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Doctor's prescriptions have to be substantiated by an Affidavit of the said doctor

In  PNB METLIFE INSURANCE COMPANY LTD. vs VINITA DEVI, the claim of the respondent on death of her husband-the insured was repudiated by the insurer on th ground of suppression of material facts.

The respondent claimed heart failure as cause of death while the insurer claimed that the insured had suppressed the fact that he suffered from severe kidney problems. However, the records provided by the insurer were found not be dependable.

The District as well as the State Forum has found the insurer to have been deficient in their service. The NCDRC referring to the judgment of the Commission titled Sushil Kumar Jain Vs. United India Insurance Co. Ltd. I which has attained finality, held that it has been observed in the said judgment  that the doctor’s prescriptions have to be substantiated by an Affidavit of the said doctor,  specially in the light of the fact that it is being disputed by the Complainant. In the instant case the Insurance Company has not produced the affidavit of the concerned doctor nor did the said doctor answer any interrogatory by way of evidence before the Fora below.  At the cost of repetition, it is reiterated that the burden to prove that the life assured was suffering from any pre-existing disease lies with the Insurance Company and the Insurance Company had not filed any documentary evidence or Affidavit of the treating doctor in support of their contention.  Hence we find force in the contention of the Counsel of the Complainant that the insured was never treated by the said doctor Y.K. Thakur of Hazipur as the reports are not substantiated by any affidavit of evidence.  In the light of this observation, we are of the considered view that the aspect of nexus between  the kidney disease and heart attack is of no relevance in the instant case.

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