Gugulothu Dhudi, W/o. Late Pool Singh & 3 Others all are R/o.Bachodu Thanda, Thirumalayapalem Mandal, Khammam Dist. - Complainant(s)
Versus
The Branch Manager, LIC of India, Kothagudem Branch, Khammam District & another - Opp.Party(s)
A. Koteswar Rao, Advocate, Khammam.
11 Aug 2010
ORDER
BEFORE THE DISTRICT CONSUMER FORUM AT KHAMMAM Varadaiah Nagar, Opp CSI Church consumer case(CC) No. CC/09/59
Gugulothu Dhudi, W/o. Late Pool Singh & 3 Others all are R/o.Bachodu Thanda, Thirumalayapalem Mandal, Khammam Dist. Guguloth Swamy, S/o. Late Pool Singh Guguloth Surya, S/o. Late Pool Singh Guguloth Budda, S/o. Late Pool Singh
...........Appellant(s)
Vs.
The Branch Manager, LIC of India, Kothagudem Branch, Khammam District & another
...........Respondent(s)
BEFORE:
Complainant(s)/Appellant(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
ORDER
BEFORETHE DISTIRCT CONSUMERS FORUM AT KHAMMAM Dated this, the 11th day of August, 2010. CORAM: 1. Sri Vijay Kumar, B.Com, L.L.B., President 2. Smt. V. Vijaya Rekha, B.Sc. B.L., Member 3. Sri R. Kiran Kumar, B.Sc., L.L.B., Member C.C.No.59/2009 Between: 1. Gugulothu Dhudi, W/o Late Pool Singh, Age:50years, Occu:Housewife. 2. Gugulothu Swamy, S/o Late Pool Singh, Age:27years, Occu:Agriculture. 3. Gugulothu Surya, S/o Late Pool Singh, Age:25years, Occu:Agriculture. 4. Gugulothu Budda, S/o Late Pool Singh, Age:22years, Occu:Agriculture. All are R/o Bachodu Thanda, Thirumalayapalem Mandal, Khammam District. . Complainants. And 1. The Branch Manager, LIC of India, Kothagudem branch, Khammam District. 2. The Divisional Manager, LIC of India, Warangal Town and District. Opposite parties. This C.C. is coming on before us for final hearing in the presence of Sri A. Koteswar Rao, Advocate for the complainants, A.Sarath Chander, Advocate for opposite parties; upon perusing the material papers on record; upon hearing the arguments and having stood over for consideration this forum passed the following: ORDER (Per Sri R. Kiran Kumar, Member) This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the complainant No.1 is a house wife and complainant No.2 to 4 are agricultural coolies and residents of Bachodu Thanda, Tirumalayapalem Mandal, Khammam District, the husband of the complainant No.1 and father of complainants No.2 to 4 by name Gugulothu Pool Singh, during his life time has taken LIC endowment policy through Kothagudem Branch of Khammam District, vide policy No.687640947 on 17-01-2007 for a sum assured amount of Rs.50,000/- to be payable annually @Rs.3,594/- per each installment, according to the said policy the husband of the complainant No.1 paid one installment and submitted his proposal form agreement, medical examination and other relevant documents, the same were received by the opposite parties. As per the averments of the complaint, before taking premium from the husband of the complainant No.1, he was examined by opposite parties doctor (physician) and issued a fitness certificate, basing on that the opposite party No.1 issued a policy in favour of husband of the complainant No.1, after taking policy the husband of the complainant No.1 was hale and healthy prior to his death. On 02-08-2007 due to heart pain the husband of the complainant No.1 died, after the death of her husband the complainant No.1 along with her sons approached the opposite parties for settlement and release of death benefits under the above said policy, but the opposite parties refused to pay the claim amount and issued a letter dated 15-02-2008 to the complainants stating that the husband of the complainant No.1, Pool Singh died due to Cancer and the age of the insured is also understated by 10years. In the above circumstances, the complainants are compelled to approach the Forum for redressal. 2. On behalf of the complainants the following documents were filed and marked as Exhibits A1 to A3. Ex.A1:- Office copy of legal notice, issued by the complainants to opposite parties, dated 05-09-2008. Ex.A2:- Photocopy of repudiation letter issued by Sr. Divisional Manager, LIC Warangal, dated 15 -02-2008. Ex.A3:- Status report of Policy No.687640947, dated 07-08-2008. 3. On receipt of the notice, the opposite party Corporation appeared through their counsel and filed counter. In the counter the opposite parties submitted that as per the intimation submitted to the opposite parties corporation, the life assured died on 02-08-2007, as the death occurred with in 7 months of date of acceptance of risk under the policy, an investigation is caused into the bonafides of the same, so as to decide its admissibility, it is submitted that during investigation, it came to light that the deceased/life assured was suffering from Carcinoma Polote (i.e., Cancer of the Polote)/Ulcer Polote since July 2006, which directly affect, the issuance of the policy on his life. And also submitted that as per the case sheet dated 26-09-2006 issued in the name of deceased vide IP No.11107-27.09.2006, 12139-24.10.2006, 1579-06.02.2007 and 2900-06.03.2007; Register No.06-06971 of MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad whereat he was admitted and treated. Also submitted that the life assured was administered CHEMOTHERAPY i.e. Radiation treatment for cancer at the site FACE & NECK from 15-11-2006 to 22-01-2007. And also submitted that the proposal for insurance under the aforesaid policy was submitted by the life assured to the opposite parties corporation only after undergoing treatment for Carcinoma Polote, at MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabd, life assured underwent cancer treatment in the pink card unit and the pink ration card in the name of the deceased/ life assured bearing No. WAP 223803500232 issued by MRO, Tirumalayapalem, Khammam District enclosed with treatment record. It is submitted that the deceased/life assured had replied to all the questions under Q.No.11 (a) to (j) in his proposal for insurance dated 17-01-2007 signed by him, in that he is in good health and that he did not receive any treatment for any disease/symptoms of illness which were false and he intentionally suppressed the fact, which is fully attracting the provisions of Sec.45 of Insurance Act, 1938. And further submitted that the deceased/life assured contravened the doctrine of Uberrimae Fides (i.e. doctrine of utmost good faith), which is the basis of insurance, to support their contention submitted citation of the Honble Supreme Court of India in Civil Appeal No.5322 of 2007 in SLP(C) No.23951 of 2005 in PC CHACKO and Another Vs. LIC of India and others, in which observed that an insurer can repudiate the contract of life insurance under Sec.45 of Insurance Act for suppression of Material facts by the proposer, that there is no deficiency of service at all in the instant complaint, on the part of opposite party Corporation to repudiate the claim under the above said policy, pleased to dismiss the complaint. 4. On behalf of the opposite parties the following documents were filed and marked as Ex.B1 and B2. Ex.B1:- Proposal form for insurance dated 17-01-2007 signed by the deceased/life assured. Ex.B2:- Photo copy of Case sheet/treatment record bearing No. 11107-27-09-2006, 12139-24-10-2006, 1579- 06-02-207 and 2900-06-03-2007; Register No.06-06971 of MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad 5. Upon perusing the material papers on record, now the point that arose for consideration is, Whether the assured had suppressed the material facts pertaining to his health in the proposal form, consequently the complainant is disentitled for the claim amount covered under the policy? POINT:- In this case the husband of the complainant No.1 by name Gugulothu Pool Singh during his life time taken Life Insurance Policy, vide No.687640947, from the opposite party and the husband of the complainant No.1 paid one installment, before taking the policy he was examined by the panel doctor (physician) of opposite parties, the doctor issued fitness certificate, basing on that the opposite party No.1 issued policy in favour of insured on 17-01-2007, he died on 02-08-2007. As per the terms and conditions of the policy the complainants submitted claim form along with all the relevant documents, but the opposite party made investigation on the death of the insured, as the claim is very early. On investigation the opposite party came to know that the deceased/life assured has intentionally suppressed the material facts about his health i.e. the deceased insured suppressed the pre-proposal illness and treatment related to suffering from Carcinoma Polote (i.e. Cancer of the Polote)/Ulcer Polote since July 2006, which directly affects the issuance of policy on his life as such repudiated the claim of the complainants, for that the complainants approached the Forum. It is an undisputed fact that the husband of the complainant No.1 died on 02-08-2007, while he had taken policy on 17-01-2007, with in 7 months from the date of commencement of the policy. By virtue of Insurance Act, since the death was within 7 months from the date of commencement of the policy, the opposite parties Insurance Corporation had ordered investigation. During the course of investigation, the opposite parties Corporation came to know that the husband of the complainant No.1 joined in MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad for treatment and opposite party Corporation filed Ex.B2, Patient record, issued by the said hospital. The record shows that the deceased has taken treatment relating to Carcinoma Polote (i.e. Cancer of the Polote)/Ulcer Polote since September 2006. In the proposal for Insurance Ex.B1, signed by the deceased assured on 17-01-2007, he had answered the questions particularly for Q.11 (a) During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week? - No. (b) Have you ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation? - No (e) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer Epilepsy, Hernia, Hydrocele, Leprosy or any other disease? - No and (i) What has been your usual state of health? - Good. That the opposite parties Corporation in their counter mentioned about the treatment taken by the assured in MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad for Carcinoma Polote (i.e. Cancer of the Polote)/Ulcer Polote. The complainants in para No.4 of the complaint taken plea that the insured died on 02-08-2007 due to heart pain and denied the contention of the opposite parties. To support their contention they failed to file any document or cause of death certificate. 6. From the above there is no reason to doubt the medical record furnished by the opposite party Corporation. The complainants did not file any evidence to show that the insured died due to heart pain. In fact, when the assured had taken treatment in MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad. It cannot be said that there was no nexus between the cause of death and the ailment he had suffered. The fact remains that the insured had suppressed the material facts regarding his health. He took treatment before the date of proposal for insurance evidenced from Ex.B2, from MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad. Since the suppression is material, the repudiation which according to us was justified. 7. In the result the complaint is dismissed. No costs. Typed to my dictation, corrected and pronounced by us in the open forum, on this 11th day of August 2010. PRESIDENT MEMBER MEMBER DISTRIC CONSUEMRS FORUM, KHAMMAM APPENDIX OF EVIDENCE Witnesses examined for complainant: None Witnesses examined for opposite party: None Exhibits marked for Complainant: Ex.A1:- Office copy of legal notice, issued by the complainants to opposite parties, dated 05-09-2008. Ex.A2:- Photocopy of repudiation letter issued by Sr. Divisional Manager, LIC Warangal, dated 15 -02-2008. Ex.A3:- Status report of Policy No.687640947, dated 07-08-2008. Exhibits marked for opposite party: Ex.B1:- Proposal form for insurance dated 17-01-2007 signed by the deceased/life assured. Ex.B2:- Photo copy of Case sheet/treatment record bearing No. 11107-27-09-2006, 12139-24-10-2006, 1579-06-02-207 and 2900-06-03-2007; Register No.06-06971 of MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad PRESIDENT MEMBER MEMBER DISTRIC CONSUEMRS FORUM, KHAMMAM
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