BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. M.N.MANOHARA, B.A., LLB., Member, 3. A.P.MAHADEVAMMA, B.Sc., LLB., Member, ORDER Complaint No.MDF/C.C.No.113/2009 Order dated this the 19th day of February 2010 COMPLAINANT/S S.A.Hemavathi W/o Late H.S.Nagaraju, R/o Huligerepura (V), Malagaranahalli (P), Maddur Taluk, Mandya 571 401. (By Sri.H.S.Prabhakar., Advocate) -Vs- OPPOSITE PARTY/S The Branch Manager, Branch Office, L.I.C. of India, Maddur. (By Sri.B.A.Vijay., Advocate) Date of complaint 29.09.2009 Date of service of notice to Opposite parties 08.10.2009 Date of order 19.02.2010 Total Period 4 Months 11 Days Result The complaint is dismissed. In the circumstances of the case, there is no order as to costs. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act, 1986 against the Opposite party claiming insurance amount of Rs.1,00,000/-. 2. The case of the Complainant is that her husband H.S.Nagaraju, had obtained two policies from the Opposite party bearing No.722702242 for Rs.1,00,000/- on 28.05.2003 and another policy No.720026280 for Rs.40,000/- on 20.11.1989. The husband of the Complainant died on 17.02.2006 at JSS Hospital, Mysore, while taking treatment for hyper tension and diabetics. Thereafter, the Complainant approached the Opposite party for settlement of the insurance amount. The Opposite party settled full policy amount of Rs.40,000/- pertaining to policy No.720026280 on 24.01.2006. But, before the settlement of another policy, the Complainant mother-in-law had filed a Civil suit in O.S.No.94/06 for partition and on 24.04.2009 the said suit was decreed in favour of the Complainant. Again, the Complainant approached the Opposite party for the policy amount. But the Opposite party demanded for the Civil case decree copy and the Complainant furnished the same, But the Opposite party did not respond. Again on 17.06.2009, the Complainant sent the decree copy by registered post. Even though, the Complainant requested for several times, it was no use. Therefore, the present complaint is filed. 3. The Opposite party has filed version admitting two policies obtained by deceased H.S.Nagaraju husband of the Complainant and Complainant is the nominee and also settlement of policy No. 720026280 as it was a non-early claimed. In OS.94/2006 filed by the mother of the life assured, the Opposite party has specifically stated in the written statement that the claim under the policy No.720702242 was repudiated by the Opposite party for suppression of material facts regarding the health of deceased life assured and nothing is payable and death of the life assured occurred within a short period of 2 years 9 months from the date of commencement of the policy. When investigation was conducted as to the genuineness or otherwise of the claim, the investigation revealed that he was a patient of diabetes mellitus, hypertension and ischemic heart disease from 2000. He was treated at Jayadeva Institute of Cardiology, Bangalore from 23.01.2001 to 27.01.2001. Again he was treated at JSS Hospital, Mysore from 12.02.2006 to 17.02.2006 for hypertension, diabetes mellitus and intracerebral bleeding. The diseased life assured falsely answered the questions negatively with regard to the health and treatment in the proposal form, these answers were false. The contract of insurance is a contract of utmost good faith and if it contains any statement, the contract become null and void and all money paid thereunder will be forfeited by the corporation. The Opposite party is not liable to pay any amount to the Complainant. Therefore, the complaint is to be dismissed with costs. 4. During trial, the Complainant is examined and she has produced documents Ex.C.1 to C.6. The Opposite party examined two witnesses and produced Ex.R.1 to R.16. 5. Both sides have filed written arguments. 6. We have perused the records. 7. Now the points that arise for our considerations are:- 1. Whether the life assured has suppressed the material facts with regard to the health and treatment by falsely answering to the questions in the proposal form? 2. Whether the Opposite party has committed deficiency in service? 3. Whether the Complainant is entitled to the insurance amount? 8. Our findings and reasons are as here under:- 9. The undisputed facts are that H.S.Nagaraju, the husband of the complainant had obtained two insurance policies from the Opposite party bearing No.720026280 on 20.11.1989 for Rs.40,000/- and policy No.722702242 on 28.05.2003 for Rs.1,00,000/-and the complainant is nominee for policy of Rs.40,000/- and the nominee is the minor son of the H.S.Nagaraju and the guardian is the Complainant for policy of Rs.1,00,000/-. It is also admitted fact that on 07.02.2006 the life assured H.S.Nagaraju died at JSS Hospital, Mysore, while taking treatment for hypertension and diabetes. It is an admitted fact that after death of life assured, the Complainant submitted claim form and the policy amount of Rs.40,000/- in respect of policy No.720026280 commencing from 20.11.1989, was settled fully and policy amount was paid on 24.01.2006. Now, with respect to the policy in dispute it is admitted fact that the mother-in-law had filed a Civil suit in OS No.94/2006 for partition against the Complainant and others and on 24.04.2009 it was compromised as per Ex.C.2 and the suit was decreed as per the compromise petition and the amount of the policy in question should be paid to the Complainant. It is an admitted fact that in that suit the Opposite party was 3rd defendant and it filed written statement as per Ex.R.15 and in that statement it is clearly stated that the Opposite party has repudiated the claim under policy No.720702242 for reason of suppression of material facts by the life assured and hence the contract is rescinded and nothing is payable under the policy. So, before filing of this complaint, the Complainant was made known that the claim was repudiated on the ground of suppression of material fact with regard to the health by the life assured. 10. Now, in this complaint also, the Opposite party has contended that the claim is repudiated on the ground of suppression of material fact with regard to the health and treatment by the life assured while taking the policy, wherein he has given false answers to the questions in the proposal form. According to the Opposite party, the life assured was treated in Jayadeva Institute of Cardiology Hospital, Bangalore from 23.01.2001 to 27.01.2001 as he was a patient of diabetes mellitus, hypertension and isthamic heart disease from 2000 and further, he was admitted to J.S.S.Hospital, Mysore on 12.02.2006 for hypertension, diabetes mellitus and intracerebral bleeding and died on 17.02.2006. But, the life assured has given false answers to the questions to the question with respect to the health condition and treatment in the proposal form. 11. So, the burden is on the Opposite party to prove that the life assured had the knowledge of diseases namely diabetes mellitus, hupertension and heart disease prior to obtaining the policy in May 2003 in spite of taking treatment and suppressed the same by giving false answers to the questions in the proposal form. The Opposite party has examined the doctor from Jayadeva Hospital as R.W.2 apart from the Officer of Opposite party as R.W.1. The evidence of Dr.B.Kumar (R.W.2) who was working at Jayadeva Institute of Cardiology, Bangalore clearly established that the life assured H.S.Nagaraju, was admitted to Jayadeva Hospital on 23.01.2001 with a history of chest pain and disclosed as a known case of diabetes mellitus, hypertension and on medication and also case of bronchial asthma often and after treatment of angiogram, he was discharged on 27.01.2001 with a diagnoses of unstable angina, hypertension and bronchial asthma. They are supported by the documents Ex.R.7. His evidence is not challenged at all and this Doctor P.W.1, the specifically stated that the patient himself stated above previous illness and treatment. So, the life assured himself given the history of previous illness and treatment for the diabetes and hypertension and he was on medication and it is an admitted fact that again life assured was admitted to J.S.S.Hospital as inpatient on 12.02.2006 with known case of type 2 diabetes mellitus with hypertension and isthamic heart disease since 6 years and is on regular medication for the same, patient had underwent PTCA-Stenting 5 years back and admittedly died in J.S.S.Hospital, Mysore on 17.02.2006. There is no reason to suspect these documents at all. 12. It is amply proved by perusing the proposal form Ex.R.1 that to the question No.11(a), (b), (d), (e) life assured answered in the negative and positively for the question one (j) knowingly that they are false and it is proved that at the time of giving the proposal form Ex.R.1 on 31st May 2003, he had the knowledge of the disease of suffering from hypertension diabetes and on treatment and in spite of the knowledge has given false answer to the proposal form and hence, he has suppressed the material facts with regard to the contract of insurance. 13. The contention of the Complainant counsel is that the Medical Examiner of the Opposite party Company has examined and gave the report as per Ex.R.2 and he has not revealed any diseases and therefore, the life assured was healthy at the time of obtaining the policy. But, in Ex.R.2, the life assured has to answer the question no.4 about the hospitalization, test of Radiological Cardialogical, Pathological or any other tests and whether he was under any treatment. Only on that basis, further investigation will be made by the Medical Examiner of the Opposite party Company. So, if the life assured do not furnish any information about his past illness and treatment, it would be impossible to diagnose any kind of diseases without any test by the Medical Examiner and Medical Examiner has relied upon by the answers given by the insured. 14. Admittedly, due to hypertension and diabetes while taking treatment, the life assured died on 17.02.2006. The hypertension and diabetes will not cause death immediately, but those diseases take number of years for aggravation and causing death, if not controlled by proper treatment and medication. In the decision reported in (1) 2007 CPJ page 51 in the case of LIC Vs- Krishna Chander Sharma, the Honble National Commission has held that the policy holder died due to heart failure, claim was repudiated because of concealment of material facts regarding health, it was held that insured is guilty of suppressing of ailment and the repudiation is justified, because the assured died within two years of policy date as the insured suffered and treated at hospital for asthma. The nexus between cause of death and illness treatment is not material. So, in the present case, the Opposite party has proved to satisfaction of this Forum that the life assured had suppressed material facts with regarding to the health condition and treatment while giving proposal form for the policy in question giving false answers to the question in the proposal form with respect of his health condition and treatment and hence, the repudiation of the claim by the Opposite party is justified and we cannot attribute any deficiency in service by the Opposite party. 15. Therefore, the Complainant is not entitled the claim of Rs.1,00,000/-. 16. In the result, we proceed to pass the following order; ORDER The complaint is dismissed. In the circumstances of the case, there is no order as to costs. (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 19th day of February 2010). (PRESIDENT) (MEMBER) (MEMBER)
