DOF.01.02.2005
DOO.03.11.2011
IN THE CONSUMER DISPUTES REDRESSAL FORUM, KANNUR
Present: Sri.K.Gopalan : President
Smt.K.P.Preethakumari : Member
Smt.M.D.Jessy : Member
Dated this, the 3rd day of November 2011
CC.32 /2005
P.Suma,
W/o/Late R.M.Ravindran,
“Kavyalayam”’
Pavannur,
P.O.Paavannur Motta
(Rep. by Adv.P.P.Venu) Complainant
Divisional Manager,
Life Insurane Cporporation of India,
Divisional Office,
Kozhikode.
(Rep. by Adv.O.K.Sasindran) Opposite party
O R D E R
Sri.K.Gopalan, President
This is a complaint filed under section 12 of consumer protection Act for an order directing the opposite party to pay a sum of `2, 12,000 to the complainant with interest @12% p.a from the date of claim till realization and compensation of `50,000 and cost of this complaint.
The case of the complainant in brief is as follows: The complainant’s husband insured his life with opposite party for a sum of `1, 00,000 with accident benefit. The complaint is the nominee. The insured died in a fire accident on 18.7.2003. The complainant lodged claim for the above benefits. The claim of the complainant repudiated on flimsy and untenable reasons. The benefits includes insured sum of `1, 00,000, accident benefit of `1,00,000 and a sum of `12,000 as bonus accrued i.e. a total sum of `2,12,000. The letter of repudiation dt.24.11.2003 stated the reason that the insured withheld correct information regarding his health at the time of affecting the insurance. It was alleged by opposite party that 4 months prior to the proposal for the policy the insured had suffered from meningioma and undergone operation on 13.3.2002 and as such the answers given to the questions under col. No.II to the proposal were false. Complainant has written the question and answers. The deceased was in good health during the period of proposal and thereafter also. His death was caused due to burn injury in the fire accident. The signature of doctor now seen in the proposal form certifying is a fabricated one. None of the answers to the questions were on material matters. The insured was a coolly who do not know how to read and write English. Repudiation of claim is illegal and deficiency in service. Hence this complaint.
Opposite party filed version contending as follows: The Life Insurance Policy 793408282 was issued to Ravindran accepting his proposal. The nominee under the policy informed the Branch Manger that insured Ravindran expired on 17.7.2003. The last premium paid under the policy was against the due January 2003 which was made on 15.1.2003. The death certificate, claimant’s statement claim form C and original policy were submitted to the Branch Office, Taliparmba of the LIC. The cause of death given by the complaint in the claimant’s statement was suicide. The last occupation of the life assured was Skilled Worker, RUBCO, Thalassery. As it was case of suicide, the body of Ravindran was subjected to post-mortem examination. The examination had shown that he had multinodular tumour on the right side of top of the head. As per the FIR life assured committed suicide as he was totally disturbed due to the disease he was suffering from. He embraced death out of sheer desperation. The false answers to the questionnaire in the proposal form suppressing the material facts given by the insured Ravindran vitiate the contract of insurance and the Corporation is entitled to repudiate the policy and declining payment there under.
On the above pleadings the following issues have been taken for consideration.
1. Whether there is any deficiency on the part of opposite
Party?
2. Whether the complainant is entitled for the remedy as
prayed in the complaint?
3. Relief and cost.
This is a mater once decided by the Forum allowing the complaint directing the opposite party to pay a sum of 2 lakhs to the complainant. But the Hon’ble State Commission pleased the matter remitted back for fresh disposal after permitting the parties to adduce evidence if they so desire. Hence fresh evidence was taken.
Evidence consists of Exts. A1 & A2 and DWs 1 to 3 and documents Ets.B1 to B7.
Issue Nos.1 to 3
Admittedly Mr.Ravindran, the deceased was insured under LIC at the time of death. The main contention of the opposite party is that the insured suppressed the material facts at the time of taking the policy. He was a man of serious illness and even undergone operation before taking the policy which did not disclose at the time of answering the questionnaire. Much force is given to FIR and contended that Life assured committed suicide as he was totally disappointed due to the diseases he was suffering from. The case of the complainant is that the death of the insured was due to burn injuries. Deceased was in good health condition during the period of proposal and throughout thereafter till his death.
It is an important point to be answered whether there is any suppression of facts on the part of complaint or not in order to determine correctness of repudiation of claim. Complainant produced two documents Exts.A1 & A2,copy of the lawyer notice and reply to the same. Ext.A2 reply to lawyer notice stated that the life assured Mr.Rvidnran had qualification of SSLC. He was admitted to Koyili Hospital, Kannur on 11.3.2002 with IP.No.11490 for meningioma, operated on 13.3.2002 and discharged on 20.3.2002.He had undergone an operation previously also. He was on sick leave from 12.3.02 to 17.7.02 as he was suffering from recurrent Meningioma. The insured had made incorrect statement and withheld correct information from the insurer regarding his health at the time of effecting the assurance which made the contract of insurance void. Admission of hospital and of the operations and connected treatment so also the sick leave on those days for the purpose are all not denied by the complainant.
The evidence of Dr.Gangadharan, DW2, the Superintendent of Koyili Hospital is a very material evidence to the facts of the case. He has stated that the first page of the case sheet which is marked as Ext.B4 is the copy of certificate issued by him. The letter is Ext.B4. He has also stated that he has signed every pages of the case sheet except page 14 that contained 34 pages which is marked as Ext.B5. He adduced evidence that Ext.B4 certificate and B5 case sheet is with respect to Ravindran, 39 years male, S/O.Narayanan with I.P.No.11490. He deposes that as per the case sheet the diagnosis of his disease is recurrence of “Meningioma” previously operated case. The admission was on 11.3.02. He continued to state that as per the case sheet he was previously operated and there is the second operation for the same illness, second operation was on 13.3.2002 as per the case sheet and it was a major operation. Informed consent was obtained from the patient and from his brother-in-law. In the cross examination he has deposed that he is remembering the issuing of certificate because he insisted fee for issuing the certificate and then the LIC told that the fee will be issued only to the hospital. He has also adduced evidence to the effect that he is able to identify the handwriting of the doctors in Ext.B5. DW3 Dr.K.C.Remesan in his cross examination deposed that it was he who entered the particulars of insured in the Medical statement.
The case sheet of the patient Mr.Ravindran Ext.B5 reveals that on 13.3.02 informed written consent for re-exploration of head has been obtained from Ravindran and also from his brother-in-law Mr.M.C.Prabhakran. Nurses record remark column specifically recorded consent obtained.Ext.B5 proves that operation conducted on 13.3.02. The evidence shows that it is a second operation and also a major operation. The evidence adduced by Dr.Gangadharan together with the case sheet of Mr.Ravindran it can very well be concluded that the patient Ravindran was suffering from recurrence of Meningioma and he was previously operated for this. The evidence shows that Mr.Ravindran was again operated on 13.3.2002. Mr. Ravindran while answering to the question in column No.II (b) of Ext.B6 proposal form did not disclose the fact of his disease and treatment. Column II (b) & (d) answered suppressing the actual truth.
Upon the above discussion we find that there is suppression of material facts and hence complainant is not entitled for any remedy. The issues 1 to 3 are answered against complainant.
In the result, the complaint is dismissed.
Sd/- Sd/- Sd/-
President Member Member
APPENDIX
Exhibits for the complainant
A1. Copy of the lawyer notice dt.20.9.04 sent to OP
A2. Reply notice
Exhibits for the opposite party:
B1. Copy of the policy document
B2.Copy of FIR
B3.Copy of postmortem certificate
B4.Copy of the certificate issued by Dr.P.K.Gangadhran
B5.Copy of the case sheet maintained in Koyili Hosptal
B6. Application for Insurance Policy Submitted by complainant
B7.Medical Examiner’s confidential report of Ravindran
Witness examined for the complainant: Nil
Witness examined for the opposite party:
DW1. Mohandas
DW2. Dr.P.K.Gandadhran
DW3. Dr.K.C.Remasan
/forwarded by order/
Senior Superintendent
Consumer Disputes Redressal Forum, Kannur.
