The Senior Divisional Manager, LIC of India, Raichur V/S Smt. Khasimbee W/. Late Meerasab, Sindhanoor - Consumer Court Case

Karnataka

Raichur

CC/10/16

Smt. Khasimbee W/. Late Meerasab, Sindhanoor - Complainant(s)

Versus

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

Sri. C. Pandu

22 Jun 2010

ORDER

Dist. Consumer Disputes Redressal Forum, Sath Kacheri, Raichur.
Dist. Consumer Disputes Redressal Forum, Sath Kacheri, Raichur.
consumer case(CC) No. CC/10/16

Smt. Khasimbee W/. Late Meerasab, Sindhanoor						...........Appellant(s)
Vs.
The Senior Divisional 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 Smt. Khasimbee against the opposite LIC of India U/sec. 12 of Consumer Protection Act for to direct the opposite to pay sum of Rs. 2,25,000/- with interest and cost. 2. The brief facts of the complainants case are that, her husband late Meerasab subscribed two LIC policies on different dates, one policy is for assured sum of Rs. 2,00,000/- and another policy is of Rs. 25,000/-, thereafter on 10-05-06 her husband Meerasab died. She being the nominee under the said two policies filed claim petition before opposite LIC of India, but opposite repudiated her claim by stating that, her husband gave personal statement on 24-08-05 with false information by suppressing the material facts regarding his health condition and thereby he violated the terms and conditions of the policy. Hence this complaint is filed by her for the reliefs as prayed in her complaint. 3. The opposite LIC of India appeared in this case through Advocate, filed its written version by admitting the subscription of two LIC policies by Meerasab on different dates as pleaded in the complaint. It also admits that, the complainant is the nominee under the said two LIC policies. It is contended that prior to the death of Meerasab he was subscribing from cancer and took treatment from 04-08-05 to 16-09-05 in Kidwai Institute of Oncology, Bangalore as in-patient. He gave statement on 24-08-05 by suppressing fact that, he was suffering from cancer, he violated the terms and conditions of the policy. Therefore complainant is not entitled for amount under any one of the policy as claimed in this complaint. Hence it rightly repudiated the claim of complainant, there is no deficiency in its service and thereby it 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, her husband Meerasab subscribed two LIC Bimakiran Policies on two different dates at his life time, among them the first policy is for assured sum of Rs. 2,00,000/- and another one policy is of Rs. 25,000/-, and thereafter he died on 10-05-06, she filed claim petition before opposite LIC of India being a nominee under the said two policies for to make the payment assured sum under the policies, but opposite shown its negligence in settling her claim, thereafter on 22-07-08 it repudiated her claim on untenable and illegal grounds and thereby opposite LIC of India found guilty under deficiency in its service.? 2. Whether complainant is entitled for the reliefs as prayed in her 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 the 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 administrative officer of the opposite LIC of India was filed, he was noted as RW-1. The documents Ex.R-1 to Ex.R-3 are marked. 7. In the instant case, the some of the following facts are undisputed facts in between the parties are:- 1. It is undisputed fact that, the husband of the complainant Meerasab obtained two LIC Policies bearing No. 661362320 dt. 28-09-2000 for assured sum of Rs. 2,00,000/- and another one policy is bearing No. 661366530 dt. 15-12-2001 for assured sum of Rs. 25,000/-. 2. It is further undisputed fact that, the present complainant is the wife of deceased Meerasab and nominee under the said two policies. 3. It is undisputed fact that, policyholder Meersab died on 10-05-06. 4. It is further undisputed fact that, the complainant filed claim petition before the opposite LIC of India for to make the payment under the two policies, but opposite LIC of India repudiated the claim of complainant vide its letter at Ex.P-4 dt. 22-07-08. 8. In the light of these admitted facts, now we have to appreciate the affidavit-evidence PW-1 and her documents at Ex.P-1 to Ex.P-9. Affidavit-evidence of RW-1 and documents at Ex.R-1 to Ex.R-3. To decide the disputed facts in between the parties. It is a fact that, LIC of India repudiated the claim of complainant by its letter vide Ex.P-4. According to the facts noted in Ex.P.4, late Meerasab took treatment prior to his death for cancer in Kidwai Hospital at Bangalore. At the time of revival of the said two policies Meerasab gave his personal statement vide Ex.R-1 dt. 24-08-05 regarding his health condition by suppressing the fact of suffering from cancer and treatment taken by him from 04-08-05 to 16-09-05 in the said hospital and thereafter he died on 10-05-06. Hence it is a violation of the terms and conditions of the policies, therefore it rightly repudiated the claim of complainant. 9. In the light of this fact, we have referred the decided case by the Honble Supreme Court reported in 1996 III CPJ 8 (SC) LIC of India V/s. Smt. Channabasamma. The Honble Supreme Court held in the said case as the burden of proving suppression of material facts regarding the health condition of insured is on the Insurance Company. The Honble National Commission also of the same view, in the decided case National Insurance Company V/s. Bipul Kunda reported in 2005 CTJ 377 CP (NC). 10. In the light of the principles of the Honble Supreme Court as well as the Honble National Commission it is burden on the opposite LIC of India to prove the fact that, Meerasab gave false personal statement on 24-08-05 vide Ex.R-1 by suppressing the fact that, he was suffering from cancer by intending to get wrongful gain out of the said two policies. 11. To discharge the burden by the opposite LIC of India the affidavit-evidence of RW-1 and documents Ex.R-2 & Ex.R-3 are the material evidences for our appreciation to see that, the insurance company has discharged its burden. 12. Ex.R-2 is the printed form of LIC of India regarding information furnished by the Professor of Head of the Department of Kidwai Memorial Institute Oncology, Bangalore. Ex.R-3 is the Medical Attendants Certificate of Medical Officer Sindhanor. Ex.R-2 is dt. 18-08-06. Ex.R-3 is dt. 10-01-07. Ex.R-3 is later to Ex.R-2, Ex.R-1 is said to be a statement given by deceased regarding his health condition at the time of revival of those lapsed policies. No doubt Ex.R-1 is signed by Meerasab by stating that, he not suffered from any illness not undergone any operation and also he not undergone Electro Cardiogram, X-ray, screening, Blood, Urine or stool examination. Admittedly opposite LIC of India not filed any affidavit-evidence of medical officer who issued Ex.R-3 or doctor who issued Ex.R-2. 13. Ex.R-2 & Ex.R-3 are the documents much later documents accepted to document Ex.R-1 and those documents came into existence after the death of Meersab. In the said circumstances, we are unable to accept the case of opposite LIC of India that deceased Meerasab gave his personal statement vide Ex.R-1 fraudulently knowing fully well that the said statement given by him was false with an intention to get wrongful gain out of those policies. The persons who signed Ex.R-3 as witnesses also not came before us by filing affidavit-evidence to support the case of opposite. In the above said circumstances, we are unable to accept the submissions made by the learned advocate for opposite that LIC of India discharged its burden of proving fact of suppression of material facts by deceased Meerasab at the time of giving his statement Ex.R-1. 14. Hence rejecting the claim of complainant by showing the said reasons vide its repudiation letter at Ex.P-4 is nothing but deficiency in its service towards complainant, accordingly we answered Point No-1 in affirmative. 15. Admittedly the first policy bearing No. 661362320 is for assured sum of Rs. 2,00,000/- and the second policy bearing No.661366530 is for assured sum of Rs. 25,000/-, as such the complainant is entitled to get total amount of Rs. 2,25,000/- under the said two policies. 16. We have noticed the deficiency in service on the part of opposite LIC of India, as such the complainant is entitled to recover a lumpsum amount of Rs. 3,000/- under the head of deficiency in service. 17. A lumpsum amount of Rs. 3,000/- is granted to the complainant towards cost of this litigation, as such the complainant is entitled to get an amount of amount of Rs. 2,31,000/- from opposite LIC of India. She also entitled to recover future interest at the rate of 9% p.a. on the total sum of Rs. 2,31,000/- from opposite LIC of India 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 is entitled to recover a total amount of Rs. 2,31,000/- (as detailed in the body of the judgment) from opposite LIC of India. The complainant is also entitled to recover future interest at the rate of 9% p.a. on the above total sum of Rs. 2,31,000/- 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 for to make the payment. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 22-06-10) 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 Smt. Khasimbee against the opposite LIC of India U/sec. 12 of Consumer Protection Act for to direct the opposite to pay sum of Rs. 2,25,000/- with interest and cost. 2. The brief facts of the complainants case are that, her husband late Meerasab subscribed two LIC policies on different dates, one policy is for assured sum of Rs. 2,00,000/- and another policy is of Rs. 25,000/-, thereafter on 10-05-06 her husband Meerasab died. She being the nominee under the said two policies filed claim petition before opposite LIC of India, but opposite repudiated her claim by stating that, her husband gave personal statement on 24-08-05 with false information by suppressing the material facts regarding his health condition and thereby he violated the terms and conditions of the policy. Hence this complaint is filed by her for the reliefs as prayed in her complaint. 3. The opposite LIC of India appeared in this case through Advocate, filed its written version by admitting the subscription of two LIC policies by Meerasab on different dates as pleaded in the complaint. It also admits that, the complainant is the nominee under the said two LIC policies. It is contended that prior to the death of Meerasab he was subscribing from cancer and took treatment from 04-08-05 to 16-09-05 in Kidwai Institute of Oncology, Bangalore as in-patient. He gave statement on 24-08-05 by suppressing fact that, he was suffering from cancer, he violated the terms and conditions of the policy. Therefore complainant is not entitled for amount under any one of the policy as claimed in this complaint. Hence it rightly repudiated the claim of complainant, there is no deficiency in its service and thereby it 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, her husband Meerasab subscribed two LIC Bimakiran Policies on two different dates at his life time, among them the first policy is for assured sum of Rs. 2,00,000/- and another one policy is of Rs. 25,000/-, and thereafter he died on 10-05-06, she filed claim petition before opposite LIC of India being a nominee under the said two policies for to make the payment assured sum under the policies, but opposite shown its negligence in settling her claim, thereafter on 22-07-08 it repudiated her claim on untenable and illegal grounds and thereby opposite LIC of India found guilty under deficiency in its service.? 2. Whether complainant is entitled for the reliefs as prayed in her 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 the 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 administrative officer of the opposite LIC of India was filed, he was noted as RW-1. The documents Ex.R-1 to Ex.R-3 are marked. 7. In the instant case, the some of the following facts are undisputed facts in between the parties are:- 1. It is undisputed fact that, the husband of the complainant Meerasab obtained two LIC Policies bearing No. 661362320 dt. 28-09-2000 for assured sum of Rs. 2,00,000/- and another one policy is bearing No. 661366530 dt. 15-12-2001 for assured sum of Rs. 25,000/-. 2. It is further undisputed fact that, the present complainant is the wife of deceased Meerasab and nominee under the said two policies. 3. It is undisputed fact that, policyholder Meersab died on 10-05-06. 4. It is further undisputed fact that, the complainant filed claim petition before the opposite LIC of India for to make the payment under the two policies, but opposite LIC of India repudiated the claim of complainant vide its letter at Ex.P-4 dt. 22-07-08. 8. In the light of these admitted facts, now we have to appreciate the affidavit-evidence PW-1 and her documents at Ex.P-1 to Ex.P-9. Affidavit-evidence of RW-1 and documents at Ex.R-1 to Ex.R-3. To decide the disputed facts in between the parties. It is a fact that, LIC of India repudiated the claim of complainant by its letter vide Ex.P-4. According to the facts noted in Ex.P.4, late Meerasab took treatment prior to his death for cancer in Kidwai Hospital at Bangalore. At the time of revival of the said two policies Meerasab gave his personal statement vide Ex.R-1 dt. 24-08-05 regarding his health condition by suppressing the fact of suffering from cancer and treatment taken by him from 04-08-05 to 16-09-05 in the said hospital and thereafter he died on 10-05-06. Hence it is a violation of the terms and conditions of the policies, therefore it rightly repudiated the claim of complainant. 9. In the light of this fact, we have referred the decided case by the Honble Supreme Court reported in 1996 III CPJ 8 (SC) LIC of India V/s. Smt. Channabasamma. The Honble Supreme Court held in the said case as the burden of proving suppression of material facts regarding the health condition of insured is on the Insurance Company. The Honble National Commission also of the same view, in the decided case National Insurance Company V/s. Bipul Kunda reported in 2005 CTJ 377 CP (NC). 10. In the light of the principles of the Honble Supreme Court as well as the Honble National Commission it is burden on the opposite LIC of India to prove the fact that, Meerasab gave false personal statement on 24-08-05 vide Ex.R-1 by suppressing the fact that, he was suffering from cancer by intending to get wrongful gain out of the said two policies. 11. To discharge the burden by the opposite LIC of India the affidavit-evidence of RW-1 and documents Ex.R-2 & Ex.R-3 are the material evidences for our appreciation to see that, the insurance company has discharged its burden. 12. Ex.R-2 is the printed form of LIC of India regarding information furnished by the Professor of Head of the Department of Kidwai Memorial Institute Oncology, Bangalore. Ex.R-3 is the Medical Attendants Certificate of Medical Officer Sindhanor. Ex.R-2 is dt. 18-08-06. Ex.R-3 is dt. 10-01-07. Ex.R-3 is later to Ex.R-2, Ex.R-1 is said to be a statement given by deceased regarding his health condition at the time of revival of those lapsed policies. No doubt Ex.R-1 is signed by Meerasab by stating that, he not suffered from any illness not undergone any operation and also he not undergone Electro Cardiogram, X-ray, screening, Blood, Urine or stool examination. Admittedly opposite LIC of India not filed any affidavit-evidence of medical officer who issued Ex.R-3 or doctor who issued Ex.R-2. 13. Ex.R-2 & Ex.R-3 are the documents much later documents accepted to document Ex.R-1 and those documents came into existence after the death of Meersab. In the said circumstances, we are unable to accept the case of opposite LIC of India that deceased Meerasab gave his personal statement vide Ex.R-1 fraudulently knowing fully well that the said statement given by him was false with an intention to get wrongful gain out of those policies. The persons who signed Ex.R-3 as witnesses also not came before us by filing affidavit-evidence to support the case of opposite. In the above said circumstances, we are unable to accept the submissions made by the learned advocate for opposite that LIC of India discharged its burden of proving fact of suppression of material facts by deceased Meerasab at the time of giving his statement Ex.R-1. 14. Hence rejecting the claim of complainant by showing the said reasons vide its repudiation letter at Ex.P-4 is nothing but deficiency in its service towards complainant, accordingly we answered Point No-1 in affirmative. 15. Admittedly the first policy bearing No. 661362320 is for assured sum of Rs. 2,00,000/- and the second policy bearing No.661366530 is for assured sum of Rs. 25,000/-, as such the complainant is entitled to get total amount of Rs. 2,25,000/- under the said two policies. 16. We have noticed the deficiency in service on the part of opposite LIC of India, as such the complainant is entitled to recover a lumpsum amount of Rs. 3,000/- under the head of deficiency in service. 17. A lumpsum amount of Rs. 3,000/- is granted to the complainant towards cost of this litigation, as such the complainant is entitled to get an amount of amount of Rs. 2,31,000/- from opposite LIC of India. She also entitled to recover future interest at the rate of 9% p.a. on the total sum of Rs. 2,31,000/- from opposite LIC of India 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 is entitled to recover a total amount of Rs. 2,31,000/- (as detailed in the body of the judgment) from opposite LIC of India. The complainant is also entitled to recover future interest at the rate of 9% p.a. on the above total sum of Rs. 2,31,000/- 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 for to make the payment. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 22-06-10) Sri. Pampapathi, President, District Forum-Raichur. Sd/- Sri. Gururaj, Member, District Forum-Raichur. Sd/- Smt.Pratibha Rani Hiremath, Member. District Forum-Raichur.