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.111/2008 Order dated this the 11th day of February 2009 COMPLAINANT/S Sri.Doddalingegowda S/o Late Siddegowda, M.G.Hally Village, N.K.Hally Post, Malavally Taluk, Mandya District. (By Sri.Yogananda., Advocate) -Vs- OPPOSITE PARTY/S 1. Senior Divisional Manager, LIC of India, Divisional Office, Jeevan Prakash, P.B.No.37, Mysore-Bangalore Road, Bannimantap, Mysore. 2. LIC of India, Branch Office, Bandigowda Layout, M.C.Road, Mandya. (By Sri.S.Sudarshan., Advocate) Date of complaint 31.10.2008 Date of service of notice to Opposite parties 20.11.2008 Date of order 11.02.2009 Total Period 2 Months 21 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 parties for settlement of insurance claim of Rs.50,000/- and compensation of Rs.20,000/- with costs. 2. The case of the complainant is that his father Siddegowda had obtained insurance policy from the Opposite party Corporation for sum of Rs.50,000/- nominating the complainant. Unfortunately, the insured died natural death on 19.04.2007. His father had paid premiums regularly. After death of his father, the complainant has submitted claim form to the Opposite party for settlement of the claim. But the Opposite party has repudiated the claim on the ground that his father had made deliberate mis statements and with held the material information regarding his health at the time of getting the policy. But, his father was an illiterate and never with held any material information. In spite of it, the Opposite party has repudiated the claim on flimsy ground and hence, they have committed deficiency in service. Hence, the complaint. 3. The Opposite parties have filed version admitting the policy obtained by Late Siddegowda, the father of the complainant and the complainant is the nominee and the sum assured is Rs.50,000/- and commencement of the policy is 14.05.2005. It is denied that the life assured had natural death and also the life assured was paying the premiums regularly. The life assured was not deligent in keeping the policy in force and allowed the policy to lapse for non-payment of May 2006 premium. However, the policy was revived by the life assured on submission of personal statement of health date 15.04.2007, but received by the Opposite party on 18.04.2007 and on payment of arrears of premium with interest. The claim of the complainant has been repudiated on due application of mind. An investigation of the claim revealed that the life assured was a patient of T.B. and Jaundice prior to the date of revival of the policy. The assured had taken treatment at Community Health Centre, K.M.Doddi on 17.11.2006 and was referred to further treatment and had taken treatment under T.B.No.889/24.11.2006 at P.H.C. Halagur, Mandya District. Further, he was treated for jaundice disease two weeks prior to the date of revival. The life assured suppressed all these material information regarding his health and falsely answered in personal statement regarding health dated 15.04.2007. The revival of the policy is a new contract and the contract will be null and void. If the statement made in the personal statement regarding health are untrue averments and all money paid thereunder will be forfeited by the insurer. The repudiation is just and proper. The complainant is not entitled to any amount and the complaint is liable to be dismissed with costs. 4. During trial, the complainant is examined and he has produced the document Ex.C.1. On behalf of the Opposite parties three witnesses are examined and Ex.R.1 to R.15 are marked. 5. We have heard the counsel for the Opposite party and the complainant and his counsel remained absent. 6. We have perused the records. 7. Now the points that arise for our considerations are:- 1. Whether the insured had suppressed the material information about his health at the time of revival of the policy? 2. Whether the repudiation is just and proper? 3. Whether the complainant is entitled to the insurance amount with compensation? 8. Our findings and reasons are as here under:- 9. POINTS NO.1 & 2:- The undisputed facts are that Siddegowda, the father of the complainant had obtained insurance policy from the Opposite party for a sum of Rs.50,000/- commencing from 14.05.2005 as per Ex.R.2 and the premium payment is yearly payment and the complainant is the nominee. It is also admitted that the insured died on 19.04.2007 and at that time his age was 39 years. It is an admitted fact that after death of the insured, the complainant as a nominee submitted the claim form as per Ex.R.8 along with the death certificate Ex.R.7 and letter Ex.R.6 and medical attendance certificate Ex.R.10 and Opposite party has repudiated the claim by sending the letter Ex.C.1. 10. The ground of repudiation is that the assured at the time of revival of the policy while giving personal statement of health, suppressed material information regarding his health and falsely answered the questions in the personal statement regarding health dated 15.04.2007, though he was suffering from T.B. and Jaundice disease and took treatment prior to the revival of the policy. 11. Though the complainant has stated that his father died a natural death, but admittedly his age was between 39 40 at the time of death and what is the reason for death is not at all stated. The death at the age of 39 40 years cannot said to be a natural death. To prove the defence, Opposite party has relied upon the evidence of R.W.2 & 3 the doctors and the documents apart from the evidence of the complainant. The evidence of R.W.2 Dr.M.L.Shivaswamy reveals that the insured Siddegowda visited the hospital at K.M.Doddi on 17.11.2006 with the complaint of cough and his sputum was tested and found the T.B. infection germs and he was advised to take treatment at Halagur Hospital and Ex.R.13 & R.14 clearly established the same. Further, the evidence of R.W.3 Dr.Niranjan, Medical Officer at P.H.C. Halagur establishes that the insured Siddegowda was referred by K.M.Doddi Hospital and treatment for T.B. was given to him from 24.11.2006 to 12.04.2007 and he has produced the document Ex.R.15, this document cannot be disputed at all. 12. Further, according to the Opposite party, the insured was also suffering from jaundice two weeks earlier to the revival of the policy. Though, the complainant has denied the same and pleaded that the insured died a natural death, but in the cross-examination, the complainant has admitted that his father was shown to a local doctor in the village one week prior to the death and he was suffering from jaundice and then he was also shown to Dr.Siddaraju three days earlier to his death and the doctor told that there is jaundice illness and it is out of control for treatment. Further, in the claimant statement Ex.R.8, the cause of death is shown as unexpected jaundice and duration of last illness date is 18.04.2007 at 7.00 p.m. and died on 19.04.2007 at 7.00 a.m. In Ex.R.9 certificate of identity and burning cremation, the cause of death is shown as jaundice and in Ex.R.10 medical attendance certificate issued by Dr.Siddaraju which was furnished by the complainant discloses the primary cause of death is viral hepatitis and secondary cause is hepatic encephalopathy hepatic coma. According to this statement, the insured consulted this doctor first on 17.04.2007 and treated on 18.04.2007. But the complainant has deposed that 3 days prior to the death his father was shown to the Dr.Siddaraju, but has admitted that one week earlier his father was shown to local doctor for jaundice disease. Under these circumstances, when the policy was reviewed as per Ex.R.4 on 18.04.2007 on the basis of personal statement Ex.R.3 dated 15.04.2007, the illness of T.B. and Jaundice and treatment were not at all disclosed in the personal statement by the insured and he has suppressed the material information about his health at the time of revival of the policy. 13. In the decision reported in 1 (2006) CPJ page 78 in the case of Goparatnam Vs- LIC of India, the National Commission as held the contract of insurance is a contract of good faith, suppression of material information at the time of revival of the policy and obtaining new policies is a violation of the contract by any party and the repudiation of the claim is justified. 14. Though, the complainant has deposed that his father was regular in paying the premium, but the complainant has not produced any premium receipts. On the other hand, the Opposite party has proved that after obtaining the policy in May 2005 he did not pay the annual premium in May 2006, but the policy was revieved on payment of premium with late fee on 18.04.2007 on the basis of personal statement regarding health Ex.R.3. Ex.R.5 reveals that the deposit of premium due for May 2006 with late fee on 18.04.2007. In the decision reported in 4 (2008) CPJ page 19 in the case of Santhosh Kanwar Vs- LIC of India, the National Commission has held treatment taken for trivial ailments such as fever, pain in abdomen, treatment for urinary infection, tenderness or pain muscles are not required to be noted at the time of taking the policy. If the ailment referred by insurer has no connection with the death of the insured, then only the repudiation is unjustified. 15. But in the present case, the treatment of T.B. for more than 6 month and the illness of jaundice cannot said to be trivial ailments. It is admitted in the documents of the complainant that his father died due to jaundice. All of a sudden a person will not die on account of jaundice disease. It takes some period for seriousness of the ailment and therefore it cannot be said that the insured had no knowledge of disease of jaundice and T.B. The documents and the evidence on record clearly established that the insured had knowledge of illness of T.B. and jaundice and taking treatment before the revival of the policy and in spite of it, he has suppressed the material information and has given false answers regarding health. Therefore, the repudiation of the claim by the Opposite party is just and proper and it cannot be said that the Opposite party has committed deficiency in service. 16. The complainant has sought for insurance amount of Rs.50,000/- with compensation. Since, the deficiency in service is not proved and on the other hand, it is established that the repudiation is just and proper, the complainant is not entitled to the insurance amount, nor any compensation. 17. 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 11th day of February 2009). (PRESIDENT) (MEMBER) (MEMBER)
