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.8/2009 Order dated this the 31st day of March 2009 COMPLAINANT/S Sri.Boregowda S/o Boregowda, H/o Late Smt.Yashoda, Tendekere Post, Hadanur Village, K.R.Pet Taluk, Mandya District. (By Sri.C.Thammanna., Advocate) -Vs- OPPOSITE PARTY/S 1. The Branch Manager, LIC of India, Branch Office K.R.Pet, Mandya District. 2. The Divisional Manager, Divisional Office, JEEVAN PRAKASH, P.B.No.37, Mysore-Bangalore Road, Bannimantap, Mysore. (By Sri.S.Sudarshan., Advocate) Date of complaint 22.01.2009 Date of service of notice to Opposite parties 03.02.2009 Date of order 31.03.2009 Total Period 1 Month 28 Days Result The complaint is dismissed. However, 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 to pay Insurance amount of Rs.50,000/- with Bonus and accidental benefit. 2. The case of the complainant is that the complainants wife Yashoda had taken L.I.C. policy from the Opposite party for a sum of Rs.50,000/- under policy No.723644031 and the complainant is the nominee to the said policy. The assured Yashoda died due to accidental fall into the well at the time of washing the clothes and the last rites have been performed as per the customs of their caste and village. Thereafter, the complainant being the nominee gave requisition to the Opposite party to settle the claim, but the Opposite party has repudiated the claim by assigning the reason that deceased did not disclose the details of earlier policies at the time of giving the proposal. The assured was not an highly educated and she know only to put signature learnt through Adult education programme and she was not having so much of ideas about the terms and conditions of the policy and she had no intention to suppress the material fact and the Corporation Agent also misguided the wife of the complainant at the time of taking the signature to the proposal only with a intention to obtain the policy from the deceased and so the repudiation of the claim is not proper and hence, the present complaint is filed. 3. The Opposite party has filed version, admitting the policy obtained by the deceased, but not for Rs.50,000/-, but the policy is for Rs.1,00,000/-. In addition to this policy, she had obtained another two policies which fact has been suppressed by the complainant. The deceased assured had obtained three life insurance policies in total including the one referred in the complaint. The sum assured under all the three policies are Rs.12,000/-, Rs.30,000/- and Rs.1,00,000/- respectively. The non-early claim in respect of policy nos.720950460 was settled for Rs.16,823/- and the claim in respect of policy no.722885018 was settled for Rs.33,899/- in favour of the complainant. Though the cause of death given by the complainant for settlement of those two policies was accidental fall into the well, however the complainant never produced post mortem report, FIR, Medical Certificate to prove that she died due to accidental fall into the well. Hence, in both cases, the accidental benefit was not paid and the complainant has signed the discharge form in full and final settlement of all his claim. The disputed policy was repudiated by the Opposite party for suppression of material facts as to the previous two policies. The deceased has paid only one initial premium and died within a period of 1 month and 12 days from the date of obtaining the present policy. The deceased assured was a literate female and was self-employed. The age proof submitted by her was a self-declaration. For this category where the life assured has submitted her age by a self-declaration, the maximum allowable insurance cover is Rs.1,00,000/- only. Since, the deceased had already obtained two insurance policies totaling for Rs.42,000/, she was not eligible to obtain this disputed policy. If she had revealed the existence of earlier two policies, the Opposite party would not have issued this policy. The non-disclosure of this material information is an apparent violation of the terms of the policy contract. The deceased had signed the declaration in the proposal form and she had signed after fully understanding the contents in the proposal form. The complaint is frivolous one and the Opposite party is not liable to pay amount claimed and the complaint is to be dismissed with costs. 4. During trial, the complainant is examined and has produced Ex.C.1. The Opposite party witness is examined and Ex.R.1 to Ex.R.14 documents are produced. 5. We have heard both sides. 6. Now the points that arise for our considerations are:- 1. Whether the repudiation of the claim by the Opposite party is illegal? 2. Whether the complainant proves that the death of assured was accidental one? 3. Whether the complainant is entitled to the policy amount claimed with accidental benefit? 7. Our findings and reasons are as here under:- 8. It is an admitted fact that deceased Yashoda wife of the complainant had obtained the policy No.723644031. The Opposite party has produced the policy Ex.R.13 and it is L.I.C. Money Plus policy and it is taken on 16.03.2007 for Rs.1,00,000/- with accidental benefit of Rs.1,00,000/- and complainant is not nominee. But surprisingly the complainant has pleaded that policy is obtained for Rs.50,000/-. So, on what basis he stated that the policy was for Rs.50,000/-, though he was in custody of the policy as per Ex.R.13. The death of deceased assured on 28.04.2007 is not disputed and the complainant has furnished the death certificate Ex.R.1 to Opposite party, when he submitted the claim application. It is an admitted fact that the deceased Yashoda wife of the complainant had obtained earlier two policies for Rs.12,000/- and Rs.30,000/- and after the death he submitted claim applications and those two policies have been settled by paying the assured amount with bonus and the complainant has executed discharge vouchers as per Ex.R.4 & R.5. Though, as per Ex.R.3, he submitted claim application for Rs.1,00,000/- with regard to the policy in question and though the cause of death is shown as sudden drown in the water i.e., accidental death, but he has not at all claimed accidental benefit in respect of earlier two policies and kept quiet. 9. The Opposite party has repudiated the claim for this policy for Rs.1,00,000/- as per the repudiation letter Ex.R.1 stating that the assured had suppressed material information about holding two earlier policies and had the details of the two policies had been disclosed, this policy would not have been issued under non-medical scheme. The Opposite party has relied upon the proposal form Ex.R.9 and we find the signature of the assured and she has furnished the age as 30 years. At item No.3 of the proposal form Ex.R.9 the proposer has to furnish the details of existing policies. Admittedly on the basis of proposal form Ex.R.9, the Opposite party has issued the policy Ex.R.12 on 16.03.2007. The installment premium is inclusive of extra premium. 10. The contention of the complainant side is that the deceased assured was a illiterate women except putting her signature learnt in the Adult Education Scheme and the agent had not disclosed all the details of the proposal form and simply obtained the signature in order to obtain the policy for the sake of earning commission and hence there is no suppression of material fact. The contention of the Opposite party side is that the insured is a illiterate lady and given all the particulars and it is not proved that the contents were not read over by examining the L.I.C. Agent who filled up the proposal form and it proves that the deceased has suppressed the two policies obtained earlier. The learned counsel for the Opposite party has relied upon the decision reported in Appeal No.622/2002 decided on 30.03.2004 by the Honble State Commission, in the case of Sri.Hanumanthe Gowda Vs- L.I.C. of India and the decision of Revision Petition No.982/2004 in the case of L.I.C. of India Vs- Roshan Lal Gupta by the Honble National Commission. 11. It is established law that suppression of material facts by the assured gives right to the insurance company to repudiate the claim. In the case of Roshan Lal Gupta, the Honble National Commission has observed that Before us a plea is advanced that the complainant and deceased were not highly educated and these forms were filled in by the agents; Secondly, the insurance agents have not been examined before us by the complainant in support of their contentions. In the present case, according to the evidence of the complainant, the agent who obtained all the 3 policies from the deceased is one Ashoka, but the proposal form pertaining to the disputed policy is filled up by one LIC Agent, H.B.Siddegowda. So, it cannot be said that LIC agent Rajesh has simply obtained the signature on proposal form without explaining the contents of the proposal form. The Proposal form proves that H.B.Siddegowda, LIC Agent has filled up and it is not the evidence of the complainant that he was present when the agent obtained signature of his wife to the proposal form to say whether the contents were read over and whether the assured gave information properly the agent, when H.B.Siddegowda, the Agent has filled up the proposal form and he has endorsed that the contents read over in Kannada Language and even writing is made that the above statement was explained in Kannada and knowing same signature is put. The complainant has not examined the person who filled up proposal form. When the assured is dead, we have to hold that there is no acceptable evidence that the contents were not read over to the assured and simply the signature of the assured was obtained to the proposal form Ex.R.9. The date of birth, occupation and annual income is given by the assured. It cannot be said that without these information H.B.Siddegowda would not have filled up. Merely because, the proposal form is in English language, it cannot be said that the particulars in the proposal form were not explained to the assured and she has not answered. In fact, while dealing with the appeal preferred against the order of this Forum in CC 1/2002, the Honble State Commission in Appeal No.622/02, in the case of Sri.Hanumanthe Gowda referred above held that in spite of two other policies, the policy of Rs.4,00,000/- obtained from the Opposite party is based on suppression of the material fact and merely because, the Officer of the Opposite party believed on such proposal and issued the policy does not rectify the material fact. The Honble State Commission dismissed the appeal holding that the dismissal of the complaint by the District Forum is correct. In the present case also though the assured was a milk vendor had obtained two policies earlier for Rs.12,000/- and another policy for Rs.30,000/-, obtained the present policy for Rs.1,00,000/-. In the circular of the LIC as per Ex.R.14 in case of married women, the maximum insurance cover is Rs.1,00,000/- if amount is illiterate or educated up to 8th standard. In the present case, the assured was a married woman and according to the complainant, she is illiterate studied in adult education scheme and learnt to put signature. Therefore, if the assured had disclosed the earlier two policies mentioned above, the Opposite party would not have accepted the proposal and issued policy for Rs.1,00,000/- if the proper information had been given. There is clear suppression of material information. Therefore, the repudiation of the claim by the Opposite party is just and proper. 12. In view of our above finding, the question of consideration of accidental benefit does not arise. In fact, the complainant has not pressed for accidental claim in respect of other two policies. Under these circumstances, the complainant is not entitled to insurance amount claimed. 13. In the result, we proceed to pass the following order; ORDER The complaint is dismissed. However, there is no order as to costs. (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 31st day of March 2009). (PRESIDENT) (MEMBER) (MEMBER)
