CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM Present Sri.Santhosh Kesavanath.P. President Smt.Bindhu M.Thomas Member Sri.K.N.Radhakrishnan Member.
CC.No.321/08 Friday, the day of 31st, October, 2009.
Petitioner. James George Elanjimattathil house Aruvithura.P.O. Erattupetta Village Meenachil taluk, Kottayam. (Adv.K.R.Ramachandran) Vs. Opposite party. 1. The Divisional Manager Life Insurance Corporation Divisional Office Jeevan Prakash PB No.66, Sagar Road Bikaneer P.O. & District Rajasthan, rep. By the Divisional Manager LIC of India Divisional Office, Kottayam. (Adv.K.C.Tharakan) O R D E R Smt.Bindhu M.Thomas, Member. The crux of the complainant's case is as follows. The complainant is the husband of Saramma.P.K. who expired on 21/8/2007 at Rajasthan due to blasting of pancreas. The deceased Saramma.P.K. availed an insurance policy from the opposite party bearing number 502063292 dated 26/3/07 by paying one premium of Rs.10,000/-. The date of commencement of policy was on 30/3/2007 and the term was 20 -2- years and the date of maturity is on 30/3/2027. As per rules, in case the death of the policy holder occur prior to the date of maturity of the policy an assured sum of Rs.1,00,000/ shall be payable. The complainant surrendered the original policy certificate before the opposite party in September 2007 claiming assured amount. But the opposite party repudiated the claim stating reason that the deceased Saramma withheld a material information with regard to her health. Hence the complainant filed this complaint claiming the claim amount with 12% interest and Rs.2500/- as cost. The opposite party entered appearance and filed version with the following main contentions. (i) The complaint is not maintainable either in facts or in law. (ii) The petition is bad for non jointer of necessary parties. The daughter of the life assured is the nominee under the policy. All the legal heirs of the life assured are necessary parties in this case. (iii) The life assured had suppressed material facts at the time of effecting proposal to the abovesaid policy. (iv) The deceased life assured was absent from her work place due to the diseases inter verterbal disc prolapse and low backache. (v) The life assured died within 3 years from the date of commencement of the said policy. The cause of death of the life assured was acute pancreatitis e shock multiple -3- organ failure which was directly related to the suppressed facts. (vi) If the life assured had disclosed her absence from work place or if there was any such information to the opposite party they would not have accepted the proposal of the said policy. (vii) Since the life assured has willfully suppressed material information in the proposal form the repudiation of the claim is valid and sustainable.
According to the opposite parties there is no deficiency in service or unfair trade practice on their part. Hence they prayed to dismiss the complaint with costs to them. Points for consideration are: (i) Whether there is deficiency in service or unfair trade practice on the part of the opposite party? (ii) Reliefs and costs.
Evidence consists of affidavits filed by both parties and exhibits A1 to A4 and B1 to B5. Point No.1 The learned counsel for the opposite party argued that the deceased had suppressed the details of the diseases, prolapse inter vertebral disc and low back ache while filling up the proposal form. To substantiate the above said argument the opposite party has produced the proposal form and the -4- certificate dated 25/9/07 from the employer of the deceased and they are marked as exhibit B4 and B1 respectively. Exhibit B1 shows that the deceased had availed leave from her work place due to prolpase inter verterbal disc and low back ache. The repudiation letter dated 15/12/07 is marked as exhibit A2. As per exhibit A2, the said claim was repudiated stating reason that life assured has wilfully suppressed material information in the proposal form. The opposite party's counsel further argued that if the life assured had disclosed the material facts, they would not have accepted the proposal to the said policy. Whereas the complainant's counsel submitted that at the time of taking policy, the deceased was fully healthy and therefore there was no need for her to suppress any material facts. The learned counsel further submitted that the insured died due to blasting of pancreas which has no nexus with the alleged suppressed material fact regarding back pain. The opposite party produced copy of hospital treatment certificate dated 21/8/07 and medical certificate dated 21/8/07, and they are marked as exhibits B2 and B3 respectively. In exhibit B3, the reason for death of the deceased is mentioned as ''Acute Pancreatitic multiple Organ Failure''. Nothing is placed on record to prove that there is any nexus between the alleged suppressed material facts and the real cause of death. The Hon'ble National Commission in Life Insurance Corporation of India and another V. Smt.Chandrakanta Lahande, 2009 CTJ 73 (CP) (NCDRC), has held that in today's world, people face problems like acidity, indigestion, back pain, headache and they may occur time to time with -5- different levels of intensity. They cannot be considered as diseases, required to be enumerated in proposal form. Relying on the abovesaid decision we are of the view that the non-mentioning of diseases like interverbral disc prolapse and low back ache cannot be considered as suppression of material facts. In our considered opinion if the deceased had taken leave from her work place due to low back ache and prolapse inter verterbal disc and if that fact was not mentioned by the deceased in the proposal form, it would not amount to suppression of material facts as that fact has no bearing with the so called death of the deceased as she had died due to Acute pancreatitis c shock c multiple organ failure. In our opinion the repudiation of the claim of the complainant on the ground of suppression, of material facts is improper and unjust. On perusal of exhibit B4, proposal form it is seen that the daughter of the deceased is the nominee who is a minor. In our view the ends of justice would be adequately met by directing the opposite party to deposit the insured sum with interest @ 9% p.a. in the name of minor. Point No.1 is found accordingly. Point No.2. In view of the findings in point No.1 the petition is allowed. The opposite party is ordered to deposit the sum insured with interest @ 9% p.a.from the date of repudiation till payment in the name of the minor, nominee, Ms.Dhaniya James in a Nationalised bank till she becomes a major. The opposite party is also ordered to pay Rs.1500/- as litigation cost to the petitioner. As interest is allowed no compensation is ordered.
-6- This order will be complied with within one month of receipt of its copy. This petition is disposed of with the aforesaid directions. Smt.Bindhu M.Thomas Member Sd/- Sri.Santhosh Kesavanath.P. President Sd/- Sri.K.N.Radhakrishnan Member. Sd/- APPENDIX Documents of the complainant. Exhibit A1 Copy of policy certificate Exhibit A2 Copy of repudiation letter Exhibit A3 Copy of advocate's notice sent by the petitioner to the opposite party. Exhibit A4 Postal receipt. Documents of the opposite party. Exhibit B1 Copy of certificate dated 25/9/07. Exhibit B2 Copy of certificate of Hospital treatment dt.21/8/07. Exhibit B3 Medical Attendant's certificate dt. 21/8/07. Exhibit B4 Copy of proposal of the policy dt. 26/3/07. Exhibit B5 Copy of medical examiner's confidential report. By Orders,
Senior Superintendent. Kgr/4 copies.
......................Bindhu M Thomas
......................Santhosh Kesava Nath P | | 
