BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. A.P.MAHADEVAMMA, B.Sc., LLB., Member, ORDER Complaint No.MDF/C.C.2/2009 Order dated this the 20th day of March 2009 COMPLAINANT/S Smt.B.R.Vinutha W/o Late Ravikumar, R/at Bharathinagara, C.A.Kere Hobli, Maddur Taluk. (By Sri.B.Ramakrishne Gowda., Advocate) -Vs- OPPOSITE PARTY/S 1. Senior Divisional Manager, Life Insurance Corporation of India, Divisional Office, Jeevan Prakash, P.b.No.37, Mysore Bangalore Road, Bannimantap, Mysore. 2. The Manager, Life Insurance Corporation of India, Maddur Branch, Maddur, Mandya District. (By Sri.B.A.Vijay., Advocate) Date of complaint 03.01.2009 Date of service of notice to Opposite parties 22.01.2009 Date of order 20.03.2009 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, for settlement of insurance claim of Rs.3,00,000/-. 2. The case of the complainant is that her husband Sri.Ravikumar S/o Boregowda had obtained Life Insurance from the Opposite party for a sum of Rs.3,00,000/- vide Policy No.721196368 dated 15.10.2000. That policy had been lapsed for non-payment of premium from April 2001 and same has been revived on 19.05.2005 and when policy was in force death took place. The complainant filed claimants statement and other documents as a nominee. The Opposite party Company repudiated the claim vide letter dated 28.05.2008 stating that deceased assured withheld material information with regard to his health at the time of getting the policy and the assured had suffered from T.B. since 2004 and took treatment in Asha Kiran Hospital. But, the ground of the Opposite party has no basis at all. In spite of legal notice, the Opposite parties have failed to comply with the claim. Therefore, the present complaint is filed, for the insurance amount of Rs.3,00,000/- with interest and compensation of Rs.50,000/- for mental agony. 3. The Opposite parties have filed version. Admitting that the policy was taken for Rs.3,00,000/- and also revival of the policy on 28.05.2005 and the complainant is the nominee, but pleaded that at the time of revival of the policy, the assured has submitted personal statement regarding his health dated 24.05.2005. Death was occurred within 5 months and 14 days from the date of revival. As it is early claim, investigation was conducted and it revealed that the life assured was a patient of Crypto Vollal Meningitis, Pulmonary T.B. and AIDS and had availed treatment from 2004 at Asha Kiran Hospital, Mysore and further, treated from 18.09.2005 to 11.11.2005. The fact of ill-health was not disclosed by the deceased while reviving the policy. The assured has given false statement and suppressed the material facts and hence, the Opposite party repudiated the claim of the complainant. The revival policy is a new contract. Therefore, the Opposite party has right to repudiate the claim and Opposite parties have not committed any deficiency in service and the complaint is liable to be dismissed with costs. 4. The complainant has filed affidavit and is examined and produced the documents Ex.C.1 & C.2. On behalf of the Opposite parties one witness is examined and Ex.R.1 to R.12 are produced. 5. We have heard both sides. 6. Now the points that arise for our considerations are:- 1. Whether the deceased assured had suppressed the material facts at the time of revival of the police regarding health? 2. Whether the Opposite parties have committed deficiency in service by repudiating the claim? 3. Whether the complainant is entitled to the insurance amount with interest? 7. Our findings and reasons are as here under:- 8. The undisputed facts are that Ravikumar S/o Boregowda, the husband of the complainant had obtained L.I.C. policy on 15.10.2000 for Rs.3,00,000/- as per Ex.R.1 and the complainant is the nominee. It is also admitted fact that the policy was lapsed due to non-payment of premiums from April 2001 to April 2005 and the policy was revived on 19.05.2005 on paying the arrears of premiums, by giving personal statement regarding his health as per Ex.R.2. The complainant reported the death of her husband on 12.11.2005 due to heart-attack as per her letter dated 06.02.2006 as per Ex.R.5 and then submitted claim application Ex.R.7 with death certificate Ex.R.6. Then Opposite parties repudiated the claim, on the ground that deceased assured had suffered from T.B. since 2004 and took treatment from 18.09.2005 to 11.11.2005 at Asha Kiran Hospital, but he did not disclose these facts in his personal statement and hence withheld material information regarding health at the time of revival of the policy. 9. So, the burden is on the Opposite parties to prove that the deceased assured had suppressed material facts with regard to his health at the time of revival of the policy. Admittedly, the policy had lapsed for nearly 4 years from April 2001 to April 2005 and on payment of arrears of premium, it was revived. At that time, the Opposite party has taken personal statement regarding health of the deceased as per Ex.R.2 and it is not in dispute. He answered No about the illness, treatment, operation or any test reporting good health. But according to the Opposite parties, the deceased had suppressed the material facts about his illness and treatment at the time of revival of the policy, though he was suffering from Crypto Vollal Meningitis, Pulmonary T.B. and AIDS and took treatment in Asha Kiran Hospital, Mysore from 2004. 10. According to the complainant, the assured died due to heart-attack, but no document is produced. Though the complainant has denied that her husband Ravikumar was suffering from Pulmonary T.B., AIDS and Crypto Vollal Meningitis and took treatment at Asha Kiran Hospital, Mysore, but Opposite party has examined R.W.2 Dr.Swamy, who is R.M.O. of Asha Kiran Hospital and he has produced the case sheet records Ex.R.12. In fact, the Opposite party had written letter Ex.R.8 to Asha Kiran Hospital to furnish the documents and R.W.2 has sent reply Ex.R.9 stating that Ravikumar S/o Boregowda, residing at K.M.Doddi, Mandya got admitted to hospital on 18.09.2005 and discharged on 11.11.2005, he had taken treatment for Crypto Vollal Meningitis, Pulmonary T.B. and AIDS, he had taken out patient treatment since 2004. R.W.2 is the R.M.O. of this Asha Kiran Hospital has sent reply Ex.R.9. The evidence of R.W.2 Dr.Swamy is that Ravikumar S/o Boregowda, K.M.Doddi was referred by Dr.Poornima at Mandya for further treatment as he was diagnosed of having H.I.V. positive on 14.05.2004 and at every month he was treated as out patient and he was admitted on 18.09.2005 to 11.11.2005 with H.I.V. positive and he was also treated for Crypto Vollal Meningitis and Pulmonary T.B. (Brain infection). In fact, he was admitted on 04.07.2005 and discharged on request on 11.07.2005 and has produced the case sheet Ex.R.12, the case sheet records proves that Mandya Diagnostic Centre has diagnosed on reference by Dr.Poornima that Ravikumar is reactive for H.I.V I & II test and this report is dated 13.05.2004. On 14.05.2004 at Ashakiran Hospital, the complainant was examined and counseling was done and investigation revealed that he was H.I.V. positive and he was treated again on 17.05.2005, 17.06.2005 as a out-patient and he was admitted on 04.07.2005 and suspected tuberculosis and meningitis and discharged on request on 11.07.2005. Again he was admitted on 18.09.2005 and discharged on 11.11.2005 diagnosis was Crypto Vollal Meningitis, Pulmonary T.B. There is no reason to suspect this documents and the evidence of the doctor R.W.2. So, though he was positive to H.I.V. as on 13.05.2004 and diagnosed at Asha Kiran Hospital of having H.I.V. positive and took treatment as an out-patient, he did not disclose in his personal statement of regarding health on 24.05.2005 in Ex.R.2, but stated no hospitalization, no disease, but having good health at the time of revival of the policy. Of course, he was admitted to Asha Kiran Hospital on 04.07.2005 and suspected tubercular meningitis and C.T. Scan of the Brain was conducted and there was Meningitis with Diffuse Cerebral Oedema, and was in hospital up to 11.07.2005, but this treatment was before the giving declaration of health at the time of revival of the policy. Even though, the Opposite parties have produced the documents and evidence of the doctor he was suffering from Pulmonary T.B. and Crypto Vollal Meningitis, it is subsequent to the revival of the policy and it was not within the knowledge of the deceased assured, but it is proved that at the time of revival of the policy, he was positive H.I.V. and taking treatment. 11. After the claim made by the complainant, investigation has been conducted and the Opposite parties have sent repudiation letter, stating that the assured had suffering from T.B. since 2004 for which he took medical treatment at Asha Kiran Hospital from 18.09.2005 to 11.11.2005 and he suppressed the material information deliberately in his personal statement. Admittedly, for the revived policy, personal statement of the assured was taken on 24th May 2005 as per Ex.R.2, thereafter he was admitted to hospital on 04.07.2005 and discharged on 11.07.2005 with diagnoses of tubercular meningitis. So, this disease was subsequent to the revival letter, but there is no evidence that he was suffering from T.B. at the time of revival of the letter. Of course, the Opposite party has proved that the assured was positive to H.I.V. at the time of revival of the policy i.e., in May 2005 up to 24th May 2005 (date of personal statement) and had taken treatment visiting every month. 12. The contention of the complainant side is that death is due to heart-attack and not for pulmonary tuberculosis or brain illness and there is no connection between the disease suppressed and the cause of death and hence, the repudiation is improper. The learned counsel for the complainant has relied upon the decision reported in 2006 (2) CPR page 195 of Rajasthan State Commission in the case of Mangej Kanwar Vs- L.I.C. of India and 2008 (1) CPR page 299 of Punjab Chandigarh State Commission in the case of L.I.C. Vs- Sukhpal Kaur. On the other hand, the learned counsel for the Opposite party has relied upon the decision of the Honble National Commission in Revision Petition No.2142/1999 in the case of L.I.C. of India Vs- Smt.Savitri Devi and I (2009) CPJ page 231 of Honble National Commission in the case of L.I.C. of India Vs- M.Bhavani, we have perused those decisions. 13. The decision cited by the learned counsel for the complainant which were rendered by the Honble State Commissions are not applicable to the facts of the case and they are overruled by the Honble National Commission decisions. 14. It is settled law that revival of policy is a fresh contract. The Honble National Commission in the case of L.I.C. of India Vs- Bhavani referred above, has held that false declaration given at the time of revival of the policy leads to repudiation of the claim. Further, in the decision reported in II (2007) CPJ page 51 in the case of L.I.C. of India Vs- Krishan Chandar Sharma, the Honble National Commission has held that nexus between cause of death and illness with treatment is not material. So, applying the above position of law to the facts of the case, the evidence clearly proves that at the time of revival of the policy, the insured Ravikumar had given fresh declaration as per Ex.R.2, but he has failed to disclose the disease namely H.I.V. Positive, though he had the knowledge and he had taken treatment at Asha Kiran Hospital, Mysore. So, there is suppression of the disease H.I.V. by the insured and it is a material information, because H.I.B. Positive is a serious disease. So, it is established that the insured had given false declaration suppressing the fact of H.I.V. positive disease and treatment before the revival of the policy. Though in the repudiation letter, the Opposite parties have stated that assured had suffered from T.B. since 2004 and took treatment in Asha Kiran Hospital, but further pleaded that he had made deliberate mis-statements and withheld material information regarding his health at the time of getting the policy revival. The Opposite parties have taken specific contention in the version about the AIDS apart from pulmonary T.B. and Crypto Vollal Meningitis from 2004. Therefore, it is open to the Opposite parties to take the defence that the insured was suffering from H.I.V. Positive (AIDS) before the revival of the policy and he had the knowledge, but suppressed the same at the time of revival of the policy. Therefore, the repudiation of the claim of the insurance preferred by the complainant is justified. 15. Hence, the complainant is not entitled to the insurance claim of Rs.3,00,000/- with benefits. 16. 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 20th day of March 2009). (PRESIDENT) (MEMBER)
