BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ADDITIONAL BENCH, MANGALORE
Dated this the 20th May 2017
PRESENT
SRI VISHWESHWARA BHAT D : HON’BLE PRESIDENT
SRI T.C. RAJASHEKAR : HON’BLE MEMBER
ORDERS IN
C.C.No.209/2013
(Admitted on 12.8.2013)
Balakrishna P Shetty,
S/o Late Parameshwara Shetty,
Aged about 57 years,
Pallki Restaurant,
Opp. Jyothi Talkies, Balmatta,
Mangalore.
….. COMPLAINANT
(Advocate for the Complainant: Sri JRN)
VERSUS
The manager
Life Insurance Corporation of India,
Branch I, Popular Building,
K.S.Rao Road,
Mangalore 575001.
…...........OPPOSITE PARTY
(Advocate for the Opposite Party: Sri. MSKP)
ORDER DELIVERED BY HON’BLE MEMBER
SRI T.C. RAJASHEKAR:
I. 1. The above complaint filed under Section 12 of the Consumer Protection Act 1986 alleging deficiency in service against the Opposite Party claiming, to pay a sum of Rs.1,00,000/ to the complainant the assured benefit under policy No.626236584, to pay a sum of Rs.5,000/ towards mental agony, to pay the cost of Rs.5,000/.
2. In support of the above complaint the complainant Mr. Balakrishna P. Shetty, filed affidavit evidence as CW1 and answered the interrogatories served on him and produced documents got marked at Ex.C1 to C3 as detailed in the annexure here below. On behalf of the opposite party Mrs. M. Jacintha Pais, (RW1) Manager, L and HPF, LIC of India, also filed affidavit evidence answered the interrogatories served on her and produced documents got marked at Ex.R1 to R12 as detailed in the annexure here below.
The brief facts of the case are as under:
We have perused the complaint and the version of the parties. The dispute is with regard to repudiation of the LIC policy for non disclosure of pre disease. The complainant alleges that his brother has obtained a life policy and the complainant is the nominee. His brother expired and the complaint submitted the claim, but opposite party repudiated the claim on the ground that the insured has taken treatment of pulmonary TB and since 2007 he was under treatment. The complainant alleged the opposite party has examined the insured and issued the policy hence they cannot raise the issue of non-disclosure. The opposite party contended that as per hospital records the insured was suffering from Pulmonary TB since 2007 which is not disclosed in the proposal form. Hence as per terms of the insurance policy it amounts to non disclosure of material facts and hence the opposite party is not liable to settle the claim and hence there is no deficiency in service on their part. These are being the facts of dispute we are of the view to decide the following
POINTS FOR ADJUDICATION
We traversed through the documents produced and the evidence lead by the parties. The admitted facts are, the issue of the policy to the deceased insured and the complainant is the nominee. The death of the insured on 02.10.2011 and the policy commence from the date of 06.01.2011. It is admitted the repudiation of the policy on the ground of non-disclosure of pre-disease Pulmonary TB. It is denied by the complainant that the deceased insured was suffering from the Pulmonary TB and he was taking treatment at the time of proposing for the policy. Admissions and denials reconciled and the following points are taken for consideration in resolving this dispute.
- Whether the complainant is the consumer under the consumer protection Act 1986?
- Whether opposite party proves the deceased insured suppressed the material facts while proposing for the life insurance policy and violates the terms of the policy?
- Whether the complainant is entitled for the relief prayed for?
- What order?
On having close examination of the materials available on record, we have taken note of the notes of arguments filed by the parties and heard the submissions of the party counsels. We answered the above points as under.
- In the affirmative.
- In the affirmative.
- In the negative.
- As per delivered order.
REASON
POINT NO 1: We have observed in the EX C 1 is the copy of the policy taken in the name of the deceased insured Ramakrishna B. Formerly it was nominated in the name of Leelavathi P shetty related as mother of the life assured. It is seen from record, later the nomination was changed in the name of the complainant herein. As such the complainant has become the claimant on death of the life assured and has become consumer as per law and the opposite party is the service provider. Hence we answered the point no 1 in the affirmative.
POINT NO 2&3: The summation of the dispute is the opposite party repudiated the LIC policy on the false ground of non disclosure of pre diseases alleged by the complainant. The complainant denied that the deceased insured was suffering from any disease and the opposite party have examined the life assured and issued the policy. The opposite party in assailing the complainant contention stated that they have proof of medical record and their investigators found the life assured was under treatment for Pulmonary TB since 2007 hence there is non disclosure of the material facts. As such it is the opposite party burden to prove there is non-disclosure of pre-disease by the life assured hence the point no 2 taken for consideration.
2. The opposite party produced the EX R 3 PROPOSAL FOR INSURANCE ON OWN LIFE. In page 6 there is declaration by the life assured to the effect that the life assured has agreed and declared that these statements and the declarations shall be the basis of the contract of assurance between him and the life Insurance Corporation of India and that if any untrue averment be contained therein the said contract shall be absolutely null and void and all money which shall have been paid in respect there of shall stand forfeited to the corporation. The page 4 of the proposal Form contains the personal history to be declared by the life assured. The question No (a) &(b) are direct question on the history of illness to be answered by the life assured. The question to be answered is, in last five years whether the life assured consulted any doctors for any ailment requiring treatment more than a week? And whether he had ever been admitted to any hospital for check up, observation, treatment or operation? The answer given by the life assured is in the negative.
3. The opposite party has produced the hospital medical reports as EX R 7. The page No 10 and 20 shows that the deceased insured was suffering from Pulmonary TB since 2007 and page No 38 & 40 shows he was admitted and treated Pulmonary TB in 2009 and page no 42 shows he has taken treatment for Pulmonary TB in 2008 also. TB is the protracted illness and needs continuous treatments and the deceased insured has taken treatment continuously and succumbed due to the same illness on 02.10.2011 after admitting on 21.09.2011 as per EX R 7 page 2. It is difficult to believe the deceased insured was not known these treatments and the illness he was suffering from at the time of proposing for the Life insurance. We are of the view that the deceased insured was known about his illness and of undergoing treatment but not disclosed it at the time of taking policy on 06.01.2011 from the opposite party. Hence there is breach of policy condition. It is pertinent to note that the deceased insured expired within one year of the policy taken and section 45 of the Insurance Act 1938 is not applicable. We hold the deceased insured had suppressed the material facts in spite knowing he is suffering from the Pulmonary TB and taking continuous treatment from 2007 till his death as a result of the same disease which he suppressed. We hold the opposite party proved the suppression of facts and there is no deficiency in service from the part of the opposite party and hence we answered the point No 2 in the affirmative and the point no 3 in the negative.
POINT NO 4: In the light of the above discussions and the adjudication of above points we deliver the following
ORDER
The complaint is dismissed. No cost.
Copy of this order as per statutory requirements, be forwarded to the parties free of cost and file shall be consigned to record room.
(Page No.1 to 7 directly typed by Member, revised and pronounced in the open court on this the 20th May 2017)
MEMBER PRESIDENT
(T.C. RAJASHEKAR) (VISHWESHWARA BHAT D)
D.K. District Consumer Forum D.K. District Consumer Forum
Additional Bench, Mangalore. Additional Bench, Mangalore.
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 : Mr. Balakrishna P. Shetty
Documents marked on behalf of the Complainant:
Ex.C1: Copy of Insurance policy No. 626236584.
Ex.C2: Copy of letter dated 4.4.2013.
Ex.C3: Copy of nomination.
Witnesses examined on behalf of the Opposite Party:
RW1: Mrs. M. Jacintha Pais, Manager, L and HPF, LIC of India
Documents marked on behalf of the Opposite Party:
Ex.R1: Policy bond No.626236584 on the life of late Ramakrishna B.
Ex.R2: Review slip in the policy.
Ex.R3: Proposal form
Ex.R4: SSLC Marks Card
Ex.R5: 04.04.2013: Repudiation letter
Ex.R6: Form for obtaining medical opinion from DMR/ZMR in respect of claim case.
Ex.R7: 28.02.2013: Letter from LIC Do.II enclosing 34 certified case papers of Ramakrishna.
Ex.R8: Affidavit of complainant while filing claim before Opposite Party with enclosures.
Ex.R9: Death Certificate of Life Assured.
Ex.R10: Claimants statement
Ex.R11: Certificate of Hospital treatment.
Ex.R12: Certificate of identity and burial of cremation.
Dated: 20.5.2017 MEMBER
