State Consumer Disputes Redressal Commission
Divisional Manager, Life Insurance ... vs Smt.Laxmi Ashok Mahajan on 19 May, 2009
CONSUMER DISPUTES REDRESSAL COMMISSION CONSUMER DISPUTES REDRESSAL COMMISSION MAHARASHTRA STATE, MUMBAI FIRST APPEAL NO. 1471 OF 2001 Date of filing : 03/10/2001 IN CONSUMER COMPLAINT NO. 32 OF 2001 Date of order : 19/05/2009 DISTRICT CONSUMER FORUM : SATARA Divisional Manager Life Insurance Corpn. of India Jeevantara, Ganpatdas Devi Path, Satara thru Zonal Manager Western Zonal Office, Life Insurance Corpn. of India, Yogakshem, East Wing, III floor, Nariman Point, Mumbai. Appellant/org. O.P. V/s. Smt.Laxmi Ashok Mahajan 351, Shaniwar Peth, Karad, Dist. Satara. Respondent/org. complainant Corum : Shri P.N. Kashalkar, Honble Presiding Judicial Member
Smt. S.P. Lale, Honble Member Present: Mr.Vivek Kaushik, Advocate for the appellant.
None for the respondent.
- : ORDER :-
Per Shri P.N. Kashalkar, Honble Presiding Judicial Member Being aggrieved by the judgement and award passed by District Consumer Forum Satara in consumer complaint No.32/2001 dated 30/08/2001, whereby allowing complaint of the complainant, Forum below directed the O.P./LIC to pay to the complainant claim amount under both the policies with all benefits within 30 days from the date of the order and further directed to pay interest @ 9% p.a. from 21/04/1999 till realization of the said amount and also directed to pay Rs.10,000/- as compensation for mental harassment and Rs.2,000/- towards cost, the org. O.P./LIC has filed this appeal.
The facts to the extent material may be stated as under :-
Husband of complainant Ashok Ramkrishna Mahajan had taken two insurance policies from LIC bearing No.940427141 and 940426808 dated 28/09/1992 one for amount of Rs.25,000/- and another for amount of Rs.50,000/- with quarterly premium. It was pleaded by the complainant in the complaint that her husband had paid the premium of the two policies regularly. Policies were issued after medical examination of her husband and when policies were in force, her husband died on 01/09/1993. The complainant therefore lodged claim for both the policies. But, LIC repudiated the claims on the ground that deceased had suppressed material facts that he was suffering from chronic renal failure with mitral valve pro-lapse. As such complainant filed consumer complaint and claimed Rs.75,000/- under both the policies with interest @ 18% p.a. from September 1993 to June 2000 and also claimed Rs.15,000/- for mental harassment and Rs.5,000/- towards cost. The complainant filed affidavit and some documents in support of her case.
O.P. filed written statement and contested the claim. According to O.P. they had repudiated the claim under both the policies based on provisions of Section 45 of the Insurance Act. O.P. pleaded that deceased had suppressed that he was suffering from chronic renal failure with mitral valve pro-lapse before he had taken two policies. He had also taken treatment for the said disease. This fact was revealed by the Medical Attendant at Pune Hospital and Research Centre in his certificate dated 25/04/1995. It was also found that deceased had bodily defects like stammering and deafness by birth. This fact was admitted by the complainant herself. O.P. pleaded that Agent had fully informed the complainant of all the facts of the matter. O.P. had replied the legal notice issued by the complainant through Advocate Vijaykumar Raut. As such LIC pleaded that there was no deficiency in service and they had justifiably repudiated the claim of the complainant. The complainant had approached Zonal Review Committee, headed by retired High Court Judge. The Review Committee upheld the decision of repudiation and therefore, repudiation was just, proper and there was absolutely no deficiency in service on their part. The LIC further pleaded that Policy No.940427141 was time-barred. This claim was repudiated for suppression of material fact in April 1996. Death of deceased life assured on 01/09/1993 and it was claimed after three years from the date of death. On that ground also claim was not payable and hence, it is pleaded that complaint should be dismissed with cost. O.P. also filed affidavit in support of its written statement.
Considering the documents and affidavits filed before it, the learned Forum below was pleased to allow the complaint holding that repudiation was improper and the so called certificate was not supported by doctors affidavit. It held that widow was entitled to get claim amounts under both the policies of her deceased husband with all its benefits accrued thereon. The Forum below also held that she is entitled to get compensation for mental harassment and passed the impugned order. Aggrieved thereby, LIC has filed this appeal.
We heard Mr.Vivek Kaushik, Advocate for the appellant/LIC. None is present for the respondent.
We perused the appeal memo and the documents placed on record and rival pleadings of the parties. We are finding that the claim under Policy No.940426808 was repudiated by the LIC vide its letter dated 10/04/1996. It was for assured sum of Rs.50,000/-. After repudiation, within two years complainant should have filed consumer complaint. But, complaint came to be filed on 08/02/2001 covering both the policies. So far as Policy No.940426808 is concerned, same was repudiated on 10/04/1996. But, consumer complaint came to be filed on 08/02/2001 i.e. four years after repudiation of the said claim. So far as this policy is concerned, consumer complaint based on this policy was clearly barred by limitation and there was no condonation of delay application filed by the complainant. Under the circumstances, claim allowed under impugned award in respect of this policy is improper, unjust and cannot be allowed to sustain in law. A claim which is barred by limitation cannot be allowed by the Forum below exercising powers under Consumer Protection Act, 1986. Law of limitation is very much applicable to such proceedings. Under Section 24-A specifically limitation is provided for filing complaint and it is of two years. Of course, on just and sufficient grounds being shown, Forums are empowered to condone the delay, but there should be an application and request to that effect made by the complainant. In the instant case, no such request was made. Therefore, as far as policy No.940426808 is concerned, complaint as filed was barred by limitation and therefore, claim for that policy should have been rejected or negatived by the Forum below by allowing the complaint partly. We are inclined to quash the order of the Forum below pertaining to policy No.940426808.
As far as other policy is concerned, policy No.940427141 appears to have been repudiated by letter dated 21/04/1999 in which reference to repudiation of previous policy was mentioned. Thus, policy was repudiated on 21/04/1999 and filing of consumer complaint in 2001 by the complainant in respect of this policy appears to be within limitation. So, on the ground of limitation, claim under this policy cannot be turned down. Mr.Kaushik submitted that deceased was suffering from renal failure and this was amply made clear from Medical Attendants certificate issued by Pune Hospital & Research Centre. However, mention of certain diseases in the Medical Attendants certificate is not sufficient to prove that deceased had suffered from renal failure and he had suppressed material fact. What is pertinent to note is the fact that deceased died owing to heart attack. Death of deceased Ashok Mahajan was due to heart attack and not because of renal failure. So, cause of death is not as LIC wants us to believe. Deceased died because of heart attack and not because of renal failure. So, policy No.940427141 for Rs.25,000/- cannot be allowed to be repudiated simply because deceased died due to heart attack. Suppression of material fact must be with reference to the cause of death of the life assured. If life assured had suppressed something, but death occurred because of another thing, LIC cannot be permitted to take benefits of the fact under Section 45 of Insurance Act that deceased had not disclosed that material fact and therefore, it was entitled to repudiate the claim. In the circumstances, repudiation of policy No.940427141 was improper and Learned Forum below rightly allowed the complaint so far as this policy is concerned turning down the plea sought to be taken by the LIC. In the circumstances, Forum below rightly passed order so far as policy No.940427141 is concerned, but Forum below erred in law in allowing claim of other policy, which was repudiated in 1996 and for which complaint was filed as late as on 08/02/2001. Therefore, we are inclined to allow this appeal partly to quash order of the Forum below so far as policy No.940426808 is concerned. Hence, we pass the following order :-
-: ORDER :-
1.
Appeal is partly allowed.
2. Order of the Forum below is upheld in respect of policy No.940427141 and order of the Forum below is quashed partially which relates to policy No.940426808.
3. Appellant/LIC shall pay sum assured of Rs.25,000/- under policy No.940427141 with all benefits accrued thereon to the respondent/org. complainant.
4. Rest of the order is confirmed so far as policy No.940427141 is concerned and it is quashed so far as policy No.940426808 is concerned.
5. No order as to costs.
6. Copies of the order be furnished to the parties.
(S. P. Lale) (P.N. Kashalkar) Member Presiding Judicial Member dd.