M SABHJAN Vs. NEW INDIA ASSURANCE CO LTD

JUDGEMENT

(1.) THIS Revision Petition has arisen out of the order dated 11.8.94 of the State Commission, Tamil Nadu at Madras dismissing the complaint by reversing the order dated 22.12.93 of the District Forum, Krishnagiri which had allowed the complaint and directed the opposite party to pay Rs. 15,000/ - as consolidated compensation.

(2.) THE complainant and his wife applied on 6.6.91 for a Hospitalisation and Domiciliary Hospitalisation Benefit Policy from the New India Assurance Company Ltd. in pursuance of which Policy No. 4871140400746 for the period 6th June, 1991 to 5th June, 1992 was issued and was renewed for a further period of one year upto 5th of June, 1992. At the time of taking the said policy, the complainant filled up the proposal form in which he declared that his wife had undergone treatment for stone in the bile duct. In April, 1991 from Dr. Krishna Rao, Lady Wellington Nursing Home, Madras and was fully cured. According to the complainant there was no stone in the bile duct as it had passed out by then, that she was discharged from the Nursing Home as completely cured and that no further treatment was prescribed nor was she called for review at a later date as Dr. Krishna Rao did not consider it necessary. The complainant submitted a claim for Rs. 10,796.64 in respect of the treatment taken by his wife for removal of stones from the Gall Bladder/Bile Duct at Baptist Hospital, Bangalore during the period 2nd May, 1992 to 13th May, 1992 and another claim for Rs. 8,822.34 in respect of the treatment in the same hospital during the period 22nd June, 1992 to 1st July, 1992. The complainant also supported the claims by vouchers from the said hospital.

(3.) THE complainant then made the complaint to the District Forum, Krishnagiri which by the order dated 22.12.93 allowed the complaint and directed the Insurance Co. to pay a sum of Rs. 15,000/ - in settlement of the two claims. The Insurance Co. filed an appeal before the State Commission. The State Commission considered the grounds of repudiation namely (1) there was deliberate suppression in the proposal form to the effect that patient Mumtaz Begum suffered from stones in Gall Bladder, (2), she has made mis -statement in Exhibit B4 proposal form that she was completely cured of the stones in the bile duct and the stones in the Gall Bladder was a pre -existing disease and excluded risk under the condition 4.13 of the Exhibit A2 - Prospectus. The State Commission considered the report (Exhibit Bl) of St. Johns Medical College Hospital, Bangalore for the treatment undergone by Mrs. Mumtaz Begum on 15.3.91 and 16.3.91. Exhibit B2 is the discharge note issued by the Lady Wellington Nursing Home, Madras where she was admitted on 8.4.91 and discharged on 11.4.91. It is clearly recorded in Exhibit B2 that ultra sound showed Cholelith Cholecystitis (Gall Stone) 'dilated CBD with calculus obstruction'. Exhibit B2 reads as under : -