Karnataka

Kolar

CC/40/2022

Sri.Subramani - Complainant(s)

Versus

The Zonal Manager,LIC of India - Opp.Party(s)

24 Jan 2023

ORDER

Date of Filing: 02/09/2022

Date of Order: 24/01/2023

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, OLD D.C. OFFICE PREMISES,KOLAR – 563 101.

 

Dated: 24^thDAY OF JANUARY 2023

SRI.SYED ANSER KALEEM, B.Sc., B.Ed., LL.B., …… PRESIDENT

SMT.SAVITHA AIRANI,B.A.L., LL.M., …..LADY MEMBER

CONSUMER COMPLAINT NO :: 40 OF 2022

Sri. Subramani,

S/o. Gundappa,

Aged About 60 Years,

C-Block, Vemgal Village & Post,

Kolar Taluk & District.

(Rep. by Sri.N.Ravindra Gowda, Advocate)               ….  Complainant.

 

- V/s -

1) The Zonal Manager,

LIC of India,

South Central Zonal Office,

Saifabad, Hyderabad-500 063.

(Rep. by Sri.A.V.Ananda, Advocate)

 

2) Manager,

Bangalore Divisional Office,

Life Insurance Corporation of India,

Jeevan Jyoti, Indiranagar, II nd Stage,

Bangalore-560 038.

(Rep. by Sri.A.V.Ananda, Advocate)

 

3) Manager,

LIC Divisional Office,

Near KSRTC Bus Stand,

Dr. Rajkumar Road,

Kolar Taluk & District.

(Rep. by Sri.A.V.Ananda, Advocate)                         …. Opposite Parties.

-: ORDER:-

BY SRI. SYED ANSER KALEEM, PRESIDENT

01.   The complainant has filed this complaint Under Section 35 of the Consumer Protection Act 2019 against the OP Nos.1 to 3 alleging deficiency in service and prays to direct the Ops to pay the insurance policies amount of Rs.4,00,000/- (i.e., in respect of policy Nos.609756948, dated: 29.07.2019, for a sum of Rs.2,00,000/- and policy No.613897949, dated: 25.01.2020 for a sum of Rs.2,00,000/-) together with interest at the rate of 18% per annum till realization and to direct the Ops to pay a sum of Rs.1,00,000/- towards compensation with cost of the proceedings and such other reliefs as this Hon’ble Commission deems fit.

2)  The brief facts of the complaint is that, the complainant and his son by name Kempegowda. V.S were permanently residing at the above given address in the cause title and they are doing agriculture in their land.  It is stated that, during the life time of the complainant’s son i.e., insured he was heal and healthy.  It is stated that, the deceased insured had obtained the insurance policies from the Ops that is, LICs New Endowment Plan bearing policy No.613897949 and the validity period is from 25.01.2020 and the date of maturity is 25.01.2041 and the sum assured is Rs.2,00,000/-.  Also obtained another LICs Jeevan Labh policy bearing No.609756948 commencing from 28.07.2019 and the date of maturity is 28.07.2044 and the sum assured is Rs.2,00,000/-.  It is stated that, the beneficiary of the insurance policies on account of was suffering from pneumonia fever accordingly he was admitted to Manipal Hospital, Bangalore, on 28.10.2021 for treatment and ultimately he was died on 04.11.2021.  Thereafter the father of the insured and as a nominee of the insurance policies applied for the death claim on 27.12.2021 before OP No.3 with relevant original policy bonds along with medical documents and ultimately the OP Nos.1 to 3 have repudiated the claim of the complainant on 16.03.2022 through letter on the ground that, the insured had suppressed the previous health issues were occurred during his life time while obtaining the policies in question.  That the complainant stated that, he has not suppressed any material facts and got obtained the above said insurance policies and non-honouring the same and the complainant alleged that, the deficiency in service on the part of the Ops.  Hence this complaint.

03.   On issuance of notice OP Nos.1 to 3 appeared through their counsel and OP No.2 filed its version, however OP Nos.1 & 3 adopts the version of OP No.2 by filing the Memo.

04.   In the version of OP No.2 it has denied all the allegations of the complainant and required the complainant to prove all the allegations averred in the complaint to the strict proof of the same. 

04(a).       It is specifically contended that, the insured by name Kempegowda V.S by suppressing the earlier health issues caused due to accident and got obtained the insurance policies in question.  Further contended that, on investigation Ops learnt that, the insured on 14.10.2015 with alleged history of Road Traffic Accident and thereby the Doctors found to have insured suffered following injuries like Liver Laceration, Splenic construction, fracture shaft of righthumerus, fracture left radius.  Also contended that insured required resection of liver on 23.12.2015 through laparotomy and he is having scar of surgery in the abdomen along with unhealed wound on the left flank which got infected and developed in to abscess.  Further contended that, insured has also filed a motor vehicle accident case bearing MVC No.40/2016 before the tribunal at Kolar and the said tribunal awarded compensation of Rs.9,89,000/- with 9% interest per annum in respect of the accident caused.  Hence contended that, complainant has suppressed the above facts and filed this complaint.  It is specifically contended that, the insured died on 04.11.2021 at 03.40 AM and on that day above 02 insurance policies were lapsed at the time of the deceased (insured).  Hence contended that, Ops repudiated the claim and there is no deficiency in service or unfair trade practice and on these grounds ops prays to dismiss the complaint.

05.   In order to prove the case of the parties and both parties have filed their affidavit evidence along with documents.

06.   On the basis of the pleadings of the parties and the evidence placed on record, the following points will do arise for our consideration:-

(1) Whether the complainant has proved deficiency in service on the part of Ops?

(2) Whether the complainant is entitled for the relief as sought for in the complaint?

(3)  What Order?

07.   Heard the arguments and so also both parties have also filed their written arguments.

08.   Our findings on the above points are:-

             POINT Nos. (1) & (2):-     Are in the Negative

             POINT No.(3):-        As per the final order

                                           for the following :-

                             REASONS

09.     POINT NOs.(1) & (2):- These points are interlinked to each other and hence taken up together for common discussion, for the sake of convenience and to avoid repetition of reasonings.

10. Perused the complaint, version, affidavit evidence along with documents and written arguments placed on record.  It is an undisputed fact that, one Kempegowda V.S had insured with the Ops that is, LICs New Endowment Plan bearing policy No.613897949 and the validity period is from 25.01.2020 and the date of maturity is 25.01.2041 and the sum assured is Rs.2,00,000/- and also obtained another LICs Jeevan Labh policy bearing No.609756948 commencing from 28.07.2019 and the date of maturity is 28.07.2044 and the sum assured is Rs.2,00,000/-.  The said insured Kempegowda V.S was died on 04.11.2021.

11.   The main allegation of the complainant is that, the complainant being the father and nominee of the above said two insurance policies, despite submitting all the claim papers to the Ops insurance company and finally the Ops have repudiated the claim and hence alleged that, there is deficiency in service on the part of the Ops. 

12.   Per contra, in the version the Ops have denied all the allegations made by the complainant and contended that, the complainant by suppressing the material facts had filed this complaint.  The complainant had canvassed that, prior to obtaining the policies the insured Kempegowda V.S was heal and healthy.  Per contra, the Ops have contended that, the son of the complainant (insured) met with an road traffic accident and he was admitted to Manipal Hospital with a history of road traffic accident and evaluated by a team of doctors that, the insured had the following injuries like Liver Laceration, Splenic construction, fracture shaft of righthumerus, fracture left radius.  Also contended that insured required resection of liver on 23.10.2015 through laparotomy and he is having scar of surgery in the abdomen along with unhealed wound on the left flank which got infected and developed in to abscess.  Further contended that, the complainant had also filed a motor vehicle accident case bearing MVC No.40/2016 before the tribunal at Kolar and the said tribunal awarded compensation of Rs.9,89,000/- with 9% interest per annum in respect of the accident caused.  In order to substantiate the case of the Ops, the Ops have filed Certificate dated: 19.01.2016 issued by Dr. Ravichand Siddachari at ink page No.35 of the Memo with documents.  On perusal of the same the certificate issued “To whom it may concern” reads thus:-

“This is to certify that Master Kempegowda, aged about 14 years was admitted to our hospital on 14.10.2015 with alleged history of road traffic accident.  He was evaluated by team of doctors (Pediatric Surgeon, physician, orthopaedics, Gl surgeons) and found to have following injuries: Liver laceration, splenic contusion, fracture shaft or right humerus, fracture left radius.  He required resection of liver on 23.10.2015 through a laparotomy.  He is now having a scar of surgery in the abdomen along with unhealed wound on the iert flank which got infected and developed in to abscess.  He is still under treatment with me”.

However on perusal of the complaint the complainant did not whispered anything about the insured previous ailments as certified by the above doctor in his complaint.  Further the OPs also produced the copy of the judgment rendered by the Motor Accident Claims Tribunal, Kolar.  On perusal of the above judgment it discloses that, the Hon’ble Tribunal observed that, the petitioner injured (insured) was admitted on 14.10.2015 and he was referred to him on 21.10.2015 for liver injury and liver Laceration was done, he was conducted surgery and around 50% of liver was removed and ultimately the Hon’ble Tribunal passed the award in the form of compensation amount of Rs.9,81,000/- in favour of the Petitioner Kempegowda (Insured).  On care full perusal of the entire complaint and the affidavit placed on record the complainant did not whispered anything in his complaint regarding the MVC case and awarding compensation by the Tribunal.   Hence we come to the conclusion that, on perusal of the policies in question issued by the Ops it discloses that, the date of issuance of policies commencing from 28.07.2019 and 25.01.2020 and these documents clearly reflects that, subsequent to road traffic accident the complainant’s son had obtained the policies by suppressing the material facts.  The insurance is a contract based on Uberrima fide (utmost good faith), so that it is the duty of the complainant to disclose the previous health issues of the insured and non-disclosing the same while obtaining the policies in question amounts to suppression of material facts.  Above all, one who seeks equity should also do equity. 

13.   It is quite interesting to note that, the death of the insured was on 04.11.2021 at about 03.40 AM as evident from the claims statement at Ink page No.14 produced by the complainant himself with the list of documents.  It clearly discloses that, the time of death of the insured is mentioned at 03.40 AM and the policies renewed by paying the late fee renewal charges on 04.11.2021 at 11.01 AM and hence Ops rightly contended that, the renewal of the policies is afterthought and the policies in question is not in force.  From the above evidence placed on record we reached to conclusion that, complainant by suppressing the material facts had got obtained the policy and acted contrary to the principle of Uberrima fide (utmost good faith) and hence allegations of the complainant against the Ops holds no water and the complainant has failed to prove deficiency in service on the part of the Ops and thereby the complainant is not entitled for the reliefs as sought in the complaint.  Accordingly we answered Point Nos. 1 & 2 are in the Negative.

POINT No.3:- 

14.   On the foregoing reasons assigned while answering Point Nos. (1) & (2) we proceed to pass the following:-

ORDER

01.   The complaint is dismissed.  No order as to costs.

02.   Send a copy of this order to all the parties to the proceedings.

(Dictated to the Stenographer, transcribed by him, corrected and then pronounced by us on this 24^th DAY OF JANUARY 2023)

 

 

 

   LADY MEMBER                               PRESIDENT