Tamil Nadu

North Chennai

CC/129/2016

Mrs.Uttamadevi - Complainant(s)

Versus

The Senior Manager ,Life Insurance Corporation of india - Opp.Party(s)

P.Anbalhagan

14 Aug 2019

ORDER

 

                                                            Complaint presented on:  23.04.2014

                                                               Order pronounced on:  14.08.2019

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

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

 

PRESENT:  TMT.K.LAKSHMIKANTHAM, B.Sc., B.L., DTL.,DCL, DL & AL -  PRESIDENT

 

TMT.P.V.JEYANTHI B.A., MEMBER - I

 

WEDNESDAY  THE 14^th   DAY OF AUGUST 2019

 

C.C.NO.129/2016

 

 

Mrs.Uttamadevi,

W/o.Late.Tulashiram,

No.21/38, Krishnamurthy Nagar,

Dr.Amebedkar Street,

Chennai – 600 118.

                                                                                       …..Complainant

 ..Vs..

 

The Senior Manager,

Life Insurance Corporation of India,

Divisional Office – II,

Anna Nagar,

Chennai – 600 040.

.....Opposite Party

Counsel for Complainant                         : M/s.P.Anbazhagan, K.Shanmugam

 

Counsel for  opposite party                        : M.B.Gopalan Associates,

                                                                      N.Vijayarghavan, M.B.Raghavan

 

 

 

 

 

ORDER

 

BY PRESIDENT TMT.K.LAKSHMIKANTHAM, B.Sc., B.L., DTL.,DCL, DL & AL

          This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

           The complainant’s husband is the holder of three policies detailed as follows:

Policy No	Sum Assured	Date of Commencement of Policy
718486728	Rs.50,000	28.10.2017
103593201	Rs.1,00,000	28.01.2008
719030237	Rs.9,00,000	28.10.2009

Out of the above 3 polices, two comes under  the opposite party branch jurisdiction and another one of Rajasthan. The opposite party branch had settled only one policy amount, i.e. in respect of Policy No.718486728 leaving another policy insured amount of Rs.9,00,000/- not settled as on date (more than 29 months over) even though the claim for the above policies were submitted by the complainant on on the same day i.e. on 13.09.2011 enclosing Original Policy No.719030237. The complainant made several attempts by visiting the opposite party’s office to know the settlement of this policy. But the complainant was informed that the amount will be settled early on the pending policy. The complainant waited for long 29 months but the said claim was not settled as on date. Hence this complaint.  

 

 

2. WRITTEN VERSION OF THE   OPPOSITE PARTY IN BRIEF:

          Policy No.719030237 had been issued on 13.11.2009 based on a proposal dated 03.11.2009, which was obtained without truthful and complete disclosure of acts. Hence the said policy is void having been obtained by suppression and misrepresentation. In the Proposal no adverse health history or of any medical consultation/treatment was disclosed by the complainant in good faith. The opposite party had issued the policy on 13.11.2009  as though commencing from 28.10.2009 dated back as per request in proposal. The claimant has stated in her letter of intimation that her husband died due to cardiac failure, in the claim form she had submitted the cause of death as jaundice and that no hospital treatment was taken as if the death was sudden.  The deceased was having pre-existing diseases of AIDS & Tuberculosis as confirmed by Government Hospital of Thoracic  Medicine, Tambaram. The Life  Assured had been suffering from TB/AIDS since 05.01.2009 and had taken treatment at TB Hospital, Otteri and later at Govt. Hospital of Thoracic Medicine Tambaram from 15.07.2009 prior to Proposal. The complainant had suppressed the material facts. Hence claim is vitiated by gross misrepresentation, suppression of facts in an attempt to misuse the scheme of insurance. He was admitted in the hospital on 10.02.2010 and was discharged on 12.03.2010 in poor condition followed by death on 18.03.2010. The opposite party has not committed any deficiency in service by repudiating the claim. The complaint may be dismissed.

3. 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?

 

4. POINT NO :1 

The complainant’s  Husband  late Thulshiram had taken three policies in the year 2007 to 2009 during his lifetime which bears numbers as 718486728, 103593201,719030237  for an amount of Rs.50,000, Rs.1,00,000,  & Rs.9,00,000/-  respectively. The complainant’s claim in the complaint is that one of the policy in that the opposite party  have been settled but in respect of the policy No. 718486728  insured for Rs.9,00,000/- was not settled inspite of repeated request and also the claim before the opposite party  was rejected.  Hence the complaint is  preferred for the direction to the opposite party  to pay the insurance amount which is not settled so far and also for deficiency in service.

            05. The opposite party  would contend that the disputed policy was obtained without disclosing the  facts.  Hence the policy became void and opposite party  had no liability for the claim and there is no deficiency in service on the part of opposite party.  Death certificate of the complainant’s husband dated  18.03.2010 and certificate of identity are marked as Ex.A1 & Ex.A2. Claim form is Ex.A3  and the complainant’s representation dated 12.08.2013 is Ex.A4. The lawyer’s notice issued to opposite party by the complainant  and it’s acknowledgement card are marked as Ex.A5 & Ex.A6. Policies taken by the complainant’s  husband is not denied. Among the  two policies referred by the complainant, settlement of  one  of the policy is not disputed by the complainant. The claim intimation for the third policy dated is Ex.B3.  Proposal form submitted  by the husband of the complainant  and insurance policy with terms and conditions are marked as Ex.B1  & Ex.B2. Complainant’s  husband submitted  the proposal on 03.11.2009  for an amount of Rs.9,00,000/-  As per the document submitted to the  opposite party  no adverse health  history or treatment was disclosed by the complainant’s husband and hence believing the statement as true, the policy was issued on 13.11.2009 as though commencing from 28.10.2009  as per the request in the proposal.

           06. As per death certificate in Ex.A1  complainant’s  husband died on 18.03.2010 due to ailments. Immediate cause of death stated in claimant’s statement in Ex.B4, as jaundice and in certificate of identity the cause of death  is stated as “Sudden”. It is also stated that hospital treatment was not taken due to sudden death. A form of declaration for non-attendance of doctor during the last illness was submitted along with other certificates in Ex.B4 wherein the cause of death is stated as ‘Sudden Heart Attack’. Around 4 months after the issue of policy  complainant’s husband died.   Being an early claim  opposite party  had investigated the cause which reveals that the deceased suffered from pre-existing diseases such as AIDS and Tuberculosis and is confirmed by the certificate issued by  Government  Hospital of  Thoracic Medicine, Tambaram which is enclosed with opposite party’s documents. The disease  was observed  by  the treated hospital on September 2009 and the first admission was on  July 2009.  All these  days are early to the  disputed policy date.

          07. The complainant   reported that she had not received any reply from opposite party  even after the receipt of  her legal notice dated 29.10.2013 in  Ex.B7 by opposite party.   But opposite party  had submitted the reply notice dated 09.11.2013 with the enclosure of the copy of the earlier intimated  repudiation letter. Repudiation letter along with postal receipt are Ex.B6. Agents letter stating the facts regarding non-disclosure of the pre-existing disease of the deceased is in Ex.B5.

            08. Having gone through all the documents, it is noticed that the  husband of the complainant was found to have been suffering from severe ailments which was not disclosed and as pointed out by the opposite party, the policy was obtained suppressing material facts and the complainant was also guilty of misrepresentation. It is against the policy terms and conditions. Hence the repudiation of the claim by opposite party is correct. The allegation of the complainant for the receipt of information from opposite party for an early settlement after her several attempts is also not substantiated by any proof. For all the reasons stated, the complainant does not deserve getting the policy amount and compensation from opposite party.    Repudiating the claim for the proper reason does not mean as deficiency in service. Therefore there is no deficiency in service on the part of opposite party and the complainant is liable to be dismissed.

09. POINT NO:2

          As discussed above  the complainant  is dismissed.  Hence there cannot be any mental agony caused by opposite party. The complaint  is dismissed.

          In the result this complaint is dismissed. No costs. 

Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 14^th  day of August 2019.      

MEMBER – I                                                                PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1 dated 18.03.2010                   Copy of Death Certificate

Ex.A2 dated NIL                     Certificate of Identity & burial or cremation

Ex.A3 dated Sep 2011             Copy of Claim Form

Ex.A4 dated 12.08.2013                   The complainant made a representation to the

                                                     opposite party

 

Ex.A5 dated 29.10.2013                   Copy of Lawyer Notice to opposite party

Ex.A6 dated 04.11.2013                   Acknowledgement Card

LIST OF DOCUMENTS FILED BY THE   OPPOSITE PARTY:

 

Ex.B1 dated 03.11.2009                   Copy of Proposal Form

 

Ex.B2 dated 13.11.2009                   Insurance Policy with terms and conditions

 

Ex.B3 dated NIL                      Copy of Claim Intimation

 

Ex.B4 dated 12.09.2011                   Claim Form with all certificates

 

Ex.B5 dated 11.01.2012                   Agent’s letter with supporting documents

 

Ex.B6 dated 31.03.2012            Repudiation letter along with postal receipt/AD

  Card

 

Ex.B7 dated 09.11.2013          Reply to legal notice with post receipt/AD Card   

 

 

MEMBER – I                                                               PRESIDENT