BEFORE THE DISTRICT CONSUMER FORUM :: WARANGAL
Present : Sri D. Chiranjeevi Babu,
President.
And
Patel Praveen Kumar,
Member.
Wednesday, the 08th day of June, 2011.
CONSUMER COMPLAINT No.49/2010
Between:
Smt.Lavudya Anasurya,
W/o late Santhosh,
Age: 36 yrs, Occ: Household,
R/o Ramnagarthanda H/o Kashimdevpeta,
Mandal Mulugu, District Warangal.
… Complainant
And
1) The LIC of India,
Rep. by its Branch Manager,
Branch Office, Hanamkonda Branch,
Warangal.
2) The LIC of India,
Rep. by its Senior Divisional Manager,
Divisional Office, Balasamudram,
Hanamkonda, Warangal District.
… Opposite Parties
Counsel for the Complainant :: Sri G.Rajendra Prasad, Advocate.
Counsel for the Opposite Parties :: Sri K.S.Raju, Advocate.
This complaint is coming for final hearing before this Forum, the Forum pronounced the following order.
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ORDER
Sri D. Chiranjeevi Babu, President.
This complaint is filed by the complainant Lavudya Anasurya against the opposite parties under section 12 of Consumer Protection Act, 1986 for a direction to pay the policy amount of Rs.1,50,000/- with interest @12% p.a. from the date of death of the deceased, to award Rs.5,000/- towards damages and costs.
The brief averments contained in the complaint filed by the complainant is as follows:
The case of the complainant is that she is the wife of the deceased Lavudya Santosh who died on 02-03-2008 with fever. The deceased worked as Driver in APSRTC, Parkal depot. During his life time, the deceased Santosh obtained (03) LIC policies, in which (02) policies were settled, but the Policy bearing NO.688141006 for Rs.50,000/- commenced from 07-02-2008 under the table and term 133-15 i.e, Jeevan Mitra-Triple Cover Endowment Assurance Plan (With profits) premium payable under Salary Saving Scheme for which the complainant is the nominee and the said policy was not settled by the opposite parties. After the death of her husband, the complainant approached the opposite party No.1 and submitted the claim form along with relevant documents, but the opposite parties dragged the matter, and lastly they have repudiated the claim vide letter dated 31-03-2010 stating that the life assured had availed sick leaves on number of occasions before the date of proposal. The repudiation grounds mentioned in their letter by opposite parties are not based on record. The complainant is entitled Triple Cover of sum assured under the above said policy. The act of opposite parties amounts to deficiency of service. Hence, filed this complaint praying to direct the opposite parties to pay Policy amount of Rs.1,50,000/- with interest and to award damages of Rs.5,000/- with costs.
The opposite parties filed the Written Version stating that it is true the life assured had taken the policy under Salary Savings Scheme. As per the intimation received by Hanamkonda branch Office that the life assured died on 2-03-08, the death of life assured occurred within one month of taking the aforesaid policy, treating the same as a very early claim, an investigation was caused into the bonafides of the claim, so as to take a decision on its admissibility. During the course of the said investigation, it came to light that the deceased life assured had availed Leave on Sick Grounds prior to
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date of proposal under the aforesaid policy i.e, for a period of 9 days from 19-04-06 to 27-04-06, and also for a period of (27) days from 6-6-06 to 02-07-06, yet another 25 days of leave on sick grounds from 19-2-07 to 16-03-07. In addition to the above said dates, the deceased life assured had availed leave on sick grounds for the following periods in the five years prior to the date of taking the above said policy. F.No.3787, Claim Form E furnished by the Depot Manager, APSRTC, Warangal II Depot which is marked as Exhibit clearly establishes the fact that the deceased life assured
had intentionally suppressed the material facts related to his ill health and treatment therefore undergone by him, thus attracting the provisions of Section 45 of Insurance Act. Thus the complainant suppressed the material facts and obtained policy so Section 45 of Insurance Act is applicable to this case and requested this Forum to dismiss this case.
The complainant in support of her claim, filed her Affidavit in the form of chief examination and also marked A-1 to A-5. On behalf of opposite parties Sri V.Bhaskar filed his Affidavit in the form of chief examination and also marked Exs.B-1 to B-3.
Now the point for consideration is:
1) Whether there is any deficiency of service on the part of the opposite parties?
2) If so, to what Relief?
Point No.1:-
Both the Advocates argued the matter elaborately. The opposite parties counsel argued that this case is comes under suppression of material facts and Section 45 of Insurance Act is Applicable to this case because at the time of taking the policy by the insured i.e, the deceased has suppressed his sick leaves in the proposal form. So when he suppressed the facts in proposal form certainly it comes under suppression of material facts and section 45 of Insurance Act is applicable.
For this the complainant’s counsel argued that whatever the arguments advanced by the opposite parties counsel is not at all valid to this case because in this case as per the arguments of opposite parties counsel that the deceased obtained so many leaves for his ill health and he has not mentioned the same leaves in column of the proposal form. It is not the big error as per the arguments of complainant counsel.
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After arguments of both side counsels we are of the opinion that it is a fit case for repudiation of the claim. Because during the course of investigation by the insurance, it came to the light that the deceased life assured had availed leave on sick grounds prior to date of proposal under the aforesaid policy i.e, for a period of 9 days from 19-04-06 to 27-04-06, and also for a period of (27) days from 6-6-06 to 2-7-06, yet another 25 days of leave on sick grounds from 19-2-07 to 16-03-07. In addition to the above said dates, the deceased life assured had availed leave on sick grounds for the following periods in the five years prior to the date of taking the above said policy. F.No.3787, Claim Form E furnished by the Depot Manager, APSRTC, Warangal II Depot which is marked as Exhibit clearly establishes the fact that the deceased life assured had intentionally suppressed the material facts related to his ill health and treatment therefore undergone by him, thus attracting the provisions of Section 45 of Insurance Act.
Further Ex.B-1 is the proposal form, Ex.B-2 is the Certificate by Employer, Ex.B-3 is the leave record. These documents clearly goes to show
that the deceased obtained sick leaves for his illness. Further at the time of taking the policy he has mentioned in his proposal form under 11 (a) During the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week. He stated No. Further under 11 © Have you remained absent from place of work on grounds of health during the last 5 years, he replied NO. Lastly as per 11 (g) Did you ever have any accident or injury, he replied No. So these all were comes under suppression of material facts because as per the arguments of opposite parties counsel that the deceased obtained so many leaves we already stated in supra but he has not mentioned in Ex.B-1. We also accept that the deceased has not mentioned in Ex.B-1 with regard to the sick leaves and he was sick. So when he has not mentioned in Ex.B-1 certainly it comes under suppression of material facts and Section 45 of Insurance Act is applicable to this case.
Further in Ex.B-3 Medical Certificate and Fitness Certificate also issued by Doctor in it the name and number of the driver is also mentioned in it. It clearly mentioned that the deceased applied sick leave and sick leave forms also filed by the opposite parties. Those clearly goes to show that the deceased applied sick leave. When the deceased applied sick leave and when he has not mentioned the same in proposal form certainly it comes under suppression of material facts and Section 45 of Insurance Act is applicable.
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In proposal form for insurance dated 07-02-2008 were suppressed facts which were material to disclose, and that the said statements were fradulently made by the proposer and that the proposer knew at the time of making the statement that it was false to his knowledge, thereby fully attracting the provisions of Section 45 of Insurance Act, 1938.
On suppression of material facts the following judgments are filed by the opposite parties counsel i.e, in Civil Appeal No.5322 of 2007 in SLP © NO.23951 of 2005 in PC CHACKO and another Vs LIC of India and others as pronounced by Hon”ble Judtice SB Singha of Supreme Court of India, an insurer can repudiate the contract of life insurance under S.45 of Insurance Act for suppression of material facts by the proposer.
Insurance Act, 1938 – S.45 – Repudiation of claim under insurance policy on ground of mis-stament –Held misstatement by itself not reason for recission of the policy unless the same is material in nature – However a deliberate wrong answer given by insured have a great bearing on contract of insurance may lead to policy being vitiated in law – Policy can be repudiated if obtained with a fraudulent act.”
Another judgment in State Consumer Disputes Redressal Commission, Mumbai
LIC of India … Appellant
Vs
Smt Pratibah Shivraj Jondhate … Respondents
(through L.Rs.)
Head Notes:- The claim was repudiated on the ground that the deceased life assured had not disclosed about medical heave availed by him at the time of
proposal. District Forum allowed the complaint, hence this appeal.
Held: that the deceased life assured was know of his ailment and also availed leave before submission of proposal form. Thereby he had suppressed the fact of his ailment and his absence from place of work on ground of health. Appeal allowed.
This judgment is clearly applicable to the case of the opposite parties because in the present case also the deceased availed sick leave from 19-04-06 to 27-04-06, and also for a period of (27) days from 6-6-06 to 2-7-06, yet another 25 days of leave on sick grounds from 19-2-07 to
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16-03-07. He has not mentioned in proposal form. So these all are comes under suppression of material facts, so the above citation is applicable to the case of opposite parties.
On the basis of the above 2 citations i.e, PC Chacko and another Vs LIC of India and others and LIC of India Vs Smt.Prathiba Shivaraj (through L.Rs.), we come to the conclusion that the deceased suppressed the material facts so, Section 45 of Insurance act is applicable and the complainant is not entitled to get anything from the opposite parties and we answered this point accordingly in favour of the opposite parties against the complainant.
Point NO.2: To what Relief:- The first point is decided in favour of opposite parties against the complainant this point is also decided in favour of opposite parties against the complainant.
In the result this complaint is dismissed without costs.
(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum today, the 8th June, 2011).
President Male Member
District Consumer Forum, Warangal.
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
On behalf of Complainant On behalf of Opposite Parties
Affidavit of complainant filed. Affidavit of opposite parties filed.
EXHIBITS MARKED
ON BEHALF OF COMPLAINANT
1. Ex.A-1 is the Status Report of the Policy No.688141006.
2. Ex.A-2 is the letter from opposite parties to complainant, dt.31-03-10.
3. Ex.A-3 is the Death Certificate issued by Thaisildar, Mulugu Mandal, District Warangal.
4. Ex.A-4 is the Benefits of Jeevan Mitra – Triple Cover Endowment Assurance Plan (with profits).
5. Ex.A-5 is the Provisions of Jeevan Mitra _ Triple Cover Endowment Assurance plan (with profits).
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ON BEHALF OF OPPOSITE PARTIES
1. Ex.B-1 is the proposal for insurance of the deceased L.Santosh.
2. Ex.B-2 is the Certificate by the employer.
3. Ex.B-3 is the 13 pages of sick leave record furnished by Depot Manger, Warangal depot.
PRESIDENT
