BEFORE THE HON’BLE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM BAGALKOT

                                                                                                                                          Date of Admission: 16-05-2015

                                  Date of Order       : 26-11-2016

  Consumer Complaint No: 39/2015

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. Smt Laxmi W/o Yalagurappa Nadagaddi

Age: 31 Years Occ: House hold work,

R/o Mannikeri Village

Tq: Bilagi

Dist: Bagalkot

                                                       (By Shri C.B.Sobarad Advocate)

                    V/s

1. Branch Manager,

Life Insurance Corporation of India,  

         Navanagar, Bagalkot

         Dist: Bagalkot.

2. Divisional Manager,

         Life Insurance Corporation of India,  

         Basaveshwara Circle Goa Ves,

         Belagavi.

                                       (By Shri P.S.Bhairmatti 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 1,00,000/-  with interest at 18% from the date of death to the complainant and Rs 80,000/- towards Compensation to the complainant with cost of Rs 15,000/-.

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

        That the Complainant husband by name Yalagurappa Nadagaddiduring his life time got insured his life insurance policy with Op No. 1 office under LIC’s Jeevan Saral on payment of Rs 412/- as a monthly premium amount for a sum assured amount of Rs 1,00,000/- Insurance policy bearing  No 636525016 and said policy is commence its risk from 30-11-2011 and date of maturity is on 28-11-2027. The Complainant who is wife of deceased Yelgurappa and also a nominee to said life insurance policy. That deceased Yelgurappa has paid total premium of 30 months and policy is valid at the time of death of Yelgurappa.The Op No-2 is divisional office, who had repudiated the complainant claim. That the Late Yelgurappa who is working as an Civil Police constable in Jamakhandi town police station and living with his wife and son that, for securing to his family members he got insured his life insurance with this Op-1 on 28-11-2011.But unfortunately at the age of 37 years Complainant husband Yelgurappa succumbed to be dead on 11-06-2014 due to Heart attack in Bilagi taluk hospital in this regard Complaint is lodged in Bilagi Police station and registered under U.D No 22/2014. 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 1,00,000/-. 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 05-02-2015 on grounds that deceased Yelagurappa had suppressed the materials facts. That prior to death of deceased Yelagurappa he 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-reasonable 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 Yelgurappa for sum Assured of Rs 1,00,000/-with plan and term and the date of commencement of the said policy is 28-11-2011 with monthly premium of Rs 412/-. That the deceased Yelgurappa had deliberately suppressed the material facts, said Yelgurappa gave false information in respect of his health condition. life assured died on 11-06-2014.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 MALARIA, ENERIC FEVER, PERIANAL AND PERI URETHRAL ABSCESS 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 Smt Laxmi W/o Yelgurappa Nadagaddi  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, Yelagurappa Nadgaddi died on 11-06-2011 the deceased Yalagurappa was working was an Civil Police constable in Jamakhandi town Police station. Deceased was taken Life Insurance Policy bearing No 636525016 dated 30-11-2011 sum assured Rs 1,00,000/- monthly  premium of Rs 412/- and Complainant as a nominee for this policy. That the complainant is the wife of and legal heir of the deceased Yalagurappa Nadagaddi who died on 11-06-2011, left behind his wife i.e., complainant and his son. 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 prescriptions.

              That the Opponent No 1 & 2 stated deceased Yalgurappa suffering from  MALARIA, ENERIC FEVER, PERIANAL AND PERI URETHRAL ABSCESS and also hospitalized for the same on 13-08-2010 to 23-08-2010 admitted to Dr M.S.Daddennavar Hospital,Bagalkot. Deceased was taken sick leave upto 2-10-2010 and availed leave for this period on medical grounds from 13-08-2010 to 02-10-2010 and further the deceased was once again admitted at Kerudi Hospital, Bagalkot from 02-10-2011 to 05-10-2011 for treatment of Fistula in Ano and was on leave upto 11-12-2011 and availed leave on medical grounds from 02-10-2011 to 11-12-2011 for 71 days. The deceased life Assured did not disclose these facts in his proposal dated 30-11-2011 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 and sick leave availed. Attested Copies of the medical documents as per Annexure.

         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 Exhibit Op-5 observed that hospitalization of deceased in 2010-11, summary sheet observed that no evidence was led before the For a below. The Opponent had produced the Summary sheet, and Consultation record of the Daddennvar Hospital Bagalkot and Kerudi Hospital Bagalkot  which was not proved. Nor was the evidence of the treating doctor led.
2. That the deceased died on 11-06-2014 due to cardiac arrest in Bilagi taluk Hospital as per Ex C4. It is clearly shows that Complainant husband by name Yalagurappa died on 11-06-2014 due to Heart Attack as per PM Report.
3. That the Opponent counsel produced the citation of Supreme court of India Civil Appeal No 2776 of 2002, P.C.Chacho and another V/s Chairman, LIC and others (2007) INSC 1160, and National Consumer Disputes Redressal Commission New Delhi Revision Petition No 2406 of 2012 these citations are not applicable in this case observation is different from one case to another.  
4. That the deceased was taking policy on 30-11-2011, 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 13-08-2010 to 23-08-2010 in Daddenavar Hospital with history of Malaria, again admitted at Kerudi Hospital Bagalkot from 02-10-2011 to 05-10-2011 for treatment of Fistula in Ano, above decease was common decease. Except this document Opponent did not produce any other record of treatment, and Opponent did not produce any evidence of Treated Doctor.

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 to 3 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 1,00,000/-, with interest at the rate of Rs 9% per annum from the date of death of the policy holder i.e.,11-06-2014 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 1,00,000/- with interest at the rate of Rs 9% per annum from the date of death of the policy holder i.e.,11-06-2014  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 death of the policy holder i.e., 11-06-2014 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)

ANNEXURE

Witness examined on behalf of the complainants:-

1. Smt Laxmi W/o Yalagurappa Nadagaddi

   Documents produced on behalf of the Complainants

Ex C1:- copy of Repudiation Letter dated 05-02-2015

Ex C2:- True copy of FIR

Ex C3:-True copy of Complaint

Ex C4:- True copy of PM Report

Ex C5:- True copy of policy issued by Opponents

Ex C6:- Attested copy of Medical Attendants Certificate

Ex C7:- Attested copy of Certificate of Hospital treatment       

       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

Ex Op1:- Self Attested copy of Repudiation letter

Ex Op2:- Self Attested copy of Proposal form

Ex Op3:-Self Attested copy of Policy bond

Ex Op4:-Self Attested copy of Proposal form

Ex Op5:- Self Attested copy of Hospital reports

Ex Op6:- Self Attested copy of Claimants Statements

Ex Op7:- Self Attested copy of Death Certificate 

Ex Op8:- Self Attested copy of Claim form C for Identified of deceased

Ex Op9:- Self Attested copy of Medical Attendants certificate

Ex Op10:- Self Attested copy of Certificate of Hospital Treatment

Ex Op11:- Self Attested copy of Certificate by Employer

Ex Op12:- Self Attested copy of Medical Certificate dated 02-10-2010

Ex Op13:- Self Attested copy of Medical Certificate dated 05-10-2011