SRI.K. VIJAYAKUMARAN, PRESIDENT. This complaint filed by the complainant for realization of insurance claim. The averments in the complaint can be briefly summarized as follows: The complainant’s wife Sulochana joined the LIC of India as per policy NO.782402882 for Rs.25,000/-. She has remitted the preimium regularly and the premium upto 11/2005 has been remitted. The period of policy was 20 years. The insured committed suicide on 16.4.2005. The complainant reported the matter to the first opp.party and as per the direction of the first opp.party produced relevant documents such as death certificate, Postmortem certificate etc. and preferred a claim. Thereafter an enquiry was conducted by the first opp.party. On 5.9.2005 the complainant received a letter from the 2nd opp.party informing the complainant that at the time of joining the policy the diseased was over aged and that she was suffering from various disease and that the complainant suppressed this fact. The agent of the opp.party informed the complainant that the scheme is intended for person above 55 years and therefore the persons aged 58 years could joined the scheme and filled up the form brought the agent in which the insured put her signature. Insured was having no serious illness at that time. Thereafter on 3.10.2005 the complainant was informed that the claim of the complainant is forwarded to review committee. On 17.2.2006 the 2nd opp.party inform the complainant that the matter has been referred to the Insurance Ombudsman man, Kochi and directed the complainant to file complaint before the Ombudsman. The complainant accordingly sent a complaint to the Insurance Ombudsman on 13.3.2006. The Ombudsman conducted an enquiry and passed an order directing the payment of the premium already remitted to the complainant. At the time of joining the policy the insured was aged 58 years. The LIC agent has made them believe that the scheme is intended for old aged persons and persons aged 60 years also could join the scheme. The insurance agents himself has filled up the form and with medical certificate and collected the premium from the insured and remitted to the first opp.party. The insured has put her signatures in the form as told by the insurance agent. As the insured has no knowledge in English if the insurance agent has played any fraud for getting commission the insured is not liable for the same. If there was any defects the opp.party could have repudiated the same during the period of 3 years up to which the insured has remitted the premium. The conduct of the opp.party in repudiating the claim after about 3 years after the death of the insured is denial of justice. The complainant is entitled to get insurance claim. Hence the complaint. Opp.parties 1 to 3 filed a joint version contending, interalia, that the complaint is not maintainable either in law or on facts. It is admitted that the first opp.party issued LIC Policy No.782402882 to one Sulochana for a sum of Rs.25,000/- with risk commencing from 14.12.2002. The term was 14-20. The mode of premium was yearly and the amount of premium was fixed as Rs.1622/-. The nominee under the policy is S. Thankappan Pillai, the husband of the life assured. The life assured died on 16.4.2005. The cause of her death was recorded as suicide by hanging.. The application for settlement of the claim was submitted by the nominee on 19.5.2005. Since the death of the assured occurred within 3 years of the commencement of the policy, a detailed investigation was conducted by the LIC in the matter of the claim to find out whether there was any willful suppression and fraudulent misrepresentation. In the investigation it was revealed that there is non disclosure of preproposal illness and hence the policy was repudiated. The contract of insurance is a contract uberrimae fidei and hence obligation to deal fairly and honestly is upon the parties to the contract in equal degree. In the particular case at the time of submitting the proposal for the policy the life assured had fraudulently suppressed material facts regarding her age and illness. For certain specific questions in the proposal form the insured has given false answers. The investigation revealed that the answers furnished by the insured were false and she had under gone treatment at the Holy Cross Hospital, Kottiyam since 1987 for various illness.. These facts were not mentioned in the proposal form. The opp.party issued the policy to the life assured believing the answers to various questions given by the life assured and also her declaration. The averments in the complaint that the life assured does not know English is false and immaterial because LIC of India have received the proposal forum in the name of Sulochana duly filled up in all respect with her signature in English. Along with the proposal form a medical certificate dated 3.11.2002 was also received by the LIC from the medical examiner Dr. Salila wherein Sulochana has affixed her signature in English. The proof of the age at the time of proposal was a self declaration in which her age is stated as 50 years. The policy was issued based on the self declaration. In the first information report prepared by the police and the postmortem examination report prepared by the doctor the age of the deceased is mentioned as 63 years. The age of the of the assured at the time of issuing the electoral identity card on 1.1.97 is 53 years. So naturally on 1.1.2002 her age will be 58 years. At the time of submitting the proposal form on 7.11.20002 the life assured was nearing 59 years. It is quiet evident that there is suppression of material facts regarding her age also which is one of the important factor in calculating the premium. The investigation conducted by the LIC revealed that there was fraudulent suppression of material facts regarding her health and age of the insured. Therefore the claim was repudiated by the opp.party. The repudiation was made after proper investigation and due application of mind. There is no deficiency in service on part of the opp.parties. Hence opp.parties 1 to 3 prays to dismiss the complaint. Points that would arise for consideration are: 1. Whether there is deficiency in service on the part of the opp.parties 2. Reliefs and costs. For the complainant PW.1 is examined. Ext. P1 to P4 are marked. For the opp.party DW.1 is examined. Ext. D1 to D15 are marked. Points 1 and 2 The complainant filed this complaint against the repudiation of his claim in connection with the insurance policy taken by his diseased wife from the 1st opp.party. The contention of the opp.parties is that there is suppression of material facts in the proposal form by the assured and therefore the claim was repudiated. According to them the diseased was under going treatment for various ailments at the time of taking the policy which she had suppressed and therefore the policy claim was repudiated. The definite contention of the complaint is that the details in the proposal form were filled in by the LIC agent and all that the policy holder did was to put her signature in the proposal form. It is further contended that the LIC agent told the insured that the policy is one in which persons below the age of 60 years can join and that aspect is not disputed by the opp.parties. As per the records produced and in the proposal form the age of the assured is shown as 50 years whereas according to opp.parties the age of the assured at the time of taking the policy was 58 years, which she conveniently suppressed. Therefore the learned counsel for the opp.party argued that there is material suppression and as such they are entitled to repudiate the claim and in support of his contention he has relied on the decision reported in AIR 1981 MP 69. The above decision, in our view, cannot be made applicable in this case. In that case the assured was more than 60 years of age at the time of taking the policy. But in this case even according to the opp.party the assured was 58 years only. If as per the scheme of the policy a person can join the policy upto 60 years it cannot be considered as a material suppression. The opp.parties come to the conclusion that the assured was 58 years old at the time of taking policy based on Ext.D6,7,11 and 12. The electron identity card and ration card cannot be accepted as conclusive proof of age. The opp.parties come to the conclusion that the diseased was aged 58 years at the time of taking the policy based on the FIR and postmortem certificate. From the available materials in this case it is obvious that as on the date of taking the policy the assured was within the insurable age. The opp.parties have also no case that the assured was beyond the insurable age. Their grievance is that had they known the correct age the premium of the policy would have been a larger sum. Therefore we are of the view that with regard to the age it cannot be said that there is material suppression. The policy is repudiated mainly on the ground that the assured had pre- existing diseases at the time of taking the policy which she suppressed. According to the opp.party this fact was revealed when they conducted an investigation and from Ext. D10 certificate issued by a doctor who is alleged to have treated the assured. But neither the person who conducted the investigation nor the doctor who issued Ext. D10 was examined to establish this aspect and therefore Ext.D10 cannot be safely relied on to come to a conclusion that the assured was suffering from any pre existing disease. The burden to establish that the assured was having pre existing diseased while taking the policy and this fact was suppressed in the proposal form by examining proper persons is on the opp.party who in our view failed to establish this aspect. In these circumstances we are of the view that the repudiation of the complainant’s claim is not proper and there is deficiency in service on the side of the opp.party. Point found accordingly. In the result the complaint is allowed directing the opp.parties 1 to 3 to pay the complainant Rs.25,000/- being the policy amount with interest at the rate of 12% per annum from 14.3.2006 till the payment. Opp.parties 1 to 3 are also directed to pay Rs.2, 500/- towards compensation and costs. The order is to be complied with within one month from the date of this order. Dated this the 14th day of November, 2008. . I N D E X List of witnesses for the complainant PW.1. – Thankappan Pillai List of documents for the complainant P1. – Death certificate P2. – FIR P3. – Postmortem certificate P4. – Policy Deposit Receipt List of witnesses for the opp.parties DW.1. – N. Chandrasekharan List of documents for the opp.parties D1. – Proposal form dt. 7.11.2002 D2. – Medical Examiner’s confidential report D3. – Report of LIC agent D4. – Self declaration of life assured D5. – Policy certificate D6. – FIR D7. – Postmortem certificate D8. – Death certificate D9. – Death intimation letter D10 – letter dated 21.7.2005 D11. – Copy of Ration card D12. – Electoral Identity card D13. – Repudiation letter D14. – Copy of letter dated 6.9.2005 D15. – Letter dated 14.3.2006 from the Senior District Manager.
......................K. VIJAYAKUMARAN : President ......................RAVI SUSHA : Member ......................VIJYAKUMAR. R : Member | |