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.66/2009 Order dated this the 18th day of August 2009 COMPLAINANT/S Smt.Thayamma W/o Late Nagaraju, R/o Marakadadoddi, Goravanahalli Village, Maddur Taluk, Mandya District. (By Sri.U.V.Girish., Advocate) -Vs- OPPOSITE PARTY/S 1. The Divisional Manager, Life Insurance Corporation of India, Jeevan Prakash, P.B.No.37, Mysore Bangalore Road, Bannimantap, Mysore. 2. The Branch Manager, Life Insurance Corporation of India, Maddur Branch, Near Kolli Circle, Maddur Town, Maddur Taluk, Mandya District. (By Sri.B.A.Vijay., Advocate) Date of complaint 02.06.2009 Date of service of notice to Opposite parties 13.06.2009 Date of order 18.08.2009 Total Period 2 Months 5 Days Result The complaint is dismissed. No costs. Sri.Siddegowda, President 1. This is a complaint filed under section 12 of the Consumer Protection Act, 1986 against the Opposite parties for claiming insurance amount of Rs.50,000/- with interest with bonus. 2. The facts of the complaint are that one Sri.Nagaraju, the husband of the complainant had obtained policy from the Opposite party for a sum of Rs.50,000/- on 09.08.2005 under policy No.723086759. The insured died on 23.11.2006 suddenly falling down infront of the house by holding chest and before he was taken to hospital. The complainant being a nominee submitted the claim and the Opposite party has repudiated the claim without proper reasons and repudiation is baseless and not based on sound legal principles. Therefore, the Opposite party has committed deficiency in service. Hence, the present complaint. 3. The Opposite party has filed version contending that the repudiation is proper. It is further contended that the death of the deceased occurred within a short period of 1 year 3 months from the date of commencement of the policy. The investigation revealed that the life assured was a T.B. patient and there is a direct nexus between the cause of death and illness suffered. Further, the deceased life assured falsely answered, the questions in the proposal form with regard to the question No.11(a) and (e). Therefore, the insured suppressed the material facts. If the life assured revealed true facts, the Opposite party would have declined to issue the policy or subjected to higher medical examination. Therefore, the Opposite party has not committed any deficiency in service and the complaint is liable to be dismissed. 4. During trail, the complainant is examined and has produced Ex.C.1 to C.4. The Opposite party is examined 3 witnesses and produced Ex.R.1 to R.11. 5. We have heard both the sides. 6. Now the points that arise for our considerations are:- 1. Whether the Opposite party proves that the deceased assured has suppressed material fact at the time of obtaining the policy? 2. Whether the Opposite party has committed deficiency in service by repudiating the claim? 3. Whether the complainant is entitled to the insurance amount with bonus? 7. Our findings and reasons are as here under:- 8. POINT NOS.1 & 2:- The undisputed facts are that Sri.Nagaraju, the husband of the complainant had obtained the LIC policy for Rs.50,000/- on 09.08.2005 as per Ex.R.2 by submitting proposal form Ex.R.1 on 11.08.2005. It is undisputed that the insured Nagaraju died on 23.11.2006 and the complainant being the nominee submitted the claim along with statement Ex.R.8 reporting the death as per the letter Ex.R.6. The Opposite party has repudiated the claim sending the letter Ex.C.1 dated 23.03.2009 on the ground that about 2 years before he proposed, the insured had taken treatment at P.H.C., Gurudevarahalli, Maddur Taluk, for Tuberculosis and did not disclose these facts and gave false answers and withheld correct information. Even, for the legal notice Ex.C.2, the Opposite party has sent reply Ex.C.3 stating that the repudiation is on the ground of suppression of material facts by the life assured while taking the policy. 9. Now, the burden is on the Opposite party to prove that the deceased insured was suffering from T.B. and taken treatment in the hospital prior to obtain the policy and has suppressed the said fact. The Opposite party has relied upon the evidence of R.W.2 & 3 and the documents Ex.R.9, R.10 and R.11. The evidence of R.W.2 & 3 and perusal of Ex.R.9(a), R.10(a) and R.11(a) clearly proves that the deceased Nagaraju was admitted as inpatient for T.B. disease in T.B. Centre, Hosur Mandya and took treatment from 24.02.2003 till 24.03.2003 as per treatment card Ex.R.10 and then he took treatment as out patient from 07.04.2003 to 14.12.2003 at Primary Health Centre, Gurudevarahally, Maddur as per Ex.R.11(a) and the evidence also disclosed that the insured was completely cured of T.B. disease. 10. The evidence of R.W.2 & 3 and documents are not denied, Opposite party has obtained the certificates Ex.R.4 & R.5 with regard to the treatment for T.B. disease of the insured Nagaraju. 11. Now, the question is whether the T.B. is a material fact and deceased assured has suppressed the material fact knowingly. The Opposite party has produced Ex.R.1 the proposal form wherein for Question no.11(a) During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week and Question no.11(e) are you ever suffered from diabetes, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia, hydrocele, leprosy or any other disease, the insured answer No, this proposal form is dated 11.08.2005. The evidence clearly proves that the deceased was suffering from T.B. disease and took treatment as inpatient from 24.02.2003 to 24.03.2003 (for a period of one month) and further took treatment as outpatient from 07.04.2003 to 14.12.2003 at Gurudevarahalli, Primary Health Centre. Though, he was cured of tuberculosis disease, but it is proved that the insured was aware of suffering from T.B. disease and taking treatment as inpatient and outpatient from 24.02.2003 to 24.03.2003. In spite of it, he has answered the questions in the negative and apparently they are incorrect statements and the insured has suppressed the same at the time of submitting the proposal form. It cannot be said that the T.B. disease is of a trivial nature just like taking treatment for fever, cold or flue etc. Though, T.B. is a curable disease, but it is also major disease, because if proper treatment is not taken in time, it leads to death. 12. The learned counsel for the complainant has relied upon the following decisions; (1) I (2006) CPJ 553 in the case of Mangej Kanwar Vs- LIC of India. In that case, the contention of the LIC that the deceased was suffering from T.B. and that fact was suppressed, but no evidence was produced in support to prove the same. Therefore, the Honble State Commission has held that suppression of chest disease does not amounts to suppression of material facts, since the death was due to heart attack and there is no nexus of T.B. with cause of death. But in the present case, the complainant has not proved the cause of death except pleading that the deceased suddenly fell down complaining chest pain and died before taking for treatment. Further, the Honble National Commission in number of cases has held that there need not be nexus between the cause of death and the disease suppressed at the time of obtaining the policy. (2) I(2006) CPJ page 497 in the case of LIC of India Vs- Hansraji Yadav, it is held that the repudiation of the claim is improper on the ground that there is no question of suppression of material fact, because the insured never hospitalized in near proximity of date of obtaining of policy. But, in the present case, there is ample evidence by the Opposite party that from 24.02.2003 to 14.12.2003, the insured was suffering from T.B. and taking treatment and the proposal was given on 11.08.2005 to obtain the policy from the Opposite party. So, within 2 years of obtaining the policy, the insured was suffering from T.B. But, he has suppressed the same while giving answer to question no.11(a) and question no.11(e). Therefore, this decision is not helpful to the complainant. Then II(2007) CPJ 242 (NC) in the case of LIC of India Vs- Patel Ganesh Bhai Ramji Bhai. In that case, the suppression of material fact about the pre-existing T.B. disease was not accepted on the ground that the life assured medically examined before issue of policy and presence of T.B. was not found at that point of time. But, in the present case, it is an endowment policy and it is a non-medical policy and no medical examination on behalf of the Opposite party was made in respect of the insured. Therefore, this citation is not applicable to the facts of the case. I(2006) CPJ 494 in the case of Oriental Insurance Company Vs- Madhusudhan Sharma. In that case, there was claim for Mediclaim expenses and it has held that diseases like hypertension, diabetes etc., so common and are always controllable and unless and until the patient has undergone long treatment including hospitalization and undergoes operation etc., in near proximity of taking policy cannot be accused of concealment of material fact. But, in the present case in near proximity of obtaining the policy, the insured was hospitalized for T.B. disease and took treatment for nearly 9 months. Therefore, this decision is not applicable to the facts of the case. Our Honble State Commission in the case of LIC of India Vs- Smt.G.Nagamma by its order dated 28.10.2003 set aside the order of the District Forum which allowed the complaint holding that though the deceased was suffering from Tuberculosis disease at one time, he was cured from the same and the last date of treatment was 25.06.1995, but when the policy was taken by the deceased was free from tuberculosis. Our Honble State Commission has held that the approach of the District Forum proceeding on the basis that there should be a nexus between the cause of death and the suppression of material facts is erroneous. 13. Therefore, in the present case even though cause of death is other than the T.B. disease which was concealed by the deceased assured, but he has suppressed the same in spite of having knowledge of disease of T.B. and taking treatment within proximity of time of obtaining the policy. Therefore, the Opposite party is justified in repudiating the claim and hence, the Opposite party has not committed any deficiency in service. 14. The complainant has sought for insurance amount of Rs.50,000/- with benefits. In view of our finding on the above points no.1 & 2, the complainant is not entitled to the insurance amount. 15. In the result, we proceed to pass the following order; ORDER The complaint is dismissed. No costs. (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 18th day of August 2009). (PRESIDENT) (MEMBER) (MEMBER)
