BEFORE THE HON’BLE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM BAGALKOT

                                                                                                                                          Date of Admission: 16-04-2016

                                  Date of Order       : 26-11-2016

                                Consumer Complaint No: 53/2016

PRESENT

1. Smt K.Sharada  B.A.L.L.B. (Spl)                          : President
2. Smt Sumangala Hadli   B.A.(Music)                     : Lady Member
3. Shri Shravanakumar. D. Kadi M.Com. L.L.B.(Spl : Member

           COMPLAINANT

1. Feerasab S/o Fakeersab Karemanasur,

Age: 35 Years Occ: Driver of K.S.R.T.C.,

R/o Ugalawat Village,

Tq: Badami,

Dist: Bagalkot

                                          (By Shri M.D.Kiragi & C.B.Sobarad Advocate)

                    V/s

1. The Branch Manager,

Life Insurance Corporation of India,  

          Badami, Dist: Bagalkot.

2. Divisional Manager,

         Life Insurance Corporation of India,  

         Basaveshwara Circle, Goa Ves,

        Belagavi.

                                       (By Shri M.C.Hiremath Advocate for the Op No 1 & 2)

Speaking through Shri Shravanakumar.D.Kadi, Member

        Complaint filed by the complainant under section 12 of the consumer Protection Act 1986 (herein after referred to as Act) against the opposite parties (in short the Ops) Claiming the Assured Amount of Rs 1,50,000/-  with interest at 18% from the date of reputation of complainant and Rs 75,000/- towards Compensation to the complainant with cost of Rs 25,000/-

2. Brief facts of the case are as follows:-

That the Complainant wife by name Sainaj during her life time got insured her life insurance policy with Op No 1 office under LIC’s Jeevan Ananda on payment of Rs 7777/- as a Yearly premium amount for a sum assured amount of Rs 1,50,000/- Insurance policy bearing  No 669230245 and said policy is commence its risk from 28-03-2012 and date of maturity is on 28-03-2033 The Complainant who is husaband of deceased Sainaj and also a nominee to said life insurance policy. That deceased Sainaj has paid total premium of two years and policy is valid at the time of death of Sainaj. The Op No-2 is divisional Office, who had repudiated the complainant claim. That the Late Sainaj who is doing household work and living with her husband and family member, for securing to her family members he got insured his life insurance with this Op-1 on 28-03-2012.But prior to her death since from four months back deceased Sainaj is suffering from her mental ill-health and she got treatment in various hospitals but she could not get recovered from her ill-health finally due to her mental ill-health she fell down in a well and died on 25-01-2014 at Ugalwati village and consequence complaint is filed before Kerur Police station and same is registered under UDR No 2/2014. Thereafter as per the above said policy terms and condition the Complainant filed the application to opponents office with praying to grant the sum assured amount of Rs 1,50,000/-. The Complainant along with an application submits the original policy bound and other documents. But that claim was repudiated the Complainant claim with intimation letter on 16-01-2016 on grounds that deceased Sainaj had suppressed the materials facts with regards to her ill-health at the time of obtaining the policy with opponents. That prior to death of deceased Sainaj she was hale and healthy person and not suffering from any disease. Hence, these opponents have causes deficiency of service by reputing the Complainant claim on un-regionable grounds. Due to this act of the Op’s the complainant suffered financial loss and mental agony and hence has prayed for allowing the complaint.

3) That the Op No 1 & Op No 2 have appeared through the counsel   and opposed the claim of the complainant by filing his written version wherein he has denied the allegations made by the complainant against them. That the Complainant has raised unreasonable objection and the averments mentioned in the complainant are baseless and devoid of any merit. That the Op No 1 admits that the life assured late Sainaj for sum Assured of Rs 1,50,000/-with plan and term and the date of commencement of the said policy is 28-03-2012 with Yearly premium of Rs 7777/-. That the deceased Sainaj had deliberately suppressed the material facts, said Sainaj gave false information in respect of his health condition. life assured died on 25-01-2014.Since the death of the life assured has taken place within 3 years from the date of commencement of the policy and such claims are categorized as Early claim and requires investigation to ascertain the genuineness of the claim, cause of death of the life assured and any suppression of health ailments/treatments taken prior to taking the policy. As a result of investigation, it is found that the deceased life assured was suffering from Cancer of Thyriod and taken treatment prior to taking the policy. Therefore, this Op is not liable to pay any claim amount as per the terms and conditions of the policy contract and the complainant is not eligible for any compensation as there is no deficiency of service on the part of this Opponent. Hence has prayed for dismissal of the complainant with compensatory cost.

        4.   Both the parties have filed affidavits in support of their cases. Affidavit filed on behalf of the complainant by name Feerasab S/o Fakeersab Karemanasur  and Opponent No 2 has filed his affidavit by name Shri Sharanayya S/o Machayya Hiremath Manager (L & HPF),LIC of India, Divisional Office, Belagavi  Both the parties produced documents are marked as per Annexure.

          5.  Opponents Advocate filed written arguments. Now the following points do arise for our consideration in deciding the case. They are;          

1. Whether the Op’s have rendered deficiency in service to the Complainant?
2. Whether the complainant is entitled to the relief as is sought for?
3. What Order?

Answer to the above points;

1.  Affirmative,
2. Partly Affirmative,
3. As per the final order

           6.  POINT NO 1:- In order to avoid repetition of the facts and reasons and also to save time, we take up the complaint for passing order as follows:-

       The learned counsel for the complainant strenuously contended that unfortunately, Sainaj was fell down in a well and   died on 25-01-2014 at Ugalawati Village. Deceased was taken Life Insurance Policy bearing No 669230245 dated 28-03-2012 sum assured Rs 1,50,000/- Yearly premium of Rs 7777/- and Complainant as a nominee for this policy. That the complainant is the husband of and legal heir of the deceased Sainaj who died on 25-01-2014, left behind her husband i.e., complainant and her family. Thereafter the Complainant has submitted application along with duly completed claim papers to Op No 1. Thereafter Op No 1 referred the matter to Op No 2 and Op No 2 sent the reply notice that claim was repudiated on the basis of medical records.

       That the Opponent No 1 & 2 stated deceased Sainaj suffering from  Cancer of Thyriod and also hospitalized for the same on 18-10-2004 to 24-10-2004 admitted to Dr M.S.Daddennavar Hospital, Bagalkot. Deceased Sainaj took treatment for Papillary Ca-thyroid in the year of 2004 that is eight year before taking the policy with opponents. The deceased life Assured did not disclose these facts in his proposal dated 28-03-2012 and gave false answers to Question No 11 of the proposal. That the Opponents counsel further stated that deceased had never disclosed the material facts at the time of insuring himself and violated the policy conditions. Therefore, the claim was repudiated on grounds of suppression of material facts based on the treatment details.

         However, we have perused the entire records of both the parties and also heard the counsels for the parties in length, in view of above document this forum observed the following points :-

1. This forum observed that hospitalization of deceased in 2004, the Opponent had produced the Xerox copy of Medical certificate of M.S. Daddennvar Bagalkot which was not proved. Nor was the evidence of the treating doctor led.
2. That the deceased died on 25-01-2014 due to Suicide in Ugalawati village as per Ex C4 and Ex C5 It is clearly shows that Complainant wife by nameSainaj died on 25-01-2014 due to Suicide as per PM Report.
3. That the Opponent counsel produced the citation of Supreme court of India Civil Appeal No 2776 of 2002, and National Consumer Disputes Redressal Commission New Delhi Revision Petition No 3794-3796 of 2007 and Revision Petition No 1004 of 2010 these citations are not applicable in this case observation is different from one case to another.  
4. That the deceased was taking policy on 28-03-2012, at the time of submitting the proposal form he was hale and healthy person and he was not suffering from any disease, but deceased admitted on 18-10-2004 to 24-10-2004 in Daddenavar Hospital with history of the papillary ca thyrid in the year 2004. Eight Year before taking the policy with Opponents after getting the treatment she has not taken any treatment to her ill-health in any of the hospital further, cause of death of Sainaj is no ever concern to above treatment.Therefore question of material facts with regard to ill-health does not arise in this case. Except Xerox copy of medical certificate Opponent did not produce any other record of treatment, and Opponent did not produce any evidence of Treated Doctor, or Medical records.

       As held by the Hon’ble National Consumer Disputes Redressal Commission New Delhi III (2014) CPJ 221 (NC) Baja Allianz Life Insurance Co Ltd and Ors V/s Raj Kumar the Lordship observed that “Authorized doctor of insurance Company examined insured, assessed fitness and after complete satisfaction policy was issued- It cannot be presumed that insured/deceased was aware of Multiple myeloma/Blood Cancer and he concealed previous illness- Repudiation not justified.”

              2009 (3) CPR 53 (L.I.C. of India and Others V/s Kailash Chandra Kar) That Hon’ble court observed that “ Consumer Protection Act, is a beneficial legislation and it cannot allow Insurance Company to escape liability on technical grounds to deprive the consumer of benefits to which he was entitled to.”

              As held by the Hon’ble National Consumer Disputes Redressal Commission New Delhi I (2016) CPJ (NC) National Insurance Corporation of India and Anr V/s Chawali Devi that the Lordship observed that “Only on basis of recorded history of deceased, it cannot be held that deceased was suffering from breathlessness, cough C expectoration,etc since last 10 years and had taken any treatment-Merely because deceased omitted to mention one of the policies while mentioning other two policies, it cannot be held that deceased concealed this fact with ulterior motive or for any fraudulent insertion particularly when earlier policy was taken under salary savings scheme which was known to department as well petitioner- Repudiation not justified.

        Therefore this is none other than deficiency in service rendered by the Op No 1 and 2 we answer to point No 1 in affirmative.

        7.   POINT No2:- Once the deficiency in service is provide, the next point is how much compensation complainant is entitled for? That the Op No 1 & 2 jointly or severely have to pay assured of the said Insurance Policy is Rs 1,50,000/-, with interest at the rate of Rs 9% per annum from the date of reputation of Complainant claim ie.,16-01-2016 i.e., to till realization, towards mental agony of Rs 5,000/- and cost of the complaint is Rs 2000/-Hence, we answer Point No 2 partly in the affirmative.

           8.   POINT NO3:- In view of our findings to point No 1 and 2 we proceed to pass the following. . .

Complainant’s Complaint is allowed in part as follows:-

1. That the Op No 1 and 2 jointly or severely have to pay the assured of the policy bearing No 636525016 amount of Rs 1,50,000/- with interest at the rate of Rs 9% per annum from the date of reputation of Complainant claim ie.,16-01-2016 to till realization.
2. Op No 1 and 2 shall have to pay an amount of Rs 5,000/-(Five thousand only) towards mental agony caused to the complainant. And Rs 2000/- towards cost of the litigation.
3. Op No 1 and 2 shall have to comply this order within Two month from the date of receipts of this order, failure of which the above said amount shall carry an interest at the rate of Rs 12% per annum from the date of reputation of Complainant claim ie, 16-01-2016 to till realization.
4. Free copy of this order shall be sent to the parties immediately.

(Dictated to the Stenographer directly on computer corrected by me and then pronounced in the open Forum on this 26^{th day} of November 2016)

Witness examined on behalf of the complainants:-

1. Shri Feerasab S/o Fakeersab Karemanasur

                  Documents produced on behalf of the Complainants

Ex C1:- copy of Repudiation Letter dated 16-01-2016

Ex C2:- Policy Status report

Ex C3:- Policy Renewal premium Receipt

Ex C4:- True copy of UDR No 2/2014

Ex C5:-True copy of P.M of deceased  

       Witnesses examined on behalf of the Opponent No 1:-

1.  Shri Sharanayya S/o Machayya Hiremath Manager Divisional Office Belagavi.

Documents produced on behalf of the Opponent No 1 & 2

1) Ex Op1:- Self Attested copy of Proposal form

2) Xerox copy of Hospital reports