Date of filing : 16-07-2011
Date of Disposal :31-05-2013
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTAPUR.
PRESENT: - Sri S.Niranjan Babu, B.A., B.L., President (FAC).
Smt. M.Sreelatha, B.A., B.L., Lady Member
Friday, the 31st day of May, 2013
C.C.NO.123/2011
Between:
P.S.Venugopal
S/o P.Satyanarayana Setty
D.No.4-96, Amarapuram
Anantapur District. … Complainant.
Vs.
1. The Branch Manager,
Life Insurance Corporation of India
Opp: Market Yard, Rahamathpur
Hindupur, Anantapur District.
2. The Divisional Manager,
Divisional Office,
College Road,
Kadapa. … Opposite Parties
This case coming on this day for final hearing before us in the presence of Sri H.Nageswara Rao, Advocate for the complainant and Sri T.Viswanath, Advocate for the opposite parties 1 & 2 and after perusing the material papers on record and after hearing the arguments on both sides, the Forum delivered the following:
O R D E R
Sri S.Niranjan Babu, President (FAC): - This complaint has been filed by the complainant under section 12 of Consumer Protection Act, 1986 against the opposite parties 1 & 2 claiming a sum of Rs.40,000/- towards the sum assured with interest @ 12% p.a. from the date of death of the complainant’s wife till the date of realization, a sum of Rs.10,000/- towards damages and Rs.1,500/- towards litigation expenses.
2. The brief facts of the complaint are that: - The complainant’s wife during her life time has taken insurance policy bearing No.652702357 dt.28-01-2001 from the 1st opposite party. The mode of payment of premium is half yearly and the sum assured under the policy is Rs.40,000/- and the complainant is nominee for the said policy.
3. Subsequently the policy lapsed on 28-01-2005 due to non-payment of premium amount by the complainant’s wife to the 1st opposite party. Later the complainant’s wife approached the 1st opposite party for revival of the policy and as per the directions of the 1st opposite party; the complainant’s wife submitted personal statement regarding her health for the purpose of revival of the policy and the complainant’s wife submitted statement on 11-02-2009. In her statement she stated that she never took any treatment to any illness for a period of one week or more and she never went for an operation, accident or injury and she never went for ECG, X-ray, screening, blood, urine or stool examination and she was hale and healthy at the time of giving statement for revival of the policy. Considering her personal statement, the 1st opposite party revived her policy on payment of Rs.5,322/- on 19-02-2009. Subsequently on 14-05-2009 the complainant’s wife died at Amarapuram and after her death the complainant, who is the nominee made a claim to the 1st opposite party by submitting the documents. Later the 2nd opposite party sent a letter dt.22-03-2010 stating that the complainant’s wife was suffering with cancer due to which she died and the above fact was not disclosed by the complainant’s wife at the time of giving statement for revival of policy and repudiated the claim for suppression of material fact. The repudiation of the claim by the 2nd opposite party with untenable reason is deficiency of service on the part of the opposite parties and this complaint is filed against the opposite party claiming the sum assured and other reliefs.
4. Counter filed by the 2nd opposite party stating that it is true that the 1st opposite party has issued an Insurance Policy bearing No.652702357 dt.28-07-2002 for a sum assured of Rs.40,000/- in favour of the complainant’s wife. The opposite party submits that the above said policy was lapsed due to non-payment of half yearly premium by the complainant’s wife from 1/2005 onwards. Later the complainant’s wife sought for revival of the said policy by submitting personal statement regarding her health dt.11-02-2009 to the opposite party by paying total half yearly premiums which fell due from 01/2005 to 01/2009. Subsequently the complainant’s wife died on 14-05-2009. The opposite party submits that the deceased life assured has got revived her policy by giving wrong answers in column No.2 (a to c) & No.4 in the above said personal statement regarding her health dt.11-02-2009 by suppressing the material information that she was suffering from Cervical Lymphadenopathy “ as per the medical report dt.03-03-2008 issued by St.John’s Medical College Hospital, Bangalore. The 2nd opposite party submits that it is well established principal of law that contract of insurance is contract uberrimafides and there must be utmost good faith on the part of the assured. This imposes a duty and an obligation on the assured to make a full disclosure of all material facts which would affect the mind of the insurer whether to accept the risk or not and on what terms. Further the opposite party submits that in the present case the deceased life assured has deliberately and fraudulently with malafide intention has given false answers in column 1 to 9 in the personal statements regarding her health dt.11-02-2009 in order to revive the lapsed policy by suppressing the fact that she was suffering from Cervical Lymphadenopathy as per the medical report dt.03-03-2008 issued by St.John’s Medical College Hospital, Bangalore. Further the 2nd opposite party submits that basing on the medical report, the 2nd opposite party has repudiated the claim on the ground that there is suppression of material facts. Hence, there is no deficiency of service on the part of the opposite parties and the opposite parties are not liable to pay any compensation.
5. The 1st opposite party filed a memo adopting the counter of 2nd opposite party.
6. Basing on the above pleadings, the points that arise for consideration are:-
1. Whether there is any deficiency of service on the part of the opposite parties 1 & 2?
2. To what relief?
7. In order to prove the case of the complainant, the evidence on affidavit of the complainant has been filed and marked Ex.A1 to A3 documents. On behalf of the opposite parties, the evidence on affidavit of the 2nd opposite party has been filed and marked Exs.B1 to B4 documents.
8. Heard arguments on both sides.
9. POINT NO.1: - The counsel for the complainant argued that the complainant’s wife has taken the Insurance Policy from the 1st opposite party bearing No.652702357 dt.28-07-2002 for a sum assured of Rs.40,000/-. The counsel for the complainant argued that due to financial problems the complainant’s wife could not pay half yearly premiums from 01/2005 to 01/2009. Later the complainant’s wife sought for revival of the said policy by submitting personal statement regarding health dt.11-02-2009 and basing on the above statement, the 2nd opposite party has collected a sum of Rs.5,322/- and revived the policy on 19-02-2009. The counsel for the complainant argued that as the 2nd opposite party has revived the policy retrospectively the opposite parties are liable to pay sum assured under the policy as she died on 14-05-2009. The counsel for the complainant argued that the repudiation of the claim made by the complainant clearly establishes that there is deficiency of service on the part of the opposite parties as the policy was in force as on the date of death of the complainant’s wife.
10. The counsel for the opposite party argued that it is an admitted fact that the complainant’s wife had taken the policy and the said policy was in lapsed condition from 01/2005 to 01/2009. Further the opposite party argued that basing on the personal statement regarding health of the complainant’s wife with good faith the opposite party revived the policy by collecting premium arrears and revived the policy from 19-02-2009. The counsel for the opposite party argued that as the complainant’s wife died within 3 months from the date of revival, they made enquiries and came to know that the complainant’s wife died due to cancer and as this matter was suppressed by the complainant’s wife while submitting her personal statement regarding her health. Prior to revival and further argued that the 2nd opposite party has rightly repudiated the claim of the complainant for suppressing the material fact that she was suffering with cancer prior to her statement.
11. The counsel for the opposite party relied on the following citations in support of his arguments:
(1) Legal Digest April 2011 – National Commission in Revision Petition No.50/2011 between Kajol and Guardian Smt.Chancier Kanta Vs. Life Insurance Corporation of India, wherein it is mentioned that “ Life Assured had taken two insurance policies on 28-03-2001 and 27-02-2002. Both the policies had lapsed for a period of about 12 months during 2004-2005 and were subsequently revived on 10-06-2005. The insured died on 19-11-2005. Claim was repudiated on the ground that the insured was suffering from tuberculosis since 2004 and had been under treatment for the same. While applying for revival in both the cases the information relating to this ailment was not disclosed. “
Held: The repudiation of the claim upheld for non-disclosure of the facts.
(2) Legal Digest October 2009 – National Commission in Revision Petition No.649/2005 between Life Insurance Corporation of India Vs. M.Bhavani wherein it is mentioned that “ The claim was repudiated on the ground that at the time of revival of policy, it was not disclosed that the life assured (deceased) was suffering from ‘Malignant Brain Tumor.’ The Hon’ble National Commission held that the orders passed by the District Forum and State Commission run counter to the well-established principle that if a policy is taken or revived by suppressing pre-existing material fact like pre-existing disease, then the insurance company is not liable to pay the amount insured under the policy. “
12. After hearing arguments of both counsels, it is very clear that there is no dispute with regard to taking of the policy by the deceased or revival of the policy after it was lapsed from 01/2005 to 01/2009. The only point that has to be taken into consideration that whether the policyholder has given the correct and true statement with regard to her health while submitting her personal statement regarding her health before reviving the lapsed policy. Considering the arguments of opposite party, as per Ex.B3 issued by St.John’s Medical College Hospital, Bangalore stating that the deceased Roja Rani was admitted for multiple cervical Lymphadenopathy dt.03-03-2008 and another document pertaining to repudiation of the claim made by the complainant for cashless hospitalization dt.05-03-2008, which is marked as Ex.B3. The above said two documents clearly establish that the complainant’s wife prior to revival of the policy in her personal statement regarding her health failed to disclose that she was suffering with cancer one year prior to the date of her statement though she was aware of the fact that she was suffering with cancer. If at all the complainant’s wife has given the correct information with regard to her health condition, it is upto the opposite parties whether to revive the policy or not. But the complainant’s wife fraudulently did not disclose that she was suffering from cancer and got revived the policy by giving false information with regard to her health.
13. The above two citations on which the opposite party relied exactly suits to this case and considering the fact that the policyholder has suppressed the material fact while giving personal statement regarding her health in order to get revived the policy.
14. In the above circumstances, the opposite parties have no option but to repudiate the claim of the complainant on the ground that there is material suppression of fact. In view of the above observation, the opposite parties have rightly repudiated the claim and there is no deficiency of service on the part of the opposite parties, hence they are not liable to pay any compensation to the complainant.
12. POINT NO.2 - In the result, the complaint is dismissed without costs.
Dictated to the Steno, transcribed by him, corrected and pronounced by us in open Forum, this the 31st day of May, 2013.
Sd/- Sd/-
LADY MEMBER PRESIDENT (FAC),
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR.
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
ON BEHALF OF THE COMPLAINANT: ON BEHALF OF THE OPPOISITE PARTIES
-NIL- - NIL-
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Ex.A1 - Original Policy Deposit Receipt dt.11-02-2009 issued by the 1st opposite party.
Ex.A2 - Original Death Certificate relating to deceased Rorjarani issued by the Panchayat
Secretary, G.P.Amarapuram.
Ex.A3 - Original repudiation letter dt.22-03-2010 issued by the 2nd opposite party to the
Complainant.
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES
Ex.B1 - Original Policy bearing No.652702357dt.28-07-2002 issued by the opposite parties
In favour of the deceased Rojarani.
Ex.B2 - Original Personal Statement for revival of policy obtained from the deceased
Rojarani by the opposite parties.
Ex.B3 - Photo copy of letter issued by St.John’s Medical College Hospital, Bangalore to
Pathology Department, Bangalore.
Ex.B4 - Certificate issued by the Station House Officer, Amarapuram Police Station
dt.04-06-2009.
Sd/- Sd/-
LADY MEMBER PRESIDENT (FAC),
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR.
Typed by JPNN
