State Consumer Disputes Redressal Commission
Priya Prakash Malpani vs L.I.C. Of India on 20 April, 2016
1 C.C..No.:25/2014
Date of filing :24.11.2014
Date of order :20.04.2016
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION,MUMBAI, CIRCUIT BENCH AT AURANGABAD.
COMPLAINT CASE NO.: 25 OF 2014
Priya D/o Prakash Malpani,
(Priya W/o Pawankumar Jaju),
R/o EATOL 1121-Highway,
74 South TEACHTR City,
GA-30269 U.S.A.
Through G.P.A.holder,
Prakash Meghraj Malpani,
R/o Ashok Paper Mart,
G.G.Road, Nanded,
Tq. & Dist.Nanded. ...COMPLAINANT
VERSUS
1. Life Insurance Corporation of India,
Through its Secretary,
C.E./C.R.M. Yogakshema Building,
Central Office, Mumbai.
2. The Divisional Manager,
Life Insurance Corporation of India,
Divisional Office, "Jiwan Prakash",
Gandhi Nagar, Hingoli Road,
Nanded.
3. The Branch Manager (Claim),
Life Insurance Corporation of India,
Nanded. ...OPPONENTS.
CORAM : Mr.S.M.Shembole, Hon`ble Presiding Judicial
Member.
Mr.K.B.Gawali, Hon`ble Member.
Present : Adv.Mr.H.I.Pathan for complainant, Adv.Mr.S.P.Golegaonkar for opponents.
2 C.C..No.:25/2014O R A L JUDGMENT (Delivered on 20th April 2016) Per Mr.S.M.Shembole, Hon`ble Presiding Judicial Member.
1. This is a complaint U/s 17 of Consumer Protection Act 1986 (hereinafter referred as 'The Act') claiming amount of insurance policy.
2. Brief facts giving rise to the complaint are that:-
Late Pawankumar Jaju who was husband of complainant Smt.Priya Jaju was a M.S.graduate and was working as software engineer in USA. He was drawing yearly package of Rs.25 lakhs. He died on 15.9.2012 due to heart attack in Washington Hospital. During his life time on 5.11.2011 he obtained insurance policy from opponent LIC known as LIC Jeevan Saral life insurance policy covering risk of Rs.25 lakhs. Proposal was submitted on 5.11.2011 through agent of LIC. He paid premium of Rs.1,17,600/-.
3. During the subsistence of policy he died on 15.9.2012. After his death on 6.10.2012 his widow complainant Priya submitted insurance claim with the opponent LIC along with necessary documents. She submitted insurance claim through her father by executing general power of attorney in his favour as she is residing in USA. Thereafter her father by application dated 25.12.2012, 24.1.2013 & 1.1.12013 requested opponent LIC to settle the claim at the earliest. But opponent LIC without considering his request repudiated the claim alleging that insured Pawankumar suppressed material fact about his underging Laparoscopic Cholecystectomy operation which was performed on 28.1.2011 at Deccan Hospital at Hyderabad, while submitting proposal for obtaining policy. Accordingly by letter dated 12.5.2013 complainant was informed. Therefore alleging deficiency in service on the part of opponent LIC, complainant has filed consumer 3 C.C..No.:25/2014 complaint claiming amount of insurance Rs.25 lakhs, compensation Rs.5 lakhs towards deficiency in service and amount of Rs.10,000/- towards cost of the proceeding.
4. In response to the complaint notice, opponents appeared before the Forum and by written version resisted the complaint contending inter alia that it has rightly repudiated the insurance claim as insured Late Pawankumar suppressed material fact about his earlier ailment and while submitting proposal for obtaining insurance policy. Further it is contended that consumer complaint is being barred by limitation is not maintainable. It has denied all other adverse averments made by complainant and submitted to dismiss the complaint .
5. In support of the complaint , complainant has produced copy of proposal form, copies of proposal, cremation certificate, copy of claim statement, copy of certificate dated 29.5.2014 issued by Deccan Hospital, copy of repudiation letter. Complainant has also produced evidence affidavit of father Prakash who is her G.P.A. along with copy of G.P.A. As against evidence of complainant, opponents also filed evidence affidavit of Mr.Mahesh Sahastrabuddhe, Manager of LIC of India, Aurangabad Division. They have also produced documents as per list of documents i.e. discharge summary dated 29.10.2015 of Deccan Hospital, Hyderabad, medical literature, medical papers of Washington Hospital and copies of other documents. In addition to the evidence affidavit and documents produced by parties their counsel also submitted written notes of argument and advanced oral argument.
6. In view of the facts of the matter and arguments advanced by counsel for parties, following points arise for our determination and we record our findings against each point for the reasons which follow.
4 C.C..No.:25/2014POINTS FINDINGS
i) Whether consumer complaint is barred
by limitation? ...In the negative.
ii) Whether it is proved by complainant that
opponent LIC has committed deficiency in
service by repudiating the claim? ...In the negative.
iii) Whether it is proved by opponent LIC that
insured Late Pawankumar suppressed the
material fact while submitting proposal
for obtaining policy? ...In the affirmative.
iv) What order? ...As per final order.
R E A S O N S
7. AS TO POINT NO.(i) :- It is averred by opponent LIC that as per provisions of Section 24A, Consumer Protection Act 1986, complainant should have filed complaint within two years from the date of death of insured. According to it cause of action does not continue till repudiation of claim. Mr.Golegaonkar advocate appearing for opponent LIC also tried to support it by relying on the decision of Hon'ble Apex Court in the case of Kandimalla Raghavaiah & Co. -Vs- National Insurance Co.Ltd., III(2009) CPJ 75. But we find no force in the submission of Adv.Mr.Golegaonkar appearing for the opponent. Because cause of action would arose on the date when the repudiation letter received by the complainant and not from the date of death of insured. When the claim was submitted within two years from the date of death of insured, there could be no question of continuation of cause of action. Hence without considering other facts and evidence 5 C.C..No.:25/2014 on record we record our negative finding to point No.(i) holding that complaint is not barred by limitation.
8. AS TO POINT NO.(ii) & (iii) :- In order to avoid repetition we would like to decide both these points simultaneously. It is not disputed that before submitting proposal form dt.5.11.2011 for obtaining insurance policy insured Late Pawankumar was ailing and he was admitted in Deccan Hospital, Hyderabad for the period from 25.10.2011 to 29.10.2011. Not only this but on 28.10.2011 he had undergone surgery of Laparoscopic Cholecystectomy. It is also fortified from the copies of discharge summary and medical case papers issued by Deccan Hospital, Hyderabad. But all these facts were not disclosed by insured Late Pawankumar in his proposal form which was submitted on 5.11.2011. It also manifests from the copy of undisputed proposal form.
9. However, it is submitted by Mr.H.I.Pathan learned counsel appearing for the complainant that though insured deceased Pawankumar had undergone operation prior to submitting proposal form, it has no nexus with the cause of his death. According to Adv.Mr.Pathan when undisputedly insured died due to cardio pulmonary arrest it has no nexus with the ailment i.e. gallstone performed operation for extraction of stone from Gallbladder etc. It is also submitted that at the time of submitting proposal form insured Late Pawankumar was also thoroughly examined by doctor on the panel of opponent LIC and considering all these facts proposal was accepted by opponent LIC. It is also submitted that since ailment for which insured was required to undergo operation is not serious ailment, it was not necessary to disclose same fact in the proposal form. Thus according to Mr.Pathan advocate appearing for the complainant that deceased Pawankumar had no malafide intention to suppress any fact. But opponent LIC without considering all these facts wrongly repudiated the claim.
6 C.C..No.:25/201410. Per contra, Mr.Golegaonkar advocate appearing for the opponent LIC submitted that though the ailment by which deceased insured Pawankumar was suffering from and required to undergo operation was not serious ailment and further it has no nexus with the cause of death of insured Pawankumar, it was obligatory on the part of insured Pawankumar to disclose all the facts about his ailment while submitting proposal form. But the insured obtained insurance policy immediately i.e. within one month from his discharge from Deccan Hospital, Hyderabad submitting proposal form fraudulently suppressing material fact about his ailment. It is submitted that it was obligatory on the part of insured deceased Pawankumar to make true and full disclosure while submitting proposal. He has also supported his contention by relying on the following decisions of Apex Court and National Commission.
i) Satwant Kaur Sandhu -Vs- New India Assurance Co.Ltd., IV(2009) CPJ 8(SC),
ii) LIC of India -Vs- Asha Goel, (2001) 2SCC 160,
iii) P.C.Chacko -Vs- Chairman, LIC of India , (IV) 2008 CPJ 78,
iv) LIC -Vs- Panchfula Shriram Jadhav decision dated 21.5.2015 of Hon'ble National Commission in Revision Petition No.1785/2011.
11. In case of Satwant Kaur Sandhu(Supra) Hon'ble Apex Court held that "contract of insurance is being of utmost good faith, insured is under obligation to make true and full disclosure within his knowledge. If the statement made in proposal form as to the state of health is found to be palpably untrue to his knowledge, suppression of material facts is proved and repudiation of claim is justified".
7 C.C..No.:25/201412. In the case of P.C.Chacko(Supra) the Hon'ble Apex Court held that the suppression must be fraudulently made by the policy holder. Whereas in Asha Goel(Supra) case, the Hon'ble Apex Court held that "contract of insurance including the contract of life insurance are contract uberrimae fides(utmost good faith) and every material fact must be disclosed". In the case of Panchfula Shriram Jadhav's case(Supra) the Hon'ble National Commission held that "nexus between the death and the cause of immediate ailment or disease cannot be considered. The main fact is that the policy holder must tell the truth at the time when he fills up the proposal form".
13. Thus from the above authorities of Hon'ble Supreme Court and Hon'ble National Commission it is obvious that contract of insurance is being an utmost of good faith, insured is under obligation to make true and full disclosure of information though earlier ailment has no any nexus with the cause of death of insured. Moreover when undisputedly insured Pawankumar had obtained policy submitting proposal form immediately after his discharge from Deccan Hospital, Hyderabad it can safely inferred that he has obtained policy fraudulently suppressing material fact about his ailment and undergoing Laparoscopic Cholecystectomy operation. Therefore we have no hesitation to accept argument of Adv.Golegaonkar appearing for opponent LIC and hold that insured Pawankumar fraudulently obtained policy by suppressing material fact and therefore opponent LIC has rightly repudiated the complainant's claim. Opponent LIC has not committed any deficiency in service. Accordingly we record negative finding to point No.(ii) & affirmative finding to point No.(iii).
14. In the result, complainant fails. Hence the following order.
8 C.C..No.:25/2014O R D E R
1. Complaint Case No.25/2014 stands dismissed.
2. Having regard to the undisputed peculiar fact that opponent LIC has received amount of premium Rs.1,17,608/- we direct the parties to bear their own cost.
3. Copies of the judgment be supplied to both the parties.
Sd/- Sd/- K.B.Gawali, S.M.Shembole, Member Presiding Judicial Member Mane