State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Vimala Shantilal Parmar on 20 January, 2012
Draft for approval :_
BEFORE THE HON'BLE
STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MAHARASHTRA, MUMBAI
First Appeal No.
A/04/45
(Arisen out of
Order Dated 05/12/2003 in Case No. 08/2003 of District Ratnagiri)
1.
Life Insurance Corporation Of India
Ratnagiri
Branch, Opp.
Jivratna Gogate College,
District Ratnagiri
2.
The Senior Manager, Life Insurance Corporation Of India
Kolhapur
Branch, Centre Point Complex, 511K/1-A, E-Ward, Station Road, Kolhapur
...........Appellant(s)
Versus
1.
Smt. Vimala Shantilal Parmar
Ratnadeep Tower, Old Tambat
Aali, District Ratnagiri
...........Respondent(s)
BEFORE:
Hon'ble
Mr. S.R. Khanzode PRESIDING MEMBER
Hon'ble
Mr. Narendra Kawde MEMBER
PRESENT:
Mr.
K. K. Jadhav, Advocate for the Respondent
ORDER
(Per Shri Narendra Kawde, Honble Member ) (1) This appeal takes an exception to an order dated 05/12/2003 in Consumer Complaint No.08/2003, (Smt.Vimala Shantilal Parmar Vs. Life Insurance Corporation of India & anr.), passed by District Consumer Disputes Redressal Forum, Ratnagiri (District Forum in short). The District Forum allowed the complaint of the respondent/original complainant and directed the appellant/original opponent to pay proceeds under insurance policy with 12% interest together with `5,000/- as compensation and `2,000/- as costs of litigation. Aggrieved by this order, the appellant LIC has preferred this appeal.
(2) The case in brief is that Shri Shantilal Parmar, husband of the complainant subscribed to the policy under Salary Savings Scheme of the LIC, appellant w.e.f.11/06/1998. The said policy was lapsed in June 1999. However, it was revived w.e.f.
17/05/2000 by paying outstanding premiums. Thereafter, the respondent/complainants husband expired on 05/09/2000. The complainant as a nominee under the policy filed death claim with the appellant LIC which was repudiated on the ground that the insured suppressed pre-existing disease. The complainant approached Claim Review Committee of the appellant LIC.
However, there is no record to show the decision of the Claim Review Committee. Therefore, the complainant approached Insurance Ombudsman. Ombudsman also passed an order dated 30/04/2002 upholding the repudiation of the claim. Feeling aggrieved thereby, the respondent/complainant filed consumer complaint, which was decided in her favour.
(3) The contention of the appellant LIC is that the claim was repudiated on the ground of suppression of material facts as deceased life assured was under treatment for sleeplessness and panic and his medical report also shows count of cholesterol & triglycerides were high.
The certificate of Dr.Shenai (attending doctor) has clearly established that the deceased life assured has suffered from ailments which were suppressed while subscribing to the policy and even at the time of revival of the policy. Death of life assured occurred due to acute myocardial infarction. The insurance is a contract of utmost good faith and person desirous of having insurance policy is under obligation to disclose full facts before subscribing the LIC policy as principle of utmost good faith is foundation of Insurance Company.
(4) This is an old appeal placed on board for hearing and disposal from sine-die list. Stay was granted by this Commission till disposal of the appeal by an order dated 19/07/2004. The appeal was fixed for hearing on 23/08/2011. Advocate for the appellant was present and respondent/complainant was present in person. On the next date of hearing i.e. 10/10/2011, advocate for the appellant was present, however the respondent/complainant remained absent.
Thereafter on 12/01/2012, the appeal was finally heard. Advocate for the respondent was present, however the appellant was absent and appeal was reserved for order.
(5) Heard the learned counsel for the respondent and perused the record.
Admittedly, appellant LIC had issued policy No. 946006651 in the name of lat Shantilal Parmar with sum assured `50,000/- under Salary Savings Scheme of the appellant LIC commencing on 11/06/1998. Due to non-payment of monthly premium in June 1999, the policy attained lapse status. However, after submission of declaration of good health by the late life assured and payment of outstanding premium dues, the policy was revived on 17/05/2000 and life assured died on 05/09/2000. The appellant LIC investigated the matter of the complainant/respondent as early claim and repudiated on the ground that the life assured suffered from heart disease. At the time of revival of the policy, the declaration of good health was signed and submitted to the appellant LIC by the late life assured and it is alleged that no mention was made of the ailment. There is certificate of Dr.Kelkar, who is one of the panel doctors of the LIC, on record. This certificate does not show pre-existing disease as alleged by the appellant LIC, nor LIC could produce tangible evidence as alleged to prove that the deceased had suppressed pre-existing disease of heart ailment. Since the appellant LIC relied on the certificate issued by Dr.Shenai which shows that life assured was having cholesterol and accordingly he was advised to reduce the cholesterol level. Dr.Kelkars certificate who is panel doctor of LIC does not support the contention of the appellant LIC, as the said certificate does not mention about heart ailment of the deceased and not established by tendering or adducing evidence by the appellant LIC as required U/s.13(4) of Consumer Protection Act, 1986. Mere averment in the appeal without adducing any documentary evidence to substantiate the contention of the appellant LIC cannot be considered. We do not find any merit in the appeal. Therefore, impugned order passed by the District Forum, Ratnagiri cannot be faulted with. We hold accordingly, and pass the following order.
ORDER (1) The appeal stands dismissed, resultantly the stay granted stands automatically vacated.
(2) Impugned order dated 05/12/2003 passed in Consumer Complaint No.08/2003 by District Forum, Ratnagiri is hereby confirmed.
(3) Parties to bear their own costs.
Pronounced on 20th January, 2012.
[Hon'ble Mr. S.R. Khanzode] PRESIDING MEMBER [Hon'ble Mr. Narendra Kawde] MEMBER pgg