BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, VELLORE DISTRICT AT VELLORE. PRESENT:THIRU. A. SAMPATH, B.A., B.L., PRESIDENT TMT. G. MALARVIZHI, B.E. MEMBER – I THIRU. K. DHAYALAMURTHI,B.SC. MEMBER – II CC. 2 / 2003 WEDNESDAY THE 27TH DAY OF JULY 2011. 1. T. Mythili, W/o. Late Thiagarajan, 2. Minor Harini, Rep. by T. Mythil, Complainants 1 & 2 are Residing at No.16-281, Veppamaram Street, Chittoor, Andhra Pradesh, 3. Kuppammal (died) W/o. Badrachalam, Melpudhur Village & Post, Chengam Taluk, Tiruvannamalai District. 4. J. Indraniammal, W/o. Jayaram Naicker, No.16, Pappathiamman Koil Street, Arani. 5. K. Sundariammal, W/o. Karunanidhi, No.2103/5, Vanavil Nagar, Tiruvannamalai. 6. Murugan, 7. Kalaiarasi, 8. Jeeva, 9. Priya, 10. Ganga, 11. Amutha, 12. Remesh, 13. Indira, 14. Suresh, 15. Pappi Complainant No.6 to 11 are Residing at Melpudur Village, Chengam Taluk, Tiruvannamalai District. … Complainants. - Vs – 1. The Zonal Manager, Life Insurance Corporation of India, Southern Zonal Offices, L.I.C. Buildings, 102, Anna Salai, Chennai. 600 002. 2. The Divisional Manager, Life Insurance Corporation of India, “Jeevan Prakash” Arcot Road, P.B.No.423, Vellore 632 004. 3. The Senior Branch Manager, Life Insurance Corporation of India, Arani Town, Tiruvannamalai District. … Opposite parties. . . . . This petition coming on for final hearing before us on 28.6.11, in the presence of Thiru. R. Santhanam, Advocate for the complainant and Thiru. L. Pandurangan, Advocate for the opposite parties, and having stood over for consideration till this day, the Forum made the following: O R D E R Pronounced by Thiru. A. Sampath, President of the District Consumer Disputes Redressal Forum, Vellore District. 1. The brief facts of the case of the complainant is as follows: The Late Thiyagarajan, husband, father and son of the complainants respectively took a Life Insurance Policy in Life Insurance Corporation of India, Arani Branch for Rs.1,00,000/- on 11.3.99 by paying a total sum of Rs.11,802/-. The said proposed policy was accepted and there was concluded contract of Insurance after Medical Examination of Thiyagarajan, by the LIC Doctor. The Policy No.is 730809523 of Arani Branch LIC. The assured Thiyagarajan died on 23.6.99 in C.M.C. Hospital, Vellore owing the “Intra Cerebral Hemorrhage”. On 10.3.00 the 1st complainant made a request to LIC to send the policy to her. She had sent the copies of the same to the opposite parties 2 and 3. As she did not receive any reply for the same, she had caused the issue of the notices dt. 31.5.00 and 22.6.00 through her counsel to the 3rd opposite party. The 3rd opposite party had received the notice dt. 22.6.00 on 23.6.00 and sent the letter dated 24.6.00 stating that the policy had been dispatched on 3.4.99 to the Policy Holder. As the policy had not been received as mentioned in the above letter, again a notice dated 7.7.00 was sent by the counsel for which the 3rd opposite party had sent a reply on 21.7.00 reiterating the reply in his previous letter dt. 24.6.00. They are the legal heirs of late Thiyagarajan as per Hindu Law since they are all class –I heirs. The copy of the Death Certificate. 2. The 3rd complainant died on 12.8.04 leaving her tow daughters complainants 4 and 5 predeceased son Pasupathi’s son and daughters complainants 6 to 10, predeceased son Sundaram’s daughters and sons complainants 11 to 15 and predeceased son Thiyagarajan’s daughter 2nd complainant as her legal heirs in Hindu Law Her right to sue had survived on them. The Insurance amount of Rs.1,00,000/- is payable to the complainants, since they are the legal heirs of Late Thiyagarajan as per Hindu Law. The complainants 1 and 2 caused the issue of the notice dated 11.7.02 calling upon the 1st opposite party to settle the claim under the said policy No.730809523 since the 2nd opposite party had repudiated the claim on the ground of with holding correct information regarding health at the time of affecting the assurance by the communication dt.19..3.01. The said notice was received by the 1st opposite party on 12.7.02. But he has not chosen to either reply or comply with the claim made in the said notice. The 2nd opposite party has not made available the alleged indisputable proof for the repudiation in the said communication dt.19.3.01. The 1st opposite party has not cared even to reply as stated above. The opposite parties who have received the deposits totaling Rs.11,802/- and accepted the policy, by their unreasonable, arbitrary, illegal and unfair stand, caused deficiency in service namely repudiating the lawful claim of the complainants, the complainants have approached this Forum for the insured amount. As the opposite parties have repudiated the reasonable claim of the complainants, and caused them mental agony, they are liable to pay damages to the complainants which they estimate as Rs.5,00,000/-. Therefore the complainants are pray this Forum for directing the opposite parties to pay a sum of Rs.1,00,000/- with interest ant 24 per cent p.a. from the date of the petition till the date of payment and to pay a sum of Rs.50,000/- as damages with costs. 3. The averment in the counter filed the by 2nd opposite party and adopted by the 1st and 3rd opposite party are as follows: The complaint is not maintainable either in law or on facts. The opposite party denies all the allegations made in the complaint save those which are specifically admitted herein and puts the complainant to strict proof of the same. The opposite party reserves his right to file additional counter if necessary in the course of the proceedings. It is true that late Sri. Thiyagaran had taken a policy bearing policy No.730809523 for a sum of Rs.1,00,000/- on 20.3.99 under 12 years “Jeevan Sanchay” Plan. He had paid Rs.11,802/- towards first premium. The deceased life assured had nominated his wife Smt. T. Mythili to receive the policy monies in the event of his death during the term of the policy. It is true that the proposal was accepted on the basis of the Medical Report submitted by the deceased life assured from a doctor who is in our penal of medical examiner. The doctor who examined the deceased life assured has given a report on the basis of the information given by the deceased life assured about his present and past health condition. The medical examination done for the purpose of insurance is only a clinical and not pathological one. Additional reports will be called for only on the basis of the information given by the life assured. The deceased life assured had not disclosed to the doctor about the fact of having Hypertensive for the past 4 years and the treatment taken by him for the above ailment. If the said information was known to the doctor he would have called for ECG and other reports at the time of medical examination for new proposal. The opposite party came to know about the suppression of material facts by the deceased life assured at the time of medical examination only at the time of claim. The information of Hypertension for the past 4 years was given by the deceased life assured to the attending doctor at CMC, Hospital, Vellore, when he was admitted during his last illness. The CMC doctor has given certificate which was obtained by the nominee and submitted to us in our printed form. Therefore the claim form B1 is the document of the complainant and not the document of the opposite party. On the basis of the information given by the complainant and the reports of CMC Hospital the claim was repudiated for non-disclosure of material facts. The claim has arisen within three months of the issue of the policy the non-disclosure takes more importance. Life Insurance Contract is a contract of Uberima Fidea. The statements made and answers given in the proposal by the proposal form the basis of contract. The DLA had also agreed and declared that the statements and declarations given in the proposal form shall be the basis of the contract of assurance and if any untrue averments be contained therein, the said contract shall be absolutely null and void and monies which shall have been paid in respect thereof shall stand forfeited to the Corporation. But he had given false answers to Q.No. 11 (a) 11 (e) & 11 (i) in the proposal for assurance. Since the decision to repudiate the claim has been taken in terms of policy contract and declaration contained in the proposal after due application of mind and in good faith and the same was properly communicated to the claimant, the question of deficiency of service on the part of the corporation does not arise at all. The Corporation acts as a trustee in safeguarding the interest of lakhs and lakhs of policy-holders money. The Corporation has to satisfy itself before payment of any claim whether the claim is genuine or not, the Corporation is always interested to settle all the claims but never at the cost of genuine policy-holders interest. The opposite party reserves its to file additional counter if it feels necessary in the course of the case. The repudiation of the claim was made by the 2nd opposite party on the basis of the information available to him and the 1st opposite party is not connected in the above process. Therefore this complaint is to be dismissed with cost. 4. Now the points for consideration are: a) Whether there is any deficiency in service, on the part of the opposite party b) Whether the complainant is entitled to the reliefs asked for?. 5. Ex.A1 to Ex.A15 were marked on the side of the complainants and Ex.B1 to Ex.B5 were marked on the side of the opposite parties. Proof affidavit of the complainants and Proof affidavit of the opposite parties have been filed. No oral evidence let in by either side. 6. POINT NO. a): It is admitted case of the parties that the 1st complainant’s husband Thiru.Thiyagarajan, had taken a policy bearing policy No.730809523 for a sum of Rs.1,00,000/- on 20.3.99 under 12 years “Jeevan Sanchay” Plan from the 3rd opposite party. He had paid Rs.11802/- towards first premium. Thereafter the assured Thiyagarajan died on 23.6.99 in Christian Medical College Hospital, Vellore owing the Intra Cerebral Hemorrhage. The deceased life assured had nominated his wife Smt. T. Mythili to receive the policy amount in the event of his death during the term of the policy. The complainants 1 and 2 caused the issue of the notice dt. 11.7.02 calling upon the 1st opposite party to settle the claim under the said policy No.730809523 since the 2nd opposite party had repudiated the claim. 7. The complainants contended that the opposite parties have received the premium amount totally Rs.11800/- and accepted the policy by their unreasonable, arbitrary illegal and unfair stand caused deficiency in service namely repudiating the lawful claim of the complainants. Further, as the opposite parties have repudiated the reasonable claim of the complainants and caused them mental agony. Therefore directing the opposite parties to pay the assured sum and the compensation mentioned in the complaint. In this connection the learned counsel for the complainant relied upon the following Judgment of High Court of Madras 2010 (1) CTC 192 The Life Insurance Corporation of India, Rep. by its Branch Manager, Vellore and another. ..Vs.. S. Anusuyabai Wherein the Hon’ble High Court of Madras is held that Insurance Act, 1938 (4 of 1938), Section 45 – Evidence Act, 1872 (1) of 1872), Sections 101 to 104 – Burden of Proof – Applicability of payment of policy amount – Deliberate suppression of material information – Ingredients of Section 45 would be attracted if (a) Policy holder suppresses material facts that he was required to disclose or statement made by policy holder is material matter; (b) Such suppression must be fraudulent; (c ) Policy holder makes such statement knowing it to be false at time of making it or with knowledge of suppression – LIC being an established Corporation, burden is heavy upon it to escape from statutory obligation – LIC failed to discharge its burden and coupled with lack of evidence to show that insured was aware of consequences of making statement of good health in policy – Moreover, misstatement by itself not material for repudiation of policy unless same is material in nature – Evidence disclosed that insured did not know of Hepatitis which caused death at time of taking policy – No proof of deliberate suppression of ailments – Held, no deliberate wrong answer on part of insured to have bearing on contract of Insurance – Orders of lower Courts directing LIC to pay policy amount along with interest confirmed. 8. The opposite parties contended that the claim was repudiated for non disclosure of certain material facts regarding the health condition of the life assured Thiyagarajan at the time of taking the policy. It is further contended that from the perusal of the Medical Attendance Certificate along with the patient records of Christian Medical College Hospital, Vellore Exs.B3, it is proved that four years before he purposed for the policy, he had suffered from Intra Cerebral Hemorrhage and Hyper tension for which he had taken treatment in a hospital. The policy holder knewfully well when he made the statement that his statement given by him to the Doctor was false and that he has suppressed the facts which was material to be disclosed. Therefore, the opposite parties have not liable to pay the amount claimed by the complainants in their complaint. In this connection learned counsel for the opposite parties are relying upon the following Judgments of Hon’ble Supreme Court, I. AIR 2008 SUPREME COURT 424 P.J. Chacko and Anr. ..Vs.. Chairman, Life Insurance Corporation of India & Ors. Wherein the Hon’ble Supreme Court is held that ” The well settled law in the field of insurance is that contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission. And this duty to disclose continues up to the conclusion of the contract and covers any material alteration in the character of the risk which may take place between proposal and acceptance. “ (A) Insurance Act (4 of 1938) S.45 – Insurance Policy – Repudiation – Deliberate wrong answer given by Insured having a great bearing on contract of insurance - Policy may be repudiated. Contract Act (9 of 1872) S.126. II 2009 (IV) CPJ 8 (SC) SATWANT KAUR SANDHU ..Vs.. NEW INDIA ASSURANCE COMPANY LTD. Wherein the Hon’ble Supreme Court is held that “Section 45 – Insurance Regulatory and Development Authority (Protection of Policy Holder’s Interests) Regulations, 2002 – Regulation 2(1)(d) – Insurance – Mediclaim Policy – Suppression of material facts – Policy holder suffering from chronic diabetes and renal failure not disclosed – Claim repudiated by insurer – Section 45, Insurance Act, applicable in life insurance policy, has no application in case related to mediclaim policy – Contract of insurance, contract of uberrimae fidei – Insured under obligation to make true and full disclosure of information, within his knowledge – Insured on regular haemodialysis, fully aware of state of health – Statement made in proposed form as to state of health palpably untrue to his knowledge - Suppression of material facts proved – Repudiation of claim justified. “ It is further contended that the decision cited by the learned counsel for the complainants is not applicable to the facts of this case. 9. The 1st complainant’s husband Thiru. Thiyagarajan made proposal for insurance on own life Ex.B1 before the 3rd opposite party on 11.3.99 From the perusal of Ex.B1, it is seen that the life assured Thiru. Thiyagarajan made a declaration before the medical examiner of Insurance Company that during the last five years he has not consulting the medical practitioner for any ailment requiring treatment for more than a week and his health condition was good. From the perusal of Medical Attendance Certificate of Life Insurance Corporation of India, Vellore Division along with the patient record of Ex.B3 of the deceased Thiyagarajan issued by the Christian Medical College Hospital, Vellore, it is seen that the deceased Thiyagarajan was admitted on 16.6.99 and he was died in the said Hospital on 23.6.99. Further it is seen from the above medical records and death certificate that the deceased Thiru. Thiyagarajan suffering from Intra Cerebral Hemorrhage and Hyper Tension for the past four years. Therefore it is clear that Thiru. Thiyagarajan was suffering from Intra Cerebral Hemorrhage and Hyper Tension four years before to obtaining the policy. But at the time of presenting the proposal for insurance on own life before the 3rd opposite party on 11.3.99 the assured Thiyagarajan did not disclose before the doctor of the Insurance company that he was suffering from Intra Cerebral Hemorrhage and Hyper Tension for the past four years. 10. Considering the effect of Sec.45 of the Insurance Act, the Insurance Policy is a contract falling in the category of utmost good faith on the part of the assured, and if the assured has not made full disclosure correctly or in other words, if the declaration so made found to be false to the knowledge of the declarant, then the insurance company is entitled to repudiate the claim. The Hon’ble Supreme Court has observed in above two cases cited by the learned counsel for the opposite parties that under section 45 of Insurance Act deliberate wrong answer given or statement made in proposal form as to state of health condition and true to his knowledge he suppressed of material facts the Insurance Company can repudiate the claim. 11. In the present case at the time of presenting the Ex.B1 proposal for insurance on own life before the 3rd opposite party, the assured Thiru. Thiragarajan stated falsely that for the last five years, he was not consult with the medical practitioner for any disease and also he was a good health condition. The opposite parties have proved through the Ex.B3 Medical attendance Certificate along with patient records and death certificate of Thiru. Thiyagarajan issued by the Christian Medical College Hospital, Vellore, that last four years before taking the Insurance policy, he was suffering from Intra Cerebral Hemorrhage and Hyper Tension and taking treatment. Therefore it is clear that during the time of taking the Insurance Policy on 11.3.99, the first complainant’s Husband suppressed the material facts before the Insurance Company Doctor. Under Section 45 of Insurance Act, insured Thiru.Thiyagarajan under obligation to make true and full disclosure of information, within his knowledge. But he made false statement before the Insurance Doctor, on 11.3.99 regarding his health condition. Based on the suppression of material facts the opposite party of the Insurance Company repudiated the claim. Therefore, there is no deficiency in service on the part of the opposite parties. The authorities cited by the learned counsel for the complainant is not applicable to this case. But the authorities cited by the learned counsel for the opposite parties are squarely applicable for the facts and circumstances of this case. 12. Hence, taking all the above facts into consideration from the contention in the complaint and the counter, as well as proof affidavit of the both the parties, and from the documents Ex.A1 to A15 and Ex.B1 to B5, we have come to the conclusion that the complainants herein have not clearly proved the deficiency in service on the part of the opposite parties herein. Hence we answer this point (a) as against the complainant herein. 13. POINT NO : (b) In view of our findings on point (a), since, we have come to the conclusion that the complainants herein have not clearly proved the deficiency in service on the part of the opposite parties herein. We have also come to the conclusion that the complainants are not at all entitled to any relief asked for by them, in this complaint. Hence we answer this point (b) also as against the complainant herein. 14. In the result this complaint is dismissed. No costs. Dictated to the Steno-typist and transcribed by her, corrected and pronounced by the President, in Open Forum, this the 27th day of July, 2011. MEMBER-I MEMBER-II PRESIDENT. List of Documents: Complainant’s Exhibits: Ex.A1- 23.6.99 - X-copy of Death Certificate. Ex.A2- 31.5.00 - X-copy of lawyer notice. Ex.A3- 23.6.00 - x-copy of lawyer notice. Ex.A4- 24,6,00 - X-copy of letter by the opposite party. Ex.A5- 21.7.00 - x-copy of letter to the complainant. Ex.A6- 11.7.02 - X-copy of lawyer notice. Ex.A7- -- - X-copy of Postal Ack. Ex.A8- 19.3.01 - x-copy of letter by the opposite party to the complainant. Ex.A9- -- - O.S.No.177/2001. Ex.A10- -- - O.S.No.177/2000. Ex.A11- -- - O.S.No.95/2004. Ex.A12- -- - Appeal No.42/2006. Ex.A13- 11.7.02 - X-copy of lawyer notice. Ex.A7- -- - X-copy of Postal Ack. Ex.A8- 19.3.01 - x-copy of letter by the opposite party to the complainant. Ex.A9- -- - O.S.No.177/2001. Ex.A10- -- - O.S.No.177/2000. Ex.A11- -- - O.S.No.95/2004. Ex.A12- -- - Appeal No.42/2006. Ex.A13- -- - O.S.NO.95/04 in E.P.14/08 Ex.A14- -- - O.S.NO.94/04 in O.E.P.No.14/08. Ex.A15- -- - F.S. Memo in E.P.14/08 in O.S.No.95/04. Opposite party’s Exhibits: Ex.B1- -- - Proposal for Insurance on own life. Ex.B2- -- - Claimant’s Statement. Ex.B3- -- - Medical Attendants Certificate Ex.B4- -- - X-copy of medical Attendant’s certificate. Ex.B5- -- - X-copy of Hospital Treatment. MEMBER-I MEMBER-II PRESIDENT.
| | [ Hon'ble Tmt G.Malarvizhi, B.E] MEMBER[ Hon'ble Thiru A.Sampath, B.A., B.L] PRESIDENT[ Hon'ble Tr K.Dhayalamurthy, Bsc] MEMBER | | 
