BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 29th day of September, 2009

Present:

SRI.LAIJU RAMAKRISHNAN PRESIDENT

SMT.SHEELA JACOB MEMBER

SMT.BINDU SOMAN MEMBER

C.C No.28/2009

Between

Complainant : Aneesha E.P,

D/o A.N.Padmakumar & Late Santha P.K,

Represented by her father and next friend

A.N.Padmakumar,

Edaparambath House,

Thodupuzha East P.O,

Pin 685 585,

Idukki District.

(By Adv: Prince.J.Pananal)

And

Opposite Parties : 1. The Branch Managaer,

Life Insurance Corporation of India,

Branch Office,

Thodupuzha P.O.

(By Advs: K.M.Sanu & C.M.Tomy)

2. The Senior Divisional Manager,

Life Insurance Corporation of India,

Divisional Office, Jeevan Prakash,

P.B No.609, Nagampadam,

Kottayam – 686 001.

3. The Zonal Manager,

Life Insurance Corporation of India,

Zonal Office, Anna Road,

P.B No.2450, L.I.C Building,

Chennai – 600 002.

O R D E R

SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
 

Complainant's mother Santha P.K. had availed a Life Insurance Policy from the 1st opposite party through their agent as policy No.391956763, for Rs.1,60,000/-. The said Santha expired on 10/01/2008 due to ovarian cancer at Sunrise Hospital, Kakkanadu. The primary cause of her death is ovarian cancer, which was detected in the month of January 2008 through expert diagnosis. After the death, a claim was filed by the complainant to the opposite party. But they repudiated their liability on the ground that the deceased withheld correct information regarding her health at the time of effecting the assurance with them. They also alleged that column No.12 (a), (b), (i) and 14 (A) of the proposal of the policy was furnished with incorrect information, as they have evidence and reasons to believe that, she underwent two LSCS (Lower Segment Caesarian Section), history of appendectomy in 2002 and uterine fibroid detected 14 years back. 2nd opposite party also informed the complainant that as per the terms of the policy contract, the declarations contained in the forms of proposal for assurance are not correct, they repudiate the claim and all money paid towards the policy are forfeited. Therefore the complainant has preferred a representation before the 3rd opposite party, but it was also rejected. The complainant understood that the answers given in the proposal dated 22/12/2006 were filled up by the agent of the opposite party and the complainant's mother Santha P.K. had only put her signature. The disease caused to the death of the insured has no nexus with the alleged fact of lower segment caesarian sections for appendicitis and uterine fibroid, alleged to have been withheld by the deceased Santha P.K. So the repudiation of the claim is neither justified nor bonafide. So this petition is filed for getting insurance claim of the insured and also for compensation.

2. As per the written version filed by the opposite parties, all the legal hairs are not joined as the parties of the case, complainant alone filed claim for the sole beneficiaries. The disease of the insured was detected in the month of January 2008. The deceased had 2 LSCS and history of appendectomy in 2002 and uterine fibroid was detected 14 years back. The insurance policy is the result of the contract entered between the deceased and Life Insurance Corporation, the contract is best upon the proposal by the deceased on 22/12/2006. The deceased was an Assistant Administrative officer at KSEB for the last 21 years and it is unimaginable to believe that she signed proposal without perusing the same. The Corporation is not in a position to accept the claim because the proposer had made deliberate incorrect information and withheld material information, hence suppression of facts and non disclosure of material facts dis-entitled the claims originated on the basis of the policy. So the petition is not maintainable.
 

3. The point for consideration is whether there was any deficiency in service on the part of the opposite parties, and if so, for what relief the complainant is entitled to?

4. The evidence consists of the oral testimony of Pws 1 and 2 and Exts.P1 to P4 marked on the side of the complainant and the oral testimony of DW1 marked on the side of the opposite parties.
 

5. The POINT:- The petition is filed for getting the Insurance amount of the mother of the petitioner, who expired due to ovarian cancer. The petitioner is a minor and his father represented by him and was examined as PW1. PW1 deposed that the policy was for Rs.1,60,000/-. Ext.P1 is the medical attendant's certificate issued from Sunrise Hospital, Kakkanadu. She was under treatment of Dr.Beena Kumari from January 2008. The uterine fibroid was identified before 14 years back. An LSCS was conducted on her. The treatment for uterine fibroid was not done because there was no growth. Ext.P4 is the certificate issued from Dr. Beena Kumari, Medical College Hospital Kottayam and Ext.P2 is the repudiation letter given from the opposite party on March 2008. Ext.P3 is the letter written from 2nd opposite party on 16/09/2008. The Gynecologist from District Hospital Idukki, who was examined as PW2 an expert. As per PW2, LSCS is not an operation conducting for uterine fibroid. There is no treatment is needed for uterine fibroid in ordinary circumstances. If any problem occurs then only the treatment is needed. Sometimes it will cause obstructions of the pregnancy, so it may be removed in such cases. Ovarian cancer is a multi factorial disease and can be caused due to several reasons. In ordinary circumstances uterine fibroid never leads to ovarian cancer. In rare cases only it leads to cancer. LSCS means, in the surgery used for taking the baby out. As per Ext.P1 it is understood that the patient was admitted in the hospital only on the nearest day that is on 04/01/2008. But the symptoms of the disease was appeared before 3 months. As per Ext.P4, scanning was conducted on 31/12/2007 and Professional diagnosis was done only on 01/01/2008. The OP2 was examined as DW1. DW1 deposed that the claim was rejected because the insured suppressed the original facts. DW1 is not aware that whether she fully filled up the proposal form or the agent. On cross examination of the learned counsel for the complainant, DW1 deposed that the LIC agents are trained persons and the commission for them are giving by the company itself. So it is very clear from the evidence of PW2, who is the expert that LSCS surgery done on the insured is no way connected to the ovarian cancer and the uterine fibroid is not at all the prime reason for uterine cancer. Moreover the ovarian cancer was detected only 10 days before the death of the insured. So the contention of the opposite party that the insured furnished incorrect information and suppressed material fact will not sustain. It is the duty of the Life Insurance Corporation to conduct medical check up before issuing policy for such a huge amount. Repudiating the claim after receiving the premium without any medical check up is a gross deficiency from the part of the opposite party. The patient was died due to ovarian cancer and the petitioner may have spend a lot of money for the treatment of the deceased. So we think it is fit to order the insurance amount of the insured, but the complainant is only a minor person and all the legal heirs of the deceased are not made the party to the petition. So the petitioner must produce legal heirs certificate from the concerned authority and the claim must be distributed among them.

Hence the petition allowed. The opposite parties 1 to 3rd are directed to disburse the insurance amount which is Rs.1,60,000/- to the legal heirs of the insured for the Policy No.391956763 with 12% interest from the date of this petition and Rs.2,000/- (Rupees Two Thousand only) as cost of this petition to the complainant within one month of the receipt of a copy of this order, failing which the amount shall carry further interest at 12% per annum from the date of default.

Pronounced in the Open Forum on this the 29th day of September, 2009

Sd/-

SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
 

Sd/-

I agree SMT.SHEELA JACOB(MEMBER)

Sd/-

I agree SMT.BINDU SOMAN(MEMBER)

APPENDIX

Depositions :

On the side of Complainant :

PW1 - A.N.Padmakumar

PW2 - Dr.Vincent Lobo

On the side of Opposite Parties :

DW1 - C.Kanakaraj

Exhibits:

On the side of Complainant:

Ext.P1 - True copy of Medical Attendant's Certificate

Ext.P2 - True copy of Repudiation letter dated 31.03.2008 issued by the 2^nd opposite party

Ext.P3 - True copy of Intimation dated 16.09.2008 issued by the 2^nd opposite party regarding the claim appeal

Ext.P4 - Case Sheet issued by Dr.Beenakumari.R, Medical College Hospital, Kottayam

On the side of Opposite Parties :

Nil