Per Smt T. Suneetha, Member:-

This complaint is filed U/s 12 of Consumer Protection Act, Seeking directions on opposite parties to pay the insurance amount of Rs.5,00,000/- with interest @ 24% from 01-01-11 to till the date of payment i.e., Rs.1,70,000/- and to pay Rs.1,00,000/-towards compensation for damages and mental agony, apart from costs. 

2.   In brief the averments of the complaint are here under:

          Complainant’s husband late Chandika Srinivasa Rao has obtained L.I.C. policy in the year 2008 and policy bearing No.675244504 for Rs.5,00,000/- from the 2^nd opposite party and the complainant as nominee.  The deceased paid the premiums regularly till his death.  The insured/deceased Chandika Srinivasa Rao expired on 26-11-10 due to cardiac respiratory arrest when he was undergoing treatment for abdomen pain in Government General Hospital, Guntur, from 19-11-10 to 26-11-10.  

3.     The complainant submitted claim to the 2^nd opposite party with all required papers with in one month from the date of death of the deceased.  But the opposite parties have not settled the claim of the complainant. The complainant issued legal notice to the opposite parties, but no response.   The complainant suffered inconvenience and lot of mental agony due to the negligence of the opposite parties.  Therefore there is deficiency of service on the part of the opposite parties.  Thus the complaint.         

4.      1^st Opposite party filed its version and was adopted by 2^nd opposite party which is in brief as follows. 

          It is true that the deceased Chandika Srinivasa Rao, obtained a L.I.C policy during his life time on his life in the year 2008 under No.675244504 for Rs.5,00,000/- from the 2^nd opposite party and paid the premium regularly till March - 2010.  As per the claim form the deceased died on         26-11-10 due to cardiac arrest.  But as per the claim from- B i.e. Ex. B-1, the cause of death of deceased was Pancreatitis and  in our enquiries the assured suffered from Jaundice 3 years back and suffered from abdominal pain 2 years prior to the date of death i.e., prior to the policy.  The life assured gave declaration in the proposal form dated 27-03-2008 that he was not suffering from any ailment and had not taken treatment or consulted any doctor five years prior to the date of proposal form.  Hence the life assured has not disclosed material facts and complainant her self approached the Forum with un-cleaned hands.    Hence the complaint may be dismissed with exemplary costs. 

5.      The complainant and opposite parties filed their respective affidavits. Exs.A-1 to A-5 were marked on behalf of the complainant.  Ex. B-1 to B-8 were marked on behalf of the opposite parties.   

6.      Now the points that arose for consideration in this          complaint are:      

1.  Whether the opposite parties committed deficiency of     

     service?

2.  To what relief the complainant is entitled to?

7.      POINT NO. 1:-   The complainant’s claim was repudiated by the opposite parties on the ground that the deceased suppressed the material fact that the complainant was alcoholic and smoker and he suffered from jaundice three years prior to the date of death and had abdomen pain two years prior to date of death(26-11-10) i.e., prior to the policy (27-03-08).   In support of their contention the opposite parties filed Ex.B-7 (Ex.X-1) Hospital record of the deceased.  The notes written by the treating doctor is extracted below.     

      “ Previous illness :  Had previous attack of pain abdomen 2 years back. 

                                Had jaundice 3 years back. 

        Habits              : Chronic alcoholic and smoker”. 

        The hospital record revealed that the problem of complainant was Biliary Pancreatitis and the cause of death as Cardiac Arrest. The Forum verified about the decease the complainant suffered, in the internet and extracted the following information   

Acute Pancreatitis   :  (www.webmd.com/digestive-disorders/digestive-diseases-pancreatitis)

Acute Pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, Acute Pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. In about 10% to 15% of people with acute Pancreatitis, the cause is unknown.

The severity of acute Pancreatitis may range from mild abdominal discomfort to a severe, life-threatening illness. However, the majority of people with acute Pancreatitis (more than 80%) recover completely after receiving the appropriate treatment.

In very severe cases, acute Pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation. Severe Pancreatitis can also create conditions which can harm other vital organs such as the heart, lungs, and kidneys.

        The above information revealed that the chronic alcoholism leads to Pancreatitis.  The complainant’s husband herein is a chronic alcoholic and smoker too according to the record.  The point No.6(c) in Medical Attendant’s Certificate i.e., Ex.B-6 revealed that the patient himself reported his history which means that the notes recorded in the case sheet Ex.X-1 and also Ex.B-7 was in accordance with the revelation of the deceased. The deceased took the policy on 27-03-08.   The deceased suffered jaundice 3 years before the date of death (26-11-10) which comes to 26-11-07 i.e., prior to the date of the policy as rightly contended by the opposite parties.  The complainant answers for the questions in policy proposal are extracted below for better appreciation:   

The complainant did not disclose the facts about his consumption of alcohol, smoking and attack of jaundice before policy at the time of entering into the policy which amounts to suppression of material facts. 

“ The National Consumer Disputes Redressal Commission in (2012 (1) C.P.R. 48 (NC)) Lalchand Vs Life Insurance Corporation of India, held 

“Any material suppression by insured would entitled L.I.C. to repudiate claim”

“The National Consumer Disputes Redressal Commission in (2010 (1) C.P.R. 36 (NC)) Life Insurance Corporation of India Vs Bhagya held

“Where there had been suppression of material facts L.I.C was well within its rights to repudiate claim as contract of policy rests on the edifice of good faith”. 

        In these circumstances the Forum comes to a considered opinion that the deceased suppressed the material fact at the time of taking policy,  that he was a chronic alcoholic and smoker suffered jaundice prior to the date of policy.  Therefore, the repudiation made by the opposite parties is justified.  The point is answered in favour of the opposite parties. 

8.      POINT NO.2:-   Since the opposite parties repudiation of the complainant’s claim was justifiable and the complainant is not entitled to any compensation or policy amount. 

9.     In the result, the complaint is dismissed without costs. 

Typed to my dictation by Junior Stenographer, corrected by us and pronounced in the open Forum dated this the 28^th day of February, 2013.

Sd/-XXX                                    Sd/-XXX                                  Sd/-XXX

MEMBER                                    MEMBER                               PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties: -

Marked by the Forum : 

                                                                                                            Sd/-XXX

                                                                                                         PRESIDENT     

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.