FA 860/2008 against CC No. 527/2006 on the file of the

District Consumer Forum I, Visakhapatnam.

Between :

The Senior Divisional Manager,

Life Insurance Corporation of India

Visakhapatnam

Rep. by S. N. Natarajan, Secretary ( L & HPF )

LIC of India, South Central Zonal office,

Hyderabad                                               .. Appellant/opposite party

And

Smt. Bobbili Anasuya,

W/o late B. Ramalingam

Qtr. No. 336/E, Section 3, Ukku Nagaram,

Visakhapatnam                                       .. Respondent/complainant

Counsel for the Appellant           :           Mr. K. Narayana Rao

Counsel for the Respondent      :           M/s. M. S. R. Subrahmanyam

CORAM    :   

SRI SYED ABDULLAH                  ..             HON’BLE MEMBER

AND

SRI R. LAKSHMINARASIMHA RAO         .. HON’BLE MEMBER

Wednesday, the Fourth Day  of August, Two Thousand Ten

Oral order :   ( as per Sri Syed Abdullah, Hon’ble Member )

********

The appellant is the unsuccessful opposite party in CC 527/2006 on the file of the District Forum I, Visakhapatnam  where under an order was passed directing to pay Rs.1,40,000/-  with benefits if any covered by the policy in question and also directed to pay Rs.10,000/-  towards compensation and costs of Rs1000/-

The facts as stated in the complaint are that the complainants’ husband B. Ramalingam haD ensured his life by obtaining  six polices from the Opposite party. While undergoing treatment in seven hills hospital he died on 28.2.2004.  Prior to obtaining policy he never took any treatment and he never complained of ill health.   The Opposite parties  repudiated the claim in respect of the  last three policies bearing Nos. 692633484, 692635176  and 673597498 alleging  that the deceased had suppressed material information regarding his personal health. The  repudiation of the claim is aributed  as deficiency in service  and unfair trade practice.

The opposite party  has resisted the claim by raising  its defence that as per the medical book issued by the Steel Plant hospital , Visakhapatnam the life assured had taken treatment right from 1994. On 27.10.99 the life  assured had taken ECG which revealed heart problem SINSZ and BP 170/130 which was diagnosed as inferolateral ischemia. He was admitted in the hospital on  18.4.2000 and discharged on 21.4.2000. It is mentioned in that record that it is an old case of hypertension with IHD  with R R Hemparesis and  also underwent CT scan. Again admitted on 24.7.2001 and discharged on 25.07.2001. The  diagnosis was vertigo. Again admitted in March, 2003  and took treatment up to April, 2003. The assured in his answers to various questions in the proposal form has not mentioned the real state of affairs with regard to vital information about his health though he suffered from heart disease and hypertension. If he had disclosed the material facts, the OP  would have called for special reports and decided to issue the policies.   The repudiation is proper in respect of the three polices as the policies are invalid. 

During the   enquiry the complainant filed evidence affidavit and Ex. A1 to A10 and the administrative officer of OP filed Ex. B1 to B6 along with evidence affidavit.

After going through the evidence on record, while admitting the fact that the policy holder had aken  treatment and intermittently by joining as inpatient but the said period was for  a short period with which  he survived up to 28..2.2004 and  during this period he was regularly  attending  to his duty . The attendance certificate issued by the employer did not reveal that he  was never on medical leave. He was availing  other leave during the period from May, 2000 to February, 2004  for short period.  Thereby gave a decision that it cannot be said as suppression of material fact  which is so imminent and critical in the near future of his life.

Questioning the legality and propriety of the order, in the   grounds of appeal, the appellant/opposite party had raised the contention that the case sheet issued by  Seven Hills hospital which contains the details of past history and treatment taken by the policy holder right from 1994 onwards for heart ailment and blood pressure yet the said information was suppressed while obtaining the polices in question which amounts to material suppression of material information regarding his health  at the time of entering in to contract and there is an obligation on the part of the proposer to disclose all the facts which are material to the contract at the time of entering into the contract.

The learned counsel for the appellant has relied upon a decision  of the  Apex Court in CA No. 1682/2004 in  LIC of India and others Vs. T. Venkateswarlu and also relied upon judgment rendered in between P. C. Chacko and another Vs. Chairman of LIC of India in CA No. 5322 of 2007 and the other decision  in Mithoolal Nayak  VS LIC of India AIR 1962 SC 814 ( V 49 C 117), in which,  the implications of Sec. 45 was discussed  holding  that deliberate concealment of facts would amounts to vitiation  of  contract.

It is an undisputed fact that the policy holder had taken six polices from time to time and in subsequent policy nos. 692633484, 692635176  and 673597498, he failed to mention about the  treatment taken for his heart ailment. The medical certificate and the leave particulars of the policy holder issued by his employer clinchingly prove and establish that the deceased was suffering from heart ailment for which he was taking treatment by joining in the hospital. Availment of medical leave arises when the Earned Leave  at credit lapses.  Suppression of the personal health and treatment undergone by the insured  amounts to material suppression as such it is a violation of contract as per Sec. 45 of the Insurance Act. The District Forum has observed that since the policy holder has not applied for medical leave it would not  amount to a serious lapse or suppression of material fact is untenable in view of the settled law  that furnishing of wrong statement or suppression amounts to vitiation of  contract. The reasoning given by the District Forum  is contrary to fact, evidence and law as such it is not sustainable  and it is liable to be set side.

In the result, the appeal is allowed  setting aside the order dated 27.09.2007 passed by the District Forum holding that it Is not sustainable and consequently the complaint is dismissed. In the circumstances of the case there is no order as to costs.

                                                                                                                                                                                                Sd/- MEMEBR

                                                                                                                                                                                                Sd/- MEMBER

                                                                                                                                                                                                DATED : 04.08.2010.