KERALA STATE CONSUMER DISPUTE REDRESSAL COMIISSION VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL No 394/2006
JUDGMENT DATED : 28.07.2010
PRESENT:-
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
SHRI.M.K.ABDULLA SONA : MEMBER
APPELLANT
Rasiya, W/o late Mohammed Basheer,
Zuhara Nivas,
T.S. Road,
Chaliyam, Kozhikode
( Rep. by Adv. Sri. R. Narayan . & Sri. A. Electron)
RESPONDENTS
1. Branch Manager, L.I.C. of India
Branch Office, Jeevan Jyothy,
Ramanattukara, Kozhikode – 673 633
2. Senior Divisional Manager
Divisional Office,
Jeevan Prakash,
Hozur Road,P.B. No. 177,
Kozhikode – 673 011.
( Rep. by Adv. Sri. S. S. Kalkura, Sri. R.S. Kalkura & Sri.
G.S. Kalkura)
JUDGMENT
SHRI. M.K. ABDULLA SONA : MEMBER
This appeal preferred from the order passed by the CDRF, Kozhikode in the O.P. 377/04 Order dated. 14.12.2005. The appellant is the complainant in the above O.P. and the respondents are the first and second opposite parties respectively. This appellant prefers this appeal from the order of the Forum below. The Forum below found that the complaint is not entitled to get any relief. In this view it can be seen that the non-disbursement of the claim by the opposite party does not account to any deficiency in service and dismiss the complaint.
In short the complaint is framing a case that she is the widow of Late Mohammed Basheer who died in a motor accident. The complainant’s husband had taken a Life Insurance policy of the opposite parties for Rs. 1 lakh on 24.1.2003. At the time of taking the policy the complainant’s husband had given the details of a kidney stone operation he had undergone a year back. The opposite parties had informed the complainant that her husband with a minor operation was not a bar to his taking the policy, and only non-disclosure of major disease like cancer or cardiac policy be a bar. The opposite parties represented that in case of an accidental death, the nominee will get double policy amount. On the basis of that assurance, the complainant’s husband gave the proposal form for obtaining the policy. The complainant’s husband was also declared medically fit for taking the policy. Accordingly to the complainant’s husband aged 35 years died in connection to a major accident at Tiroorangadi. On 28.2.04, the complainant had preferred a claim for the policy amount. The opposite party repudiated the claim. The rejection of the claim amounts to deficiency of service and hence the complaint is filed to get the policy amount of Rs. 2 lakhs and a compensation of Rs. 20,000/- for mental agony and hardship.
But the Respondents/Opposite parties contented that the deceased P.K. Mohammed Basheer was insured with the Life Insurance Corporation. On the days of the proposal, submitted by him on 24.1.2003, the complainant has informed the opposite party that her husband died in a road traffic accident on 13.2.2004. Death occurred within one year and 15 days of commencement of the policy . Hence the claim is an early one. In the postmortem report it was mentioned that there is an old surgical scar on the right waist of the life assured. This fact was brought to the notice of the complainant and she was asked to furnish details of the surgery and treatment undergone by the deceased. The right kidney had a stone at its lower calyx, left kidney was found shrunken. It has come to the notice of the opposite parties that the life assured was taken to the Medical College Hospital on 12.11.2001 and had undergone surgery for kidney stone. It is nothing but a suppression of material facts and the opposite parties are not liable to honour the claims as per ;the terms and conditions of the policy. Hence the claim is rejected.
The complainant was examined as pw1 and opposite parties examined as Rw1 and the documents marked Ext. A1 to Ext. A7 on the side of the complainant and Ext. B1 to B5 were marked on the side of the opposite parties.
The Forum below found that there is a suppressant of material facts by the policy holder at the time of taking the policy. The complainant is not entitled to get any compensation as per the policy conditions and dismiss the complaint.
This appeal filed from the above impugned order passed by the Forum below.
On this stage the appeal came before this commission for final hearing; both parties are appeared and submitted that the case through their Counsel. The Counsel of the appellant argued on the grounds of Appeal Memorandum that the order passed by the Forum below is not accordance with the provisions of law and evidence. It is liable to be set aside and to allow this appeal. .
This Commission is seeing that the husband of the complainant who died due to a motor accident. He has undergone a surgery due to the accident. The Respondent/Opposite parties having any case that the death of the husband of the complainant did not suppressed by the policy holder. Opposite parties are not having any case that the pre-existing decease which accelerated the critical conditions of the victim after the accident and the said surgery. From the evidence, it is very clearly seeing that the death of the husband of the complainant late Mohammad Basheer was incidented due to the motor accident. Heard. There is no question of suppression of material facts is araised. The Life Insurance Corporation of India is a public undertakings of the Government of India. Their object is not only to gain profit but also to provide some benefits to the members of the society. In other words the Insurance policy offered for a social security. But in this case the opposite parties had taken a very strange attitude to dismiss the claim. We are seeing as per the provisions of law and evidence the complainant is entitled to get the claim amount from the opposite parties. The order passed by the Forum below is not according to the provisions of law and evidence it is not legally sustainable. It is proved that there is no suppression of material facts by the complainant and the opposite party is liable to settle the claim.
In the result, this appeal is allowed and directing the opposite parties to pay the claim amount to the complainant as per the policy and also pay Rs. 5,000/- as compensation for mental agony and hardships sustained by the complainant. This appeal disposed accordingly. Both parties are directed to suffer their respective expenses. The points to the appeal answered accordingly.
M.K. ABDULLA SONA : MEMBER
S.CHANDRA MOHAN NAIR : MEMBER
