KERALA STATE CONSUMER DISPUTES             REDRESSALCOMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.

APPEALNO. 143/2006

JUDGMENT DATED 04.01.2011

PRESENT:-

JUSTICE SHRI.K.R.UDAYABHANU      :    PRESIDENT

 SHRI. M.K. ABDULLA SONA                 :     MEMBER            

APPELLANTS

Senior Divisional Manager,

Life Insurance Corporation of India,

Divisional  Office, M.G. Road, P.B. No. 1133,

Ernakulam.

Rep. by The Manager(Legal & HPF),

L I C of India,

Divisional Office, Ernakulam.

                           (Rep. by Adv. Sri. S.S. Kalkura & others)

                                         Vs                          

RESPONDENT

P.V. Sreekumar,

Puthenpurayil House,

Nellikuzhi P.O.,Kothamangalam

                               (Rep. by Adv. Tom Joseph).

JUDGMENT

JUSTICE SHRI.K.R.UDAYABHANU      :    PRESIDENT

The appellants are the opposite parties/LIC of India in C.C.  409/2005 in the file of CDRF, Ernakulam.  The appellants are under orders  to pay the assured  sum   of Rs. 50,000/- to the complainant with interest at 12% per annum from the date of claim till realization and also to pay Rs. 1,000/- as costs.

 The  case of the complainant  is that his brother Mr. P.V. Ajayakumar had availed the LIC policy from 28.11.2001.  On 16.10.2003, he was ill and he was admitted at the Medical College  Hospital.  He was further referred to the Regional Cancer  Center and was diagnosed as Carcinoma at oesophago gastric junction and died on 11.2.2004.  The claim was repudiated alleging suppression of material facts with respect to his health ie. Diabetes and tuberculosis.  It is contented that the said deceases has no nexus with the decease, on account of which he died.

          The opposite parties/appellants had contented that at the time of submitting the proposal on 30.11.2001 the deceased was suffering from diabetics and tuberculosis.  The above ailments were noticed on 27.11.2000 and he was undergoing treatment for the same.  Leave particulars provided by his employer also showed that he had availed considerable  periods of leave between January  2000 to January 2001 for medical reasons like Pneumonia.  The above facts were suppressed and hence the policy is invalid.

 The evidence adduced consisted of the testimony of Pw1, Dw1 and Exts. A1, A2 and B1 to B6.

          The Forum has allowed the complaint on the ground that  the policy holder had not undergone  inpatient treatment prior to 1.11.2003 and that the decease on account of which  the assured died has no nexus with the alleged deceases  that he suppressed.

We find that in Ext. B3 the proposal submitted by the deceased,  he has answered in the negative all questions with  respect to previous ailments that included  diabetics and tuberculosis and also as to the information sought  with respect to his absence from office and treatment   etc.  Ext. B4 is the certificate of hospital treatment issued by the consultant physician of St. Joseph’s Hospital, Kothamangalam wherein it is mentioned that the deceased was having diabetes mellitus and was on treatment and that he had tuberculosis in the past.  It is also noted that such decease was first observed by the patient on 27.11.2000.  It is also mentioned that he undervened  treatment from Dr. Ninan Kuruvila(MD).  He was treated as outpatient and the date of first O.P. treatment is 27.11/2000.  We find that Ext. B4 is not been disputed or disproved.  Ext. B6 is the out patient  treatment record  of St. Joseph’s Hospital, Kothamanalam  with respect to the deceased  wherein entries are seen from 27.11.2000 onwards.  Evidently diabetics and tuberculosis are serious illnesses and it can not be contented that the above are not material with  respect to   the state of health of the assured.   The contract of insurance is based   on good faith and hence the suppression of the above matters vitiated the contract.  The contention that the above deceases has no nexus with cancer the decease on account of which he died can not be sustained (P.C.Chacko and Anr. Vs. Chairman, LIC and others (2008) SAR(Civil) 44 of Supreme Court).  The nexus theory has no applicability as the facts with respect to the health of the assured are of paramount importance so far as the policy of life insurance is concerned.  Hence we find that the order of the Forum is liable to be set aside; and we do so. 

In the result, the appeal is allowed. 

The office is directed to forward the LCR along with the copy of this order to the Forum. 

            JUSTICE. K.R. UDAYA BHANU          :  PRESIDENT

            M.K. ABDULLA SONA                         :  MEMBER

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