BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 47/2012.
THIS THE 14th DAY OF DECEMBER 2012.
P R E S E N T
1. Sri. Pampapathi B.sc.B.Lib. LLB PRESIDENT.
2. Sri. K.H. Sri Ramappa, B.A.LLB. MEMBER.
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COMPLAINANT :- Smt. Mahadevamma W/o. late Basavarajappa,
age: major, Occ: Household, R/o. Sirwar, near Maremma Temple, Sirwar, Tq. Manvi, Dist: Raichur.
//VERSUS//
OPPOSITE PARTY :- The Senior Divisional Manager, Life Insurance
Corporation of India, Divisional office, Station Road, Raichur.
CLAIM : For to direct the opposite LIC of India to pay
assured policy amount of Rs. 55,000/-, to pay an amount of Rs. 15,000/- towards mental shock, inconvenience etc., with interest and cost.
Date of institution :- 02-07-12.
Notice served :- 18-07-12.
Date of disposal :- 14-12-12.
Complainant represented by Sri. M. Virupaxigouda, Advocate.
Opposite represented by Sri. T. Keshavacharya, Advocate.
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This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.
JUDGEMENT
By Sri. Pampapathi President:-
This is a complaint filed by complainant Mahadevamma against the Opposite Life Insurance Corporation of India U/sec. 12 of Consumer Protection Act for to direct the opposite LIC of India to pay assured policy amount of Rs. 55,000/-, to pay an amount of Rs. 15,000/- towards mental shock, inconvenience etc., with interest and cost.
2. The brief facts of the complainant’s case are that, her husband by name Basavarajappa subscribed LIC policy for assured sum of Rs. 55,000/- from opposite Insurance Company. She is the wife and nominee of late Basavarajappa. Her husband died on 27-03-2011 while the policy was in force. Thereafter, she filed claim petition with all necessary records, but opposite Insurance Company repudiated her claim by its letter dt. 03-10-2011 on untenable grounds. Hence, opposite found guilty under deficiency in its service and thereby, she filed this complaint for the reliefs as noted in it.
3. The opposite Insurance Company appeared in this case through its Advocate, filed its written version by denying all the allegations made by the complainant. It is contended that, deceased Basavarajappa was suffering from heart disease. He not disclosed this fact in his proposal form, he also took treatment as in patient from 03-03-2009 to 04-04-2009. Hence this is material suppression regarding the health of Basavarajappa in his proposal form. This fact was confirmed by investigation from the LIC officers, as such, it rightly repudiated the claim of complainant, there is no deficiency in its service. Accordingly, 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, she being the nominee and wife of policyholder Basavarajappa filed her claim petition after the death of her husband with all necessary records, but opposite LIC of India repudiated her claim on untenable grounds and thereby it 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 NOs.1 &2 :-
6. To prove the facts involved in these two points, affidavit-evidence of the complainant was filed, who is noted as PW-1. The documents Ex.P-1 to Ex.P-3 are marked. Affidavit-evidence of officer of opposite was filed, who is noted as RW-1. The documents Ex.R-1 to Ex.R-4 are marked.
7. In view of the pleadings of the parties, their respective affidavit-evidences and documents relied by them. It is a fact that, the status of complainant as a nominee under the policy is not in dispute. The death of Basavarajappa and subscription of LIC policy for assured sum of Rs. 55,000/- are also not in dispute.
8. In the light of these undisputed facts. The only disputed point for to decide by us is that, whether complainant has suppressed material facts regarding his prior health condition in his proposal form and thereby, he obtained policy under question fraudulently with an intention to get monetary benefit out of it.
9. The learned counsel for complainant relied on the following rulings:
1) II (2005) CPJ 9 (NC). Life Insurance Corporation of India V/s. Badri Nageshwaramma & Ors.
2) I (2009) CPJ 161 NC. Vanita Ben Ritulal Fulbaria V/s. LIC of India.
3) III (1998) CPJ 475 (HP) LIC of India & Anr. V/s. Savitri Devi.
4) III (2004) CPJ 165 United India Insurance Company Ltd., V/s. Mahenga Singh.
10. The learned advocate for opposite relied on unreported ruling of Hon’ble National Commission bearing Revision Petition No. 4208/2007 Sadananda Bag V/s. Divisional Manager & Branch Manager LIC of India dt. 12-07-2012.
11. We have gone through the principles of the rulings referred above by both parties. Now, it is well settled law that, material suppression regarding the health condition of policyholder at the time of filing proposal form is to be proved by the LIC of India. It cannot take any weakness or lacuna of the case of complainant. Keeping in view of this settled principle of law and also observations made by the lordships in the rulings referred above. We have to see as to whether, opposite LIC of India has discharged its burden in proving the material suppression regarding the health condition of policyholder in the proposal form. According to case of opposite deceased Basavarajappa concealed regarding the treatment taken by him in Rajiv Gandhi Super Specialty Hospital, Raichur for chest pain by admitting on 03-03-2009 and discharged on 04-04-2009, as per discharge summary Ex.R-4 with clinical reports.
12. Discharge summary discloses the fact that, Basavarajappa developed a case of accelerated HTN for few years and complaining of chest pain for three hours.
13. Keeping in view of the facts stated in Ex.R-4, without filing affidavit-evidence of the doctor of the Rajiv Gandhi Super Specialty Hospital, who said to be treated the deceased in that period and absence of affidavit-evidence of the doctor who issued discharge summary are sufficient to say that, LIC of India has discharged its burden in proving material suppression. The principles of the Hon’ble National Commission in LIC of India V/s. Badri Nageshwaramma & Ors are aptly applicable to this case, in that case similar contention was taken by the LIC of India without filing the affidavit-evidence of doctor. In that circumstances the Hon’ble National Commission held as, mere filing medical certificates are not conclusive evidence to suggest the suppression of material facts by deceased. Hence, with great respect to the Hon’ble National Commission with regard to the rulings referred above. We followed the principles of the ruling Badri Nageshwaramma & Ors and accordingly, we are of the view that, mere production of Ex.R-4 with pathological test reports are not conclusive evidence to say that, deceased Basavarajappa suppressed material facts regarding his health condition in his proposal form, intentionally and fraudulently to get monetary benefit out of the said policy. Hence, we have not accepted the submissions made by the learned advocate for opposite Insurance Company. The submissions made by the learned advocate for complainant in this regard are convincing and thereby repudiation of the claim of complainant on that ground is deficiency in service by the opposite Insurance Company, accordingly we answered Point No-1 in affirmative.
14. As regards to the reliefs are concerned, it is a fact that, assured sum under the policy of late Basavarajappa is of Rs. 55,000/- for which the complainant is entitled to get that amount from opposite Insurance Company.
15. The complainant is entitled to get a lumpsum amount of Rs. 3,000/- towards deficiency in service by the opposite and at the same time, she also entitled to get another lumpsum amount of Rs. 2,000/- towards cost of litigation. Hence totally the complainant is entitled to get Rs. 60,000/- from opposite. She also entitled to get interest at the rate of 9% p.a. on total amount of Rs. 60,000/- from the date of this complaint till realization of the full amount. Accordingly, we answered point No-2.
POINT NO.3:-
16. 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 get total amount of Rs. 60,000/- from Opposite Insurance Company.
The complainant also entitled to get interest at the rate of 9% p.a. on total sum of Rs. 60,000/- form the date of this complaint till realization of the full amount.
Opposite Insurance Company is given one month time, from the date of this judgment to make the payment.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 14-12-2012)
Sri. K.H. Sri Ramappa Sri. Pampapathi,
Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur.
*RK*
