Tamil Nadu

North Chennai

CC/82/2015

T.Vijayalakshmi - Complainant(s)

Versus

1G BranchThe Chief Branch manager LIC of India BO - Opp.Party(s)

C.Paranthaman, K.Sitharthan

25 Apr 2017

ORDER

 

                                                            Complaint presented on:  05.05.2015

                                                                Order pronounced on:  26.05.2017

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd 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 26^th 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,

3^rd 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.

1. P.No. 711415344, DOC. 20.11.1991
2. P.No. 715926371, DOC. 20.03.2995
3. P.No. 716116183, DOC. 13.08.2008
4. P.No. 718558891, DOC. 31.03.2008
5. P.No. 719167949, DOC. 24.03.2010

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 1^st Opposite Party Branch and is being serviced by the said office only and the 3^rd 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 1^st 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

3. P.No. 716116183, DOC. 13.08.2008
4. P.No. 718558891, DOC. 31.03.2008
5. P.No. 719167949, DOC. 24.03.2010

 

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 5^th 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 26^th 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