Karnataka

Gadag

CC/34/2015

Smt.Iravva W/o Shivappa Guggari - Complainant(s)

Versus

The Branch Manager, Life Insurance Corporation of India - Opp.Party(s)

B.V.Neeraloti

04 Jun 2016

ORDER

JUDGEMENT DELIVERED BY

SMT.C.H.SAMIUNNISA ABRAR, PRESIDENT:

The complainant has filed this Complaint against the Opposite Parties (herein after referred in short as OPs) u/s 12 of Consumer Protection Act, 1986 alleging deficiency in service against OPs. 

 

2.    The brief fact of the case is that the Complainant is the mother of the insured Manjunath Shivappa Guggari who died on 27.09.2013 who was suffering from fever. The deceased had obtained the insurance policy from OP No.2 by paying a premium of Rs.1,650/- namely JEEVAN ANAND bearing Policy No.639276182 on 28.06.2008. The deceased had paid all the premium of the insurance policy i.e. from 28.06.2008 to 08.08.2013, sometime the premium had been not paid in-time due to the financial problems, but along with the fine of Rs.19,072/- full dues had been cleared. That the total amount of R.19,800/- had been paid towards the premium of the insurance policy.

 

3.      The Insured Manjunath Shivappa Guggari was suffering from fever and died on 27.09.2013, mother of the deceased (Complainant) being a nominee submitted the Claim Form to claim the insured assured amount of Rs.1,00,000/-. The OP has not paid the insured amount to the nominee till the date. The Complainant issued legal notice to the OP on 01.09.2014 through her counsel for which the OP had not replied, by not paying the insured amount to the Complainant, the OP had committed deficiency in service and the Complainant prayed to order the OP to pay insured amount of Rs.1,00,000/- along with interest @ 18% p.a. and other compensation as the Forum deems fit.

 

4.      The Complaint was registered and notices were issued to the Ops, Ops appeared through their counsel and filed Wakalath and Written Version.   

 

Brief facts of the Written Version of OPs:

The OP had admitted that deceased Manjunath S Guggari is a policy holder. He had insured his life with OP No.2 under policy No.639276182 for Rs.1,00,000/-. The insured had died on 27.09.2013.

 

5.      The OP had further submitted that the commencement of the policy was in 28.06.2008 and the mode of premium is half yearly for Rs.1,650/-.The said policy was lapsed due to the non-payment of agreed premium, the same had been revived on 08.08.2013 by payment of seven half yearly installments with interest on the strength of personal statement of health. Further, the OP had denied the content in Para No.2 of the Complaint and stated that the Complainant had deliberately suppressed the material and real fact, the policy was lapsed for the non-payment of the agreed premium it had been revived on the payment of dues by the submission of declaration of personal statement of health, the policy holder died within a short period of revival of the policy. There is clear breach of contract by the policyholder.

 

6.      After the submission of the Death Claim of deceased policyholder by the Complainant, the OP conducted investigation as an early claim and found that the deceased policyholder had suppressed the real and material fact of his health that the deceased policy holder was suffering from AIDS and Pulmonary T.B. This material of fact had been deliberately suppressed by the deceased policyholder. He had filed a false declaration about his health at the time of revival of the policy with ulterior motive, this is clear breach of contract by suppression of state of health the claim had been rejected on the basis of clear violation terms of the contract and suppression of material fact at the time of revival of the policy by deceased policyholder. This had been intimated to the Complainant and his Advocate.

 

7.      Hence, there is no negligency or deficiency in service on the part of the OP No.1 and 2. Hence, the Complainant is not entitled to get any relief as sought. Further, Op had prayed that the Complaint filed by the Complainant is untenable and vexatious and prayed that the case may be dismissed with heavy costs.   

 

8.      On perusal of the Complaint, allegation and detailed version, the documents on records the Complainant himself has been examined before this Forum as CW1 and got marked the documents as EX. C1 to EX. C9 are as follows:

1)  EX C1 and EX C2 Premium Receipts

2)  EX C3 and EX C4 Renewal Premium Receipt,

3)  EX C5 Reminder of premium letter.

4)  EX C6 and EX C7 Postal Receipts,

5)  EX C8 Notice

6)  EX C9 Death Certificate

 

     On the other hand, OPs filed a written version and examined as RW1 and got marked documents as EX OP1 to OP23.

1. EX OP1 L.I.C. Bond
2. EX OP2 Proposal Form,
3. EX OP3 Laboratory Report,
4. EX OP4 Pharmacy Cash Paid Receipt,
5. EX OP5 Lab Report,
6. EX OP6 Laboratory Report Form
7. EX OP7 Referral to ART Centre
8. EX OP8  In patient slip,

9) EX OP9 Status of report of policy

10) EX OP10 Personal Statement regarding health,

11) EX OP11 Claimant Statement

12) EX OP12 Confident report by the Agent,

13) EX OP13 Medical Attendance Certificate,

14) EX OP14 Certificate of Hospital Treatment

15) EX OP15 Claim Form “C”

16) EX OP16 Letter from Complainant to OP

17) EX OP17 Claimant Requisition for Claim Form,

18) EX OP18 Death Certificate

19) EX OP19 Letter to Complainant by OP

20) EX OP20 Postal Acknowledgment,

21) EX OP21 Legal Notice,

22) EX OP22 Reply to Notice

23) EX OP23 Authorization Letter, 

 

 

9.      On the basis of above said pleading, oral and documentary evidence, the following points arises for adjudications are as follows:   

 

1.   2.	Whether the Complainant has suppressed the material and real fact?   Whether the Complainant is entitled for the reliefs as sought?
3.	What Order?

 

Our Answer to the above Points are:-

Point No.1 – Affirmative,

Point No.2 – Negative,

Point No.3 – As per the final order.

                

R E A S O N S

 10.  POINT NO.1 and 2:  Since both the points are inter-link and identical, we proceed with both the points together.

11.   The deceased Mr.Manjuanth had obtained a JEEVAN ANAND Insurance Policy from OP bearing Policy No.639276182 for assured amount of Rs.1,00,000/-, the deceased policyholder died on 27.09.2013. This is the undisputed fact of the Ops. On careful perusal of the documents presents before the Forum, the deceased Manjunath S. Guggary had obtained JEEVAN ANAND Policy and insured his life from OP No.2. The mode of premium is half yearly by Rs.1,650/-. This policy has obtained on 28.06.2008. The policy stand lapse for the non-payment of agreed premium, on 08.08.2013 the payment of seven half yearly installments along with the interest paid to the OP and the policy was revived on the strength of personal statement of health declared by the insured. After short period of revival of said policy, the policyholder of Mr.Manjunath died on 27.09.2013, the mother of deceased (Complainant) insured submitted a Claim Form to the OP to claim assured amount. The OP had rejected the claim stating the reason that the insured had made deliberated Mis-statement and withheld material information regarding his health at the time of revival of the policy.  

 

   12.      The deceased have kept quiet for a long time without paying the premium of the insurance policy after dues of seven half yearly premium the deceased (insured) came forward to revive his insurance policy on the payment of dues outstanding along with the interest on the strength of personal statement regarding the health. The OP had revived the policy of the deceased (Insured) on his personal statement of health statement mark as EX OP10 stated as follows:  

 

 

2. Since the date of your proposal of the above mentioned policy.   a) Have you ever suffered from any illness/disease requiring treatment for a week or more?   b) Did you ever have any operation, accident or injury?   c) Did you ever undergo Electro cardiogram, X-Ray screening, blood, urine or stool examination?

Answer “Yes” or “No”         2. a) ……..NO…..     b) ……..NO ……     c) ……..NO…….

If “Yes’ give details of ailment such as nature of illness date of onset, duration of illness etc.

 

On careful verification of materials on record the document marked EX OP6 i.e. Laboratory Report for Integrated and Counselling and Testing Centre clearly states that the deceased Manjunath Guggary having PID No.M/3521 had been declared as H.I.V. Positive on 08.12.2011 and the document marked as EX.OP3 R.N.T.C.P. (Revised National Tuberculosis Control Programme), Gadag clears that on examination the Laboratory Report diagnosis that the deceased Manjunath S Guggary was suffering from Pulmonary diseased on 10.05.2013.

 

13.         On carefully scanning the material on records, the deceased was suffering from H.I.V. Positive. The deceased insured was well aware of the fact in the year 2011 by a Laboratory Report, knowing well the insured (deceased) come forward to renew his lapsed policy on 08.08.2013 by stating that insured (deceased) was in sound health in his Proposal Statement of health.  

 

   14.      Due to diseases like Pulmonary Tuberculosis and H.I.V./AIDS which was not disclosed to the OP while reviving the policy and the death of insured was within one month twenty days from the date of revival of policy. By this, it is crystal clear that the deceased insured has revived his policy to obtain undue monetary benefit by suppression of diseases which amounts to the suppression of material fact if insured suppress the material fact about his health while submitting the Proposal Form the Life Insurance Corporation of India had powered to repudiate the claim as so, there is no deficiency or negligence of service by the OP.

 

 15.        We relied upon a citation in I (2016) CPJ 54 (NC), National Consumer Disputes Redressal Commission, New Delhi (Life Insurance Corporation of India V/s Braham Singh). The important point reads as under:

     “Consumer Protection Act, 1986 – Section 2 (1) (g), 21 (b) – Insurance – Death claim – Suppression of pre-existing disease – Violation of conditions of policy – Claim repudiated – Alleged deficiency in service –District Forum allowed Complaint – State Commission dismissed appeal – Hence revision – Insured instead of specifically denying that he had not been taking treatment for AIDS prior to applying for insurance, gave a vague reply that he had told about his ailment in detail to agent without specifying nature of ailment – Vague reply amounts to implied admission that before obtaining insurance policy insured was suffering from AIDS – Insurance contract obtained by concealment of material fact is not a valid contract – Repudiation justified”.  

 

We relied upon one more citation in I (2016) CPJ 57 (NC), National Consumer Disputes Redressal Commission, New Delhi (Life Insurance Corporation of India and another V/s Bimla Devi). The important point reads as under:

     “Consumer Protection Act, 1986 – Section 2 (1) (g), 21 (b) – Insurance (Life) – Death claim – Suppression of pre-existing disease – Violation of policy  conditions of policy – Claim repudiated – Alleged deficiency in service –District Forum dismissed Complaint – State Commission allowed appeal – Respondent took policy for Rs.80,000 on 18.2.2000 and he died within four months on 30.06.2000 – In May 1998 he had been operated upon for removal of multiple stones from kidney – Patient history as given in discharge summary of Apollo Hospital in year 2000 states that he had been operated for gall stones two years back and after few days he had genelaized tonic clonio seizures – Concealment of medical history and deliberate wrong information by insured established – Repudiation justified”.

 

   In view of the discussion made above and cited citations, we are of the opinion that insured deceased had suppress the material fact of his health which is fraudulently act, it is established that suppression was fraudulently made by the policyholder at the time of revival of the policy as so the Complainant is not entitled for any relief.  Hence, we answer to Point No.1 in affirmative and Point No.2 in negative.

 

  16.     POINT NO.3: For the reasons and discussion made above and finding on the above points, we proceed to pass a following:  

//ORDER//

        1.   This Complaint is dismissed. No order on costs.

2.  Send the copies of this order to the parties free of cost.

 (Dictated to the Stenographer, transcribed by him, corrected and then pronounced by me in the Open Court 04^th day of June, 2016)

 

Member

Member

President