Per:  K.V.Krishna Murthy:   

            The deceased policy holder’s wife is the complainant.  The policy holder had taken Jeevan Anand policy on 28-10-2010.  The sum assured was Rs.1,50,000/-.  Half-yearly premium of Rs.5,834/- has been paid.  He died on 10-05-2011 due the mouth cancer.  Claim for the insured amount was made subsequent to 18-06-2013.  An investigation was conducted and the insurance company repudiated the claim as per letter Ex.A.5 dated
03-4-2014.  Hence the claim for sum assured compensation and costs.

            2.  It is pertinent to notice that the averments in paragraph – 3 of the complaint, as such the same is extracted herein below;

“xxxx, thereafter on 10-05-2011 the husband of the complainant died due to Cancel of Mouth Ulcer and heart attach.  But, while assuring his life, the husband of complainant was hale and healthy and was no suffering with any diseases.  But, later on he died due to cancel and mouth ulcer and heart attack, the husband of complainant died.”

            3.  In the written version, OP contended as follows;

“The averments made in the column no 3 in complaint, the Complainant herself stated that her husband has died due to Cancer of Mouth Ulcer disease.  It is evidence from above facts that, the deceased used to consult the Doctor occasionally for the last one year prior to the date of death as per letter dated 24-03-2014 issued by the Dr.Manohar.B.Havinal, who has treated prior to death of the Deceased Life assured and mentioned that the deceased was operated for Ulcer on one side of the Mouth and there was a scar on the other side of the Mouth which indicated the symptoms of the Mouth Ulcer and was referred to Hubli or Bangalore for further treatment.  Copy of the Dr. Letter dated 24.03.2014 is enclosed herewith.

It’s clearly shows that, the complainant’s husband made false statement and suppressed his illness prior to the date of proposal i.e. 30.10.2010 and he did not disclose the matter at the time of making of policy.  These facts revealed that policy holder suppressed the material facts i.e, Cancer of Mouth Ulcer decease.  Hence these Opponents repudiated the claim of the complainant.

In the Porposal dated 30.10.2010 the deceased Life Assured has answered the following questions as under noted in the proposal form.

Further states that it is well settled principle of law, the contract of Insurance between Insurer and Insured is made in Utmost good faith and suppression of any material information at the time of submission of proposal/renewal of Insurance would justify the repudiation of claim by Insurer.  The Deceased Life Assured has made deliberate misstatements and with hold material information from us regarding his health at the time of effect the assurance.”

4.  The claimant’s statement is marked as Ex.A.4, in which document there is a certificate issued by Dr. Manohar.B.Havinal, R.M.O. Sri Jagadguru Gavisiddeshwara Ayurvedie Medical College & Hospital, Koppal, wherein he has clearly stated that the nature of the complaint was Cancer (mouth ulcer) and heart attack. 

5.  In Medical Attendance Certificate, Ex.A.2 issued by
Dr. Manohar.B.Havinal primary cause for death was mouth ulcer.  However, at the end he has mentioned as Mouth Cancer.

6.  There is a certificate issued by this doctor to the insurance company, which is produced at Ex.B.1 dated: 24-03-2014, which reads as follows

“THIS IS TO CERTIFY THAT LATE NARAYANSA S/O PARASHURAMSA BHAVIKATTI WAS OCCASIONALY CONSULTING ME AS OUT PATIENT DURING ONE YEAR PRIOR TO DATE OF DEATH.  BEFORE CONSULTING ME FOR TREATMENT I WAS INFORMED BY THE PATIENT THAT HE WAS OPERATED FOR ULCER ON ONE SIDE OF HIS MOUTH.  THERE WAS WOUND SCAR ON OTHER SIDE OF MONTH WHICH INDICATES THE SYMPTOMS OF ULCER.  I ADVISED HIM TO TAKE FURTHER TREATMENT EITHER AT HUBLI OR BANGALORE.”

7.  In the lawyer notice dated: 20-05-2014 as per Ex.A.6, it is stated as follows;

“That, my husband Late Narayanasa P Bhavikatti was assured his life with your corporation under policy No.665293505 for Rs.1,50,000/- on dated 30-10-2010.  Later on, on 10-05-2011 my husband died due to Cancer Mouth ulcer and heart attach.  But, while assuring his life, my husband was hale and healthy and was not suffering with any diseases.  But, later on he died due to cancer and mouth ulcer and heart attack, the husband of my client died.”

8.  The facts mentioned above are sufficient for us to conclude that the deceased was suffering from mouth cancer disease and died.  He was taking treatment from Dr.Manohar.B. Havinal during one year prior to his date of death.  Therefore he was under treatment for atleast one year prior to making proposal for policy on 28-10-2010.  So the reply given by him in Proposal Form, Ex.B.3 at page – 4 pertaining to his personal history in particular to question No. 11 (a) & 11 (b) must be false to his knowledge.  As such the LIC is justified in repudiating the claim on the ground of
mis-statement in the proposal form for insurance.

9.  For the reasons stated above, the complaint is without merits and therefore dismissed. 

// ANNEXURE //

List of Documents Exhibited for the Complainant.

Witnesses examined for the Complainant / Respondent.