THE CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM Present: Sri. Santhosh Kesavanath P., President Smt. Bindhu M. Thomas, Member Sri. K.N. Radhakrishnan, Member CC. No. 318/2008 Wednesday, the 12th day of November, 2009.
Petitioner : Usha Susheelan Chalumkal House, Erumely P.O (By Adv. K.S Asif) Vs. Opposite parties : 1) LIC of India LIC Office, Mundakkayam Branch Reptd. By its Manager.
The Senior Divisional Manager,
LIC of India, Divisional Office, Jeevan Prakash, P.B No. 609, Nagampadom, Kottayam. (By Adv. K.C Philipose Tharakan)
The Zonal Manager,
LIC of India, Zonal Office, Anna Road, P.B No. 2450, LIC Building, Chennai.
O R D E R
Sri. Santhosh Kesavanath P., President.
Case of the petitioner is as follows:
Petitioner ‘s husband insured his life with a policy with vide policy No. 392311871with opposite party. Amount covered by the policy is Rs. 50,000/-. Petitioner’s husband met with a road traffic accident on 7..9..2006 at Manimala and he succumbed to injuries on 9..9..2006 and later he died. On the death of the insured, as the legal heir, petitioner submitted a claim before the opposite party for disbursement of the amount covered by the policy. Opposite party as per letter Dtd. 3..1..2008 repudiated -2- claim of the petitioner on the ground that petitioner’s husband was deliberately stated mis statements and withheld material information from the opposite parties regarding his health at the time of taking policy. According to the petitioner, act of the opposite party is repudiating claim of petitioner is a clear deficiency in service. So, he prays for a direction directing opposite parties to disburse the policy amount of Rs. 50,000/- with 12% interest. Petitioner claims Rs. 25,000/- as compensation and Rs. 5,000/- as cost of proceedings. Opposite party entered appearance and filed version contenting that petition is not maintainable. Opposite party admitted that he issued a policy from their Mundakkayam branch for an amount of Rs. 50,000/- to the husband of the petitioner. According to the opposite party they conducted detailed investigation with regard to the claim of the petitioner. On enquiry it is found that on 5..9..2006 life assured was traveling in Motor Bike, driven by his friend, and when the vehicle reached near Kadayanikkadu the life assured fell down from the bike. On the next day he was admitted at Kanjirappaly Taluk Hospital and there after transferred and admitted at Medical College Hospital and died on 9..9..2006. According to the opposite party claim under the policy was repudiated on the ground that life assured suppressed material facts regarding his health at the time of effecting the proposal. Deceased was suffering from diabetes since three years before submitting proposal of the said policy. The deceased life assured did not disclose these details in the proposal dated 24..12..2004 . The life assured died in 3 years from the date of commencement of the said policy. The primary cause of death of the life assured was Meningo encephalitis and it was also directly -3- related to the suppressed illness. So according to the opposite party claim of the petitioner was repudiated on valid reason and there is no deficiency in service on their part. So, they pray for dismissal of the petition with their costs. Points for determinations are: Whether there is deficiency in service on the part of the opposite party? Relief and costs.
Evidence in this case consists of affidavit filed by both parties and Ext. A1 to A11 documents on the side of the petitioner and Ext. B1 to B4 documents on the side of opposite parties. Point No. 1 Petitioner produced a copy of repudiation letter Dtd: 3..1..2008 said document is marked as Ext. A1. In Ext. A1 reason for repudiation is stated that petitioner had a history of Diabetes Mellitus and was under treatment with oral hypoglycemic agents for last 3 years and it caused meningo encephalitis, optic nerve neuropathy and diabetic keto acidosis and diabetic condition of petitioner was a major cause leading his death and petitioner did not disclose this facts in his proposal Dtd: 24..12..2004. Opposite party produced the proposal Dtd: 24..12..2004 and said document is marked as Ext. B4. In Ext. B4 it is mentioned as follows:- Questions Answers
During the last 5 years did you consult a Medical
Practitioner for any ailment requiring treatment For more than a week? No. Have you ever been admitted to any hospital or
Nursing home for general check-up, observation Treatment of operation? No. -4-
Are you suffering from or have you every suffered
From ailments pertaining to liver, stomach, heart, Lungs, kidney, brain or Nervous system. No.
Are you suffering from or have you every suffered from
Diabetes, tuberculosis’s, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, hernia, Hydrocele, Leprosy or any Other disease? No.
v) What has been your usual state of health? Good.
The answer given by the petitioner are No. According to opposite party, petitioner suppressed the disease of Diabetes. In our view diabetic, hyper tension etc. are daily ease of life and cannot be considered as a disease. Opposite party produced a copy of certificate of hospital treatment Dtd: 3..4..2006 said document is marked as Ext. B2. . In Ext. B2 it is stated that petitioner developed Diabetes Keto acidosis on 8..9..2006. We are of the view that developing of Diabetes Keto acidosis on 8..9..2006 does not mean that that petitioner was suffered from diabetic at the time of proposal. Opposite party has not produce any document to prove that petitioner was suffering from diabetics at the time of proposal. Petitioner produced certified copy of postmortem certificate and said document is marked as Ext. A2. In Ext. A2 police surgeon stated opinion as to the cause of death is “death due to head injury”. In our view the cause of death and the diabetics has no direct nexus. So, repudiation of the claim of the petitioner in our view is a clear deficiency in service. So, point No. 1 is found accordingly. Point No. 2 In view of the finding in point No. 1, petition is allowed and the petitioner is entitled for relief sought for. In the result opposite party is ordered to disburse the petitioner an amount of Rs. 50,000/- with 9% interest from the date of repudiation till -5- realization. Opposite party is also ordered to pay an amount of Rs. 2,000/- as cost of the proceedings. Since interest is allowed no compensation is ordered. Order shall be complied with within one month of the receipt of this order. Dictated by me transcribed by the Confidential Assistant corrected by me and pronounced in the Open Forum on this the 12th day of November, 2009. Sri. Santhosh Kesavanath P. President Sd/- Smt. Bindhu M. Thomas, Member Sd/- Sri. K.N. Radhakrishnan, Member Sd/- APPENDIX Documents for the petitioner. Ext. A1: Repudiation letter Dtd: 3..1..2008. Ext. A2: Certified copy of the postmortem certificate Ext. A3: Copy of letter issued by the petitioner to the Zonal Manager. Ext. A4: Letter Dtd: 8..3..2008 issued by the Divisional Manager to the petitioner. Ext. A5: Copy of the Lawyers Notice Dtd: 25..7..2008 Ext. A6: Postal Receipt Ext. A6(a) Postal Receipt Ext. A7series Postal receipt Ext. A8 Certified copy of the FIR Ext. A9 Certified copy of the wound certificate Ext. A10: Certified copy of the inspection report Ext. A11: Certified copy of the final report. Documents for the Opposite party: Ext. B1: Copy of the Medical Attendance certificate Ext. B2: Copy of the certificate of hospital treatment Ext. B3: Copy of the treatment certificate Ext. B4: Copy of the proposal Dtd: 24..12..2004. By Order,
Senior Superintendent
amp/ 6 cs.
......................Bindhu M Thomas
......................K.N Radhakrishnan
......................Santhosh Kesava Nath P | | 
