BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 49/2012.
THIS THE 18th DAY OF JANUARY 2013.
P R E S E N T
1. Sri. Pampapathi B.sc.B.Lib. LLB PRESIDENT.
2. Sri. K.H. Sri Ramappa, B.A.LLB. MEMBER.
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COMPLAINANT :- Smt.Earamma W/o. Ningappa Hutti, Age: 26
years, Occ: Agriculture, R/o. Harapur, Tq. Sindhanoor, Dist: Raichur.
//VERSUS//
OPPOSITE PARTIES :- 1. The Branch Manager, Life Insurance
Corporation of India, Branch Sindhanor,
Dist: Raichur.
2. The Divisional Manager, Life Insurance
Corporation of India, Divisional Office, Raichur.
CLAIM : For to direct the opposite Insurance Company to
pay assured sum of Rs. 1,00,000/-, under the LIC policy subscribed her mother Kariyamma Hirekurubar with interest and cost.
Date of institution :- 06-07-12.
Notice served :- 18-07-12.
Date of disposal :- 18-01-13.
Complainant represented by Sri. T.M. Swamy, Advocate.
Opposite Nos. 1 & 2 represented by Sri. Munna Kumar, Advocate.
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This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.
JUDGEMENT
By Sri. Pampapathi President:-
This is a complaint filed by complainant Smt. Earama against the Opposite Life Insurance Corporation of India U/sec. 12 of Consumer Protection Act for to direct the opposite Insurance Company to pay assured sum of Rs. 1,00,000/-, under the LIC policy subscribed her mother Kariyamma Hirekurubar with interest and cost.
2. The brief facts of the complainant’s case are that, her mother Kariyamma Kurubar purchased Jeevana Anand Life Insurance Policy bearing No. 665238559 for assured sum of Rs. 1,00,000/- with its maturity date as on 27-06-2025. Policyholder died due to chest pain on 17-04-2010 while going to hospital at Sindhanoor. Thereafter complainant being the nominee filed her claim petition with all records before opposite Insurance Company for to settle the claim. But opposite repudiated her claim on untenable grounds and thereby, she filed this complaint for the reliefs as noted in ot.
3. Opposite No-1 is the Branch Office and Opposite No-2 is the head office of LIC of India appeared in this case through its Advocate, filed its written version by denying all the allegations made by the complainant. It admitted the subscription of the policy by deceased Kariyamma Hirekurubur for assured sum of Rs. 1,00,000/- and commencement of the risk from 27-12-2010. It contended that, the said Kariyamma Hirekurubur, was admitted in the Karnataka Cancer Therapy and Research Institute Navanagar, Hubli on 21-12-2010 just six days prior to taking of the policy, she was advised to visit regularly for treatment. This material information regarding her health was suppressed by her in proposal form. Opposite Insurance Company is a statutory body having rules and regulations for settlement of the policy. In the present case, policy was subscribed by deceased Kariyamma for to seek the Insurance Company. Hence, it rightly repudiated the claim of complainant and thereby, it prayed for to dismiss the complaint with compensatory cost among other grounds.
4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that:
1. Whether the complainant proves that, she being the daughter and nominee of late Kariyamma W/o. Ningappa filed claim petition after the death of Kariyamma with all necessary records, but opposite Insurance Company repudiated her claim un tenable grounds and thereby, opposite Insurance Company found guilty under deficiency in its service.?
2. Whether complainant is entitled for the reliefs as prayed in her complaint.?
3. What order?
5. Our findings on the above points are as under:-
(1) In the affirmative.
(2) As discussed in the body of this judgement and as noted in the final order.
(3) In-view of the findings on Point Nos. 1 & 2, we proceed
to pass the final order for the following :
REASONS
POINT NOs.1 &2 :-
6. To prove the facts involved in these two points, affidavit-evidence of the complainant was filed, who is noted as PW-1. The documents Ex.P-1 to Ex.P-6 are marked. On the other hand, affidavit-evidences of the officer of opposite Insurance Company was filed, who is noted as RW-1. The documents Ex.R-1 to Ex.R-6 are marked.
7. We have gone through the pleadings of the parties, their respective affidavit-evidences and documents relied by them. We have noticed some of the following undisputed facts in between the parties.
1) It is undisputed fact that, late Kariyamma Hirekurubur subscribed LIC policy bearing No. 665238559 for assured sum of Rs. 1,00,000/- from the opposite insurance company.
2) Further it is undisputed fact that, the present complainant is a nominee under the policy.
3) It is undisputed fact that, the policy subscriber Smt. Kariyamma died on 17-04-2011 while the policy was inforce.
4) Further it is undisputed fact that, complainant submitted her claim petition being a nominee under the policy before the LIC of India after the death of Kariyamma but opposite insurance company repudiated her claim.
8. In view of these undisputed facts between the parties, we have not referred the related documents pertaining to those facts filed by the parties, as there is no need to refer them specifically.
9. The only point to decide by us in this case is, whether deceased Kariyamma policyholder was suffering from cancer before subscribing this policy, she was admitted in Karnataka Cancer Therapy and Research Institute Navanagar, Hubli just before six days of taking policy and she was regularly visited the policy till 30-03-2011. Further we have to consider as to whether, this material fact relating to decease was intentionally suppressed by Kariyamma with an intention to get monetary benefit out of the policy in her proposal form.
10. Admittedly the burden of proving the suppression of material facts regarding the health of policyholder in her proposal form is on the LIC of India. If, the LIC of India discharged this burden of proving the fact, then it is right enough in repudiating the claim of complainant. If, in case it not proved the said material suppression, then complainant is entitled to get assured sum under the policy.
11. To prove the case of complainant he relied on the rulings reported in:
1) 1986-2005 CONSUMER 9160 (NS) The Senior Divisional Manager, LIC of India Warangal and others V/s. Smt. J. Vinaya
2) II (2005) CPJ 9 NC. LIC of India V/s. Badri Nageshwaramma & Ors.
3) CC.No. 47/2012 on the file of District Consumer Forum, Raichur.
12. The learned counsel for opposite relied on the following rulings:
1) First Appeal No. 200 of 2005 State Consumer Disputes Redressal Commission (SCDRC) Chennai
2) Appeal No. 1041/2008 SCDRC Rajastan Jaipur.
3) Appeal No. 566/2006 SCDRC Rajastan Jaipur.
4) First Appeal No. 1451/2008 SCDRC Maharastra, Mumbai.
5) Revision petition No. 781/2007 NCDRC, New Delhi.
13. We have gone through the principles laid by their lordships in the above said rulings relied by the parties.
14. In the Instant case opposite Insurance Company not filed affidavit-evidence of the doctor who treated the said Kariyamma for cancer decease in the Navanagar Hospital, Hubli. Memo was filed by the opposite by stating that doctor treated her at that time is not alive.
15. Facts of the ruling referred by the learned advocate for complainant noted at Sl.No-2 is pertaining to the case similar to this case. In the said case LIC of India repudiated the claim of complainant on the ground that, deceased was an old TB patient having diabetes, which was not revealed in his proposal form. Number of medical records in that case by LIC of India filed pertaining this kind of case. The Hon’ble National Commission observed as burden of proof of false representations and suppression of facts is on the insurer__ Doctor’s certificates without affidavit evidence is not base for repudiating the claim. Further it held that, No conclusive evidence produced to suggest the suppression of material facts by deceased__ company liable under policy.
16. We have gone the observations made by their lordships at Para- 5 & 6 of the said ruling with the observations made by the different state commissions in different cases which are relied by the opposite Insurance Company, we are of the view that, if the treated doctor is not alive, then, it is the duty of the opposite company to file the affidavit-evidences of any other associated doctors of the same hospital in support of medical records relied by the insurance company. No such efforts made by the insurance company to file affidavit-evidences of any one of such doctors to prove its contention. Hence, we have not accepted by the submissions made by the LIC opposite to say that, deceased Kariyamma intentionally suppressed the material facts regarding her previous decease in her proposal form. As such, the repudiation of the claim of the complainant on these grounds is an act of deficiency in service on the part of opposite. Accordingly, we answered Point No-1 in affirmative.
17. As regards to the claim of complainant is concerned, it is a fact that, the assured sum under the policy is of Rs. 1,00,000/- as such the complainant is entitled to get that amount of Rs. 1,00,000/- from opposite Insurance Company.
18. We have granted a lumpsum amount of Rs. 3,000/- towards deficiency in service on the part of opposite Insurance Company.
19. We have also granted another lumpsum amount of Rs. 2,000/- towards cost of litigation. Hence totally the complainant is entitled to get Rs. 1,05,000/- from opposite Nos. 1 & 2 jointly and severally.
20. The complainant is entitled to get interest at the rate of 9% p.a. on total sum of Rs. 1,05,000/- from the date of this complaint till realization of the full amount. Accordingly, we answered point No-2.
POINT NO.3:-
21. In view of our findings on Point Nos-1 & 2, we proceed to pass the following order:
ORDER
The complaint filed by the complainant is partly allowed with cost.
The complainant is entitled to get total amount of Rs. 1,05,000/- from Opposite Nos. 1 & 2 jointly and severally.
The complainant also entitled to get interest at the rate of 9% p.a. on total sum of Rs. 1,05,000/- form the date of this complaint till realization of the full amount.
Opposites are hereby given one month time, to make the payment of the said amount with interest from the date of this judgment.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 18-01-2013)
Sri. K.H. Sri Ramappa Sri. Pampapathi,
Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur.
*RK*
