BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM,

ERNAKULAM.

Date of filing : 24/05/2011

Date of Order : 30/04/2011

Present :-

Shri. A. Rajesh, President.

Shri. Paul Gomez, Member.

Smt. C.K. Lekhamma, Member.

C.C. No. 266/2011

Between

And

O R D E R

A. Rajesh, President.

1. The case of the complainant is as follows :

On 17-02-2006, the complainant's husband Sasidharan availed a New Bima Gold Policy from the 2^nd opposite party for a period of 20 years with sum assured of Rs. 50,000/-. As per the policy, the quarterly premium was Rs. 701/-. Mr. Sasidharan paid the premium for 2 years, and thereafter, he could not continue with the payment of premium. However, he managed to remit the premium till 02-05-2009 and revived his policy. On 05-05-2009, Sasidharan breathed his last. The claim for insurance was rejected by the opposite parties stating the reason non-payment of premium due on May 2007. In response to the letter caused to the opposite party by the complainant, the opposite party sent a reply dated 18-05-2010 stated that the deceased did not disclose his disease at the time of revival of the policy. So, the complainant is before us seeking direction against the opposite parties to pay the maturity amount of the policy with 18% interest together with costs of the proceedings.

2. The version of the opposite parties :

The opposite parties issued an insurance policy for Rs. 50,000/- under non medical scheme with risk commencing from 17-02-2006 and with quarterly mode of payment. The insured remitted quarterly premium upto and including February 2007. Thereafter he did not remit the premium and the policy lapsed with effect from May 2007. However, he remitted the arrears of premium due for May 2007 to February 2008 on 28-04-2008. As the policy remained lapsed for more than 6 months, the same could be revived only on the strength of a personal statement regarding health. In the personal statement he suppressed his previous ailments, in fact he had undergone various treatments during the period. Since the policy was in force only for 15 months, the complainant is not entitled to get auto cover as claimed by the complainant. The opposite parties request to dismiss the complaint.

3. The complainant was examined as PW1 and Exts. A1 to A3 were marked on her side. No oral evidence was adduced by the opposite parties. Exts. B1 to B6 were marked. Heard the counsel for the parties.

4. The points that arose for consideration are :-

1. Whether the complainant is entitled to get the maturity amount in the insurance policy?

2. Whether the opposite parties are liable to pay compensation and costs of the proceedings?

5. Point No. i. :- The following points are not disputed by the parties :

1. The insured had availed an insurance policy with risk commencing from 17-02-2006.

2. The insured remitted quarterly premium upto February 2007 only.

3. The policy lapsed with effect from May 2007 due to non-remittance of insurance premium.

4. The insured revived the policy with effect from 28-04-2008 by remitting the premium due.

5. The insured submitted Ext. B1 personal statement regarding his health to revive the insurance policy.

6. In Ext. B1, the insured has stated that he had not been suffering from any ailment.

7. The insured died on 05-05-2009.

8. The opposite parties repudiated the insurance claim of the complainant stating that the deceased had suppressed his ailments in Ext. B1.

6. Firstly, the learned counsel for the complainant contended that the opposite parties denied natural justice to the complainant on rejecting the insurance claim of the complainant. Further, he stated that the deceased was not aware of his ailments at the time of his treatment. The learned counsel relied on the following decisions rendered by the Hon'ble Andhra Pradesh and Patna High Courts respectively.

1. Ramesh Vs. Govt. of Andhra Pradesh 2011 (3) ALT 664 (AP) 16-12-2010.

2. L.I.C. of India Vs. Mira Devi AR 2011 Part 144 dated 28-04-2011.

The counsel only adduced such a contention though he did not provide this Forum with the full text.

7. The learned counsel for the opposite parties vigorously contended that since the policy remained lapsed for more than 6 months, the lapsed policy was revived on the basis of Ext. B1 the statement of health conditions of the insured, in which he has suppressed his various ailments. Even according to PW1, the deceased had been suffering from various ailments prior to the submission of Ext. B1. Moreover, Exts. B3 to B6 medical certificate corroborate the same, uncontrovertedly, in Ext. B1 the deceased did not mention his previous ailments. The Hon'ble supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. 2009 CTJ 956 (Supreme Court) (CP), held in para 22 as follows :

“Answers given by the proposer to the two questions were “Sound Health” and “Nil” respectively. It would be beyond anybody's comprehension that the insured was not aware of the state of his health and the fact that he was suffering from Diabetes as also Chronic Renal Failure, more so when he was stated to be on regular haemodialysis. There can hardly be any scope for doubt that the information required in the afore-extracted questions was on material facts and answers given to those questions were definitely factors which would have influenced and guided the respondent - Insurance Company to enter into the Contract of Mediclaim Insurance with the insured. It is also pertinent to note that in the claim form the appellant had stated that the deceased was suffering from Chronic Renal Failure and Diabetic Nephropathy from 1^st June, 1990. i.e. within three weeks of taking the policy. Judged from any angle, we have no hesitation in coming to the conclusion that the statement made by the insured in the proposal form as to the state of his health was palpably untrue to his knowledge. There was clear suppression of material facts in regard to the health of the insured and, therefore, the respondent – insurer was fully justified in repudiating the insurance contract. We do not find any substance in the contention of learned counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated. Apart from the fact that at no stage the appellant had pleaded that the insured was not treated at Vijaya Health Centre at Chennai, where he ultimately died. It is more than clear from the said certificate that information about the medical history of the deceased must have been supplied by his family members at the time of admission in the hospital, a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorises the insurer to seek information from any hospital he had attended or may attend concerning any disease or illness which may affect his health.”

The above decision applies in the instant case squarely.

8. Secondly, the learned counsel for the complainant submitted that since the deceased has remitted 2 year's premium the next 2 years will be automatically covered and thus the complainant is entitled to get the insurance claim as per Clause No. 4 in Ext. B2 policy. The above decision of the Hon'ble Supreme Court precludes such a contention and fasten on the complainant abstinence of such conclusion.

9. In the result, we are only to dismiss the complaint. Ordered so.

Pronounced in open Forum on this the 30^th day of April 2012

Sd/- A. Rajesh, President.

Sd/- Paul Gomez, Member.

Sd/- C.K. Lekhamma, Member.

Forwarded/By Order,

Senior Superintendent.

A P P E N D I X

Complainant's Exhibits :-

Opposite party's Exhibits :-

=========