::BEFORE THE DISTRICT CONSUMER DISPUTES  REDRESSAL FORUM, AT BIDAR::

                                                               C.C. No.88/2016.

                                                            Date of filing: 06.10.2016.

                                                                   Date of disposal: 16.02.2018.

P R E S E N T:-    

                              (1) Shri. Jagannath Prasad Udgata,                                                                                                                                                                                                                      B.A., LL.B.,

                                                                                                President

                             (2) Shri. Shankrappa (Halipurgi),

                                                                                 B.A.LL.B.,

                                                                                           Member.

COMPLAINANT/S:    1.   Smt.Geeta W/o Late Nijlingappa Patil,

                                             Age: Major, Occ: C/o Computer Science Dept.

                                            In B.K.I.T.(REC) Bhalki Dist: Bidar,

                                            R/o Dubalgundi     
                                            Tq: Humnabad Dist: bidar.,                                            

                                      (By Sri. P.M.Deshpande, Adv.)

                                                                 VERSUS

OPPONENT/S:        1)         The zonal Manager,

                                             L.I.C. of India South Central      
                                             Zonal Office Saifabad

                                            Hyderabad-500063.,                                          

                                    2)        Claims department Divisional Office

                                                “JeevanPrakash”Station road

                                              Raichur-584101 Raichur.                                  

                                    3)        The Br.Manager,

                                                LIC of India,

                                                Railway Station Road,

                                                Bidar-585401.                                                                                                                                   

                                      (By R1.Sri. Sanjay Patil, Adv.)

::   J UD G M E N T  ::

By Shri. Jagannath Prasad Udgata, President.

      The complainant has filed this complaint u/s 12 of the Consumer Protection Act, 1986 against the opponents alleging deficiency of service.

2.            The subject matter of the complaint is as here under.  That the complainants husband late Nijlingappa Patil had obtained L.I.C. Policy bearing No.6661078 for a sum ofRs.1,50,000/- by paying the necessary premium on 28.03.2014.  The deceased was healthy at the time of obtaining the policy.  He was paying the premiums regularly.  Due to some insignificant health complications, (corn decease) he had received treatment for three days at a Gulbarga Hospital and for one day at another hospital at Secunderabad.  The Policy holder died on 16.01.2015 and a claim was lodged with the opponent Insurance company which was repudiated on fictitious grounds for which the present complaint.

3.          The opponents on receipt of Court notice have put up their appearances and have filed detail versions.  In the same they have admitted the policy but aver that, the deceased policy holder has died within three years of obtaining the policy and further that the policyholder was suffering from lung cancer at the time of taking the policy and he has concealed such material facts while filling the proposal form.  It is further stated that, the Policy holder was admitted in Basaveshwar Teaching and General hospital, Gulbarga from23.11.2013 to 26.11.2013 and Krishna Institute of Medical science Multi super specialty hospital, Secunderabad from 03.12.2013 to 04.12.2013.  He has not disclosed anything about that, in the proposal form, had cheated the insurance company and hence no claim is payable as decided by the zonal claims Review committee, Hyderabad.  Their ground of refusal is that, against the queries in Col.No.11 of the proposal form were answered wrongly.

4.         Contrary to the assertions of the opponent Insurance company not a  scrap of paper has been produced regarding ailment of lung cancer of the deceased policy holder nor the evidence of any doctor has been led to that effect.

5.         The questionnaires and answers claimed by the insurance company at Col.11 are as follows:-

                        Questions:

1. During the last five years did you ever consult a medical Practitioner for any ailment requiring treatment for more than a week. – Ans: No
2. Have you ever been admitted to any hospital or Nursing home For general check up, observations, treatment or operation. -Ans No.
3. Have ever remained absent from the place of work on grounds of health during the last 5 years. -Ans: No.
4. Are you suffering from or have ever suffered from ailments Pertaining to liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System. -Ans: No.
5. Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High blood pressure, Low blood pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease.- Ans:No.
6. What has been your usual state of health?- Ans: Good.

6.         The above being the complaint averments and counter and circumstances leading to refusal of the claim, the following points arise for our consideration:-

1. Does the complainant prove that, there has been a deficiency in service?
2. Does the opponent Insurance Company prove that, it was justified in refuting the claim?
3. What order?

 7.        Our answers to the points stated above are as follows:-

            Point No.1.       In the affirmative.

            Point No.2.       In the Negative.

            Point No.3.        As per final orders, owing to the following.

:: REASONS ::

8.         Point No.1 and 2 are inter webbd and being answered together.  The complainant has produced enough documents as listed at the end of the order to prove that, her late husband had obtained the captioned policy and was a regular premium payer.  Even if she has not produced the death certificate, the opponents have never disputed about the fact of death or obtainment and running of the policy at at the time of death on 16.1.2015.  In ordinary course, the death claim should have been settled long days back but the opponents claim that, the deceased had concealed
in-formations as were required in the Col.11 of the proposal form, and further that, he was hospitalised for lung cancer for three days in Basaveshwar hospital, Gulbarga and one day in Sri Krishana Hospital, Secunderabad.

9.         As stated above, not a single piece of paper has been produced nor any doctor has been examined by the opponents to prove that, factually the deceased policy holder was suffering from lung cancer.  Three days hospitalisation at Gulbarga and one day at Sicunderabad, could be for anything like flu or minor intestinal or urinary in-fection or muscular cramp or corn affliction as stated in the complaint.  As a whole, the opponents have failed to prove that, there was an affliction of lung cancer and the deceased has given wrong response to the queries at Col.No.11 of the proposal form. 

10.       The feuding parties have submitted the following rulings purported to support their case.

            Complainant.

                III 2009-CPJ-186 (NC).

            L.I.C. V/s Kamaladevi.

The case law is different from the complainants case and does not support.

Opponents.

[2017] CJ-254 (N.C.)

Chand Ratan Lahoti and ors v/s AVIVA LIFE  INSURANCE Co. India ltd. and Ant.  The ratio of this case is an antidote to the stand of the opponents.

[2014] CJ 381(N.C.)

L.I.C. of India v/s S.S.Jamuna.

This case also does not support the opponents claims.

[2014] CJ 194 (N.C.)

Manjinder Kaur v/s L.I.C. of India.

11.       This case also do not support the opponents since no material facts were with held or the opponents have led any cogent evidence to establish their stand.

12.       Rather, we have a case land before us reported in 2016 (1) CPR 265 (NC)- Dharmawati kumar V/s L.I.C. in which it was held that “claim of O.P. that, the Insured was suffering from jaundice without any medical certificate-rejected”.           

13.       For the fore going discussions, we are constrained to hold that, th e repudiation of claim tantamount to a garaguntan fallacy Causing deficiency of Service and further that, the opponents have failed to justify their repudiation and proceed to pass the following:-                   

                                                                      ::ORDER:: 

1. The complaint is allowed in part.
2. The opponents are jointly and severally directed to pay the sum assured of Rs.1,50,000/-(one lakh fifty thousand) in policy No.666107108 to the complainant together with interest @ 12% p.a., calculated from the date of repudiation i.e. 21.01.2016 till the date of realisation;
3. A sum of Rs. 10,000/-(Ten thousand) is awarded as compensation towards denial of just claim and mental agonies caused thereby;
4. A further sum of Rs.5,000/- (five thousand) is awarded towards litigation expenses;
5. Four weeks time is granted to comply this order.   

(Typed to our dictation then corrected, signed by us and then pronounced in the open Forum on this 16^th day of February 2018).

   Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

Member.                                                                President.                                                                                        

Documents produced by the complainant

1. Ex.P.1-  Cash receipt of opponents date 29.03.2014 (original).
2. Ex.P.2– Cash receipt of opponents date 23.07.2014 (original).
3. Ex.P.3– Cash receipt of opponents date 17.09.2014 (original).
4. Ex.P.4—Cash receipt of opponents date 09.12.2014 (original).
5. Ex.P.5 – Repudiation letter of opponents date: 21.01.2016 (original)
6. Ex.P.6- Letter of L.I.C. To Sri Baburao Gama Advocate date:        
                 19.04.2016 (original).
7. Ex.P.7- Letter of L.I.C. To Sri Baburao Gama Advocate date:        
                 18.05.2016 (original).
8. Ex.P.8- Letter of L.I.C. to complainant date: 17.06.2017 (original)     

 Document produced by the Opponents. (O.P.NO.1 only).

-NIL-

Witness examined.

Complainant.

1. P.W.1- Smt. Geetha W/o Late Nijalingappa Patil (Complainant).

Opponent No.1

1. R.W.1- Sri K.Parasuram S/o K.Bharmappa, D.M.(L and HPF) of L.I.C. of India.
2.  

Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

       Member.                                                                      President.