The Manager, LIC of India, Raichur V/S Smt. Raghamma S. Mutalik W/o. Late Srinivas R. Mutalik, Lingasugur - Consumer Court Case

Karnataka

Raichur

CC/10/56

Smt. Raghamma S. Mutalik W/o. Late Srinivas R. Mutalik, Lingasugur - Complainant(s)

Versus

The Manager, LIC of India, Raichur - Opp.Party(s)

Sri. C. Pandu

18 Nov 2010

ORDER

Dist. Consumer Disputes Redressal Forum, Sath Kacheri, Raichur.
Dist. Consumer Disputes Redressal Forum, Sath Kacheri, Raichur.
consumer case(CC) No. CC/10/56

Smt. Raghamma S. Mutalik W/o. Late Srinivas R. Mutalik, Lingasugur						...........Appellant(s)
Vs.
The Manager, LIC of India, Raichur						...........Respondent(s)

BEFORE:

Complainant(s)/Appellant(s):

OppositeParty/Respondent(s):

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ORDER

JUDGEMENT By Sri. Pampapathi President:- This is a complaint filed by complainant through his mother Smt. Raghamma against the opposite LIC of India U/sec. 12 of Consumer Protection Act for to direct the opposite to pay sum of Rs. 1,00,000/- with upto date bonus and interest. 2. The brief facts of the complainants case are that, late Srinivas R. Mutalik is the husband of Smt. Raghamma whos is the mother of complainant late Srinivas R. Mutalik subscribed LIC policy for assured sum of Rs. 1,00,000/- from opposite LIC of India. He paid regular premium, he died on 02-10-07 while the policy was inforce. The present complainant is the nominee under the said policy. He filed claim petition through his natural mother Raghamma before opposite, but opposite repudiated his claim on untenable grounds, it shows its negligence in settling the claim and thereby opposite found guilty under deficiency in its service, as such he filed this complaint for the reliefs as noted in it. 3. The opposite LIC of India appeared in this case through Advocate, filed its written version by contending that, late Srinivas R. Mutalik died due to Pulmonary T.B. He took treatment with Dr. M.V. Joshi in Mudgal, thereafter he got treated from 2004-07 in the Government Hospital at Lingasugur. This fact was not disclosed by insured Mutalik and obtained LIC policy by mis-representing the fact regarding his health condition. This was noticed after detail enquiry by the LIC therefore the claim of complainant was repudiated and directed to approach Insurance Ombudsman and prayed for to dismiss the complaint among other grounds. 4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that: 1. Whether the complainant proves that, deceased Srinivas R. Mutalik subscribed LIC for assured sum of Rs. 1,00,000/- bearing Policy No. 662273235 from opposite LIC of India at his life time, he paid premium regularly. He died on 02-10-07 while policy was inforce, thereafter the complainant being the nominee under the said policy filed his claim petition through his natural mother Smt. Raghamma before opposite LIC, but it shown its negligence in settling his claim and repudiated the claim on untenable grounds and thereby opposite found guilty under deficiency in its service.? 2. Whether complainant is entitled for the reliefs as prayed in his complaint.? 3. What order? 5. Our findings on the above points are as under:- (1) In the affirmative (2) As discussed in the body of this judgement and as noted in the final order. (3) In-view of the findings on Point Nos. 1 & 2, we proceed to pass the final order for the following : REASONS POINT NO.1 :- 6. To prove the facts involved in these two points, affidavit-evidence of natural mother of complainant was filed, she was noted as PW-1. The documents Ex.P-1 to Ex.P-9 are marked. On the other hand affidavit-evidence of Manager of opposite LIC Branch Manager, was filed, he was noted as RW-1. The documents Ex.R-1 to Ex.R-8 are marked. 7. On perusal of the pleadings of the parties and their respective affidavit-evidences and documents filed. We have noted some of the following undisputed facts in between the parties are:- 1. It is undisputed fact that, deceased Srinivas. R. Mutalik had obtained LIC policy bearing No. 662273235 for assured sum of Rs. 1,00,000/- from opposite LIC. 2. It is further undisputed fact that, the present complainant Pavan Mutalik is the nominee under the said policy. 3. It is undisputed fact that, said minor complainant is now under the care and custody of his natural mother Smt. Raghamma. 4. It is also undisputed fact that, Srinivas R. Mutalik died on 02-10-07 while policy was in force. 5. It is also undisputed fact that, the present complainant filed claim petition before LIC with necessary records and opposite repudiated his claim. 8. In the light of these undisputed facts, now let us examine the reasons for repudiating the claim under the policy by opposite LIC. It appears from the written version and affidavit-evidence of RW-1 and the submissions made by the learned advocate for opposite that, repudiation of the claim of the complainant was on only one ground, that is the said Srinivas R. Mutalik suppressed the material facts regarding his health condition in his proposal form and subscribed LIC by not disclosing the fact that, he was suffering from Pulmonary T.B. and treatment taken with one Dr. Joshi of Mudgal and after that, he taken treatment from 2004 to 2007 in Government Hospital at Lingasgur. Suppression of this material facts is in violation to the terms and conditions of the policy, therefore it repudiated the claim of the complainant. 9. In the light of these undisputed facts and disputed facts, we are of the view that, some of the documents filed by the complainant need not require any appreciation as those are relating to the policy and legal notices issued to opposite. 10. Now it is settled principles of law that, the burden of proving the suppression of material facts by the complainant is on opposite LIC. To discharge this burden, opposite relied on the affidavit-evidence of RW-1 and documents Ex.R-1 to Ex.R-8. Among those documents Ex.R-1, Ex.R-4, Ex.R-4(1) and Ex.R-5 are documents required our appreciation as the defence of opposite stands on those documents. 11. Ex.R-1 is the copy of the proposal form which is dt. 21-06-06, Ex.R-4 is the certificate issued by Medical Officer, Government Hospital, Lingasgur, Ex.R-4(1) is the Treatment Card of Srinivas.R. which shows that, he was suffering from Pulmonary T.B. Ex.R-5 is the certificate issued by Dr. Joshi Private Practitioner, dt. 27-09-08. 12. Admittedly Srinivas.R. died on 02-10-07. Ex.R-1 which is similar to Ex.P-1 is the proposal form filed by Srinivas R. Mutalik at the time of subscribing LIC policy from opposite, certainly it does not disclose any kind of disease said to have suffered by Srinivas.R.Mutalik prior to declaration in proposal form. He declared as No in column No. 11(E) of it which refers to his previous heal condition. 13. Now coming to the documents Ex.R-3, the LIC policy dt. 28-07-06. Ex.R-4 & Ex.R-4(1) shows that the said Srinivas took treatment for T.B. of the first stage from 14-10-05. Ex.R-5 is the certificate issued by Private doctor which has no information to say that, this certificate refers to this deceased Srinivas.R. Mutalik. So Ex.R-4 which is a certificate issued by Government Hospital at Lingasgur and treatment card Ex.R-4(1) discloses the treatment taken by deceased for T.B. Now the question before us is whether such T.B. causes instantaneous death of Srinivas and it promoted him to subscribe this policy with a malafide intention to get wrongful gain out of it. In this regard we have referred number of rulings reported in: 1. 1996 III CPJ SC LIC of India V/s. Smt. Channabasamma. 2. 1997 10 SCC 538 Collector of Customs Calcutta V/s. Tin Plate India 3. 2005 CTJ 377 CP (NC) National Insurance Company V/s.Bipul Kunna and also I 2009 CPJ 161 (NC) Vanita Ben Retilal Fulbaria V/s. LIC of India. 14. The learned advocate for opposite LIC referred the following judgments : 1. A copy of judgment under the case NO. 31/2010 DCF Raichur. 2. A copy of Supreme Court Judgment under a case A.P. No. 5322/2007. 3. A copy of judgment under a case R.P. NO. 649/2005. 4. A copy of Suprme Court Verdict on repudiation of policy in the Newspaper. 15. The facts and circumstances discussed by us in our earlier judgments in CC.No. 31/10 noted at Sl.No.1 are the different to the facts and circumstances of this case. 16. As regards to other rulings referred by the learned advocate for opposite, we are of the view with great respect to their lordships that, the facts and circumstances discussed in the said rulings are not similar to the facts and circumstances of this case. Mere suffering from Pulmonary T.B., one cannot say that it is a disease of such dangerous in nature which would cause Instantaneous death. Apart from it there are no grounds to say that, deceased Srinivas R. Mutalik intentionally suppressed such decease only with an intention to get wrongful gain out of that policy, accordingly we are of the view that, repudiation of the claim of complainant on that ground is deficiency in its service. Directing the complainant to approach LIC Ombudsman or any before other forms is not a service required to be done by LIC of India in the present case, accordingly we conclude that, opposite failed in proving this aspect of its case and thereby it committed the deficiency in its service and we answered Point NO-1 in affirmative. 16. Admittedly the policy is for assured sum of Rs. 1,00,000/- as such the complainant is entitled for to get that policy amount with bonus, if he is eligible. 17. As regards to deficiency in service the complainant is entitled to get a lumpsum amount of Rs. 3,000/- from opposite LIC. He also entitled to get another lumpsum amount of Rs. 3,000/- towards cost of this litigation. Hence totally he is entitled to get Rs. 1,06,000/- from opposite with interest at the rate of 9% p.a. from the date of this complaint till realization of the full amount, accordingly we answered Point NO-2. POINT NO.3:- 18. In view of our findings on Point Nos-1 & 2, we proceed to pass the following order: ORDER The complaint filed by the complainant is partly allowed with cost. The complainant and his mother Smt. Raghamma are entitled to recover a total amount of Rs. 1,06,000/- fom opposite LIC of India. The complainant and his mother Raghamma are also entitled to recover interest at the rate of 9% p.a. on the above total sum of Rs. 1,06,000/- from the date of the complaint till realization of the full amount. Opposite is granted one month time to comply the above order from the date of this judgment. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 17-11-10) Sd/- Sri. Pampapathi, President, District Forum-Raichur. Sd/- Sri. Gururaj, Member, District Forum-Raichur. Sd/- Smt.Pratibha Rani Hiremath, Member. District Forum-Raichur.

JUDGEMENT By Sri. Pampapathi President:- This is a complaint filed by complainant through his mother Smt. Raghamma against the opposite LIC of India U/sec. 12 of Consumer Protection Act for to direct the opposite to pay sum of Rs. 1,00,000/- with upto date bonus and interest. 2. The brief facts of the complainants case are that, late Srinivas R. Mutalik is the husband of Smt. Raghamma whos is the mother of complainant late Srinivas R. Mutalik subscribed LIC policy for assured sum of Rs. 1,00,000/- from opposite LIC of India. He paid regular premium, he died on 02-10-07 while the policy was inforce. The present complainant is the nominee under the said policy. He filed claim petition through his natural mother Raghamma before opposite, but opposite repudiated his claim on untenable grounds, it shows its negligence in settling the claim and thereby opposite found guilty under deficiency in its service, as such he filed this complaint for the reliefs as noted in it. 3. The opposite LIC of India appeared in this case through Advocate, filed its written version by contending that, late Srinivas R. Mutalik died due to Pulmonary T.B. He took treatment with Dr. M.V. Joshi in Mudgal, thereafter he got treated from 2004-07 in the Government Hospital at Lingasugur. This fact was not disclosed by insured Mutalik and obtained LIC policy by mis-representing the fact regarding his health condition. This was noticed after detail enquiry by the LIC therefore the claim of complainant was repudiated and directed to approach Insurance Ombudsman and prayed for to dismiss the complaint among other grounds. 4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that: 1. Whether the complainant proves that, deceased Srinivas R. Mutalik subscribed LIC for assured sum of Rs. 1,00,000/- bearing Policy No. 662273235 from opposite LIC of India at his life time, he paid premium regularly. He died on 02-10-07 while policy was inforce, thereafter the complainant being the nominee under the said policy filed his claim petition through his natural mother Smt. Raghamma before opposite LIC, but it shown its negligence in settling his claim and repudiated the claim on untenable grounds and thereby opposite found guilty under deficiency in its service.? 2. Whether complainant is entitled for the reliefs as prayed in his complaint.? 3. What order? 5. Our findings on the above points are as under:- (1) In the affirmative (2) As discussed in the body of this judgement and as noted in the final order. (3) In-view of the findings on Point Nos. 1 & 2, we proceed to pass the final order for the following : REASONS POINT NO.1 :- 6. To prove the facts involved in these two points, affidavit-evidence of natural mother of complainant was filed, she was noted as PW-1. The documents Ex.P-1 to Ex.P-9 are marked. On the other hand affidavit-evidence of Manager of opposite LIC Branch Manager, was filed, he was noted as RW-1. The documents Ex.R-1 to Ex.R-8 are marked. 7. On perusal of the pleadings of the parties and their respective affidavit-evidences and documents filed. We have noted some of the following undisputed facts in between the parties are:- 1. It is undisputed fact that, deceased Srinivas. R. Mutalik had obtained LIC policy bearing No. 662273235 for assured sum of Rs. 1,00,000/- from opposite LIC. 2. It is further undisputed fact that, the present complainant Pavan Mutalik is the nominee under the said policy. 3. It is undisputed fact that, said minor complainant is now under the care and custody of his natural mother Smt. Raghamma. 4. It is also undisputed fact that, Srinivas R. Mutalik died on 02-10-07 while policy was in force. 5. It is also undisputed fact that, the present complainant filed claim petition before LIC with necessary records and opposite repudiated his claim. 8. In the light of these undisputed facts, now let us examine the reasons for repudiating the claim under the policy by opposite LIC. It appears from the written version and affidavit-evidence of RW-1 and the submissions made by the learned advocate for opposite that, repudiation of the claim of the complainant was on only one ground, that is the said Srinivas R. Mutalik suppressed the material facts regarding his health condition in his proposal form and subscribed LIC by not disclosing the fact that, he was suffering from Pulmonary T.B. and treatment taken with one Dr. Joshi of Mudgal and after that, he taken treatment from 2004 to 2007 in Government Hospital at Lingasgur. Suppression of this material facts is in violation to the terms and conditions of the policy, therefore it repudiated the claim of the complainant. 9. In the light of these undisputed facts and disputed facts, we are of the view that, some of the documents filed by the complainant need not require any appreciation as those are relating to the policy and legal notices issued to opposite. 10. Now it is settled principles of law that, the burden of proving the suppression of material facts by the complainant is on opposite LIC. To discharge this burden, opposite relied on the affidavit-evidence of RW-1 and documents Ex.R-1 to Ex.R-8. Among those documents Ex.R-1, Ex.R-4, Ex.R-4(1) and Ex.R-5 are documents required our appreciation as the defence of opposite stands on those documents. 11. Ex.R-1 is the copy of the proposal form which is dt. 21-06-06, Ex.R-4 is the certificate issued by Medical Officer, Government Hospital, Lingasgur, Ex.R-4(1) is the Treatment Card of Srinivas.R. which shows that, he was suffering from Pulmonary T.B. Ex.R-5 is the certificate issued by Dr. Joshi Private Practitioner, dt. 27-09-08. 12. Admittedly Srinivas.R. died on 02-10-07. Ex.R-1 which is similar to Ex.P-1 is the proposal form filed by Srinivas R. Mutalik at the time of subscribing LIC policy from opposite, certainly it does not disclose any kind of disease said to have suffered by Srinivas.R.Mutalik prior to declaration in proposal form. He declared as No in column No. 11(E) of it which refers to his previous heal condition. 13. Now coming to the documents Ex.R-3, the LIC policy dt. 28-07-06. Ex.R-4 & Ex.R-4(1) shows that the said Srinivas took treatment for T.B. of the first stage from 14-10-05. Ex.R-5 is the certificate issued by Private doctor which has no information to say that, this certificate refers to this deceased Srinivas.R. Mutalik. So Ex.R-4 which is a certificate issued by Government Hospital at Lingasgur and treatment card Ex.R-4(1) discloses the treatment taken by deceased for T.B. Now the question before us is whether such T.B. causes instantaneous death of Srinivas and it promoted him to subscribe this policy with a malafide intention to get wrongful gain out of it. In this regard we have referred number of rulings reported in: 1. 1996 III CPJ SC LIC of India V/s. Smt. Channabasamma. 2. 1997 10 SCC 538 Collector of Customs Calcutta V/s. Tin Plate India 3. 2005 CTJ 377 CP (NC) National Insurance Company V/s.Bipul Kunna and also I 2009 CPJ 161 (NC) Vanita Ben Retilal Fulbaria V/s. LIC of India. 14. The learned advocate for opposite LIC referred the following judgments : 1. A copy of judgment under the case NO. 31/2010 DCF Raichur. 2. A copy of Supreme Court Judgment under a case A.P. No. 5322/2007. 3. A copy of judgment under a case R.P. NO. 649/2005. 4. A copy of Suprme Court Verdict on repudiation of policy in the Newspaper. 15. The facts and circumstances discussed by us in our earlier judgments in CC.No. 31/10 noted at Sl.No.1 are the different to the facts and circumstances of this case. 16. As regards to other rulings referred by the learned advocate for opposite, we are of the view with great respect to their lordships that, the facts and circumstances discussed in the said rulings are not similar to the facts and circumstances of this case. Mere suffering from Pulmonary T.B., one cannot say that it is a disease of such dangerous in nature which would cause Instantaneous death. Apart from it there are no grounds to say that, deceased Srinivas R. Mutalik intentionally suppressed such decease only with an intention to get wrongful gain out of that policy, accordingly we are of the view that, repudiation of the claim of complainant on that ground is deficiency in its service. Directing the complainant to approach LIC Ombudsman or any before other forms is not a service required to be done by LIC of India in the present case, accordingly we conclude that, opposite failed in proving this aspect of its case and thereby it committed the deficiency in its service and we answered Point NO-1 in affirmative. 16. Admittedly the policy is for assured sum of Rs. 1,00,000/- as such the complainant is entitled for to get that policy amount with bonus, if he is eligible. 17. As regards to deficiency in service the complainant is entitled to get a lumpsum amount of Rs. 3,000/- from opposite LIC. He also entitled to get another lumpsum amount of Rs. 3,000/- towards cost of this litigation. Hence totally he is entitled to get Rs. 1,06,000/- from opposite with interest at the rate of 9% p.a. from the date of this complaint till realization of the full amount, accordingly we answered Point NO-2. POINT NO.3:- 18. In view of our findings on Point Nos-1 & 2, we proceed to pass the following order: ORDER The complaint filed by the complainant is partly allowed with cost. The complainant and his mother Smt. Raghamma are entitled to recover a total amount of Rs. 1,06,000/- fom opposite LIC of India. The complainant and his mother Raghamma are also entitled to recover interest at the rate of 9% p.a. on the above total sum of Rs. 1,06,000/- from the date of the complaint till realization of the full amount. Opposite is granted one month time to comply the above order from the date of this judgment. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 17-11-10) Sd/- Sri. Pampapathi, President, District Forum-Raichur. Sd/- Sri. Gururaj, Member, District Forum-Raichur. Sd/- Smt.Pratibha Rani Hiremath, Member. District Forum-Raichur.