T.Vijayalakshmi filed a consumer case on 25 Apr 2017 against 1G BranchThe Chief Branch manager LIC of India BO in the North Chennai Consumer Court. The case no is CC/82/2015 and the judgment uploaded on 08 Jun 2017.
Complaint presented on: 05.05.2015
Order pronounced on: 26.05.2017
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)
2nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3
PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L., PRESIDENT
TMT.T.KALAIYARASI, B.A.B.L., MEMBER II
FRIDAY THE 26th DAY OF MAY 2017
C.C.NO.82/2015
T.Vijayalakshmi,
W/o.Late A.Thirumaran,
S.P.H/71, Anuvijay Township,
Anuvijay Post, Chettikulam,
Radhapuram,
Tirunelveli District – 627 120.
….. Complainant
..Vs..
1. The Chief Branch Manager,
LIC of India,
BO – 71G Branch,
Ambattur Branch,
87, North Park Street,
Venkatapuram, Ambattur,
Chennai – 600 053.
2. The Senior Divisional Manager,
Divisional Officer II,
LIC of India,
II Avenue, Anna Nagar Plaza,
3rd Floor, Chennai – 600 040.
3. The Zonal Manager,
LIC of India, South Zone,
Annasalai, Chennai – 600 002.
| .....Opposite Parties
|
|
Date of complaint : 22.05.2015
Counsel for Complainant :M/s. C.Paranthaman, K.Sitharthan
Counsel for Opposite Parties : M.B.Gopalan Associates,
N.Vijayaraghavan, M.B.Raghavan
O R D E R
BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,
This complaint is filed by the complainant to direct the Opposite Parties to pay the assured amount of Rs.8,00,000/- with 12% interest and also to pay compensation for deficiency in service and mental agony with cost of the Complaint u/s 12 of the Consumer Protection Act.1986.
1.THE COMPLAINT IN BRIEF:
The Complainant submits that her husband Mr.Thirumaran, insured his life with LIC of India, by taking 5 insurance policies in the following as detailed below.
The Complainant husband died on 22.02.2012 due to cardiac failure. Immediately after death of the said Thirumaran, Complainant informed the same to the Opposite Parties herein and also filed necessary claim petitions claiming the insurance mentioned in the above said Complainants. Out of 5 policies, except the policy No.719167949 all the other 4 policy amount was paid by the LIC of India to the Complainant. The respondents by letter dated 26.03.2013 requested the petitioner to inform them whether the life assured was suffering from Diabetic or not. The petitioner by letter dated 29.07.2013 informed the Opposite Parties that as far as her knowledge is concerned, her husband was hale and healthy and do not have any diseases.
2. The Complainant submits that a diabetic is not always a diabetic till his death. The said disease can be cured by taking proper medicine, regular food habit, exercise etc., In such circumstances the treatment taken by the insured during the year 2009 will not assume that the diabetic is continued in the year 2010. The Opposite Parties doctor who examined the insured Thirurrmaran took blood samples from the insured and diagnosed that the said doctor never stated that the blood sugar range in the blood is abnormal or more than normal. In such circumstances the respondents on imagination come to the conclusion that the death is caused due to diabetic without any basis and without obtaining any expert opinion. The Opposite Parties deliberately with some ulterior motive negatived the claim. The Complainant sent a legal notice to the first Opposite Party pointing out the inaction of the LIC of India to disperse the above said policy claim. However the Opposite Parties have not dispersed the policy amount. Hence the Complainant filed this Complaint to direct the Opposite Parties to pay the assured amount of Rs.8,00,000/- with 12% interest and also compensation for deficiency in service and mental agony with cost of the Complaint.
3. WRITTEN VERSION OF THE OPPOSITE PARTIES IN BRIEF
The Complainant’s policy was taken with the 1st Opposite Party Branch and is being serviced by the said office only and the 3rd Opposite Party does not provide any service in regard to the policy directly to the Complainant and the Complaint is liable to be dismissed in limine. The Complainant’s husband Mr.A.Thirumaran obtained various Life Insurance Policies from 1991 to 2010 as stated in paragraph 3 of the Complaint. The last policy No.719167949 was obtained by the Complainant’s husband on 24.03.2010 by submitting a proposal dated 24.03.2010 to the 1st Opposite Party. The information disclosed in the Proposal was the basis on which the contract of insurance was entered into by the Opposite Parties. The proposer was required to disclose the material facts in question No. 11(e) in respect of his diseases and there should not be any suppression of his ailments.
4. The Complainant husband intimated her husband death on 22.02.2012 within two years of insurance. On verification of the claim including scrutiny of medical records and information, it revealed that the Complainant was under treatment of diabetics at Dr.Mohan’s diabetes specialty centre, Chennai since 2009 prior to insurance. He is bound to disclose the above treatment in the proposal form. Failure to disclose the treatment taken for diabetics is material fact of suppression by the Complainant husband in furnishing information in the proposal. The Opposite Party repudiated the claim for the suppression of the material fact in the proposal and the same cannot be considered deficiency in service and hence prays to dismiss the Complaint with cost.
5. POINTS FOR CONSIDERATION:
1. Whether there is deficiency in service on the part of the opposite parties?
2. Whether the complainant is entitled to any relief? If so to what extent?
6. POINT NO :1
It is an admitted fact that the Complainant insured his life with the Opposite Parties and by taking 5 insurances policies
1. P.No. 711415344, DOC. 20.11.1991
2. P.No. 715926371, DOC. 20.03.2995
and he was died on 22.02.2012 due to cardiac failure and the deceased wife, the Complainant submitted 5 claims in respect of the above policies and out of the aforesaid policies, the first four policy amounts have been paid to her and the 5th policy which is marked as Ex.B3 was repudiated by the Opposite Parties under Ex.A8 that the deceased having with held material information regarding his health at the time of effecting the insurance and he had taken treatment for diabetic was not disclosed in the proposal form.
7. The Complainant would contend that having paid the other four claims the Opposite Parties are also bound to pay this claim also. Ex.A1 is the proposal form furnished by the deceased to the Opposite Parties. In said proposal column No.11(e) he furnished information as “NO” that as if he was not suffering with diseases mentioned therein including the diabetes. The Opposite Parties specifically pleaded in the written version that the diseased was suffering with diabetes and such fact was suppressed in the proposal and hence they have repudiated the claim. This fact was not denied by the Complainant in his proof affidavit which was filed subsequent to the filing of the written version. Further the Opposite Parties have filed Ex.B1 case sheet of the deceased Thirumaran issued by the Dr.Mohan’s diabetes specialty’s centre. In the said case sheet it is mentioned that the deceased was suffering diabetes for 7 years and he also furnished information that he use cigarettes 15 to 20 numbers per day for the past 15 years. The above information furnished to the Dr.Mohan’s hospital by the deceased was not furnished in the proposal while applying the insurance policy. Therefore, failure to furnish the above information in the proposal form is suppression of material fact as contended by the Opposite Parties and therefore, the Opposite Parties rightly repudiated the claim made by the Complainant and hence it is held that the Opposite Parties have not committed any deficiency in service.
08. POINT NO:2
Since the Opposite Parties have not committed any Deficiency in Service, the Complainant is not entitled for any relief and the Complaint is liable to be dismissed.
In the result the Complaint is dismissed. No costs.
Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 26th day of May 2017.
MEMBER – II PRESIDENT
LIST OF DOCUMENTS FILED BY THE COMPLAINANT:
Ex.A1 dated 23.03.2010 LIC Application – Proposal Form
Ex.A2 dated 06.02.2013 Letter by Vijayalakshmi to LIC Branch Manager
Letter of Complainant
Ex.A3 dated NIL Letter of Complainant
Ex.A4 dated 17.02.2012 Letter of Complainant to Opposite Party No.2
Ex.A5 dated 23.02.2012 AIIMS Certificate
Ex.A6 dated 26.03.2013 Letter of the Opposite Party No.2
Ex.A7 dated 29.07.2013 Letter of Complainant to Opposite Party No.2
Ex.A8 dated 14.08.2013 Letter of Opposite Party No.2 to the Complainant
Ex.A9 dated 03.11.2013 Letter to Complainant to Opposite Party No.3
Ex.A10 dated 25.11.2013 Letter of Opposite Party No.3 to Complainant
Ex.A11 dated 08.02.2014 Letter of Opposite Party No.2 to Complainant
Ex.A12 dated 25.02.2014 Letter of Complainant to Opposite Party No.2
Ex.A13 dated 05.04.2014 Letter of Complainant to Central Office Claims
Ex.A14 dated 05.04.2014 Letter of Complainant to Complaint Department
Ex.A15 dated 04.08.2014 Letter of Opposite Party No.2 to the Complainant
Ex.A16 dated 04.11.2014 Legal Notice of the Complainant
Ex.A17 dated 19.02.2015 Intimation from Insurance Ombudsman to
Complainant
Ex.A18 dated 26.02.2015 Award No.IO/CHN/A/LI/0076/2014-2015 passed
by Insurance Ombudsman
LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES :
Ex.B1 dated 18.03.2009 Diabetes Case Sheet of the Complainant
Ex.B2 dated NIL Postmortem Report issued by AIIMS
Ex.B3 dated NIL Policy Document Copy of Pol.No.719167949
Ex.B4 dated 23.03.2010 Copy of Proposal Form
Ex.B5 dated 23.03.2010 Copy of Medical Examination Report
MEMBER – II PRESIDENT
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