….Opposite Party.
This C.C coming on before us for final hearing, on 7-2-2008 in the presence of Sri. K.Babji, Advocate for Complainant , and of Sri.M.Muralidhar Rao, Advocate for the opposite party ; upon perusing the material papers on record; upon hearing arguments, and having stood over for consideration, this Forum passed the following:-
ORDER
(Per Sri.K.V.Kaladhar, Member )
1. This complaint is filed under section 12(1) of the Consumer Protection Act, 1986 with the following averments;
2. The brief facts of the complaint are that the husband of the complainant has taken life Insurance Policy for a sum assured Rs.2,07,000/- vide policy No.687018794 commencing from 15-3-04.
3. That the life assured has been regularly paying premiums and due to ill health he died on 19-7-05 and the policy was in force as on the date of his death. As per the terms and conditions of the policy the complainant being nominee is entitled to sum assured Rs.2,07,000/- along with accrued bonus. The complainant submitted the necessary claim forms to the opposite party for policy amount. But the opposite party has repudiated the claim stating that the deceased withheld correct information regarding ill health at the time of taking the policy.
4. That on 21-9-06 a representation has submitted to the Zonal Manager, LIC of India, with a request to accept the death claim but there is no response from the Zonal Office.
5. It is submitted that the complainants husband was hale and healthy at the time of taking policy and he is not withheld any information regarding his health.
6. It is submitted that the panel doctor of the opposite party after thoroughly verifying the health condition of the deceased has certified to be fit to take the above Insurance Policy. Therefore the deceased has not violated any terms and conditions of the policy contract.
7. It is submitted that the opposite party while repudiating the death claim under the above policy has stated that the deceased Satyam had history of COL, Portal HTN/Chronic Alcoholic and Grade III Varicosa prior to the date of proposal. Except the self serving above statement of the opposite party he did not file any proof to state that the deceased died only due to the above complications and he was under continuous treatment for the above ill-health till his death on 19-7-05. It is further submitted that the deceased died on 19-7-05 due to Jaundice and Anemia and he was treated by Dr.S.Komaraiah, Govt., Head Quarters Hospital, Khammam only prior to three months from his death.
8. It is further submitted that the deceased was not aware of the declarations contained in the forms of the proposal for assurance and personal statements and the answers given for the questions at Serial No. 11(a),(b),(d), (e) and (i). Since the deceased is an illiterate, he does not know the declarations contained in the forms of the proposal. Hence he cannot be held responsible for the answers to the questions given by the Agent of the opposite party. In these circumstances, it is false to state that the deceased has made incorrect statements and withheld correct information regarding his health at the time of affecting the policy. Hence this complaint to direct the opposite party to sum assured Rs.2,07,000/- along with the accrued bonus with interest at 18% per annum from the date of death of the deceased i.e., 19-7-05 till the date of payment and to award costs.
9. The complaint filed her affidavit with the following documents;
ExA1: Repudiation letter by opposite party, dated 29-3-2006. Ex A2: Letter issued to the Zonal Manager, LIC of India, Hyderabad by the complainant, dated 21-9-06. Ex A3: Postal acknowledgement, dated29-9-06. Ex A4: Status report of policy No.687018794. Ex A5: Xerox copy of medical attendance certificate of the husband of the complaint. Ex A6: Certificate of hospital treatment of the husband of the complainant, dated2-5-2005. Ex A7: Certificate of hospital treatment of Cure Emergency Hospital, dated 24-11-2003.
10. Written statement filed by the opposite party.
11. It is true that the husband of the complainant had taken a policy from the opposite party vide policy No.687018794 for sum assured Rs.2,07,000/- date of commencement was 15-3-04 and nominee is the complainant. As per the death certificate the death of life assured G.Satyam occurred on 19-7-05. It is true that late G.Satyam paid premiums due for the month of March, 205 and as such the policy is in force as on the date of death of Sri.G.Satyam.
12. It is submitted that the policy is repudiated on 29-3-06 for the reasons of suppression of material facts regarding health by the life Assured at the time of taking policy. It is submitted that it is not correct to say that deceased life assured had been maintaining good health at the time of affecting Insurance from the opposite party. The deceased life assured withheld important and vital information regarding his health prior to the date of proposal and thereby defrauded the opposite party to issue life Insurance Policy with aforesaid particulars. The contract of insurance is a contract of ‘uberrima fides’ i.e., contract of utmost good faith and he is expected to reveal everything about his health and also does not conceal or hide any such thing which may not be of much important from the view of point of the proposer. If the proposer does not furnish clear picture of his health in the proposer form the insurer shall not be in a position to assess the risk properly.
13. It is a fact that the panel Doctor of opposite party examined the life assured and submitted his opinion about the health condition of life assured. It is submitted that though the proposer is subject to medical examination, still responsibility lies on the proposer to reveal past history about his health to the medical examiner. So as to project a well and thorough picture of the life proposed.
14. It is submitted that Sri.G.Satyam concealed the fact that he had history of COL, PORTAL HTN, CHRONIC ALCOHOLIC AND VERICOSE GRADE III prior to the submission of proposal for insurance and he had consulted medical men for treatment of the same. The life assured death occurred within 2 years from the date of commencement of the policy and the opposite party investigated the matter and it is revealed that the life assured suffered from liver disease and was hospitalized on 21-11-03 in serious condition and kept in ICU/AMC/IMC and subsequently discharged on 30-11-2003 from AMC Cure Hospital, Khammam with I.P.No.1715.
15. Hence it is prayed that the Hon’ble Forum may be pleased to dismiss the complaint.
16. Documents filed by the opposite party (i) Ex B1: Original Policy Bond of the husband of the complainant.(ii) Ex B2: Proposal Forum submitted by the husband of the complainant(iii)Ex B3: For repudiation letter dated 29-3-2006 (iv) Ex B4 :Certificate of hospital treatment of the husband of the complainant at cure emergency hospital, Khammam.(v)Ex B5: A letter issued by Branch Manager, Claim department, Warangal, dated 15-2-06.
17. The complainant and opposite party filed their written arguments reiterating the facts same in the complaint and counter respectively.
18. (i)Whether the husband of the complainant is having pre existing disease.
(ii) Whether the opposite party has proved the suppression of fact?
(iii) Whether it is a material fact?
(iv)Whether the complainant is entitled as prayed for?
P O I N T:
It is a fact that the husband of the complainant obtained Life Insurance Policy for a sum assured Rs.2,07,000/- vide Policy No.687018794 commenced from 15-3-04. It is also fact that the life assured paid the premiums and the policy is in force as on the date of the death of the life assured. It is a fact that the life assured died on 19-7-05.
It is the contention of the complainant that prior to taking of the policy the life assured was hale and healthy and the panel doctors of the opposite party after verifying health condition of the diseased has certified that the life assured is hale and healthy. To prove this contention the complainant relied on the following decisions:
The decisions of National Consumer Forum, New Delhi reported in:
(i)II (2005) CPJ 32 (NC)
(ii) II(2005) CPJ 78 (NC)
(iii) II(2005) CPJ 12 (NC)
(iv)II(2005) CPJ 9 (NC)
The decisions of various state Forums reported in:
(i) I (2006) CPJ 497 OF DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI.
(ii) I(2006) CPJ 53 OF RAJASTHAN STATE CONSUMER DISPUTES REDRESSAL COMMISSION, JAIPUR.
(iii)I (2006) CPJ 513 OF RAJASTHAN STATE CONSUMER DISPUTES REDRESAL COMMISSION, JAIPUR.
(iv) II (2004) CPJ 419 OF CHHATTISGARH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, JAIPUR.
(V) I (2005) CPJ 78 OF CHHATISGARH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, RAIPUR.
(Vi)II (2005) CPJ 597 OF CHHATTISGARH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, RAIPUR.
(Vii) II (2004) CPJ 62 OF CHHATTISGARH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, RAIPUR.
(Viii) I (2004)CPJ 64 OF DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI.
(ix) I (2005) CPJ 781 OF UNION TERRITORY CONSUMER DISPUTES REDRESSAL COMMISSION, CHANDIGARH.
(X) II (2004) CPJ 146 OF UTTARACHAL STATE CONSUMER DISPUTES REDRESSAL COMMISSION, DEHRADUN.
XI. 2006 ACJ 100
IN THE HIGH COURT OF RAJASTHAN, JAIPUR BENCH
(Civil SpeciaI Appeal (W) No.1158 of 203; decided on 29-4-2004)
PRESENT:
MRS.JUSTICE SUDHA MISRA
MR,JUSTICE SHASHI KANT SHARMA
L.I.C. of India
V. …Appellant
District Permanent Lok Adalat and another …Respondents
The sum and substance of these decisions are that there is no nexus between the liver disease with cause of death.
For this the contention of the opposite party is that the life assured concealed fact that he has history of COL, Portal HTN/ Chronic Alcoholic and Grade III Varicosa prior to the date of proposal for insurance and he had consulted medical man for treatment of the same. It is also the contention of the opposite party is that for question No-11 dated 30-1-204 for columns (a) to (e) the answer No and for column No(i) what has been useful stage of his health? Ans: good. As per the investigation of the opposite party that the life assured suffered from liver disease and was hospitalized on 21-11-03 in serious condition and kept in ICU at Cure Hospital, with inpatient No.1715Khammam and he was discharged on 30-11-03 from cure hospital, khammam.
OPPOSITE PARTY RELIED ON THE FOLLOWING DECISIONS
I) Copy of the appeal No.951/198 between L.I.C. of India Vs. Smt.Shewantvevva reported Legal Digest October, 2001 dt.23-5-2001, decided by Karnataka State Consumers Forum.
(2) 2001 (3) C.P.R. Page No.133 between L.I.C. of India Vs. Consumers Education Research Society and any decided by the State Consumers Gujarath,
(3) A.I.R. 1986 Kerala Page No.201 with regard to the Section 45 of the Insurance Policy.
19. We have perused the documents filed by the complainant and as well as opposite party.
20. The opposite party relied on a documents marked as Ex B4 which is also filed by the complainant which was marked as documents Ex A7.
21. As per the above documents it is proved that the husband of the complainant admitted in Cure Emergency Hospital, at Khammam on 21-11-03 vide in patient No.1715 and he was discharged on 30-11-03. He was treated for the diseased COL, PORTAL HTN, CHRONIC ALCOHOLIC AND VERICOSE GRADE III” prior to the submission of proposal for insurance.
22. As per the Ex B4 corresponding Ex A6 the husband of the complainant is admitted in Cure Hospital, Khammam and this fact he did not disclose it in the proposal form. It is the fact that the diseased was serious ailments but he did not disclose in the proposal form. This is a material fact because it is real threat to the life, health or comfort on the person. The opposite party lost their chance because the diseased did not disclose this fact. That it was material fact as far as the LIC is concerned. The contention of the complainant that the husband of complainant was illiterate and did not know the contents of the proposal form cannot be acceptable. The insured had made incorrect statements and incorrect information to the insurer regarding hishealth at the time of effecting the Insurance Policy by suppressing his health condition.
23. Hence the opposite party has proved the suppression of material fact. Hence this point is answered accordingly against the complainant and in favour of the opposite party. It is a fact that the cause of death is liver disease and there is nexus between liver disease and cause of death. The complainant decisions are not applicable to this case.
24. Hence we are of the opinion that the insured has deliberately given false information by concealing real fact and obtained the above policy. If really these facts have been informed to the Insurance Company, probably the Insurance company could not have accepted his policy.
25. Hence we are of considered opinion that the husband of the complainant fraudulently obtained the above policy. Hence the repudiation of policy is justifiable.
26. In the result the complaint is dismissed. No Costs.
Dictated to the Stenographer and Transcribed her, Corrected and pronounced by us, in the Open Forum on this 20th day of February, 2008.
President Member Member
District Consumers Forum, Khammam
APPENDIX OF EVIDENCE
WITNESS EXAMINED FOR
Complainant Opposite parties
Nil Nil
DOCUMENTS MARKED FOR
Complainant
ExA1: Repudiation letter by opposite party, dated 29-3-2006.
Ex A2: Letter assured to the Zonal Manager, LIC of India, Hyderabad by the complainant, dated 21-9-06.
Ex A3: Postal acknowledgement, dated29-9-06.
Ex A4: Status report of policy No.687018794.
Ex A5: Xerox copy of medical attendance certificate of the husband of the complaint.
Ex A6: Certificate of hospital treatment of the husband of the complainant, dated2-5-2005.
Ex A7: Certificate of hospital treatment of Cure Emergency Hospital, dated 24-11-2003.
Opposite Parties
Ex B1: Original Policy Bond of the husband of the complainant.
Ex B2: Proposal Forum submitted by the husband of the complainant
Ex B3: For repudiation letter dated 29-3-2006
Ex B4 :Certificate of hospital treatment of the husband of the complainant at cure emergency hospital, Khammam.
Ex B5: A letter issued by Branch Manager, Claim department, Warangal, dated 15-2-06.
President Member Member
District Consumers Forum, Khammam
