Tamil Nadu

North Chennai

CC/90/2015

M/s.D.Ravi - Complainant(s)

Versus

the Manager, Life Insurance Corporation of India - Opp.Party(s)

G.Purushothaman

17 Apr 2017

ORDER

 

                                                            Complaint presented on:  25.05.2015

                                                                Order pronounced on:  17.04.2017

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,        PRESIDENT

                    TMT.T.KALAIYARASI, B.A.B.L.,           MEMBER II

 

MONDAY THE 17^th   DAY OF APRIL 2017

 

C.C.NO.90/2015

 

 

D.Ravi,

H/o.Late R.Jayanthi,

No.82, Sivan Nagar,

III Street, New Washermenpet,

Chennai – 600 081.

                                                                                    ….. Complainant

 

..Vs..

The Manager (LIC),

Life Insurance Corporation of India,

No.C47, II Avenue, Anna Nagar, Plaza,

3^rd Floor, Chennai Divisional Office – II,

Anna Nagar, Chennai – 600 040.

 

.....Opposite Party

Date of complaint                                 : 09.06.2015

Counsel for Complainant                      : M/s.G.Purushothaman & S.Baskar

Counsel for    Opposite Party                   : M.B.Gopalan, N.Vijayaraghavan&

                                                                 M.B.Raghavan       

 

 

 

 

O R D E R

 

BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,

          This complaint is filed by the complainant to direct the Opposite Party to pay a sum assured amount of Rs.2,00,000/- in respect of her policy and also compensation for mental agony with cost of the Complaint  u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The Complainant’s wife late R.Jayanthi, took a policy in the Opposite Party’s branch on 28.08.2013 and the  name of policy L.I.C. Jeevan Saral Life Insurance Corporation of India at Anna Nagar Branch for a sum assured amount of Rs.2,00,000/- and the Policy No.708030840, date of commencement on 28.08.2012 and date of maturity is on 28.08.2033. The premium installment of Rs.2525/- paid on 28.08.2013 and subsequently the policy was renewed and paid a sum of Rs.2,565/- along with late fee on 10.02.2014. The Complainant wife expired on 04.03.2014 at Government Stanley Hospital, Chennai and Corporation of Chennai has issued the death certificate on 12.08.2014. The Complainant applied for the claim sum assured with the documents (1) Original LIC Policy (2) Death Certificate (3) Claim Form on 08.09.2014 in the Anna Nagar Branch and also he received acknowledgement in the said branch.

 2. The Opposite Party sent a letter on 18.08.2014 to the Complainant that his wife was treated for the Disease of Diabetes Mellitus and Polyarthralgia for 7 years and to send details of such treatment to the Opposite Party. The Complainant replied that he do not know whether his wife was suffering with diabetic. He admitted her in the hospital as she was suffering from fever and she was died on the 3rd day due to sudden Cardiac Attack as stated by the doctor. The Doctor Certificate without affidavit in support cannot be made basis for repudiating the claim. The Complainant sent a legal notice on 05.05.2015 and the Opposite Party received a legal notice on 06.05.2015 and the Complainant received an acknowledgement card. The Opposite Party did not send any reply notice till date. Hence the Complainant filed this Complaint to direct the Opposite Party to pay a sum assured amount of Rs.2,00,000/- in respect of her policy and also compensation for mental agony with cost of the Complaint.  

3. WRITTEN VERSION OF THE  OPPOSITE PARTY IN BRIEF:

          The information disclosed in the proposal form was the basis on which the contract of insurance was entered between the Complainant and the Opposite Party and based on that the premium was fixed. The proposer was required to disclose truthfully, completely and specifically and the correct facts for each question and there cannot be any excuse for any suppression or misrepresentation of such “material facts”. The Complainant submitted Medical Attendant’s Certificate and Certificate of Hospital Treatment as part of the claim documentation, which were issued by Civil Asst. Surgeon, Government Stanley Medical College Hospital which revealed that the Complainant’s wife was

a. Suffering from Diabetes Mellitus for 7 years and Polyarthralgia     for 4 years before her death and

b. the primary cause of death itself was Type 2 Diabetes.

The policy availed by the Complainant’s wife was therefore null and void due to suppression of material facts in the proposal form and as a result no benefit can be claimed under the policy.

4. The Opposite Party’s repudiation of the claim in view of the suppression/misrepresentation of material facts in the proposal form cannot be considered to be deficiency in service. When the Stanley Hospital has confirmed Diabetes for 7 years and Polyarthralgia for 4 years, the Complainant cannot deny knowledge of the same and his denial is nothing but utter falsehood for the purpose of the claim. The Complainant himself has filed the Medical Attendant’s Certificate issued by the Civil Asst. Surgeon of Government Stanley Hospital and which was obtained and submitted by him for the purpose of the claim which would reveal cause of death as not due to “Cardiac Arrest” but due to Diabetes Mellitus. Therefore this Opposite Party has not committed any deficiency in service in repudiating the claim made by the Complainant and hence prays to dismiss the Complaint with cost.

5. POINTS FOR CONSIDERATION:

          1. Whether there is deficiency in service on the part of the opposite party?

          2. Whether the complainant is entitled to any relief? If so to what extent?

6. POINT NO :1 

          The admitted facts are that the Complainant wife late R.Jayanthi took a policy with the Opposite Party on 28.08.2013 in the name of LIC’s Jeevan Saral with profits and the Opposite Party issued Ex.A1 policy and the sum assured was Rs.2,00,000/- and the payment of premium quarterly at Rs.2,525/-. Ex.A2 is the 1^st premium and Ex.A3 is the renewal premium receipts and the said R.Jayanthi was admitted in the Government Stanley Medical College Hospital on 01.03.2014 for fever and due to Cardiac Arrest she was died on 04.03.2014 in the hospital and Ex.A7 Death Certificate issued by the corporation of Chennai and Ex.A5 Medical attendant’s certificate with certificate of hospital treatment issued by the Government Stanley Medical College Hospital.  Ex.A4 mortuary card also issued by the said hospital and the Complainant made claim from the Opposite Party and for the said claim, the Opposite Party sent Ex.A8 letter dated 18.08.2014 to the Complainant to furnish clarification and the Opposite Party repudiated the claim under Ex.A11 letter dated 05.02.2015 that the diseased deliberately made misstatement and also with held material information in respect of her health in the proposal form and hence the Complainant filed this Complaint.

          7. The Complainant contended that his wife was admitted in the hospital only for fever and due to sudden Cardiac arrest she was died and therefore he is entitled for the sum assured in the policy issued to his wife/R.Jayanthi.

          8. The Opposite Party contended that Ex.A5 issued by the Government Stanley Medical College Hospital clearly states that the diseased was suffering  from diabetic mellitus for 7 years ago and further in Ex.A4  mortuary card issued by the Government Stanley Medical College  Hospital, it has been stated that the cause of death was sudden cardiac arrest/Type-II diabetic Mellitus/ischemic and other reasons and since the diseased suppressed the material information with she was suffering from diabetic mellitus and for the said reason the claim was repudiated is sustainable and further argued that  the Opposite Party’s  case also supported by the judgment of the Hon’ble Supreme Court of India reported in 2009 (5) Supreme Today 523 (Satwant Kaur Sandhu vs. New India Assurance Company Ltd.,)  and therefore the Opposite Party repudiated the claim of the Complainant is sustainable and prays to dismiss the Complaint.

          9. Admittedly the Complainant wife was admitted in the Government Stanley Medical College Hospital on 01.03.2014 and she was died on 04.03.2014. After the Complainant made claim the Opposite Party sent Ex.A8 letter to the Complainant to disclose the fact that his wife took treatment for diabetic mellitus and Polyarthralgia. For the said letter the Complainant sent Ex.A9 reply that he was not aware that his wife suffering with diabetic disease and he had admitted her in the hospital only for fever and on the 3^rd day she was died due to cardiac arrest.  The Complainant is the husband of the diseased wife. Both of them lived under one roof as husband and wife.  In such circumstances, the husband was not aware about his wife was suffering from diabetic mellitus is unbelievable.

          10. Ex.B1 is the proposal form furnished by the diseased wife to the Opposite Party for issuing Ex.A1 policy. In the said proposal form in column 11 several particulars of personal history answered by the diseased as no.  In that question, it is specifically asked to reply whether she was suffering from diabetic disease or not and for the same she replied no. The Complainant contended that the said proposal form was filled by the agent of the Opposite Party and Dr.Pathmavathy also signed in the Form and therefore at the time furnishing proposal form she was not suffering with diabetic disease and the doctor signed in the proposal form only certifying that the life assured has signed in her presence and admitted the answer to question No.10 onwards in the form. Therefore   the doctor only simply signed and she has not examined the diseased at that time.

          11. In the Ex.A4 mortuary card, it has been stated sudden cardiac arrest/Type II diabetic mellitus and other reasons in respect of cause of death.  Therefore Ex.A4 discloses that type II diabetic mellitus is one of the reasons for cause of death. Further in Ex.A5 medical attendance certificate and certificate of treatment issued by the Government Stanley Medical College Hospital also disclosed that the diseased was suffering from diabetic mellitus over 7 years. Therefore, all the above documents establish that the diseased Jayanthi was suffering over 7 years with diabetic mellitus before her death.

          12. In 2009 (V) Supreme Today 523 facts  of the case is that the policy holder suffering from Chronic Diabetic and renal failure was material fact and was suffering for the last 16 years and that was suppressed by the diseased in that case and therefore the claim was repudiated by the Insurance Company sustainable. The Complainant relied on various decision of 1) Chhattisgarh State Consumer Disputes Redressal Commission, Raipur reported in I (2015) CPJ 7 (chha.) (Life Insurance Corporation of India vs. Kanchan Thawait), 2) Uttarakhand State Consumer Disputes Redressal Commission, Dehra Dun) reported in I (2010) CPJ 77(Life Insurance Coproration of India vs. Bina Joshi) Gujarat State Consumer Disputes Readressal Commission, Ahemedabad reported in  II(2014) CPJ 21 (guj.)  (Department of Posts & Anr. vs. Jyotsna Gaurishankar Gurjar) and judgment of the Hon’ble High Court Madras before the Madurai Bench reported in (2015) 7 MLJ page 147 and contended that once proposal form accepted by the Insurance Company and issued policy, the insurance company is bound by the contract and therefore the claim has to be paid to the claimant. The Hon’ble Supreme Court clearly  held in the above referred judgment at the time of taking policy the material fact was suppressed the insurance company is entitled to repudiate the claim with in the period of two years from the date of inception of the policy.  In the case in hand also the Opposite Party has repudiated the claim with in the period for the suppressed material fact of diabetic mellitus was suffering 7 years ago is justifiable. In view of the same various judgment referred by the Complainant is not applicable to the facts of the case in hand. In view of such conclusion it is held that the Opposite Party has not committed any deficiency in repudiating the claim of the Complainant and therefore we hold that the Opposite Party has not committed any deficiency in service.

13. POINT NO:2

Since the Opposite Party has not committed any Deficiency in Service, the Complainant is not entitled for any relief and the Complaint is liable to be dismissed.

          In the result the Complaint is dismissed. No costs.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 17^th day of April 2017.

 

MEMBER – II                                                               PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1 dated 28.08.2013                   LIC – Bond for Jeevan Saral

Ex.A2 dated 28.08.2013                   First Premium Receipt

Ex.A3 dated 10.02.2014                   Renewal Premium Receipt

Ex.A4 dated 04.03.2014                   Mortuary Card

Ex.A5 dated 28.08.2014                   Medical Attendant’s Certificate

Ex.A6 dated 08.09.2014                   Opposite Party given a acknowledgement receipt

Ex.A7 dated 12.08.2014                   Death Certificate issued by the Chennai

                                                    Corporation in the name of Late R.Jayanthi

 

Ex.A8 dated 18.08.2014                   Opposite Party sent a Register Post letter copy

 

Ex.A9 dated NIL                     The Complainant sent a reply letter copy

 

Ex.A10 dated 27.10.2014                 Acknowledgement Card

 

Ex.A11 dated 05.02.2015                 The Opposite Party sent a registered post letter

                                                    Ref.No.D.O.II/Claims/Rep.No.104/2014-15

 

Ex.A12 dated 05.05.2015                 The Complainant counsel sent a legal notice to the

                                                    Opposite Party

 

Ex.A13 dated NIL                             The Complainant  counsel received a

                                                     acknowledgement card

 

Ex.A14 dated NIL                             The Complainant Aadhar Card issued by the

                                                    Central Government

 

Ex.A15 dated NIL                             The Complainant Ration Card in the year of 2005-

                                                    2009

 

Ex.A16 dated 09.03.2006                 The policy Holder late R.Jayanthi Voter’s ID

                                                     issued by the Election Commission of India

 

Ex.A17 dated 09.06.2015                 Legal heir Certificate

 

LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTY :

 

Ex.B1 dated 29.08.2013                   Proposal Form

 

Ex.B2 dated 03.09.2012                   LIC Jeevan Saral (with profits) terms and

                                                    Conditions

 

Ex.A3 dated 28.08.2014                   Medical Attendant’s Certificate

 

Ex.A4 dated 28.08.2012                   Certificate of Hospital Treatment

 

 

MEMBER – II                                                               PRESIDENT