BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, VELLORE DISTRICT AT VELLORE. PRESENT: THIRU. A. SAMPATH, B.A., B.L., PRESIDENT TMT. G. MALARVIZHI, B.E. MEMBER – I THIRU. K. DHAYALAMURTHI,B.SC. MEMBER – II CC. 37 / 2004 MONDAY THE 21ST DAY OF JUNE 2010. Indira, W/o. Chandiran, No.2/14, Naicker Street, Veppaneri Village, Katpadi Taluk, K.V. Kuppam, Vellore District. … Complainant. - Vs – 1. Life Insurance Corporation of India, Rep. The Divisional Manager, Thilai Egambaram Thirumana Mandabam, K.V. Kuppam, Vellore District. 2. Life Insurance Corporation of India, The Zonal Manager, Southern Zonal Office, L.I.C. Building, No.102, Anna Salai, Chennai 600 002. … Opposite parties. . . . . . This petition coming on for final hearing before us on 16.6.2010, in the presence of Tmt. D. Beulah, Advocate for the complainant and Thiru. L. Pandurangan, Advocate for the opposite parties and having stood over for consideration till this day, the Forum made the following: O R D E R Pronounced by Thiru. A. Sampath, President of the District Consumer Disputes Redressal Forum, Vellore District. 1. The brief facts of the case of the complainant is as follows: The complainant is the wife of one Mr.Chandiran. The said Mr.Chandiran S/o. Mr. Muruga Naikar had insured Rs.1,00,000/- in L.I.C on his life. The Policy No is 731482852. The complainant is the nominee of the deceased Chandiran. The complainant’s husband Mr. Chandiran died of heart attack on 9.10.01. Immediately the complainant claimed the Insurance amount of the insured Chandiran but the opposite party has refused to give the claim amount. The opposite party had stated his reply dt. 31.1.03 that the insured Chandiran had suffered from Pulmonary Tuberculosis about 9 years before he proposed for the policy and thus the insurance amount of the insured Chandiran stands forfeited. The deceased Chandiran had died only due to the sudden heart attack in the year 2001. Thus the opposite party had given a false plea, that he was suffering from Pulmonary Tuberculosis 9 years prior to the proposed for the policy. After obtaining the entire medical clearance of the complainant’s husband from the medical experts of the opposite party, the said life insurance policy of my client’s deceased husband had been accepted by the 2nd opposite party through the 1st opposite party the agent one Mr.E.Vijayakumar. After receiving the L.I.C. premium amount the opposite party had refused to pay the claim amount, thereby the opposite party has committed deficiency of service against the complainant. Hence, the opposite parties are to be directed to allot the claim amount of Rs.1,00,000/- with 12% interest from the date of the death of the deceased Chandiran and to pay Rs.30,000/- towards the mental agony of the complainant and to pay Rs.3000/- as cost of the complainant. 2. The averments in the counter filed by the 1st and 2nd opposite party are as follows: The opposite party denies all the averments in the complaint except those that are specifically admitted herein and puts the complainant to strict proof of the same. It is true that Mr. Late Chandiran son of Muruga naicker was issued with a policy No.731482852 for a sum assured of Rs.1,00,000/- with date of commencement from 28.8.2000. It is also a fact that the deceased life assured nominated the complainant as his nominee under the said policy. That the nominee by her letter dated 10.11.01 had informed the date of death of the life assured to the opposite party and after receiving her letter the necessary requirements were called for by the LIC of India Gudiyattam Branch. It is also true that the opposite party sent repudiation letter to the complainant on 31.1.03 stating the reason that life assured had suppressed the material facts and about his pre insurance illness that the life assured was suffering with the deceased pulmonary Tuberculosis. The fact was ascertained from the medical certificate from the hospital that he was suffered from Pulmonary Tuberculosis for about 9 years. Hence the life assured suffered with the said deceased for a longer period before the proposal for the said policy. It is evident that the life assured at the time of taking Insurance Policy on his own life for Rs.1,00,000/- had submitted the proposal from suppressing the material facts of his ailment of deceased and illness deliberately and on the basis of information given by the deceased in the proposal form. The physical examination was only carried out by the LIC Panel doctor and since the deceased had not disclosed about his major ailment. In view of the provisions contained in Sec.45 of the Insurance Act 1938 the repudiation of the claim under the policy is quit justified and warranted. Hence the question of deficiency in service on the part of the opposite party does not arise and nothing is payable under the policy. There is no merit or bonafide. Hence the complaint may be dismissed with costs. 3. Now the points for consideration are: (a) Whether there is any deficiency in service, on the part of the opposite parties? (b) Whether the complainant is entitled to the reliefs asked for?. 4. Ex.A1 to Ex.10 were marked on the side of the complainant and Ex.B1 to Ex.B3 were marked on the side of the opposite parties. Proof affidavit of the complainant and Proof affidavit of the opposite parties have been filed. No oral evidence let in by either side. 5. POINT NO. (a):- It is admitted case of the parties that the complainant’s husband Thiru. Chandiran had taken a Policy NO.731482852 from the opposite parties on 28.8.00. Thereafter he was died on 9.10.01. In the policy, he had nominated his wife/ complainant, as nominee to receive the policy amount. Pursuant to the nomination when a claim was lodged for the assured amount, the opposite parties are repudiating the claim on 31.1.03. 6. The complainant contented that the deceased Chandiran had died only due to the sudden heart attack in the year 200, but the opposite party had given a false plea that he was suffering from Pulmonary Tuberculosis 9 years prior to the proposal for the policy. After receiving the LIC premium amount the opposite party had refused to pay the claim amount, thereby the opposite parties have committed deficiency of service against the complainant. Therefore direct the opposite parties to pay the assured sum and the compensation mentioned in the complaint. In this connection, the learned counsel for the complainant, relied upon the following Judgment of Union Territory Consumer Disputes Redressal Commission, Chandigarh I (2005) CPJ 781 LIFE INSURANCE CORPORATION OF INDIA Versus JASBIR KAUR Wherein the Hon’ble Union Territory Consumer Disputes Redressal Commission, Chandigarh is held that Consumer Protection Act, 1986 – Section 2(1) (g) – Life Insurance – Repudiation of claim – Contention, insured concealed his disease which was due to Cirrhosis of liver, not acceptable – Swelling on feet and abdomen could have been seen and noted by doctor who examined insured before acceptance of proposal form – Repudiation solely on basis of history recorded on hospital record arbitrary and illegal – Deficiency in service proved – Company liable under policy. 7. The opposite parties contended that the 1st opposite party sent repudiation letter to the complainant on 31.1.03 stating the reason that life assured Thiru. Chandiran has suppressed the material facts about his pre-insurance illness that the life assured was suffering with the decease Pulmonary Tuberculosis. The above fact was ascertained from the medical certificate Ex.B3, dt.9.10.01 issued by the Ruhsa Health Centre K.V. Kuppam that he was suffered from Pulmonary Tuberculosis for about nine years. The policy holder knowing fully well about his ailment at the time of proposal for the policy but he made the false statement before the LIC penal doctor that his health condition was good. In view of the provisions contained in Sec.45 of the Insurance Act 1938 the repudiation of the claim under the policy is quite justified and warranted. Hence the question of deficiency in service on the part of the opposite party does not arise and nothing is payable under the policy. . In this connection learned counsel for the opposite party is relying upon the following Judgements of Hon’ble Supreme Court, I. AIR 2008 SUPREME COURT 424 P.J. Chacko and Anr. ..Vs.. Chairman, Life Insurance Corporation of India & Ors. Wherein the Hon’ble Supreme Court is held that ” The well settled law in the field of insurance is that contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission. And this duty to disclose continues up to the conclusion of the contract and covers any material alteration in the character of the risk which may take place between proposal and acceptance. “ (A) Insurance Act (4 of 1938) S.45 – Insurance Policy – Repudiation – Deliberate wrong answer given by Insured having a great bearing on contract of insurance - Policy may be repudiated. Contract Act (9 of 1872) S.126. II 2009 (IV) CPJ 8 (SC) SATWANT KAUR SANDHU ..Vs.. NEW INDIA ASSURANCE COMPANY LTD. Wherein the Hon’ble Supreme Court is held that “Section 45 – Insurance Regulatory and Development Authority (Protection of Policy Holder’s Interests) Regulations, 2002 – Regulation 2(1)(d) – Insurance – Mediclaim Policy – Suppression of material facts – Policy holder suffering from chronic diabetes and renal failure not disclosed – Claim repudiated by insurer – Section 45, Insurance Act, applicable in life insurance policy, has no application in case related to mediclaim policy – Contract of insurance, contract of uberrimae fidei – Insured under obligation to make true and full disclosure of information, within his knowledge – Insured on regular haemodialysis, fully aware of state of health – Statement made in proposed form as to state of health palpably untrue to his knowledge - Suppression of material facts proved – Repudiation of claim justified. “ It is further contended that the decision cited by the learned counsel for the complainant is not applicable to the facts of this case. 8. The complainant’s husband Thiru. Chandiran made proposal for insurance Ex.B1 on own life before the 1st opposite party on 28.8.2000. From the perusal of the policy Ex.B1, it is seen that the assured Thiru. Chandiran made a declaration before the LIC penal Doctor that during the last five years he has not consulting the medical practitioner for any ailment requiring treatment for more than a years and his health condition was good. From the perused of Ex.B3, dt. 19.10.01 medical certificate issued by the Ruhsa Health Centre, K.V. Kuppam, it is seen that the life assured seen at Ruhsa Health Centre on 19.5.01 with a history of cough with expectoration of 5 to 6 days duration. He had treatment for pulmonary tuberculosis 10 years prior to that for two years duration. Investigation done proved the patient to have Relapse Pulmonary Tuberculosis and he was asked to continue treatment under the Government scheme from Primary Health Centre, K.V. Kuppam. He was again seen on 9.10.01 with Pulmonary Tuberculosis and acute exacerbation of Bronchial Asthma. He was given treatment and medication for a month. On perusing the Ex.A2, Death Certificate and Ex.B3, Medical Certificate issued by the Ruhsa Health Centre, K.V.Kuppam, it is seen that after taking the treatment at Ruhsa Health Centre, K.V.Kuppam on 9.10.01 the life assured Chandiran was died on the same day. Therefore it is clear that Thiru.Chandiran was suffered from Pulmonary Tuberculosis about 9 years before the proposal for the policy, when presenting the Ex.B1 proposal for insurance on his own life before the 1st opposite party Thiru.Chandiran did not disclose about his Pulmonary Tuberculosis disease before the LIC penal Doctor, but he made false statement before the LIC Penal Doctor that he was not consulting the medical practitioner for any ailment and he was in good health condition. 9. Considering the effect of Sec.45 of the Insurance Act, the Insurance Policy is a contract falling in the category of utmost good faith on the part of the assured, and if the assured has not made full disclosure correctly or in other words, if the declaration so made found to be false to the knowledge of the declarant, then the insurance company is entitled to repudiate the claim. The Hon’ble Supreme Court has observed in above two cases cited by the learned counsel for the opposite party that under section 45 of Insurance Act deliberate wrong answer given or statement made in proposal form as to state of health condition and true to his knowledge he suppressed of material facts the Insurance Company can repudiate the claim. 10. In the present case, according to the complainant that the life assured Chandiran had died only due to the sudden heart attack in the year 2001. But except the Ex.A8 certificate issued by the Village Administrative Officer, there is no medical record to prove the contention of the complainant that the deceased Thiru.Chandiran had died only due to sudden heart attack. But the opposite parties have proved through the Ex.B3 Medical certificate issued by the Ruhsa Health Centre, K.V.Kuppam that the life assured Chandiran was suffered from Pulmonary Tuberculosis for about nine years before the proposal for the said policy. Therefore it is clear that at the time of taking the insurance policy on 28.8.00 the complainant’s husband Thiru.Chandiran suppressed the material facts regarding his disease before the LIC penal doctor. Under Section 45 of Insurance Act, insured Thiru.Chandiran under obligation to make true and full disclosure of information, within his knowledge. But he made false statement before the LIC penal doctor on 28.8.00 regarding his health condition. Based on the suppression of material facts the opposite parties have repudiated the claim. Therefore, there is no deficiency in service on the part of the opposite parties. The authorities cited by the learned counsel for the complainant is not applicable to this case. But the authorities cited by the learned counsel for the opposite parties are squarely applicable to the facts and circumstances of this case. 11. Hence, taking all the above facts into consideration from the contention in the complaint and the counter, as well as proof affidavit of the both the parties, and from the documents Ex.A1 to A10 and Ex.B1 to B3, we have come to the conclusion that the complainant herein has not clearly proved the deficiency in service on the part of the opposite parties herein. Hence we answer this point (a) as against the complainant herein. 12. POINT NO : (b) In view of our findings on point (a), since, we have come to the conclusion that the complainant herein has not clearly proved the deficiency in service on the part of the opposite parties herein. We have also come to the conclusion that the complainant is not at all entitled to any relief asked for by him, in this complaint. Hence we answer this point (b) also as against the complainant herein. 13. In the result this complaint is dismissed. No costs. Dictated to the Steno-typist and transcribed by her, corrected and pronounced by the President, in Open Forum, this the 21st day of June 2010. MEMBER-I MEMBER-II PRESIDENT. List of Documents: Complainant’s Exhibits: Ex.A1 - -- - X-copy of the 1st premium receipt issued by the opp party to the Deceased husband of the complainant. Ex.A2- -- - X-copy of the death certificate of the complainant’s deceased Husband. Ex.A3- -- - X-copy of the claim form presented by the complainant. Ex.A4- 31.1.03 - X-copy of reply letter sent by the opp party to the complainant. Ex.A5-20.7.04 - X-copy of the legal notice sent to the complainant. Ex.A6- -- - Ack. Card Ex.A7- -- - X-copy of the Ration Card of the complainant. Ex.A8- -- - X-copy of the V.O. Certificate. Ex.A9- -- - X-copy of the Front Docket file of the insurance issued by the Opp. party to the complainant deceased husband. Ex.A10- 27.3.04 - Certificate issue by V.A.O. Veppankulam. Opposite parties’ Exhibits: Ex.B1 - -- - X-copy of the Proposal for insurance Form. Ex.B2- 9.10.02 - X-copy of the letter from the Ruhsa Health Centre to the Branch Manager, LIC of India, Guidyatham. Ex.B3- -- - X-copy of Medical Certificate. MEMBER-I MEMBER-II PRESIDENT. | 
