Karnataka

StateCommission

A/3146/2016

LIC of India - Complainant(s)

Versus

Madhumati - Opp.Party(s)

Rajesh Shetty

19 Jan 2024

ORDER

                                                                    Date of Filing : 09.12.2016

                                                                Date of Disposal : 19.01.2024

 

BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)

 

DATED : 19.01.2024

 

PRESENT

 

HON’BLE Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

Mr K B SANGANNANAVAR : JUDICIAL MEMBER

 

Mrs DIVYASHREE M : LADY MEMBER

 

 

APPEAL No.3146/2016

 

1. The Branch Manager

    LIC of India

    Narayanpur Road

    Basavakalyan - 585 327

 

2. Senior Divisional Manager

    LIC of India (Claims Department)

    Divisional Office

    Post Box No.43

    Station Rod, Raichur - 584 101

 

3. Zonal Manager

    LIC of India

    South Central Zonal Office

    Saifabad, Hyderabad

    Andhra Pradesh - 500 063

    Represented by its

    Manager (L & HPF)

    LIC of India, D.O-I

    Jeevan Prakash

    J C Road, Bengaluru - 560 002                                   Appellants

 

    (By Mr Rajesh Shetty, Advocate)

 

-Versus –

 

Smt Madhumati

W/o Late Shanker Khuba Jadhav

Aged : Major

R/at Shivajinagar Colony

Tripurant B Kalyan

Bidar District - 585 327

(Mrs Bharati Patil, Advocate)                                              Respondent

                                                  

  

 : ORDER :

 

Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

01.     This Appeal is filed under Section 15 of Consumer Protection Act 1986 by the OPs, aggrieved by the Order dated 07.11.2016 passed in Consumer Complaint No.67/2014 on the file of District Consumer Disputes Redressal Forum, Bidar (hereinafter referred to as the District Forum).

02.     Heard the arguments of the learned Counsels on record.  Perused the Impugned Order and Grounds of Appeal.

03.     The District Forum after enquiring into the matter, allowed the Complaint in part and directed the OPs to settle the Claim of the Complainant, with a sum of RS.3,50,000/- total in all the five policies by deducting the equitable amount at 20% from each Policy with no order as to costs, compensation or litigation.

04.     Aggrieved by this order, OPs are in Appeal inter-alia contending amongst other grounds that, the District Forum failed to appreciate that the Life Assured had made deliberate mis-statement and withheld material information regarding the previous Policies taken by him in Clause 10 of the Proposal Form under the heading ‘please give details of your previous Insurance’ and fraudulently obtained the Policies.   District Forum further failed to consider that under Section 45 of the Insurance Act 1938, the Corporation is entitled to repudiate the claim, if there is inaccurate or false statement or suppression of materials facts made by the policy holder which the policy holder knew at the time of making it, that the statement was false.   If the Life Assured had disclosed the details of the previous Policies taken by him in the Proposal Form it would have attracted special reports like ECG, FBS, CTMT etc., considering the age of the Life Assured, Sum Assured involved and underwriting decision would have been different and the chances of accepting the new proposals were very remote or basing on special medical test reports, OPs would have decided and has come to a wrong conclusion that the said proposition to be shoddy prima-facie.  This has resulted in mis-carriage of justice and thus seeks to set aside the Impugned Order by allowing the Appeal.

05.     During the course of arguments, the learned Counsel for the Appellant relied upon the decision of Hon’ble Supreme Court reported in AIR 2019, Supreme Court 2039 in the case of Reliance Life Insurance Co. Ltd., Vs. Rekhaben Nareshbhai Rethod decided on 24.04.2019.

06.     Admittedly, the deceased Husband of the Complainant, viz.,  Shanker Khuba Jadhav, an Assistant Teacher by profession during his life time, had obtained 5 Insurance Policies under Salary Saving Scheme on different dates as under :

Sl No	Policy No.	Sum Assured in Rs	Monthly Premium in Rs.
1	661658249	50,000/-	415/-
2	661657632	1,00,000/-	655/-
3	661766347	50,000/-	612/-
4	661655780	50,000/-	490/-
5	661768512	1,00,000/-	980/-
	Total	3,50,000/-

 

Further, the Insured had an un-timely death on 17.12.2012.  The Complainant being Nominee of the Insured in the said Policies, staked her claim for her entitled payment of the Assured Sums with OP, who repudiated the same, on the ground that the deceased insured, suppressed the material information regarding the previous Policies taken by him, while furnishing response to Clause No 10 of the Proposal Form.

07.     It is also not in dispute that the Deceased Insured had earlier obtained the Life Insurance Policies with the same OPs and obviously the same cannot escape attention of the OPs, hence, raising a presumption of non-disclosure of details of the previous Policies as the reason for repudiation of the Claims cannot arise and we don’t see any ill-conceived intentions. Further, it will be pertinent to note that the deceased Insured had not taken any of Insurance Policies from other Insurance Companies.  Therefore, repudiation of the Claim of the Complainant is not justified by producing any cogent & acceptable evidence.

08.     The observation of the District Forum in its Impugned Order that in all the Proposal Forms, we find endorsements of the Medical Examiners of the OP, after which only the Proposals accepted.  Had there been a speck of doubt by the Physicians regarding health of the Proposer, nothing was preventing them to subject the proposer for a thorough medical probe and further analysis of the proposer.  Never it done.  The authorised Medical Examiners of the OP had meekly endorsed the proposal, without demur and after the untimely death, the acceptor Corporation cannot wash of its hands.  However, we cannot endorse the misfeasance of the proposer in concealing about all his previous policies obtained and we apportion his fault to the extent of 20%.

09.     Thus, in the prevailing systems and accepted way of working, individuals approaching the Insurance Companies for obtaining Life or General Insurance is exceptional & to say the least, rare.  It is the Agents of the Insurance Companies who move around at the ground level and entice even un-willing & un-interested persons to take Policies and most of the times by providing monetary incentives, which the Insurance Companies may deny or dispute saying the same is un-authorised, as the Agents are working against set Targets.  Also, the Insurance Companies are having panel of Doctors, to whom the prospective Insured person can be directed, before accepting or rejecting the new Proposals, with specific reference to the general health condition of the proposer, over years back and at the time of the new submissions. It also cannot be disputed that the Insurance Companies welcome with both the hands, new Proposals for sale of Policies, even without seeing its prospective clients and only when claims are received for settlement of the entitled Assured Sums, the Proposal Forms are subjected to  microscopic scrutiny, working much against the well conceived concepts for introduction of the Insurance Scheme. This Commission is of the considered opinion that, in as much as the Complainant had obtained 5 policies under Salary Scheme on different dates, it is appropriate to direct the OPs to pay the entire Sum Assured of Rs.1,00,000/- in  Policy No.661657632 and further, to return the  upto-date premium amount collected under salary saving scheme in the 4 other Policies, with interest @ 8.25% p.a and  Rs.10,000/- towards  the litigation charges would  meet the ends of justice. In the circumstances, the Impugned Order passed by the District Forum requires to be interfered with by modifying the same in the following terms.

Appeal is partly allowed.  Consequently, Impugned Order dated 07.11.2016 passed in Consumer Complaint No.67/2014 on the file of District Consumer Disputes Redressal Forum, Bidar is hereby modified and OPs are directed to pay the Sum Assured of Rs.1,00,000/- in Policy No.661657632 and further directed to return the upto date Premium amounts collected under Salary Saving Scheme in respect of the 4 Policies viz., 661658249, 661766347, 661655780 & 661768512 with interest @ 8.25% p.a from the respective dates of receipt  and costs of Rs.10,000/- to the Complainant within 3 months from the date of this Order.

The Statutory Deposit in this Appeal is directed to be transferred to the District Commission for further needful.

          Send copy of this Order to the District Forum, as well as to the parties concerned, immediately.

 

 

Lady Member                     Judicial Member                         President

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