| ORDER | | BEFORE THE DISTRICT CONSUMERS FORUM AT KHAMMAM Dated this, the 10th day of December, 2010 CORAM: 1. Sri Vijay Kumar, B.Com., LL.B., President 2. Smt.V.Vijaya Rekha, B.Sc. B.L., Member 3. Sri.R.Kiran Kumar, B.Sc., LL.B., Member C.C.No.39 of 2010 Between: Dharavath Prameela, w/o.late Chander, age: 30 years, occu:Household, r/o.H.No.5-110, Peddathanda, Khammam rural Mandal, Khammam District. …Complainant and Life Insurance Corporation of India, Warangal Division, rep. by its Branch Manager at Khammam, LIC office, NSP road, Khammam town and district. …Opposite party This C.C. is coming on before this Forum for final hearing in the presence of Sri.K.Ramesh Kumar, Advocate for complainant and of Sri.K.Jagan Mohan Rao, Advocate for opposite party; upon perusing the material papers on record; upon hearing the arguments, and having stood over for consideration, till this day, this Forum passed the following:- ORDER (Per Sri.Vijay Kumar, President) This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the husband of complainant by name Dharavath Chander died on 26-5-2009 due to sudden sunstroke. During his lifetime, Dharavath Chander has taken a life insurance policy bearing No.688209124 for a sum of Rs.2,00,000/- by submitting proposal form on 10-12-2008 before issuing the policy, the opposite party authorities have verified about his health condition and upon satisfied about his health condition, he was issued policy and the deceased has been paying the premium regularly from the date of taking his policy till he died. The deceased has nominated the complainant, who is his wife as his nominee. The deceased was effected by sudden sunstroke and fell unconscious and he was admitted in Sriraksha Multi Super specialty hospital, at Khammam and on 27-5-2009 he died at 6-00 p.m. Before being effected with sunstroke, the deceased was hale and healthy and never complained about any health disorder. After his death, the complainant submitted claim form to the opposite party on 14-7-2009 claiming the benefits due to her upon the death of her husband. That on 26-2-2010 the opposite party had sent a repudiation letter to the complainant, repudiating the claim on the ground that the deceased withheld correct information regarding his health. The claim has been repudiated on the ground that all the answers to the questions were falsely stated and the opposite party has evidence to believe and show that the deceased was diabetic since 3 years prior to the date of his proposal. In fact the deceased had no history of diabetic. The contention of the opposite party that the deceased was a diabetic patient since 3 years prior to the date of proposal is baseless and ridiculous. The opposite party has to prove that the deceased was suffering with diabetes on the date of submitting the proposal and he has willfully suppressed the same. Hence, this complaint to direct the opposite party to pay an amount of Rs.2,00,000/- covered under the policy together with all benefits and Rs.50,000/- towards damages. Apart from the complaint, the complainant has filed the affidavit, reiterating the contents of the complaint and filed the following documents and the same were marked as Exs.A.1 and A.2. Ex.A.1 - Photocopy of claim statement Ex.A.2 - Repudiation letter issued by the opposite party On receipt of the notice, the opposite parties 1 and 2 appeared through their counsel and filed counter, and submitted that the deceased life assured died on 27-5-2009 since the death occurred within 5 months from the date of commencement of the policy, treating the claim under the said policy as very early, an investigation was caused into the bonafides of the said claim, during the investigation it came to light that the deceased/life assured has suppressed the material facts regarding his health, which effected the issuance of policy of his life. As per the inpatient discharge summary bearing IP No.1289 of Sri Raksha hospital, Khammam, the life assured was admitted in the said hospital on 26-5-2009 with a complaint of diabetes mellitus for the past 3 years and also recorded as a case of acute hyper tension diabetes mellitus chronic renal failure, that the deceased left the hospital against medical advise. It is further submitted that the deceased has replied all the questions 11(i) to 11(j) in his proposal in negative. As per question No.11(e) he has clearly mentioned as NO to the question whether you have suffered with diabetes and regarding his usual state of health, he answered as GOOD. All the replies given in the proposal form are false and intentionally suppressed and the said statement fraudulently made even though he knew at the time of making statements that it was false to his knowledge, thereby fully attracting the provisions of Section 45 of Insurance Act and other averments made in the complaint are denied in toto. It is further submitted that if the complainant is not satisfied with the decision of Divisional office of opposite party corporation, she was given an opportunity to prefer an appeal to the Zonal Claims Standing Committee at Hyderabad. Without exhausting the said remedy, straightly she filed this complaint. The other averments made in the complaint are not tenable and also placed a judgment of Hon’ble Supreme Court of India in Civil Appeal No.5322/2007 in SLP(C) No.23951/2005 in PC CHACKO and another Vs. LIC of India pronounced by Hon’ble Justice S.B.Sinha, wherein it is held that an insurer can repudiate the contract of life insurance under section 45 of Insurance Act for suppression of material facts by the proposer and prayed to dismiss the complaint. On behalf of the opposite parties, the following documents filed and marked Ex.B.1 is the proposal form, dt.7-1-2009, Ex.B.2 is the inpatient record I.P.No.1289, dt.26-5-2009 of Sri Rakha Hospital, Khammam. The learned counsel for the complainant filed written arguments and also submitted oral arguments. The counsel for opposite party submitted oral arguments. Heard both sides. Perused the oral ad documentary evidence, upon which the points that arose for consideration are, 1. Whether the complainant is entitled to the amount covered under the policy? 2. To what relief? Point No.1: The undisputed facts of the case are that the complainant is the wife and nominee of the life assured by name, Dharvath Chander. The deceased has taken a policy from the opposite party for a sum of Rs.2,00,000/- and he has been paying the premium regularly. It is also not in dispute that the said insured died on 27-5-2009. Since the death of the deceased taken place within 5 months, by treating the claim as early claim, the opposite party has investigated into the cause of death of the deceased and repudiated the claim on the ground that the deceased was suffering from diabetes even prior to the date of commencement of policy and he had the knowledge about the same and he underwent treatment at private medical practitioner and he willfully suppressed the same at the time of giving declaration. Whereas the case of the complainant is that her husband was hale and healthy and he never complained of any health disorder, due to high temperature in peak summer, the deceased was effected with a sudden sunstroke and fell unconscious and due to the same he was admitted in Sri Raksha hospital, Khammam and on 27-5-2009 at 6-00 p.m. he died due to sun stroke. Regarding the health condition of the deceased is concerned, the complainant refers to Ex.A.1, claimant’s statement, wherein it is clearly mentioned the cause of death as sunstroke. On the other hand the opposite party contended that the deceased was suffering with diabetes from the last three years prior his death and due to the diabetes only he died. On this aspect of the case is concerned, the opposite party refers to Ex.B.2, which is inpatient record issued by Sri Raksha Hopsital, Khamamm. Even according to Ex.B.2, the cause of death is shown as due to sunstroke. Apart from the cause of death, the doctor mentioned in his report that deceased was suffering with diabetes mellitus for the last three years, on this ground only the opposite party repudiated the claim as in Ex.A.2. On the basis of answers given to the questions at Sl.No.11. Absolutely there is no evidence or material on record to hold that these answers are false. The only question, which we are required to consider, is whether the deceased was suffering from diabetes at the time when he made proposal and if so the opposite party absolved from the liability to pay the insurance money on the ground of suppression of material facts. It is a fact that the deceased has answered the question at Sl.No.11 in negative. In other words he has stated to the effect that he was suffering from diabetes at the time of making proposal, whereas in Ex.B.2, a certificate issued by Sri Raksha hospital shows that the deceased was suffering from diabetes since about 3 years before he made a proposal for insurance. Now it is required to state whether history was reported by the patient himself or by his relative in his presence. The certificate issued by the doctor states to the effect that there was nothing on record to show that a history was reported either by the patient himself or his relatives in his presence. Therefore, history of diabetes mellitus recorded in the certificate, Ex.B.2 loses its importance or weight. Therefore in our opinion the evidence on record is not sufficient to establish that the deceased suffered from diabetes at the time when he made proposal for insurance or that he knew that he was suffering from diabetes at the time when he made proposal. In this case the deceased died due to sunstroke as per Ex.A.1. Thus no connection between diabetes and sunstroke, even otherwise also, it is not proved that the deceased had heart attack on account of diabetes. Thus, there is no nexus to the cause of his death and diabetes. Even if he was suffering from diabetes at the time when he made proposal, diabetes is not proved to have bearing on the cause, which resulted the death of deceased. Therefore, even if the deceased failed to disclose that he was suffering from diabetes at the time when he made a proposal, the liability under the policy cannot be denied on the ground of suppression of material fact. The death of the deceased has not been connected with the diabetes. It cannot be considered to be material, so far as the death of the deceased is concerned. Therefore, it cannot be said that there was suppression of material facts. Whether a fact is material or not has to be decided in the light of and in the context of the cause of death. If the fact has bearing on the cause of death it would become material, otherwise it could not be said to be material. Mere incorrect or wrong answers to questions, which ultimately do not have any bearing or connection with the death of the insured would not absolve the corporation from its liability under the policy. Therefore, in our opinion even if the deceased was suffering from diabetes as alleged by the opposite party, judging it from the point of view of the cause of his death, it was not material and the corporation cannot escape its liability on the ground of suppression of material fact. In the light of the above discussion, we are of the opinion that the opposite party corporation is not justified in repudiating the claim made by the complainant. The repudiation in our opinion was made without proper investigation and application of mind. In the result, the complaint is allowed in part, directing the opposite party to pay an amount of Rs.2,00,000/- covered under the policy bearing No. 688209124 including all the benefits accrued thereon, together with interest at 9% P.A. from the date of repudiation i.e. 26-2-2010 till the date of deposit. Further directed to pay an amount of Rs.2,000/- towards costs of the litigation. Dictated to the steno, transcribed by her, corrected and pronounced by us in the open forum on this 10th day of December, 2010. Sd/- sd/- sd/- PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM KHAMMAM Appendix of Evidence Witnesses examined for complainant: - None- Witnesses examined for opposite parties: - None- Exhibits marked for complainant: Ex.A.1 - Photocopy of claim statement Ex.A.2 - Repudiation letter issued by the opposite party Exhibits marked for opposite parties : Ex.B.1 - Proposal form, dt.7-1-99, Ex.B.2 - Inpatient record I.P.No.1289, dt.26-5-2009 of Sri Rakha Hospital, Khammam. Sd/- sd/- sd/- PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM KHAMMAM //T.C.F.B.O.// SHERISTADAR DISTRICT CONSUMERS FORUM KHAMMAM | |
