Page 50 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 50

brought our attention to Annexure A-3/P-7, the letter issued by the Administrative
Officer of Heart Hospital Ltd. which clearly mentioned about the patient that Shail
Devi was suffering from diabetes mellitus for last ten years. On the basis of the said
letter the claim was repudiated by the OP-insurance company. The learned counsel for
the complainant submitted that there was no concealment in the proposal form. The
counsel denied that the patient was suffering from diabetes mellitus for more than ten
years.
5. We have perused the proposal form, the insurance policy and the Bed Head
Ticket (BHT) of the Heart Hospital Ltd. The examination sheet of the Heart Hospital
revealed that Shail Devi, aged 60 years, was admitted in that Hospital on 16-12-2010
with complaint of chest pain since 7:00 A.M. and at one end, it was written as
―DM/10 yrs‖. It is pertinent to note that under the caption ―past history‖ it was written
as “DM……yrs”. Thus it itself indicates controversy. Secondly, the examination
sheet No.(iv) revealed the ―advice‖ given by the doctor on admission of the insured
and we do not find any medication given for diabetes mellitus except it was ordered
that ―to start NTG drip‖ and patient was under observation. She died at 6:50 P.M. by
cardiac arrest. The certificate issued by the Heart Hospital Ltd. indicates that at the
time of admission, she was suffering from acute myocardial infraction and died by
cardio respiratory arrest.
6. We do not find any weightage to the letter dated 31-05-2011 issued by the
Administrative Officer of Heart Hospital. The letter is reproduced as below:
―Subject: Your letter No.47137618 dated 18-05-2011 regarding treatment
details of late Shail Devi.
Dear Sir,
With reference to the above, please be informed that according to our hospital
records, Late Mrs. Shail Devi was suffering from Diabetes Mellitus for the last 10
years, as reported by the patient herself at the time of admission.‖
Such letters can be created at any time. It is pertinent to note that the vital
record like bed head tickets and doctor‘s notes in the medical record does not reveal
anything about diabetes mellitus. There is nothing on record to show that the patient
was diabetic. No laboratory tests are produced to prove that she was diabetic. Also
nothing was on record about the administration of any diabetic drugs during hospitali-
sation. Thus, the letter issued by Administrative Officer is a vague and unreliable
which appears to be a procured one for the benefit of insurance company.
7. On the basis of the foregoing discussion, in our view, the OP failed to prove
that the patient was diabetic. Moreover, the patient suffered acute EMI and died by
cardio respiratory arrest as per the death certificate. We do not find any merit in the
instant revision petition. The State Commission has passed a well-reasoned order
which does not warrant any interference. The revision petition is dismissed with cost
of Rs.20,000/- which is to be paid by the petitioner to the complainant within four
weeks from the date of receipt of order, failing which the entire decreetal amount will
carry interest at the rate of 12% per annum till its realisation.

......................
DR. B.C. GUPTA

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