Order No.15 Dt. 05.02.2008
In short, the facts giving rise to this application are these Md. Nuran Nabi, since deceased, husband of the petitioner purchased insurance policy bearing No.452619320 from the LICI on 20.02.2002 for a sum of Rs.2,00,000/- for a term of 25 years of which quarterly premium was Rs.520/-. During continuance of that policy the insured became ill on 11.9.2004 and for that he was treated in different institutions and lastly died on 11.09.2005. The present petitioner, being the nominee of the said policy, filed death claim before the authority concerned along with all papers which has been repudiated on the ground of suppression of material facts regarding his health at the time of renewal of policy
O.P. Nos. 1 and 3 contest the case challenging the entitlement of the petitioner on the ground of filing incorrect statements regarding health status of her husband at the time of getting the policy revived and hence in terms of declaration signed by the insurer at the foot of the said personal statement and hence the revival of the policy is void and subsequent payment stands forfeited, for which the prayer is for dismissal of the petition of complaint with cost.
The following points have emerged for effective disposal of the present case.
- Whether the petitioner be termed as ‘consumer’ in terms of Sec.2(1)(d)(ii) of the Consumer Protection Act.?
- Whether the service of the LICI suffers from deficiency?
- Whether the petitioner is entitled to get the reliefs as prayed for?
DECISION WITH REASOSN
Point No.1
‘Consumer’ means any person who hires any services for consideration. ‘Service’ means service of any description which is made available to potential users and includes the provisions of facilities in connection with insurance as defined in Clause (o) of Seb. Sec.(i) of Sec.2 of the Consumer Protection Act.
Thus having regard to the facts and circumstances of the case there can be no dispute that the complainant as nominee of her husband (since deceased) hired the services of LICI for consideration. There can also be no dispute that LICI makes its service available in connection with insurance to potential users and, as such, the petitioner has become ‘consumer’ in connection with LICI within the meaning of the Act. which disposes of the present point in the affirmative.
(Ref: 1992 CPC 333 (NC) )
Point No.2
The term ‘deficiency’ has been discussed in 1991(2) CPR 567 (569) wherein it is stated that any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance of service undertaken to be performed amounts to deficiency.
Now the Forum has to consider whether the service of repudiation of claim of the present petitioner rendered by the LIC suffers from deficiency.
It appears that the petitioner while being examined as P.W. – 1 has been constrained to admit at the time of her cross-examination “It is a fact that my husband was lying ill since 11.09.2004.” and has also admitted that her husband had to take chemo at Barasat Cancer Research Welfare society and has also admitted, “The specific word ‘Cancer’ of my husband has not been narrated in my petition of complaint” which goes abundantly to prove that the payment of premium could never be paid by the deceased atleast for three occasions i.e. on 24.09.2004, 12.07.2005 and 08.08.2005.
Admittedly, the insured became ill on 11.09.2004, but the personal statement of his health given by him on 12.07.2005 in LICI in Form No.680, the insured gave statement that he never suffered from any disease mentioned in item No.2 of the said form and accordingly it is palpably clear that the assured had made incorrect statements therein withholding material information regarding his health at the time of getting the policy revived. ‘ The notes on written arguments’ filed by the LICI at Page – 5 reveals that the policy holder revived the policy during pendency of his illness as the same lapsed due to non-payment of premium in Nov.2004 and prayed for revival of the policy by giving false statement of health. Thus, the insured deliberately withheld the information which was within his knowledge.
In the above view of the matter LICI has established the case of suppression of material fact which was required to be disclosed and was fraudulently made or was suppressed as in evident Vide Ext.V which is a personal statement regarding health of the insured as are revealed in the documents which have been marked Exts. B to R.
The Hon’ble National Commission has been pleased to reproduce the following observations from the decision in LICI :Vs: Smt. S. Viyaya, 1(1995)(CPJ) 122(NC).
“ It is evident that in the personal health statement submitted by the insured just prior to revival of policy, he had suppressed the material facts concerning his health. As such, the repudiation of the policy by the Life Insurance Corporation was fully warranted and there has been no deficiency in service because of such a repudiation.”
In the instant case having made a careful scrutiny of the facts and circumstances stated hereinabove this Forum being fortified with the observation referred to supra is of considered opinion that in the instant case by repudiating the policy by the LICI, there appears no deficiency in service. This point is thus disposed of.
Point No.3
In the result the case fails.
Proper fees have been paid.
Hence, ordered,
that Malda D.F. Case No.30/2007 be and the same stands dismissed with no order as to cost.
Let a copy of this order be given to parties free of cost.
