ORDER
(Passed this on 18th November, 2016)
Sau.Chandrika Kishorsingh Bais, Member.
01. This Complaint filed by the Complaint against O.P. LIC of India, Nagpur regarding death claim of his father U/s-12 of the Comsumer Protection Act-1986.
The complaint in brief as follows:-
02. That, the Complainant’s father namely shri Shankar Premsingh Rajumar has purchased a policy and insured himself vide Policy No.-977467728 on dated-15/10/2010 from the O.P. which is valued for Rs.9,00,000/- (Nine lakh only) and paid yearly premium of Rs.-9088/- The maturity date of policy is-15/10/2030. This insurance policy covered the life risk and after the death of insured the claim will be paid to the nominee of the insured. Policy holder Shri Shankar Premsingh Rajumar was expired on 22/12/2010. After the death of his father, he had submitted an application along with all relevant documents to the O.P. on dated-17/03/2011.
But the O.P. has not given response to him hence the complaint again given the reminder letter to the O.P. on-29/02/2012 for settling the claim but the O.P. did not given
any reply of the notice to the complainant till date. Then complainant issued legal notice to the O.P. on 29/10/2012 but the O.P. not replied this notice. Hence complaint filed this complaint before this Forum and sought following relief’s against O.P.
Complainant Prayer:-
(01) O.P. Insurance company be directed to pay insured
amount i.e.Rs.-9,00,000/- along with 14% interest
P.A. to the complainant.
(02) Cost of this proceeding be saddled on the O.P.
(03) To grant any other relief in favour of the complainant.
03. After receiving the notice of this Forum, O.P. Insurance Company present before the Forum and filed their reply on Ex.-7. As per reply of O.P., they admitted the policy of Complainant’s father and also admitted that the policy is commenced from-15/10/2010. They also admitted policy No. 977467728 and policy amount Rs.-9,00,000/-. O.P. further submitted that life assured had paid only one yearly premium of Rs.-9088/- and life assured died on 22/12/2010. O.P. also admitted that they have received death claim of policy holder from the Complaint.
O.P. further submitted that deceased life assured had deliberately suppressed material facts related to his health. As per the death certificate of insured which is issued by G.M.C. Nagpur, it is clearly mentioned that, he was suffering from Chronic Kidney disease stage V and hypertension prior to the date of commencement of this policy.
O.P. further submitted that the deceased life assured was suffering from kidney disease and hypertension prior to commencement of policy, which is evident from special query form filled up by Dr.Jayant Pawar, Family Doctor of deceased Shri Shankar Premsingh Rajkumar. It is therefore clear from the special query form that life assured deliberately suppressed the material facts related to his health and taken policy from the O.P. The policy holder given the wrong statements in the proposal form and hence the said contract shall be absolutely null & void and all money which have been paid in respect of thereof shall stand forfeited to the LIC. O.P. further contended that the policy holder died at the age of 44 years and died within 2 months and 07 days from the date of commencement of policy. O.P. further contended that the contract of insurance is based on utmost faith but policy holder suppressed the facts regarding his health in the proposal form hence he is not liable any relief from the O.P. Insurance Company. So complaint is liable to be dismissed with costs.
FINDINGS AND REASONS
04. Complaint’s father policy and policy amount is not disputed by the O.P.. The main dispute of the O.P. Insurance Company is that the Policy holder had suppressed the material facts regarding his health at the time of taking policy from the LIC. Before taking Policy, the policy holder was already suffering from Chronic Kidney disease stage V and hypertension. Policy was commenced from date-15/10/2010 and policy holder was died on 22/12/2010 within 02 months and 07 days only from the commencement date of policy. The policy holder died at the age of only 44 years.
05. O.P.LIC filed following judgments regarding their contentions-
(1) “Satwant Kaur Sandhu-Versus-New
India Assurance Company Ltd.”
-IV (2009) CPJ 8 (SC)
In the above mentioned case Hon’ble S.C.held that Policy holder suffering from chronic diabetes and renal failure not disclosed so claim repudiated by
Insurer Section 45 of Insurance Act. Insured on regular haemodialysis, fully aware of state of health. Suppression of material facts proved.
But in this case, the Insured health was normal and no any record shows that he was facing any problem of dialysis till his death.
(2) “Shnyni Valsan Pombally.-Versus-
State Bank of India& Anr.”
I (2014) CPJ 387 (NC)
In the above citation insured deceased was suffering from “Diabetes Mellitus” for which ailment was on regular medication for over three years. These were ‘material facts’ and being within knowledge of insured only, he was obliged to disclose same correctly-Repudiation justified.
But in this case, documentary evidence shows that, Insured was not suffering any such severe diseases and he was not taking any type of regular medical treatment. So it shows that he has not suppressed any material facts regarding his health at the time of taking policy.
We have carefully gone thorough above citations which is filed by O.P., these citations are not perfectly relevant with this case, so it can not be taken into consideration.
06. Complainant Advocate also filed following citation regarding his contentions –
“L.I.C. of India and others-Versus-
Smt.Surekha Rameshrao Mankar”-
(2012) A.C.559 (NCDRC)
In this citation, Insured/deceased suffered from viral infection of eye and was cured. Disease of eye infection was not related to heart attack. Non disclosure of information about his curable disease of viral infection not amounts to suppression of material facts. Repudiation of claim unjustified.
The above citation of Hon’ble National Commission is matched in our case. In this case record shows that Insured also not suppressed the material facts of his health at the time of taking policy.
07. We have carefully gone through the documents, which are submitted by both the parties. As per the O.P. contentions, deceased policy holder was suffering from kidney disease and hypertension prior to commencement of policy but O.P. Insurance Company not submitted any single document which shows that policy holder was suffering from kidney disease and hypertension prior to taking the policy. O.P. insurance company not submitted any documentary evidence regarding their contentions. It is pertinent to note that the LIC appointed their panel doctors and their doctors medically examine every policy holder before issuing the policy and in this case the LIC doctors also medically examined policy holder and after satisfied the health of policy holder they issued policy.
08. Complainant submitted policy document and we perused this policy document, as per the terms and conditions of the policy the Condition No.-2 is reproduced below :-
Condition No.2:-
“A grace period of 15 days will be allowed for payment of yearly, half yearly or quarterly premiums. If death occurs within this period and before the payment of the premium then due, the policy will still be valid and the Sum Assured paid after deduction of the said premium as also unpaid premiums failing due before the next policy anniversary of the policy. If the premium is not paid before the expiry of days of grace, the Policy lapses. If the Policy has not lapsed and the claim is admitted in case of death under a Policy where the mode of payment of premium is other than yearly, unpaid premiums, if any, falling due before the next policy anniversary shall be deducted from the claim amount.
09. O.P. LIC has failed to show that the deceased policy holder was already suffering from Chronic Kidney disease stage V and hypertension before taking policy. In the result, we partly allowed the complaint and pass the following order:-
ORDER
(01) The complaint of the complainant is partly allowed.
(02) O.P. Life Insurance Company is directed to pay insurance amount of Rs.9,00,000/- to the complainant after deducting one year policy premium of Rs.-9088/- and remaining amount i.e. Rs.-8,90,912/- (In words Eight Lakhs & Ninety Thousand & Nine Hundred Twelve only) along with 6% interest P.A. from the date of filing of this complaint i.e. dated-07/09/2013 till complete realisation.
(03) O.P. Life Insurance Company is also directed to pay cost of Rs.-1000/- (In words Rs. One Thousand only) to the complainant.
(04) The order shall be complied by O.P. Life Insurance Company within 30 days from the date of receipt of this order.
(05) Copy of the order shall be given to both the parties free of cost.
