- (1.) THE complaint relates to the Mediclaim policy. The repudiation is on the ground that the complainant was suffering from diabetes and hypertension and he has suppressed those pre -existing diseases at the time of submitting the proposal form and, therefore, the opposite party is not liable. The lower Forum did not agree with the reason for repudiation and passed an award.
(2.) NOW coming to the grounds of repudiation, we find from the declaration signed by the complainant that he has clearly stated that he was suffering from diabetes. Therefore, the contention that there was material suppression with regard to that disease vanishes. Though the opposite party had the original policy with them and the declaration in which it is specifically stated by the complainant that he was suffering from diabetes, it is rather unfortunate that the opposite party has chosen to make a definite stand that the complainant has suppressed the fact that he was suffering from diabetes. It does not befit an organization like the opposite party to misrepresent the facts.
(3.) NOW coming to the other illness, it is stated that the complainant was suffering from hypertension. The complainant has issued a notice on 28.4.2000 stating that he has not suppressed any pre -existing disease. Though the notice was received, no reply was sent. Now with regard to the hypertension, the opposite party relies upon a letter from Dr. Ravisankar. There is nothing to show that Dr. Ravisankar was the family doctor of the complainant. There is no proof affidavit filed by him. Dr. Ravisankar has stated in paragraph 2 of his letter that Mr. Sankaran was suffering from diabetes and hypertension. While the letter dated 28.12.1999 is in his own handwriting, the letter dated 24.1.2000 is typewritten and it reads as follows: "As already stated, Mr. Sankaran was suffering from hypertension and diabetes. Because of his regulated diet and exercise, both were well under control. Subsequently medication was suspended and his periodical medical checkups were continued. At the time of referring him to Dr. Chenniappan his B.P. was well within normal limits." Therefore, from this letter, it follows that even assuming he had once hypertension, it had been controlled and he was but normal and so on the date of submitting the proposal. In fact, when he was referred to Dr. Chenniappan, his B.P. was normal. Therefore, it cannot be stated that he was suffering from hypertension or that it was the pre -existing disease and he has suppressed the same. A letter from Dr. Sivasubramanian, M.D. is produced. He never treated the complainant. When his advice was sought by the opposite party, he simply says that "the claim is rejected. The patient had hypertension and diabetes prior to taking the policy. Dr. Chenniappan has clearly stated that the risk factors for the coronary artery disease were diabetes and high B.P. Hence the claim is rejected." We do not have any such report from Dr. Chenniappan. The symptom of cardiac problem had developed in the month of September, 1999. Dr. Ravisankar has clearly stated in his typewritten letter that the medication was suspended and hypertension and diabetes were controlled. In the background of above material, the lower Forum rightly held that the rejection was not proper. In the state of evidence adduced before the lower Forum, we are unable to accept the contention that there is any suppression at all. The policy was from 27.5.1999 to 26.5.2000. If really the complainant was suffering from hypertension and it was a pre -existing disease on the date of policy, he would have definitely mentioned it because he had mentioned about diabetes. There could not be any reason for him to suppress one disease and mention another disease.;