BEFORE THE  DIST. CONSUMERS DISPUTES REDRESSAL FORUM;  DHARWAD.

DATE:  23^rd July 2015       

PRESENT:

1) Shri B.H.Shreeharsha       : President

2) Smt.M.Vijayalaxmi             : Member 

Complaint No.: 68/2015  

Complaint No.: 69/2015

Complainant/s:      

Smt.Manjula w/o.Dyamanna Kerimani,    Age: Major, Occ: Household work, R/o.Banakanahalli, Po:Hirenarti, Tq.Kundgol, Dist. Dharwad 581113.

In CC 68/2015

Smt.Kalavati w/o.Chandrashekar Yakalaspur,    Age: 24 years, Occ: Household work, R/o.Kavalur, Post.Kavalur, Tq.Koppal, Dist. Koppal.

In CC 69/2015

(By Sri.B.G.Pujar, Adv.)

v/s

Respondent/s:

1. Sr. Divisional Manager, “Jeevan Prakash”, College Road, P.B.No.16, Dharwad 580001.

2. The Zonal Manager, LIC of India, South Central Zonal Office, Saifabad, Hyderabad 500063.

(By Sri.M.G.Gadgoli, Adv.)

O R D E R

By: Shri. B.H.Shreeharsha : President.

1.     Since the complaints filed by the complainants against the same respondents and as the reliefs sought are the common, for the convenience all the complaints were clubbed together and disposed in a common judgment.

2.     The complainant has filed this complaint claiming for a direction to the respondents to pay the assured amount under the policies and to pay Rs.10000/- towards compensation for mental agony and to order for cost of the proceedings and to grant such other reliefs.

Brief facts of the case are as under:

3.     The case of the complainant is that, the complainant’s deceased father insured Fakkirappa was the employee of the railway department, during his lifetime he had obtained 2 policies as detailed below.

4.     During the currency of the policy insured (father) Sri.Fakkirappa Y.Talwar died on 21.03.2013. Thereafter the complainants being the nominees submitted claim to the respondent.1 and the same was repudiated on the ground the insured at the time of proposal withheld the correct information regarding the insured’s health by a repudiation letter dt.31.03.14 & narrated the insured was suffering from “alcoholic gastritics” and anemia with ADS. But the complainants father was with good health, the repudiation of the claim is baseless  and amounts to deficiency in service. Hence, the present complaint is filed the instant complaints praying for the relief as sought.

5.     In response to the notice issued from this Forum the respondents appeared and filed the written version in detail denying and disputing the complaint averments. Further the respondents taken contention that the very complaint is false, frivolous, vexatious and prays for dismissal of the complaint. While the respondent admits issuance of the policy, coverage of the policy to the date and also submission of claim by the complainants. The respondent asserted the justification of repudiation of the claim on the valid ground that the assured at the time of proposal had withheld the real facts and sufferings and answered question no.11 of the proposal Clause(i) as good instead of mentioning the sufferings & have violated the terms and conditions of the policy as the contract of insurance is based on utmost good faith i.e. uberimmafiede & prays for dismissal of the complaint.

6.     On the said pleadings the following points have arisen for consideration:

1. Whether complainant has proved that there was deficiency in service on the part of respondents ?
2. Whether complainant is entitled to the relief as claimed ?
3. To what relief the complainant is entitled ?

Both have admits sworn to evidence affidavit, relied on documents.  Heard. Perused the records.

Finding on points is as under.

1. Negative 
2. Negative  
3. As per order

Reasons

Points 1 and 2

 7.    On going through the pleadings & evidence coupled with documents of both the parties it is evident that there is no dispute with regard to the fact, that the deceased father Fakkirappa during his lifetime had obtained the policy in question from the respondent company and to the date of death the same was in force.

8.     Now the question to be determined is, whether the respondent justified in repudiating the claim, if so, for what relief the complainants are entitled.

9.     The respondent insurer in contention of and in support of repudiation relied on health book maintained by the employer of the deceased assured Addl. Chief Health Director/ Adm. South Western Railway Central Hospital Hubli. On perusal of the said book it reveals that the assured was admitted in the hospital from 19.05.2003 to 21.05.2003 and he was continuously on different dates commencing from 2002 to the date of death 29.11.2011 the assured was under medical treatment for alcoholic gastritics and anemia with ADS. The insured had obtained the policy in the year 2011-12. On the date of proposal the assured while answering to the question.11 of the proposal to the sub question.11(i) status of health he has answered good. On the perusal of these 2 documents it is evident that the assured at the time of the proposal and prior to the proposal date he was suffering from the illness which was relied and made grounds for repudiation of the claim. Under those circumstances the respondent insurer is justified in repudiating the claim. In this regard this Forum also relies on 2015 (2) CPR 182 NC – LIC of India Vs. Shikadevi- several prescription slip of insured on which categorically recorded that he was chronic alcoholic and suffering hypertension, this information concealed in proposal form. Thus, insurance policy obtained by concealing material information is amounts to breach of trust and repudiation by the insurer is on valid grounds and complainants are not entitled for the claim.

10.   Thereby complainants utterly failed to establish their case of deficiency in service by the respondents. Interalia the respondents have successfully justified in repudiating the policy on valid grounds. Hence, the complainants are not entitled for the claim much less the relief claimed.

11.  In view of the above discussions we have arrived and proceed to held issue.1 and 2 in Negative.

12.   Point.3: In view of the finding on points 1 and 2 proceeded to pass the following 

Order

        Complaints are dismissed. No order as to costs

Original order shall be kept in CC/68/15 & its copy in CC/69/15

(Dictated to steno, transcribed by him and edited by us and pronounced in the open Forum on this day on 23^rd day of July 2015)

(Smt.M.Vijayalaxmi)                                      (Sri.B.H.Shreeharsha)

Member                                                            President

Dist.Consumer Forum                                    Dist.Consumer Forum

MSR