Tamil Nadu

StateCommission

A/30/2017

K.Adiyapatham - Complainant(s)

Versus

The Branch Manager, LIC & 3 Ors. - Opp.Party(s)

V.Chandra kanthan

20 May 2022

ORDER

IN THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI

 

                             BEFORE :      Hon’ble Mr. Justice R. SUBBIAH                              PRESIDENT

                                                    Thiru R. VENKATESAPERUMAL                                MEMBER

                        

F.A.NO.30/2017

(Against order in CC.NO.39/2010 on the file of the DCDRC, Chengalpattu)

 

DATED THIS THE 20^th DAY OF MAY 2022

 

K. Adiyapatham

S/o. Kothandapillai

No.54/2A, Chunambedu Road

Kadapperi Elango Street                                                 M/s.V. Chandrakanthan

Madurantakam Town                                                             Counsel for

Madurantakam Taluk – 603 306                                     Appellant /Complainant

 

                                                         Vs.

1.       The Branch Manager

Life Insurance Corporation of India

Jeevan Jothi, Gundur Church Road

Chengalpattu – 600 302

 

2.       The Branch Manager

          Life Insurance Corporation of India

          GST Road, Madurantakam Town & Taluk

 

2.       The Senior Divisional Manager

LIC of India, Divisional Office, Chennai Division – I

 

3.       The Zonal Manager

Life Insurance Corporation of India

South Zonal Office                                                  M/s.R.S.Anandan

No.102, Anna Salai                                                    Counsel for

Chennai – 600 002                                        Respondents/ opposite parties

 

          The Appellant as complainant filed a complaint before the District Commission against the opposite parties praying for certain direction. The District Commission had dismissed the complaint. Against the said order, this appeal is preferred by the complainant praying to set aside the order of the District Commission dt.24.7.2015 in CC.No.39/2010.

 

          This appeal coming before us for hearing finally today, upon hearing the arguments of the counsel appearing on bothside and on perusing the documents, lower court records, and the order passed by the District Commission, this commission made the following order:

ORDER

 

JUSTICE R. SUBBIAH,  PRESIDENT   

1.         This appeal has been filed by the complainant as against the order dt.24.7.2015 passed by the District Commission, Chengalpattu, in CC.No.39/2010, in dismissing the complaint.

 

2.       The brief facts of the complaint before the District Commission are as follows:

          Complainant is the father of one A.Revathy and he is the nominee of said Revathy under the LIC policy Nos.713589351 & 713670624.   The complainant’s daughter Revathy took the said policy from the 2^nd and 1^st opposite parties respectively.   The period of 1^st policy was 28.10.2002 to 28.10.2032 for the sum assured Rs.3,00,000/- and the 2^nd policy period commence from 28.10.2002 to 28.10.2023 for the sum assured at Rs.5,00,000/-.  The doctor of the opposite parties/ insurance company examined the insured thoroughly and certified that she was in good health.  The insured also gave bonofide information to the opposite parties /insurance company regarding her good health.  While so on 22.4.2004 the insured suffered from severe diarrhoea and vomiting and subsequently she died at home.  Before death, the insured Revathy was treated at Hindu Mission Hospital at Tambaram on 18.4.2004 and discharged on 19.4.2004.  As a nominee of the insured, the complainant made a claim to the opposite parties for settlement of the policy amount under policy Nos.713598351 and 713670624. One Dr.Chandrasekaran, Civil Surgeon, Government Hospital, Maduranthagam had issued a certificate that the insured died on account of diarrhoea, acute renal failure, and cardiac pulmonary arrest.  She was suffering from the said ailment for 10 days.   On receipt of the claim form from the complainant, the insurance company/ opposite parties, repudiated the claim without bonofide reason vide letter dt.31.3.2005.  Thereafter, the appellant preferred a representation to the Zonal Office, however the same was denied.  Hence he approached Insurance Ombudsman, which was also rejected.  Hence he filed the present complaint praying for direction to the opposite parties to settle all the claim benefits, alongwith compensation and cost. 

 

3.       The said complaint was resisted by the insurance company by filing a version as follows:

          The deceased Revathy had taken policy bearing Nos.713598351 and 713670624 under Bima Kiran, for the sum assured of Rs.300000/- and Rs.500000/- respectively.  She had nominated her father to receive the policy money during the term of the policy.   While submitting the proposals for both the policies, the deceased had not disclosed the details about the other policy she obtained.  She had also not given bonofide information about her health in the proposal form.  While so the insured died on 22.4.2004.   As the nominee of the policy, the appellant preferred the claim before the respondents.  But the same was repudiated by the 2^nd Respondent as on dt.31.3.2005, for the reasons that the deceased had made deliberate mis-statement and withheld material information regarding her health at the time of obtaining the policy.  The repudiation order was communicated to the appellant vide letter dt.31.3.2005.  Subsequently the appellant submitted a representation for reconsideration of his claim to the zonal office and on rejection he had also approached Insurance Ombudsman at Chennai.  The Insurance Ombudsman by award dt.22.3.2006 had dismissed the complaint of the appellant.  As per the certificate of Dr.C.Chandrasekaran, medical attendant of Hindu Mission Hospital, dt.25.4.2004, the deceased died at her residence and the cause of death was Gastro erobic dehydration, acute renal failure and cardiac pulmonary arrest and she was suffering from the said ailment for 10 days.  As per the letter dt.28.12.2004 given by the Medical Superintendent, Hindu Mission Hospital, the deceased was admitted on 18.4.2004 in their hospital and she was suffering from the disease of Leukaemia for the past 4 years, for which she was undergoing treatment and was referred to oncologist at Apollo hospital or Govt. Hospital, Chennai for further management.  Vide the complainant’s another reference letter dt.19.4.2004 given by DMO, Hindu Mission Hospital  to Adyar Cancer Institute reveals that the deceased was a known case of Cell Mediated Lympholysis (CML) for the past 4 years, and was on medication viz. Tab Hydren 500 mg. BP.  In such a situation the premium was not paid since September 2001, and hence the policy got lapsed.  It is no doubt that the opposite party had accepted the revival, but it was based on the declaration given at the end of the proposal with utmost good faith.  But the deceased had not disclosed regarding her health that she was suffering from CML.  Had she  given the details, the opposite parties would have called for special reports like CBC, ESR etc., which would have revealed her state of health.  The deceased had not disclosed the facts at the time of proposal which are material to reassess the risk due to which the insurer was denied the opportunity of assessing the risk properly.  The repudiation of the opposite parties was challenged by the complainant before the Zonal Review Committee.  On examination of the facts, the committee also had decided to uphold the decision of the Divisional Office.  Likewise the claim of the complainant had also been rejected by the Insurance Ombudsman vide their award dt.22.3.2006.  Therefore, there is no deficiency in service on their part.  Thus they prayed for dismissal of the complaint. 

 

4.       In order to prove their respective case, alongwith proof affidavits documents had also been filed by the parties, which were marked as Ex.A1 to A27 on the side of the complainant and Ex.B1 to B24 on the side of the opposite parties. 

 

5.       The District Commission after analysing the evidence had come to the conclusion that the deceased had suppressed the material facts about her health at the time of taking the policy as well as at the time of revival.  Therefore by holding that there is no deficiency in service on the part of the opposite parties, had dismissed the complaint.  Aggrieved over the said order, this appeal has been preferred by the complainant. 

 

6.       It is the specific case of the complainant that the order of the District Commission is contrary to law, facts and circumstances of the case.  The insured who died on 22.4.2004, took two Bima Kiran policies on 28.10.2002 for a sum of Rs.3,00,000/- and Rs.5,00,000/- respectively. Dr.Chandrasekaran, Civil Surgeon, Government General Hospital, Maduranthagam who treated her had also given a certificate to the effect that she had died due to acute renal failure, & cardiac arrest.  But inspite of all these documents, the District Commission had dismissed the complaint by placing reliance on the certificate issued by one Dr.K.Subramanian under Ex.B6.  But actually the said doctor had not given any treatment to the appellant/ complainant.  The treatment was given by one Dr.A.K.Gautham, but the said doctor had not given any certificate.  On the side of the opposite parties, no substantial proof had been produced to establish that the deceased was suffering from Leukaemia, except hearsay evidence by Dr.K.Subramanian.  Above all at the time of taking the policy the deceased had not suppressed her illness.  Infact at the time of taking the policy, she was examined by the doctor of the Respondent, and certified that the deceased had no ailment.  Moreover the respondent had paid a sum of Rs.3,00,000/- under  Life Insurance Policy No.713175188  dt.28.3.2001.  When they had chosen to pay for one policy, the denial of payment for other policy is not correct.  Thus he prayed for setting aside the order. 

 

7.       Per contra, the learned counsel for the Respondents/ opposite parties had submitted that the deceased had taken 4 policies, totalling to Rs.11.5 lakhs from LIC of India from three different branches viz. Madurantakam, Chengalpattu and City branch 8, Chennai.  Out of which one policy for Rs.3 lakhs was settled, since it was a non-early claim.    In the proposal dt.14.10.2002 and 30.10.2002 submitted at Chengalpattu, she did not disclose any of the previous policies and the proposal given at Maduranthakam.  Had she given the details of policies taken earlier, the opposite parties would have called for special reports like ECG, CBC, ESR etc., which would have given a correct state of her health.  Further the assured was suffering from Leukaemia, and was taking treatment for four years.  This material suppression led them to repudiate the claim.  Therefore, the appellant cannot complain deficiency in service.  The Insurance is a contract of ubarimaefide i.e., based on ‘utmost good faith’.  It is the duty of the insured to disclose all the material facts.  If the insured has a knowledge of facts which others cannot know, then she should not indulge in ‘suppressio vary (suppression of truth) or suggestio falsi’. 

          In this connection some of the judgements were relied on by the Respondents viz;

The judgement of the Hon’ble Apex court held in Srinivasan Pillai Vs. LIC reported in AIR 1997 Mad.381.

 The judgement of Hon’ble National Commission in Revision Petition No.2877/2013 dt.4.8.2015,  held in M/s. Aviva Life Insurance Co. India Pvt. Ltd.,   Vs. Smt. Phool Kunwar  and the

Judgement of the Hon’ble Apex Court held in Satwant Kaur Sandhu’s Vs. New India Assurance Co., Ltd., reported in (2009) 8 SCC 316.

          Thus he sought for dismissal of the appeal.

 

8.       Keeping the submissions of either side in mind, we have carefully gone through the entire materials available on record. 

          Since we have already dealt with the factual aspects of the case in detail, we are going to deal with only those averments, which are necessary to decide the issue involved in this case. 

 

9.       In view of the submissions made, the only question that has to be decided in this case is that as to whether there is suppression of material facts on the side of the appellant/ complainant at the time of revival of the policy.  If the answer is in affirmative, then the case has to be rejected. 

 

10.     As per the version of appellant/ complainant the insured suffered ill-health for the reasons of loose stools and giddiness with swelling of both legs for the period of two days and was admitted into Hindu Mission Hospital on 18.4.2004 and discharged on 19.4.2004.  Since the insured was not feeling well, she was again admitted on 20.4.2004 to 21.4.204 and died on 22.4.2004, whereas the policy was taken in the year 2002.

As per the certificate of Dr.C.Chandrasekaran, marked as Ex.A5, the cause for death was mentioned as Acute Gastro Erobic Dehydration, Acute Renal failure and Cardio Pulmonary arrest.  As per Ex.A3, the Medical Certificate the cause for death mentioned as Acute Gastro Erobic Dehydration and Acute Renal Failure.  But the complainant had attempted to project the case that the deceased had suffered from ailment only from 18.4.2004 to 22.4.2004. 

 

11.     The Respondents would submit that there is a clear suppression of material facts on the side of the complainant.  The complainant had taken policy for a sum of Rs.11.5 lakhs from three different branches, but he had suppressed about the earlier policies.  Further as seen from Ex.B2, letter issued by Dr.K.Subramanian, it was mentioned as “She had the history of Leukemia for the past 4 years for which she was undergoing treatment.  She was treated by the physician Dr.A.K.Gowtham and she was discharged on 19.4.2004 and referred her to oncologist at Apollo or Chennai GH for further evaluation”.  Thereby the certificate clearly shows that the complainant was suffering from Leukemia for the past 4 years. 

          But the appellant/ complainant would contend that the deceased had been treated only by Dr.Gowthaman, hence reliance could not be placed on the above certificate.

 

12.     In this connection a perusal of the document under Ex.B9, the case history of the deceased issued by Hindu Mission Hospital would clearly show that the deceased had been referred to a Haemato Oncologist at Apollo Hospital or GH for further management.  This would clearly shows that the deceased was suffering Leukamia for 4 years.  The notings in the case sheet also would further establish that at the time of admission itself, it was noted in the case sheet that the deceased was a known case of Leukamia for the past 4 years then.  Therefore, the certificate issued by the Medical Superintendent of Hindu Mission Hospital Dr.K. Subramanian was drafted only on the basis of the case history.  In view of the same, the certificate issued by the Said Dr.K.Subramanian is definitely having much force.  Hence, it is clear that the deceased had obtained policy by suppressing the decease she was suffering. 

          In a case of Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., reported in (2009) 8 SCC 316”  the Hon’ble Apex Court has held that “Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was probably untrue to his knowledge.  There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent- insurer was fully justified in repudiating the insurance contract.” 

The dictum laid down in the above judgement would clearly show that the insurance is a contract of ubarimaefide, i.e., based on ‘utmost good faith’ and it expects the insured should give all the information regarding their health.  But in the instant case, by suppressing the material facts, the policy was taken, as well as revived.  Therefore, the complainant is not entitled for any relief, accordingly we do not find any infirmity in the order passed by the District Commission.

13.     In the result, the appeal is dismissed by confirming the order of the District Commission, Chengalpattu in CC No.39/2010 dt.24.7.2015.  There is no order as to cost throughout.

         

 

 

 

  R. VENKATESAPERUMAL                                               R. SUBBIAH

               MEMBER                                                                      PRESIDENT