Karnataka

Bidar

CC/54/2015

Smt.Chandrakala W/o Late Gundappa chalkapur - Complainant(s)

Versus

LIC OF INDIA. - Opp.Party(s)

VIJAY KUMAR K

18 Apr 2017

ORDER

 

::BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

AT BIDAR::

 

 

                                                                                                         C.C.No. 54/2015

 

                                                                                          Date of filing : 27/07/2015

 

                                                                                       Date of disposal : 18/04/2017

 

 

 P R E S E N T:        (1) Shri. Jagannath Prasad Udgata,

                                                                                         B.A., LL.B.,

                                                                                                       President.

    

                                   (2) Shri. Shankrappa (Halipurgi),

                                                                                 B.A.LL.B.,

                                                                                           Member.

 

                                   

 

                                               

COMPLAINANT/S:         Chandrakala, w/o late Gundappa,

                                          Chalkapur, age: about 30 years,

                                          Occ: house hold, R/o village Benchincholi,

                                          Tq. Humnabad,Dist.Bidar.  

 

                                               

 

                                                 

 

 

                                     ( By Shri.Vijaykumar K.J., Advocate )

 

 

                                                    VERSUS

 

OPPONENT/S   :-           1. The Chief Manager,

                                           L.I.C. of India, Br.Basavakalyan.

                                              Dist.Bidar.

 

 

                                      2.  The Regional Divisional Manager,

                                           L.I.C. of India Division Office,

                                              Raichur.

 

 

                                      (  By Shri. Sanjay Kumar. S. Patil, Advocate)

                                               

 

::   J U D G M E N T  ::

 

 

By Shri. Jagannath Prasad Udgata, President.

 

                    This complaint is filed by the above said complainant U/s.12 of the C.P.Act., 1986, against the O.Ps alleging  deficiency in service  on the part of O.Ps   The subject of the case is as under:

 

2.            Complainant is resident of Ben Chincholli, Tq.Humnabad,

Dist.Bidar.  The husband of the complainant late Gundappa Chalkapur in his life time had obtained a Life Insurance Policy through the LIC agent  from the O.P.s namely “Jeevan Saral, bearing nos. 665681076 for sum assured of Rs.62,500/-and paid the premium amount of Rs.3,002/- yearly and the complainant is the nominee in the   policy.    The policy come  into effect from the date of 24/04/2013.  Complainant avers that, the husband of the complainant was hale and healthy at the time of obtaining the said policies.  The husband of complainant died   due to heart attack and thereafter the complainant had approached  the O.P for insurance claim on account of the death of her husband.  Inspite of several requests by the complainant and issuing legal notice to the O.Ps, the claims  have  not   settled hence, the complainant is before this Forum claiming total sum of Rs. 62,500/- and costs of the proceedings against the O.Ps.

 

3.             After receipt of Court notice the O.Ps have put up appearance through counsel of their choice and filed their written versions therein claiming that, the complaint filed by the complainant is misconceived both in law and facts and it is not maintainable.  The O.Ps do not dispute the complaint to the effect that the deceased life assured Gundappa, s/o Dhulappa had obtained policy no.665681076 with date of commencement i.e.  24/04/2013 for sum assured of Rs.62,500/- showing his wife namely Chandrakala as nominee.   The O.Ps deny all other allegations of the complaint and it is stated that, the matter is under investigation.  The death claim is prematured and the complainant herein has not submitted required documents for processing for the claim.  Without submitting the required documents to the O.Ps, the complainant directly approached the Forum.  Neither repudiation nor admission of the claim has taken place and hence this complaint is not maintainable.  In fact  the above policy was issued on 24/04/2013 and as per the claim forms the life assured expired on 19/11/2013.  As per the records, the policy had run for 06 months 25 days form the date of commencement of the policy.  As the duration of the policy is less than two years and death was  very early, the O.Ps have called for all claim forms through the claimant.  The O.Ps have not received the claim forms B-Medical attendants certificate ( to be completed by the medical attendant of the deceased for his last illness) and for B-1 ( Certificate of hospital treatment ).  The investigation is also entrusted to find the bonafide of the claim.  The O.Ps have not received the claim forms B and B1 and details of treatment availed during past three years prior to death with copies of the hospital report and also certificate from Doctor who declared the life assured dead with cause of death.  After receipt of the requirements the O.Ps will decide the genuineness of the claim.  Since the claim is not repudiated still is pending under decision, the complainant is not entitled to file the case without repudiation hence the complaint may dismissed.

 

4.               Later the O.P.s filed additional objection/version therein stating that after getting the required document i.e. B & B-1 the O.Ps verified the same and found the points.

 

“As per claim for B, B-1 the life assured was alcoholic since 7 years which developed to septicaemia and Hypovolumic Shock and it is clearly stated that, primary cause of death was due to acute pancreatitis.  Knowingly he was going to die within short period he had taken the policy on 24/04/2013, so it is clearly suppression of material facts, which have had a bearing on the granting of risk was clearly done with intent to deceive the respondent” corporation.

 

5.               After verification O.Ps came to conclusion and have repudiated the claim on dated 27/d12/2016 and intimated to complainant.  Further the  O.Ps are contesting the case on the ground of suppression of true facts.  While submitting  the proposal forms the late insured had answered wrongly in the proposal for assurance dated 24/04/2013.  Personal statement signed by the deceased life assured on 24/04/2013, the DLA answered the following questions as under;   

 

Sl.No.	Questions	Answers
	a) During the last five years did you ever consult a medical practitioner for any ailment required treatement for more than a week.	No  -
	b) Have you ever been admitted to any hospital or Nursing home for general check up, observations, treatment or operation	No  -
	c) Have ever remained absent from the place of work on grounds of health during the last 5 years.	No  -
	d) Are you suffering from or have ever suffered from ailments pertaiing to liver, stomach, Heart, Lungs, Kidney, Brain or Nervous system.	-No -
	h) Do you use or have you ever used alcoholic drinks?	- No-
	i)What has been your usual stat of health?	- Good -

 

Hence, the above answers are wrongly answered by DLA. Said contract was made by DLA by suppressing the fact that, life assured was alcoholic and, hence the claim is liable for repudiation.

 

6.              The deceased life assured had intentionally suppressed the material facts.  Further in case he had mentioned the real facts  the policy would not have been issued by the O.Ps. The O.Ps have repudiated the claim on legal and proper grounds hence the complaint be dismissed with costs.

 

5.         Both sides, have filed their evidence affidavits along with documents, written arguments reiterating their respective stands, so also documents listed at the end of this order, distinctly.

 

6.         Considering the rival contentions of the parties, the following points arise for our consideration:-

 

1. Does the complainant prove that, there has been a deficiency of service in the part of the Opponent?

 

2. What order ?

 

7.         Our answers to the points stated above are as follows:-

 

1. In the affirmative.

               2. As per the final order, for the following:

                                                                                               

:: REASONS ::

 

8.         In the instant case, even though the opponents had raised preliminary objections that, they had neither admitted nor repudiated the claim, the case was premature at the threshold, in course of trial, the ‘B’ and ‘B-1’forms i.e. Medical attendance certificate and certificate disclosing the cause of death, were duly submitted to the opponents.  The same have been produced in this case by the opponents as Ex.R.1 and Ex.R.2.  Per contra, the complainant has submitted documents disclosing the obtainment of policy, death certificate, raising of claim and advise of the opponents that, the matter was under consideration vide Ex.P.1 to P.6.

 

9.            While the opponents admit the fact of the policy, basing on the revelations in Ex.R.1 and Ex.R.2 recorded by the treating physician, the claim now stands repudiated.  Neither party has submitted the copy of proposal form or copy of policy to ascertain the answers of the deceased to the queries of the opponents regarding his state of health at the time of proposing the policy.

 

10.            However, in the additional objections filed, the opponents have extracted the Questions and Answers at page-2, which goes uncontroverted.

 

11.           From Ex.R1, relied upon by the opponents the cause of death has been described as Acute pancreatitis and the secondary cause has been described as septicaemia and hypovolumic shock i.e. loss of massive body fluids.  The same document also reveals the physician’s certificate that,  late Gundappa, husband of complainant was an alcoholic for 7 years and had left drinking 2 years prior to death.  This aspect i.e. abstentation from the alocohol can by no remote imagination be a contributory factor to the cause of death as stated above  and we infer that the claim has been repudiated on imaginary grounds by the opponents, Instances are there in which even complete teetotallers have undergone the pangs of acute pancreatitis and the opponents should have been pragmatic to consider the claim of the complainant positively.

 

12.                During the course of trial, the opponents had also at one point of time offered proposal of mutual settlement and have gone back after receiving the ‘B’ and ‘B-1’form.

 

13.                After  considering the entire documents filed in the case, we observe, the deceased proposer while answering the querry regarding his alcoholic dispensation has answered in the  negative which undoubtedly is a partial concealment of true facts.  We hold that, such an action should not go scot free and person concerned should be accounted for the same.  Hence we propose that, 25% of the insured amount should be deducted while settling the claim and consequentially we pass the following”-

 

 

                                                ::ORDER::

1. The opponents are jointly and severally directed to settle the claim of the complainant in a sum of Rs.46,875/- net, without any bonus or interest on the said sum.
2. In the facts and circumstances of the case there would be no order as to compensation or costs.
3. Four weeks time is granted to comply this order.

 

 

 

( Typed to our dictation then corrected, signed by us and then pronounced in the open Forum on this  18^th  day of  April-2017 )

 

 

 

   Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                   

Member.                                                                President.                  

 

 

Documents produced by the complainant

1. Ex.P.1- Copy of policy status report. 
2. Ex.P.2-  Copy of Death Certificate.
3. Ex.P.3- Copy of legal notice, dt. 26/03/2015.  
4. Ex.P.4 & P.5 Postal receipts.
5. Ex.P.6- Copy of reply to the legal notice by Chief Manager,LIC

 

 Documents produced by the Opponents

 

      1. Ex.R.1- Copy of Medical attendants Certificate.

      2. Ex.R.2- Copy of certificate of hospital treatment.

     

 

 

Sri. Shankrappa H.,                                             Sri. Jagannath Prasad,                                  

       Member.                                                                   President.

                                                                          

         

sb.