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.No.134/2009 Order dated this the 23rd day of March 2010 COMPLAINANT/S Smt.Puttathayamma W/o Late M.N.Viroopaksha, R/o Mallenahalli Village, Dudda Hobli, Mandya Taluk, Mandya District. (By Sri.Rajkumar., Advocate) -Vs- OPPOSITE PARTY/S 1. The Branch Manager, Life Insurance Corporation of India, Bandigowda Layout, Mandya. 2. Senior Divisional Manager, Mysore Divisional Office, Jeevan Prakash, P.B.No.37, Mysore Bangalore Road, Bannimantapa, Mysore. 3. Sri.M.Jayendra, LIC Agent, C.No.2922618, Javanahalli, Mallenahalli Post, Mandya Taluk, Mandya District.(EXPARTE) (By Sri.S.Sudarshan., Advocate for O.P.1 & 2) Date of complaint 13.11.2009 Date of service of notice to Opposite parties 14.12.2009 Date of order 23.03.2010 Total Period 3 Months 9 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 claiming insurance amount of Rs.1,30,000/- with bonus and compensation of Rs.2,00,000/-. 2. The case of the Complainant is that her husband M.N.Viroopaksha S/o B.Nanjappa obtained Jeevan Anand, Life Insurance Policy from 1st Opposite party Insurance Company for Rs.1,30,000/- on 19.06.2007. Her husband had obtained 3 LIC policies on 28.03.2002 for Rs.25,000/- and on 09.03.2006 for Rs.50,000/- and another on 28.06.2007 for Rs.50,000/-. Her husband died on 17.03.2008 by natural death. The Complainant being a nominee claimed the insurance amount. 3rd Opposite party the agent of the insurance company obtained her signature to the empty applications and obtained the policies to the hand of 3rd Opposite party. The 3rd Opposite party Agent had told that cheques would be sent. Thereafter, the Complainant received the amount of 3 policies through cheque. But, the amount of policy No.723858417 was not received and when approached, the 1st Opposite party by means of letter dated 21.03.2009 informed that her husband insured Viroopaksha at the time of obtaining the policy has not disclosed certain information with regard to the health and violated the condition of the insurance policy and therefore, the insurance amount cannot be paid. The Opposite party Insurance Company has falsely stated that her husband was suffering from diabetes and kidney disease since 1 ½ years prior to the policy and took treatment in Sri Sathya Saibaba Hospital, but the same was suppressed by the policy holder. Then, the Complainant got issued a legal notice on 21.03.2009 and 2nd Opposite party has sent reply in order to escape the liability. Her husband was hale and healthy and he was not suffering from any disease and has not taken any treatment at Sri Sathya Saibaba or any other hospital. Therefore, the Opposite party is liable to pay the insurance amount of Rs.1,30,000/-. The repudiation is illegal and Opposite party has committed deficiency in service. Hence, the present complaint is filed. 3. The notices were served on the Opposite parties 1 to 3. The 3rd Opposite party has been placed exparte. On behalf of the 1st & 2nd Opposite party, version is filed by 2nd Opposite party. 4. The 2nd Opposite party has filed version admitting the policy in dispute obtained by M.N.Viroopaksha, the husband of the Complainant and also the settlement of 3 earlier policies. It is false that life assured had a natural death, but as per the letter dated 16.10.2008, the life assured died due to kidney problem. The death claim was repudiated for suppression of material information regarding the health of deceased life assured. The claim was repudiated on due application of mind. The legal notice was issued and suitably replied by the Opposite party. The other allegations are denied. The contract of insurance is based upon utmost good faith and statements and answers made in the proposal form shall be the basis of contract. If it contains any untrue averments, the contract will be null and void and all money paid thereunder will be forfeited by the insurer. The deceased life assured had falsely answered the questions No.9, 11(a), 11(b), 11(d) & 11(i). The death claim under the disputed policy was treated as early claim i.e., claim arising within two years from the date of commencement of the policy. The investigation revealed that the life assured was a patient of diabetes mellitus and he had a chronic kidney disease. The deceased was treated at OPD at Sathya Sai General Hospital, Bangalore from 20.08.2005 to 23.09.2005 and on 28.09.2007. There is nexus between the cause of death and the illness suffered by the deceased life assured. The Opposite party is not liable to pay any amount. The Opposite party has not committed any deficiency in service and the complaint is liable to be dismissed with costs. 5. During trial, the Complainant and two witnesses are examined and produced the documents Ex.C.1 to C.6. On behalf of the Opposite parties 2 witnesses are examined and Ex.R.1 to R.14 are marked. 6. We have heard both the sides. 7. The Opposite party has also filed written arguments. 8. We have perused the records. 9. Now the points that arise for our considerations are:- 1. Whether the repudiation of the claim by the Opposite party Insurance Company is justified? 2. Whether the Opposite party has committed deficiency in service? 3. Whether the Complainant is entitled to the insurance amount claimed? 10. Our findings and reasons are as here under:- 11. POINTS NO.1 to 3:- The undisputed facts borne out from the materials on record are that M.N.Viroopaksha S/o B.Nanjappa of Mallenahalli Village, Mandya Taluk, is the husband of the Complainant and he had obtained three LIC policies at Srirangapatna Branch for Rs.25,000/- on 28.03.2002, Rs.50,000/- on 09.03.2006 and Rs.50,000/- on 28.06.2007. Thereafter, on 19.06.2007, he obtained Jeevan Anand policy for Rs.1,30,000/- from 1st Opposite party and policy bears No.723858417 as per Ex.C.1. It is an admitted fact that on 17.03.2008, the insured M.N.Viroopaksha died as per the death certificate Ex.C.2. It is an admitted fact that the Complainant preferred the claim of all the policies and the Opposite party Insurance Company settled the claim of three policies, but repudiated the claim of policy for Rs.1,30,000/- by means of letter dated 21.03.2009 stating that the insured had suppressed material facts about his health giving false answers, though he was suffering from diabetes and kidney disease and taking treatment in Sri Sathya Saibaba Hospital. Now, the Complainant has challenged the same pleading that the agent of the LIC i.e., the 3rd Opposite party took her signature to empty application forms with LIC bonds, since she is a illiterate and the repudiation is illegal as her husband was not suffering from any disease nor took any treatment and he met with natural death. Exchange of legal notice is also admitted. The Opposite party has challenged the case of the Complainant. 12. As per the contention of the Opposite party, when the claim was made, since it was within 2 years from the date of commencement of the policy, investigation was conducted and it reveals that the deceased life assured was a patient of diabetes mellitus and he had a chronic kidney disease and deceased was treated at Sathya Sai General Hospital, Bangalore, but he has suppressed the same. Since, the Complainant has denied the same, the burden is on the Opposite party to prove that at the time of obtaining the policy i.e., prior to 19.06.2007, the disease assured Viroopaksha was suffering from diabetes and chronic disease and he was treated in hospital and he had the knowledge of the diseases. 13. To prove the same, apart from the usual evidence of Opposite party Officer R.W.1, the Opposite party examined R.W.2 Dr.G.Ram Kumar, the Physician from Sri Sathya Sai Hospital, Bangalore and he has produced Ex.R.11 to R.14 and the certified copy of the same are Ex.R.1(a), 13(a) and 14(a). The Opposite party has also produced Ex.R.6 and also produced Ex.R.9, R.10 and Ex.R.4 the certificate of hospital treatment from J.S.S.Hospital, Mysore and the claimant statement Ex.R.5 of the Complainant. 14. Though, the Complainant has deposed that her husband was not suffering from any disease and not treated at Sri Sathya Saibaba Hospital, Bangalore or Mysore J.S.S.Hospital and also examined two villagers Ex.C.2 & C.3 who deposed that Viroopaksha, the insured was hale and healthy and the agent took signature of the Complainant to empty forms and papers, but the Complainant has not whispered in complaint that her signature was taken to empty papers, though pleaded that her signature was taken to empty claim forms. Further, the evidence of the doctor R.W.2 coupled with medical records disprove the oral evidence of the Complainant and witnesses that her husband was hale and healthy and not suffering from any disease. Ex.R.6, the letter given by the Complainant to the 1st Opposite party Office in which the Complainant has admitted her signature has stated that her husband was treated in Kavery Nursing Home and thereafter on 11.03.2008, he was taken to J.S.S.Hospital, in spite of treatment died on 17.03.2008 on account of kidney problem. Ex.C.6 is in Kannada Language and now it is not open to the Complainant to withdraw the contents of Ex.C.6. Apart from Ex.C.6, the Complainant signed the claimant statement Ex.R.5 and the cause of death is shown as kidney failure. Further, the Opposite party has produced Ex.R.4 in which the Nephrology Associate Professor of J.S.S.Hospital has certified that the insured Viroopaksha was admitted to the hospital on 10.03.2008 with Generalised weakness and loose stools and vomiting and he was referred by Dr.Nandeesh as per Ex.R.10 and he was discharged on 11.03.2008. As per Ex.R.10, the insured Viroopaksha was referred as it is a case of chronic kidney failure. According to the Ex.R.4, the case is of chronic kidney disease. But they are subsequent to issue of policy. But, the evidence of R.W.2 Dr.Ram Kumar and Ex.R.11, R.12, R.13 and R.14 undoubtedly proves that the disease assured Viroopaksha was treated for diabetes and kidney problem at Sri Sathya Sai General Hospital, Bangalore from 20.08.2005 till 23.09.2005 and again he was treated on 28.09.2007. Ex.R.1 is the out patient slip and Ex.R.12 is the out patient record, Ex.R.14 is the lab report and Ex.R.13 is the lab reported dated 28.09.2007. It cannot be said that the LIC Insurance Company has created the documents in collusion with the physician R.W.2 Dr.Ram Kumar. It is not the case that R.W.2 is the one of the doctors in the panel of doctors maintained by the LIC Insurance Company. The address in the medical records Ex.R.12 clearly proves the address of the deceased assured and there is no difference at all and the Complainant has failed to establish that these medical records are not genuine. It is pertinent to note, the age of the insured at the time of obtaining the policy Ex.C.1 was 41 years and the policy obtained on 19.06.2007 and he died on 17.03.2008. So, within two years from the date policy for Rs.1,30,000/- he died. It cannot be accepted at the age 42 ½, a person will die without any cause, so the case of the Complainant that her husband met with a natural death due to weakness cannot be accepted. On the other hand, the evidence of the doctor and medical records clearly established that the deceased life assured Viroopaksha was suffering from diabetes and kidney problem in 2005 itself and he was taking treatment. But, at the time of obtaining the policy on 19.06.2007 has suppressed the diseases he was suffering and treatment in the hospital, but falsely gave answers in the proposal form that is status of health is good and he was not suffering from any diseases or hospitalized and undergone any test. So, the material on record clearly established that the life assured was having the knowledge of his diseases i.e., diabetes and kidney problem and he was under treatment and in spite of it, has suppressed the same without disclosing at the time of obtaining the policy. It is well known that the contract of insurance is based upon utmost good faith and if untrue statements are given in the contract, the contract will become void. Therefore, in the circumstances of the case, the Opposite party has established that the deceased life assured had suppressed material facts about his diseases and treatment at the time of obtaining the policy in dispute and died within 2 years from the date of policy and under Section 45 of the Insurance Act, the Insurance Company is entitled to repudiate the claim of the policy in case of violation of conditions of the policy by virtue of fraudulent suppression of material facts. Therefore, we hold that the repudiation of the claim by the Opposite party is justified. The Complainant has failed to prove that the Opposite party has committed deficiency in service in repudiating the claim. 15. In view of the above findings, we hold that the Complainant is not entitled to the insurance amount, nor any compensation. 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 23rd day of March 2010). (PRESIDENT) (MEMBER)
