disease was, in no way, related to the heart attack. It was further held that, normally, while filling up an insurance proposal form, it is not expected that the insured has to also state all the incidents of viral infections, from which he may have suffered, since these are frequent, common place and curable. It was further held that the infection, apart from having been cured, was in no way related to the heart attack, from which the insured died. The National Consumer Disputes Redressal Commission, New Delhi, held that the repudiation of claim was illegal. In National Insurance Company Limited`s case (supra), the State Consumer Disputes Redressal Commission, Punjab, Chandigarh, held that since the Doctor did not medically examine the patient, and his opinion was only based on the examination of medical papers, it could not be said that the disease of Mona Ohri (insured), was pre-existing. It may be stated here, that, in the instant case, the father of the complainant, died on account of multiple organ failure. It was not that, he was only suffering from viral infection, which was cured and he could not disclose the same, at the time of answering the additional questions. In the instant case, he was suffering from a rare Cancer (Hairy Cell Leukemia) and heart disease, for which had taken treatment, in the Post Graduate Institute of Medical Education and Research, Chandigarh. In the instant case, the father of the complainant knew about the disease(s), which he had suffered, or was suffering and that was why, he gave the history thereof, when he was admitted in ALCHEMIST Hospital. These diseases were duly recorded, in the clinical notes aforesaid, by the Doctor. In view of the principle of law, laid down, in United Insurance Co. Ltd. Vs. M.K.J. Corporation, Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd. and P.C. Chacko and Anr. Vs. Chairman, Life Insurance Corporation of India and Ors., cases (supra), decided by the Supreme Court, no help can be drawn by the Counsel for the respondent/complainant, from the principle of law, laid down, in the cases relied upon by him. From the literature marked as Annexure AX, downloaded from the internet, the definition, causes and symptoms of Hairy Cell Leukemia, are reproduced as under:-
Hairy Cell Leukemia Definition Hairy cell leukemia is a disease in which a type of white blood cell called the lymphocyte, present in the blood and bone marrow, becomes malignant and proliferates. It is called hairy cell leukemia because the cells have tiny hair-like projections when viewed under the microscope.
Description Hairy cell leukemia (HCL) is a rare cancer. It was first described in 1958 as leukemic reticuloendotheliosis, erroneously referring to a red blood cell because researchers were unsure of the cell of origin. It became more easily identifiable in the 1970s. There are approximately 600 new cases diagnosed every year in the United States, making up about 2% of the adult cases of leukemia each year.
HCL is found in cells located in the blood. There are three types of cells found in the blood: the red blood cells that carry oxygen to all the parts of the body; the white blood cells that are responsible for fighting infection and protecting the body from diseases; and the platelets that help in the clotting of blood. Hairy cell leukemia affects a type of white blood cell called the lymphocyte. Lymphocytes are made in the bone marrow, spleen, lymph nodes, and other organ. It specifically affects B-lymphocytes, which mature in the bone marrow. However, extremely rare variants of HCL have been discovered developing from T-lymphocytes, which mature in the thymus.
When hairy cell leukemia develops, the white blood cells become abnormal both in the way they appear (by acquiring hairy projections) and in the way they act (by proliferating without the normal control mechanisms). Further, the cells tend to accumulate in the spleen, causing it to become enlarged. The cells may also collect in the bone marrow and prevent it from producing normal blood cells. As a result, there may not be enough normal white blood cells in the blood to fight infection.
The median age at which people develop HCL is 52 years. Though it occurs in all ages, HCL more commonly develops in the older population. Men are four times more likely to develop HCL than women. There have been reports of familial aggregation of disease, with higher occurrences in Ashkenazi Jewish men. A potential genetic link is undergoing further investigation.
Causes and symptoms The cause of hairy cell leukemia is not specifically known. However, exposure to radiation is a known cause of leukemia in general. Familial involvement is another theory, suggesting that there is a genetic component associated with this disease.
HCL is a chronic (slowly progressing) disease, and the patients may not show any symptoms for many years. As the disease advances, the patients may suffer from one or more of the following symptoms:
weakness fatigue recurrent infections fever anemia bruising pain or discomfort in the abdominal area weight loss (uncommon) night sweats (uncommon) Pain and discomfort are caused by an enlarged spleen, which results from the accumulation of the abnormal hairy cells in the spleen. Blood tests may show abnormal counts of all the different types of cells. This happens because the cancerous cells invade the bone marrow as well and prevent it from producing normal blood cells. Because of the low white cell count in the blood, the patient may have frequent infections. Fever often accompanies the infections. The patient is most susceptible to bacterial infections, but infections of any kind are the major cause of death. The low red cell count may cause anemia, fatigue, and weakness, and the low platelet count may cause the person to bruise and bleed easily.
23. From the above extracted definition, causes and symptoms of Hairy Cell Leukemia, it is evident, that as the disease advances, the patient may suffer from one or more of the symptoms like weakness, fatigue, recurrent infections, fever, anemia, bruising, pain or discomfort in the abdominal area, weight loss (uncommon) and night sweats (uncommon).
24. In the instant case, when the father of the complainant, took admission, in ALCHEMIST Hospital, he had been suffering from fever and abdominal pain for the last 3 to 4 days, which possibly led to frequent infections, resulting into multi organ failure, resulting into his death. It, therefore, could not be said that the diseases, from which the father of the complainant was suffering or had suffered, and which he had not disclosed, at the time of answering the additional questions, did not lead to his death. The submission of the Counsel for the respondent/complainant, in this regard, being devoid of merit, must fail, and the same stands rejected.
25. No other point, was urged, by the Counsel for the parties.
26. In view of the above discussion, it is held that there was no deficiency, in rendering service, on the part of the Opposite Party. The District Forum was wrong, in coming to the contrary conclusion. The order passed by the District Forum, being not based on the correct appreciation of evidence, and law, on the point, suffers from illegality and perversity, warranting the interference of this Commission.
27. For the reasons recorded above, the appeal is accepted, with no order as to costs. The order of the District Forum is set aside.
28. Certified copies of this order, be sent to the parties, free of charge.
29. The file be consigned to Record Room, after completion Pronounced.
January 8, 2013 Sd/-
[JUSTICE SHAM SUNDER (RETD.)] PRESIDENT Sd/-
[NEENA SANDHU] MEMBER Rg