This is a complaint filed U/s. 12 of Consumer Protection Act by the complainant S. Basangouda against Respondent-Divisional Manager LIC of India Divisional Office, Raichur. The brief facts of the complaint are as under:-<br /> <br /> The complainant is the nominee and father of late Kumari Savitri, who was policyholder of policy No. 663225596 dt. 25-06-03 for sum of Rs. 2,00,000/-. At the time of getting the policy from the Respondent the said Kumari Savitri was aged about 18 years old, unmarried, hale & healthy girl without having any prior chronical or any type of disease. So she had rightly and truly answered to all the quarries sought in the said policy. There is no any pre-history of any disease in the family of deceased Savitri-complainant.<br /> <br /> The deceased policyholder was doing only household and agricultural works in her house. She felt some illness like headache, fever, vomiting and Convulsion in the first week of January-2004. The complainant took her to a qualified doctor by name Dr. B. Basavaraj of Pothnal village Tq. Manvi on 04-01-04 who diagnosed the symptoms of ENCEPHALITIS. But in-spite of treatment the said Savitri ultimately died due to Cardio-Respiratory failure at about 5-00 am on 05-01-04 at Pothnal village and she was buried in the land at Boghavathi village. The complainant being the father and nominee of the policy of deceased Savitri has submitted claim Form on 27-05-04 along with necessary documents sought by the Respondent. In-spite of several approach, the Respondent dodged the matter on one or the other reasons ultimately on verbal clashes by the complainant the Respondent has repudiated his claim through letter of repudiation dt. 27-03-06, on the ground of pre-existence of disease and suppression of the same.<br /> <br /> Though the Respondent repudiated the claim of the complainant stating that they have un-disputable documents to prove the pre-existence of disease of policyholder but they have not at all made known or shown to the complainant while repudiating his claim that too after lapse of (1) year & (10) months and upon verbal clashes by the complainant which made lot of mental harassment to the complainant. This act of the Respondent amounts to deficiency in service and negligence. Hence for all these reasons the complainant has sought for payment of assured sum of Rs. 2,00,000/- along with compensation of Rs. 50,000/- for mental harassment and interest at 12% from 27-05-04 till realization and for cost of Rs. 10,000/-.<br /> <br /> 2. The Respondent Insurance Company have filed written version contending that late policyholder Kumari Savitri had obtained policy by suppressing material facts and giving wrong answers in filling the Proposal Form at Col.No-11 regarding personal history. She was in-patient in Annadaneshwara Maternity & Surgical Hospital at Sindhanoor during December-2002 for operation of “Ovarian Tumour” weighing 2 to 3 Kgs. This fact was not shown by her in filling the proposal form. The letter of doctor to Respondent dt. 17-03-06 clearly shows that Kumari Savitri was operated before obtaining the policy. This fact was suppressed while taking the policy for huge amount of Rs. 2,00,000/-. The life assured was taking treatment and getting operated before taking policy is a material fact and if she had stated then the life assured would have been referred to higher medical checkup before issuing the policy. The deceased has suppressed material facts before filling up the Proposal Form to question No.- 11 (a) to 11 (j) and gave wrong answers and also regarding the income at Col.No-5 she has stated her Annual Income as Rs. 75,000/- which is also wrong as per letter given to the Respondent by the father of the deceased dt. 16-11-04 which is self-explanatory. <br /> The basic principle of the Insurance contract is “Utmost Good Faith” has been violated by the policyholder. Basing on the above records and keeping in-view the legality of the matter and according to the Insurance Act the Respondent Corporation has repudiated the claim of the policy and informed the complainant accordingly. As per the policy of LIC Act and Rules no policy will be issued to a single woman without income. The actual amount of Insurance cover that can be granted would depend on her insurance income late policyholder was not doing any household work and agricultural work. The deceased Savitri who obtained a policy for Rs. 2,00,000/- has no income and her father-nominee-complainant has obtained the policy with malafide intention knowing fully well that the life assured is suffering from serious disease and to take benefit of her death, he has obtained the policy by suppressing the material facts as such the Respondents have rightly repudiated his claim which is legal and valid. There was no verbal clashes between the complainant and the Respondent, as alleged. There is no deficiency in service on the part of Respondent as the complainant has not given correct information regarding death of the life assured. The Respondent has made enquiry regarding the death of the life assured and collected records from Sindhanoor, Hospital and thereafter repudiated the claim so there is no cause of action for the complaint. Hence for all these reasons the Respondents have sought for dismissal of the complaint with cost.<br /> <br /> 3. During the course of enquiry the complainant Basangouda has filed his sworn affidavit-evidence as PW-1 and has got marked (6) documents at Ex.P.1 to P-6. In rebuttal the Manager of Legal LIC of India, (Respondent Corporation) has filed his sworn affidavit-evidence as RW-1 and affidavit-evidence of one Dr. B.N. Patil Annadaneshwara Maternity & Surgical Hospital, Sindhanoor as RW-2 and has got marked in all (13) documents at Ex.R-1 to R-13.<br /> <br /> 4. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:-<br /> <br /> 1. Whether the complainant proves deficiency in service by <br /> the Respondent Corporation in not making the payment of policy amount, as alleged.?<br /> <br /> 2. Whether the Respondent Corporation proves material <br /> suppression of the fact by the deceased policyholder and <br /> her father-complainant while taking the policy, as alleged.?<br /> <br /> 3. Whether the complainant is entitled for the reliefs sought <br /> for?<br /> 5. Our finding on the above points are as under:-<br /> <br /> 1. In the Affirmative <br /> 2. In the Negative. <br /> 3. As per final order for the following.<br /> <br /> REASONS<br /> <br /> POINT NO. 1 & 2:-<br /> <br /> 6. First we shall discuss Point NO-2 since the answer to Point No-1 is based on the answer to Point NO-2. The burden of proof of Point NO-2 is on the Respondent. Whereas the burden of proof of Point NO-1 is on the complainant. The Respondent Corporation have contended that deceased policyholder- Kumari Savitri had obtained policy by suppressing material facts as she was suffering from “Ovarian Tumour” and was in-patient in Annadaneshwara Maternity & Surgical Hospital at Sindhanoor during December-2002 for operation or “Ovarian Tumour” weighing 2 to 3 Kgs. Secondly Kumari Savitri the daughter of the complainant-nominee was not doing household work or agricultural work and she had no income, but in Col.No-5 of Proposal Form, it is wrongly stated her annual income as Rs. 75,000/-. If Savitri, Policyholder had stated her operation of “Ovarian Tumour” then the Respondent Corporation would have referred to higher medical checkup before issuing the policy and so the life assured has mis-lead the Respondent Corporation. The complainant-nominee of policyholder had obtained policy with malafide intention knowing fully well that Kumari Savitri was suffering from serious disease and in-order to take the benefit of death of his daughter the complainant, has obtained the policy by suppressing the material facts as such Respondents have rightly repudiated the claim of the complainant.<br /> <br /> 7. The Respondents have produced affidavit-evidence of Dr. B.N. Patil Surgeon, Annadaneshwara Maternity & Surgical Hospital, Sindhanoor as RW.2 and have relied on the Original Proposal Form at Ex.R-1, Original Medical Attendant’s Certificate in Claim Form No-B at Ex.R-4, Claimanant’s Statement in Claim Form-A at Ex.R-5, Certificate of Hospital Treatment in Claim Form No-B-1 at Ex.R-6, Original Letter of Dr. B.N. Patil dt. 17-03-06 at Ex.R-8, Office copy of Repudiation letter dt. 27-03-06 at Ex.R-9, Income Certificate issued by Tahasildar Manvi at Ex.R-10 and letter of complainant dt. 13-11-04 at Ex.R-3. <br /> <br /> 8. The affidavit-evidence of RW-2 Dr. B.N. Patil discloses that he has given treatment to one Savitri D/o. S.Basangouda R/o. Bhogavathi Tq. Manvi. He has done operation to the patient Savitri during December-2002 for “Ovarian” weighing 2 to 3 Kgs. He has further stated that he is not in a position to produce case sheet (three sheets) as the same is missing while shifting hospital from old building to new building and he could not trace out them. He has given a letter to the LIC of India, Divisional Office Raichur. dt. 17-03-06, the contents of the same are true and correct. This letter is at Ex.R-8 which is material reads as under:<br /> To, Date: 17-03-06.<br /> The Senior Divisional Manager,<br /> LIC of India, D.O.<br /> Raichur.<br /> Sub:- Your enquiry on Pol. No. 663225596 of late Smt. Savitri <br /> D/o. Basangouda at Bhogavathi, Tq. Manvi.<br /> <br /> Sir,<br /> <br /> I have operated the above patient during December-2002 for “Ovarian Tumour” weighing 2 to 3 Kg. But there is no case sheet due to my hospital premises shifted from old to new building. This is for your kind information.<br /> Sd/-<br /> Dr. B.N. Patil,<br /> Ms.<br /> Annadaneshwara Hospital,<br /> Sindhanoor.<br /> <br /> 9. Ex.R-6 is the Certificate of Hospital Treatment issued by Dr.Basavaraj of Shree Sharanabasaveshwara Clinic at Pothnal village, Tq. Manvi dt. 26-05-04. Col. NO.- 1, 2, & 4 of this certificate shows that the life assured Savitri was aged about (19) years of Bhogavathi village was admitted in his hospital on 04-01-04 at 6-00 P.M. with complaint of fever, unconsciousness and convulsion. Col.No-3 states no previous medical treatment. Col.No-5 shows exact history reported by the patient that “low grade fever, headache, vomiting since 3-4 days. Col.No-6 discloses that after examination it was diagnosed that the patient Kumari Savitri was suffering from ENCEPHALITIS. Col.No.7 with regard to previous suffering of any other disease or illness by the patient with other details etc., etc., shows as “No”. Col.No-8 shows that the patient Savitri was discharged on 05-01-05 at 5-00 A.M. Col.No-9 with regard to condition at the time of discharge shows as “Dead” (Patient is dead). Col.No-10 with regard to earlier treatment on any previous occasion in the hospital as “No”. <br /> <br /> 10. Ex.R-4 is Medical Attendant’s Certificate issued by same-Dr. B.Basavaraj of Shri Sharanabasaveshwara Clinic at Pothnal. Col.No-3 of this certificate shows time and place of death of the patient as on 05-01-04 at 5-00 AM in Pothnal. Col. No-4 with regard to primary cause of death as “ENCEPHALITIS” disease and secondary cause as “Cardio Respiratory failure” and was suffering from the said disease since (4) days symptoms was illness as high fever, convulsion. Col.No-5 with regard to reason to suppose/suspect reason that the deceased was aggravated by intemperate habits shows as “No”. Col.No-6 with regard to other disease or illness co-existed as “No”. These two certificates at Ex.R-6 & R-4 have been certified by Medical Attendant’ Dr. B.Basavaraj Shri Sharanabasaveshwara Clinic at Pothnal.<br /> <br /> 11. From Ex.R-6 & Ex. R-4 it is evident that deceased life assured Kumari Savitri was admitted in the hospital on 04-01-04 with history of fever, convulsion and it was diagnosed that she was suffering from ENCEPHALITIS and she died on 05-01-04 due to primary disease of ENCEPHALITIS and secondary cause of Cardio Respiratory failure. As discussed above the letter of Dr. B.N. Patil in the shape of Medical Certificate shows that deceased life assured had been operated during December 2002 for “Ovarian Tumour” weighing 2 to 3 Kgs. The Respondent Corporation have produced Insurance Proposal Form dt. 25-06-03 at Ex.R-1. Col.No-11 of this Ex.R-1 shows that late Savitri in the proposal form has shown herself as hail & healthy and of sound health by negative answer as “No” to the questions with regard to previous ailment and treatment for more than a week in the hospital treatment during the last year five years and with regard to suffering from ailment pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous system, High Blood Pressure Low Blood Pressure, Cancer, Epilepsy Herniya etc., etc., to question No-11 (a) to 11 (h). To a sub question NO-11 (i) regarding usual state of health, it is answered as “Good”. This Proposal Form also shows declaration that after understanding the contents of proposal form in Kannada Language, she has put her signature. Equally we find a declaration by the LIC agent C.P. Malikarjuna that he has fully explained the contents and the questions in the proposal form to the proposer and has truth fully recorded the answers given by the proposer. <br /> <br /> 12. Of course Ex.R-8 the letter of Dr. B.N. Patil in the shape of certificate shows that late policyholder Savitri was operated in December 2002 for “Ovarian Tumour” weighing 2 to 3 Kgs. but Medical Attendant’s Certificate at Ex.R-4 and Certificate of Hospital Treatment at Ex.R-6, as discussed supra shows that deceased Savitri was admitted in the hospital of Dr. B.Basavaraj of Sharanabasaveshwara Clinic at Pothnal on 04-01-04 and was suffering from ENCEPHALITIS disease and she died on 05-01-04 due to Cardio Respiratory failure. These two documents further shows that Kumari Savitri was admitted in the hospital of Dr. B.Basavaraj with complaint of fever, headache, vomiting since 3-4 days and after examination it was diagnosed that patient was suffering from ENCEPHALITIS.<br /> <br /> 13. According to Medical Dictionary by P.H. Collin (Second Edition, Universal Book Stall New Delhi), the Medical Term ENCEPHALITIS means inflammation of brain. The medical term “Ovarian” refers to Ovary, means one of two organs in a woman which produce Ova or Egg cells and secrete the female hormone Oestrogen. The terms “Tumour” means cyst. So “Ovarian Tumour” means ovarian cyst which develops in the ovaries. <br /> <br /> 14. According to the affidavit-evidence and letter/medical certificate of Dr. B.N. Patil at Ex.R-8, the patient Kumari Savitri was suffering from “Ovarian Tumour” and was operated in December-2002. According to Ex.R-4 & Ex.R.6 as discussed supra, the deceased Savitri was suffering from ENCEPHALITIS who was admitted in the hospital of Dr. B.Basavaraj at Pothnal on 04-01-04 and she died on 05-01-04 due to primary cause of ENCEPHALITIS and secondary cause of Cardio Respiratory failure. The Respondent Corporation have not produced any medical evidence or medical record to prove Nexus between “Ovarian Tumour” (already operated) and ENCEPHALITIS as cause for death of late assured, as rightly submitted by the learned counsel for the complainant. In the absence of the same the contention of Respondent Corporation that the cause of death of Kumari Savitri was due to “Ovarian Tumour”, does not stand to reason. Especially when she was operated for this disease in December-2002 much earlier to her death on 05-01-04 who died due to ENCEPHALITIS disease as per the Medical Certificate of Dr. B. Basavaraj. It would be more-so when the certificate of this Dr. B.Basavaraj at Ex.R-4 & R-6 have been produced by the Respondent-Corporation only. <br /> <br /> 14.A) Secondly it is contended by the Respondent Corporation that the complainant being the father of late policyholder Savitri, knowing fully well that late Savitri was suffering from serious disease and in-order to take the benefit of death of his daughter, he has obtained the policy by suppression of her health and has also wrongly shown annual agriculture income of his daughter at Rs. 75,000/- in Col.No-5 of Proposal Form since Kumari Savitri was not doing any household work or agricultural work and she had no income. As rightly argued by the learned counsel for the Respondent, the Proposal Form at Ex.R-1, shows the age of late policyholder Savitri as (18) years and her father Basangouda has been shown as Nominee. Col.No.5 of Proposal Form shows her Educational qualification as 6th standard, Annual Income at Rs. 75,000/- and sources of income as agriculture. But except this bare statement of agricultural income no other information was furnished with this Proposal Form like Survey number, extent and situation of the lands even RTC Extract were not enclosed to the Proposal Form at the time of its submission. However the Respondent have produced a letter of the Complainant/Nominee at Ex.R-3. This letter dt. 13-11-04 interalia shows that he used to pay the policy premium of his deceased daughter from his agricultural income. When the Proposal Form has been accepted by issuing policy bond (showing the commencement of policy from 15-07-03) without even seeking any clarification from the proposer with regard to her agriculture income when she was aged about 18-19 years of age having had studied upto 6th standard, now the Insurance Authorities are estopped from putting up tainted story that late policyholder was not doing household or agricultural work and she had no agriculture income, especially when according to Respondent Corporation No policy will be issued to a single woman without income as contended in the written version. It would be more se when Ex.R-3 the letter of the complainant/ father of late policyholder shows that he was paying the policy premium of his daughter from his agriculture income.<br /> <br /> 15. As discussed earlier the Respondent Corporation have failed to prove that the death of deceased policyholder on 05-01-04 due to ENCEPHALITIS was the nexus cause of her suffering from “Ovarian Tumour” operated in December-2002. Consequently the repudiation of the claim on the ground of suppression of material facts does not stand to reason and thereby the Respondent Corporation was deficient in service in not making the payment of policy amount. Hence Point No-1 is answered in the Affirmative and Point NO-2 in the Negative.<br /> <br /> POINT NO.3:-<br /> <br /> 16 The complainant has sought for policy amount of Rs. 2,00,000/- and for payment of Rs. 50,000/- as compensation for mental harrasment with 12% interest thereon and for awarding Rs. 10,000/- towards cost. So far as the policy amount is concerned, the complainant is entitled for the same. As regards awarding of compensation, 12% interest and cost of Rs. 10,000/- is concerned, having regard to the facts and circumstances of the case we feel it just and proper to award a global compensation of Rs. 5,000/- including cost of litigation. In the result we pass the following order:<br /> <br /> ORDER<br /> <br /> The complaint of the complainant is allowed in part.<br /> <br /> The Respondent Corporation shall pay policy amount of Rs. 2,00,000/-to the complainant-nominee along with global compensation of Rs. 5,000/- including cost of litigation<br /> <br /> The Respondent shall comply this order within six weeks from the date of receipt of copy of this order.<br /> <br /> Office to furnish certified copy of this order to both the parties forth with free of cost.<br /> <br /> (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 21-06-07)<br /> <br /> Sd/-<br /> Sri. N.H. Savalagi,<br /> President,<br /> District Forum-Raichur.<br /> <br /> Sd/-<br /> Sri. Vishwanath Yekkelli,<br /> I/c. Member,<br /> District Forum-Raichur<br />