BEFORE THE DISTRICT CONSUMER FORUM :: WARANGAL
Present : Sri D. Chiranjeevi Babu,
President.
And
Patel Praveen Kumar,
Member.
Monday, the 16th day of May, 2011.
CONSUMER COMPLAINT No.27/2010
Between:
Smt. Manchala Swapna,
W/o late Srinivasulu,
Age: 36 yrs, Occ: Household,
R/o H.No.12-1-47, S.V.N. Road,
Warangal.
… Complainant
And
1) The LIC of India,
Rep. by its Branch Manager,
Branch Office-I,
Warangal.
2) The LIC of India,
Rep. by its Senior Divisional Manager,
Divisional Office, Balasamudram,
Hanamkonda, Warangal District.
… Opposite Parties
Counsel for the Complainant :: Sri G.Rajendra Prasad, Advocate.
Counsel for the Opposite Parties :: Sri K.S.Raju, Advocate.
This complaint is coming for final hearing before this Forum, the Forum pronounced the following order.
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ORDER
Sri D.Chiranjeevi Babu, President.
This complaint is filed by the complainant Manchala Swapna against the opposite parties under section 12 of Consumer Protection Act, 1986 for a direction to pay the policy amount of Rs.3,00,000/- with interest @12% p.a. from the date of death of the deceased and to award Rs.5,000/- towards mental agony and costs.
The brief averments contained in the compliant filed by the complainant is as follows:
The case of the complainant is that her husband namely Manchala Srinivasulu died on 31-07-2007 at Yashoda Hospital, Secunderabad due to Cardio Respiratory Arrest. During his life time, the said Srinivasulu obtained LIC Policy bearing NO.687775387 for Rs.3,00,000/- from opposite party NO.1 commenced from 06-03-2007, for which the complainant is the nominee. After the death of the deceased, the complainant approached the opposite party No.1 and filed a petition to pay insured amount of Rs.3,00,000/- and submitted the relevant documents to opposite party NO.1. The opposite parties dodged the matter on one or other pretext and lastly on 31-03-2008 they have repudiated the claim through a letter stating that the life assured had history of Carcinoma Lung prior to date of proposal. Without any valid and reasonable ground the opposite parties have repudiated the claim. The act of opposite parties amounts to deficiency of service. Hence, filed this complaint praying to direct the opposite parties to pay Rs.3,00,000/- under the above policy with interest and to award damages of Rs.5,000/- with costs.
The opposite parties filed the Written Version stating that it is true that deceased Srinivasulu had taken life insurance policy bearing No.687775387 for sum assured Rs.3,00,000/- commenced from 06-03-2007. The life assured died on 31-07-2007. Since the date occurred within 4 months of the commencement of the policy treating the same as Very Early Claim, as per the rules of the opposite parties corporation an investigation was caused into the bonafides of the claim so as to take a decision on its admissibility. During the said investigation, it came to light that the deceased life assured was suffering from PRE-PROPOSAL ILLNESS related to RIGHT LUNG CARCINOMA i.e, CANCER WITH PLEURAL EFFUSION for which he had taken treatment under I.P.Regn.No.2940/2006 from Satya Hospital, Warangal for the period from 10-02-2007 to 13-02-2007. The deceased life assured
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underwent further treatment for the same disease with Dr.Bachu Murali Krishna M.D. of Vanamala Clinic, Warangal on 27-02-2007 who referred the patient to Dr.Satish chander, Chest Physician of Jaya Hospital, Hanamkonda on 15-03-2007. The said life assured was admitted into Yashoda Cancer Insitutute, Hyderabad under I.P.No.39747, dt.10-07-07 under the care of Dr.Babaiah, Oncologist, diagnosed as a case of RIGHT LYMPHADENOPATHY and had undergone treatment for CHEMOTHERAPY i.e, Radiation/Cancer treatment. So the deceased intentionally cheated the insurance. When the deceased intentionally cheated the insurance, Section 45 of Insurance Act is applicable to this case and requested this Forum to dismiss this case.
The complainant in support of her claim, filed her Affidavit in the form of chief examination and also marked Exs.A-1 to A-5. On behalf of opposite parties Sri V.Bhaskar filed his Affidavit in the form of chief examination and also marked Exs.B-1 to B-11.
Now the point for consideration is:
1) Whether there is any deficiency of service on the part of the opposite parties?
2) If so, to what Relief?
Point NO.1:-
No arguments advanced from complainant side Advocate and arguments heard from opposite parties side Advocate. Now this Forum has to see whether the complainant is entitled to get an amount of Rs.3,00,000/- for the death of her husband and further this forum has to see whether the deceased was having Cancer prior to taking policy or not?
For this our answer is that the deceased was having Cancer prior to taking policy. Intentionally he has not disclosed the same fact at the time of taking policy i.e, he has not mentioned in the proposal form. The main contention of the opposite parties Advocate is that the deceased was having Right Lung Carcinoma with Pleural Effusion + Mediastinal Lymphadenopathy and intentionally suppressed the material facts related to the Diagnosis and Treatment about which he has well aware as on the date of signing the proposal for insurance for the said policy. But he has not mentioned the same fact. When he as not mentioned the same fact that by the time he was having the same disease it comes under suppression of material facts as per the arguments of opposite parties counsel. We accept the arguments of opposite parties counsel because by the time he was taken the policy i.e, on
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06-03-2007 he has suffering from Cancer. As per Ex.B-11 it is evident that the date of admission of the deceased is on 10-02-2007 and date of discharge on 13-02-2007 and clearly mentioned his disease name is Plural Effusion + Mediastinal Lymphadenopathy i.e, Cancer with Pleural Effusion. In Ex.B-2 Discharge card of Satya Hospital, it clearly goes to show that the date of admission is 10-02-2007 and date of discharge is on 13-02-2007 and the deceased was having cancer. Further in Ex.B-2 in Diagnosis column it clearly mentioned as Right Pleural Effusion, Conservative i.e, the deceased life assured had taken treatment under I.P.Regn.No.2940/2006 from Satya Hospital, Warangal for the period from 10-02-2007 to 13-02-2007. We accept Ex.B-2 and Ex.B-11 and on the basis of those documents it is clear that the deceased was having Cancer prior to taking policy. Even though he was having cancer he intentionally not disclosed the same fact in Ex.B-1 i.e, Proposal Form for Insurance. I.P.Registration Number also clearly mentioned in Ex.B-11. As per Ex.B-8 i.e, Discharge Summary of Yashoda Cancer Institute it clearly goes to show that in Column History of Present Illness i.e, dt.10-07-2007 and discharge on 11-07-2007 “Mr.Srinivasulu M, a known case of Carcinoma of right Lung with Right Pleural Effusion., Post EBRT, Post concurrent weekly chemotherapy with Cytogen. Post Pleurodesis with Bleomycin. He is on Chemotherapy admitted for Cycle II Chemothpery. This Ex.B-8 also clearly goes to show that the deceased was having Cancer. This document is after obtaining of the policy. The important documents are Ex.B-2 and Ex.B-11 those clearly goes to show that the deceased is a known patient of cancer and he knows that he was having cancer prior to taking of policy i.e, on 10-02-2007. Even though he knows that he was having cancer prior to obtaining policy he intentionally not disclosed the same fact in Ex.B-1 i.e, Proposal form. In Ex.B-1 he mentioned that his health condition is good. It clearly goes to show that he cheated the insurance. It comes under suppression of material facts. When he intentionally suppressed the material facts, so Section 45 of Insurance Act is Applicable to this case and the nominee is not entitled to get anything from the insurance.
As per the Apex Court judgment in (2008) I Supreme Court Cases 321
P.C.Chacko and another … Appellants
Vs
Chairman, LIC of India & Others … Respondents
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Insurance Act, 1938 – Repudiation of claim under insurance policy on ground of misstatement – Held, misstatement by itself not reason for recission of the policy unless the same is material in nature – However a deliberate wrong answer given by insured having a great bearing on contract of insurance may lead to policy being vitiated in law – Policy cane be repudiated if obtained with a fraudulent act.
It is ruled that “a deliberate wrong answer which has a great bearing on the contract of insurance, if discovered any lead to the policy being vitiated in law and non-disclosure of and misstatement in the proposal form to the various questions to which answers were given by the insured is said to be the reason for repudiation of the contract of insurance.
In the present case also the deceased intentionally not disclosed his disease in proposal form and obtained the policy on 06-03-2007. But he knew about his disease on 10-02-2007 itself as per Ex.B-2 and Ex.B-11. So he suppressed the material facts and obtained the policy. So Section 45 of Insurance Act is applicable to this case. So as per the above citation the nominee of the deceased is not entitled to get anything from the insurance.
For the foregoing reasons given by us we come to the conclusion that there is no deficiency of service on the part of the opposite parties and we answered this point accordingly in favour of the opposite parties against the complainant.
Point NO.2: To what Relief:- The first point is decided in favour of the opposite parties against the complainant this point is also decided in favour of the opposite parties against the complainant.
In the result this complaint is dismissed without costs.
(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum today, the 16th May, 2011).
President Male Member
District Consumer Forum, Warangal.
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APPENDIX OF EVIDENCE
WITNESSES EXAMINED
On behalf of Complainant On behalf of Opposite Parties
Affidavit of complainant filed. Affidavit of opposite parties filed.
EXHIBITS MARKED
ON BEHALF OF COMPLAINANT
1. Ex.A-1 is the Xerox copy of Policy Bond of the deceased M.Srinivas.
2. Ex.A-2 is the Medical Attendants Certificate.
3. Ex.A-3 is the Certificate of Hospital Treatment.
4. Ex.A-4 is the Death Certificate of M.Srinivas issued by Sub-Registrar, Births and Deaths.
5. Ex.A-5 is the Repudiation letter from opposite parties to complainant, dated 31-03-2008.
ON BEHALF OF OPPOSITE PARTIES
1. Ex.B-1 is the proposal for insurance of the deceased M.Srinivas.
2. Ex.B-2 is the Discharge card of Srinivas issued by Satya Hospital, Warangal, dt.13-02-2007.
3. Ex.B-3 is the Prescription of Srinivas issued by Dr.Bachu Murali Krishna, dt.27-02-2007.
4. Ex.B-4 is the reference letter from Bachu Murali Krishna to Dr.Satish Chandra, Chest Physician.
5. Ex.B-5 is the Urine Examination Report issued by Laxmi Clinical Laboratory, 12-03-2007.
6. Ex.B-6 is the Haematology Report issued by Laxmi Clinical Laboratory, 12-03-2007.
7. Ex.B-7 is the Report of HIV Screening Test issued by Satya Diagnostics, dt.13-03-2007.
8. Ex.B-8 is the Discharge Summary of M.Srinivas issued by Yashoda Cancer Institute, dt.11-07-2007.
9. Ex.B-9 is the Complete Blood Picture Report of M.Srinivas issued by Yashoda Cancer Institute.
10. Ex.B-10 is the Summary of Hospital course issued by Yashoda Cancer Institue.
11. Ex.B-11 is the Case sheet of M.Srinivas issued by Satya Hospital, Warangal.
PRESIDENT
