National Consumer Disputes Redressal
Pushpa Patel vs Hdfc Standard Life Insurance Co. Ltd. & ... on 3 May, 2018
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. 630 OF 2018 (Against the Order dated 31/07/2017 in Complaint No. 61/2017 of the State Commission Chhattisgarh) 1. PUSHPA PATEL W/O. LATE SURESH KUMAR PATEL R/O. KOTRA ROAD SAVITRI NAGAR RAIGARH CHATTISGARH ...........Appellant(s) Versus 1. HDFC STANDARD LIFE INSURANCE CO. LTD. & ANR. THROUGH ITS BRNACH MANAGER 2FLOOR PUJARI CHAMBER BLOCK-B, BHAMTRI ROAD PACHPEDI NAKA RAIPUR CHATTISGARH 2. HDFC STANDARD LIFE INSURANCE COMPANY LTD THROUGH ITS AUTHORIZED PERSON LODHA EXCELS 13 FLOOR APOLLO MILLS COMPOUND N.M. JOSHI MARG MAHALAXMI MUMBAI 400 011 ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE V.K. JAIN,PRESIDING MEMBER
For the Appellant : Mr. Faraz Maqbool, Advocate For the Respondent :
Dated : 03 May 2018 ORDER
JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL)
Late Sh. Suresh Kumar Patel husband of the appellant/complainant, obtained an insurance policy from the respondents. He having died eight months after taking the policy, the claim was submitted by the petitioner, she being his widow, for payment of benefit under the insurance policy. The claim however, was repudiated by the insurer on the ground that false history with respect to the state of his health was given while responding to questions no. 28, 30 & 31 of the proposal. In substance, the deceased Suresh Kumar Patel had denied having suffering from HIV/AIDS, at the time of or prior to issuance of the policy. Being aggrieved from the rejection of the claim, the complainant approached the concerned State Commission by way of a Consumer Complaint.
2. The complaint was resisted by the insurer primarily on the ground on which the claim had been repudiated.
3. The repudiation letter to the extent it is relevant, reads as under:
"The proposal was accepted on the basis of information provided in the proposal form with the policy getting issued on September 30, 2015.
In this connection, we refer to Section in the said Application, which deals with 'Personal Details of Life to be Assured : Part II'. Under this section the following relevant questions had been answered as incorrectly.28
Have you ever been tested positive for HIV/AIDS or Hepatitis B or C, or have you been tested/treated for other sexually transmitted disease or are you awaiting the results of such a test?
No 30 During last 5 years have you undergone or been recommended to undergo hospitalization?
No 31 During last 5 years have you undergone or been recommended to undergo operation?
No From investigations, it was established that the Life Assured was suffering from Retroviral Disease prior to the policy issuance. This was not disclosed in the application dated August 18, 2015. Had this information been provided to the Company at the time of applying for the issuance policy, we would have declined the application."
It would thus be seen that the deceased insured had clearly represented to the insurer that he had not been tested positive for HIV/AIDS or Hepatitis B or C, or tested/treated for other any other sexually transmitted disease.
4. A perusal of the discharge summary of the deceased issued by the Department of General Medicine, of the hospital where the deceased died shows that the history given at the time of admission was that the patient was Sero Positive since 2011. Obviously, the said history was given either by the patient himself or by a family member/attendant accompanying the patient. Neither the patient nor any family member or attendant attending him to the hospital is likely to give a false history of his illness. Therefore, the aforesaid history contains an admission that the deceased was Sero Positive since 2011.
5. The learned counsel for the appellant refers to the certificate dated 01.08.2016 issued by Dr. I. Rahman of the aforesaid hospital certifying that no documentary evidence was produced by the attendant at the time of his admission, that the patient was Sero Positive since 2011. The aforesaid certificate, in my opinion, rather proves the case of the insurer instead of proving the case of the complainant/appellant. The only import of this certificate is that though the attendant had actually given history that the patient was Sero Positive since 2011, no documentary evidence of the said illness was produced by him. In view of the admission contained in the history given at the time of admission of the patient in the hospital, no documentary evidence of his being the Sero Positive since 2011 was required. The learned counsel for the complainant/appellant submits that a wrong information was recorded by the Doctor who prepared the discharge summary. If this was so, the complainant ought to have approached the hospital to correct the discharge summary and to clarify that no such information had actually been given by the attendant at the time of admission of the patient in the hospital. No attempt to obtain such clarification was made from the hospital either before instituting the Consumer Complaint or during the pendency of the said complaint. Therefore, I see no reason to disbelief the history given by the attendant of the deceased insured at the time of admission in the hospital and consequently, hold that he gave false information with respect to the state of his health, which influenced the decision of the insurer on the question as to whether to accept the proposal for the grant of insurance or not.
6. For the reasons stated hereinabove, I find no reason to interfere with the view taken by the State Commission. The appeal being devoid of any merits, is hereby dismissed.
......................J V.K. JAIN PRESIDING MEMBER