IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Thursday, the 30th day of October, 2008
Filed on 09/07/2007
Present
1. Sri. Jimmy Korah (President)
2. Sri. K.Anirudhan (Member)
- Smt. N. Shajitha Beevi (Member)
in
CC/No. 134/2007
between
Complainant:- Opposite party:-
Smt.M.V. Anithakumari Life Insurance Corporation of India
Thaiparambil Veedu Represented by its Branch Manager
Kanjippadam, Alappuzha Branch Office No. 1, Vellakkinar
(By Adv. Satheesh Chandra) P.B. No. 444, Alappuzha
(By Adv. S. Devalal)
O R D E R
SRI. JIMMY KORAH (PRESIDENT)
Complainant’s case is as follows: - The complainant is the wife, nominee and the legal heir of the deceased, Prabhash. The deceased was a life insurance policy holder bearing No.390887428 from the opposite party at the time of his death. The opposite party repudiated the claim lodged by the complainant on the ground that the statement tendered at the time of the renewal of the policy was fallacious. At the time of renewal of the policy the deceased was not diseased. On receipt of the notice of repudiation, the complainant impressed upon the opposite party that the insured was not unwell at the time 'of the revival of the said policy. The opposite party assured the complainant that the needful would be effected after consulting with its zonal office. The complainant hopefully waited till 26th March 2007. On enquiry the complainant learnt that the opposite party was evading the payment of the sum assured. There is deficiency on the part of the opposite party's service. The delay pertaining to the filing of the complaint was solely due to the reassuring promise of the opposite party. The opposite party declined to disburse the assured sum and other benefits, the complainant entitled to. Got aggrieved on this the complainant approached this Forum praying for the assured sum and other relief.
2. Notice was sent and the opposite party turned up. Version in detail was filed. The opposite party submitted that the policy was an 'Endowment Assurance Policy with Profit and Accident Benefit’. The sum assured was Rs.100000/-( Rupees one lakh). The opposite party forcefully contended that at the time of the revival of the policy, the opposite party suppressed the material facts. He did not divulge the factum of his treatment or surgery to the opposite party when the policy was revived. As matter of fact the insured died on 5th June 2003 within a few days after the policy was caused to be revived. Prior to that, on a couple of occasions, he was admitted in Amrutha Institute of Medical Science and on one of such occasions, he underwent a surgery on 14th June 2002. There after as afore said he died on 5th June 2003 in Assisi Hospital, Punnapra. The opposite party repudiated the claim of the complainant for the insured made untrue statement regarding material aspects, the opposite party asserts. More over the complaint is time barred. The opposite party repudiated the claim on 10th December 2003. The complainant was informed that she could take up the matter before the zonal office if she so chose. Therefore, reason assigned to the delay is seemingly baseless. The complaint is only to be dismissed with cost to the opposite party, the opposite party contends.
3. The evidence of the complainant consists of the testimony of the complainant herself as PW1 and the documents Ext. A1 was marked. Ext. A1 is the letter issued to the complainant by the opposite party repudiating her claim for the assured sum. On the side of the opposite party, its Manager, Divisional office was examined as RWl and the documents Exts.B1 to B6 were marked. Exts.B1 is the claimant’s statement. B2 is the medical attendance certificate. B3 is the certificate of hospital treatment, B4 is the details of the insured's treatment from Amritha Hospital. B5 is the personal statement of the insured regarding his health and B6 is the schedule of documents produced.
4. Taking into account the contentions raised by the parties, the questions come
up before us for consideration are:-
(a) Whether the insured suppressed any matter which disentitle the complainant
the sum insured?
(b) Whether the complaint is barred by limitation?
5. We have anxiously and carefully gone through the materials put on record by both the parties. It appears that the policy or its existence at the time of death of the insured is not disputed. The crux of the contention of the opposite party is that. at the time of reviving the policy the insured made false statements and suppressed the matters material to the policy. The other forceful contention of the opposite party is that the complaint has been filed beyond the period of limitation. In our view. the immediate short question arises for consideration is whether the insured suppressed anything material. On a bare perusal of the materials produced by the opposite party. Particularly Exts.B4 and B5 go to manifestly show that the insured underwent surgery on 14th June 2002, and more than a couple of occasions he was admitted at frequent intervals at Amritha Hospital for fairly prolonged treatments before ultimately he succumbed to his ailment at Assisi Hospital, Alappuzha on 5th June 2003. We hold that the insured made false statements and suppressed material facts which disentitle the complainant to the policy benefits. What’s more, the other contention taken out by the opposite party also does not appear unsustainable. Going by Ext. A1 produced by the complainant herself, it is evident that the claim was repudiated on 10th December 2003 and the complainant has been directed therein to approach on her choice if any to Zonal manager within one month. In this back drop, we feel that the version advanced by the complainant for the delay in filing the present complaint is unworthy of acceptance. It goes without saying that the complaint must fail.
In view of the discussion made herein above, we hold that the complaint is liable to be dismissed and the same is dismissed. The parties are left to bear their own cost.
Pronounced in open Forum on this the 30th day of October, 2008.
Sd/- Sri. Jimmy Korah:
Sd/- Sri. K. Anirudhan:
Sd/- Smt.N.Shajitha Beevi:
Appendix:-
Evidence of the complainant:-
PW1 - Anithakumari.M.V. (Witness)
Ext.A1 - Letter issued to the complainant by the opposite party
Evidence of the opposite party:-
RW1 - C.Kanakaraj (Witness)
Ext.B1 - Claimant’s statement
Ext.B2 - Medical attendance certificate
Ext.B3 - Certificate of Hospital treatment
Ext.B4 - Details of the insured’s treatment from Amritha Hospital
Ext.B5 - Personal statement of the insured regarding his health
Ext.B6 - Schedule of documents
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite party/S.F.
Typed by:-pr/-
Compared by:-
