State Consumer Disputes Redressal Commission
South Central Zone Office (Jeevan ... vs 1. Smt.C.Bujjamma W/O Late ... on 10 June, 2013
BEFORE THE CIRCUIT BENCH OF A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT TIRUPATHI FA.NO.93 OF 2013 AGAINST C.C.NO.50 OF 2012 DISTRICT FORUM-II, TIRUPATHI Between: 1. The Zonal Manager, South Central Zone Office (Jeevan Bhagya), Secretariat Road, Saifabad, Hyderabad. 2. The Senior Divisional Manager, LIC of India, Divisional Office, Dargamitta, Nellore. 3. The Branch Manager, LIC of India, Tirupathi Branch-1 Office, Narasimhatheertham road, Tirupathi. .. Appellants/Opp. Parties And 1. Smt.C.Bujjamma W/o late C.H.Balaraju, R/o H.No.6-1, Ithepalli village & Post, Chandragiri Mandal, Chittoor District. .. Respondent/Complainant 2. The Assistant Executive Officer, Pay & Accounts Office, TTD, Tirupathi. .. Respondent/OP.No.4 (R-2 is not a necessary party). Counsel for the appellants : Mr. Srinivas Karra Counsel for the Respondents : Mr.T.T.M.Ramaiah for R-1. CORAM: SMT. M.SHREESHA, HONBLE INCHARGE PRESIDENT AND SRI T.ASHOK KUMAR, HONBLE MEMBER
FRIDAY, THE TENTH DAY OF JUNE, TWO THOUSAND THIRTEEN Oral Order: (Per Sri T.Ashok Kumar, Honble Member).
1. This is an appeal preferred by the opposite parties against the orders passed by the District Consumer Forum-II, Tirupathi in CC.No.50/2012 dated 28.9.2012. For convenience sake, the parties as arrayed in the complaint are referred to as under:
2. The brief facts as set out in the complaint are that the husband of the complainant took two LIC policies bearing Nos.842128587 and 842128637 and he is paying the monthly premiums from his salary through the fourth opposite party who is his employer. While so on 7.8.2011 the husband of the complainant died due to heart attack and after his death, the complainant made a claim on 24.9.2011 along with all the required documents. Since the opposite parties have not settled the claim, the complainant issued a legal notice on 2.7.2012 and filed the complaint seeking for a direction to the opposite parties to pay a sum of Rs.3,75,000/- plus additional bonus, if any, and also to pay a sum of Rs.50,000/- towards compensation for mental agony.
3. The second opposite party filed his version which was adopted by the opposite parties 1 and 3 wherein they admitted about the issuance of policies but contended that they have repudiated the claim on 31.7.2012 on the grounds of suppression of material facts regarding the ill health of the insured at the time of taking the insurance policies and that the deceased had undergone treatment from 4.9.2008 to 9.9.2008 for type 2 DM with DKA alcoholic ketosis and admitted in SVIMS hospital prior to taking of the policies. It is contended that the deceased has also taken treatment from 6.8.2001 to 13.8.2001 and also availed medical leave from 2.9.2008 to 23.9.2008 but did not mention the same in the proposal forms of the policies and hence there is no deficiency in service on the part of the opposite parties 1 to 3 and prayed for dismissal of the complaint.
4. The fourth opposite party in its written version admitted that they have deducted the premium amount of Rs.750/- per month for each policy from the salary of the deceased Balaraju and paid the same to the opposite parties 1 to 3 without any default as per the oral request of the deceased. It is also contended that the service rendered by the fourth opposite party is free of charge and there is no deficiency in service on their part and thus prayed for dismissal of the complaint.
5. The complainant filed her evidence affidavit reiterating the facts stated in her complaint and Ex. A-1 to A10 were marked on her behalf. On behalf of the opposite parties 1 to 3 the Manager of LIC of India, Divisional Office, Nellore filed his chief affidavit and marked Exs.B-1 to B-6 documents.
6. Having heard the counsel on both sides and considering the evidence on record, the District Forum allowed the complaint and directed the opposite parties 1 to 3 to pay a sum of Rs.3,75,000/- to the complainant with interest at 9% p.a from the date of complaint till the date of realization for the policies bearing Nos.842128587 and 842128637 and also to pay a sum of Rs.10,000/- towards compensation and costs of Rs.2000/-. The complaint against the fourth opposite party was dismissed.
7. Aggrieved by the said order, the opposite parties 1 to 3 filed this appeal on several grounds and mainly contended that the District Forum failed to see that the material evidence filed in support of the appellants clearly show that the deceased life assured was a chronic alcoholic and smoker and took treatment in SVIMS from 4.9.2008 to 9.9.2008 and the said fact has been suppressed in the proposal forms marked as Ex.B-1 and B-2 and that Ex.B-4 Certificate of Employer also clearly show that the deceased undergone treatment in SVIMS and was on medical leave for the said period and that the appellants repudiated the claim basing on the documentary evidence available on record and as per the conditions of the policy and hence there is no deficiency in service on their part and thus prayed to allow the appeal and set aside the orders passed by the District Forum.
8. Heard the counsel for the respondent and Ops 1 to 3 submitted written arguments.
9. Now the point for consideration is whether the order of the District Forum is sustainable ?
10. THERE IS NO DISPUTE that one CH. Balaraju, husband of the complainant obtained two LIC policies bearing nos. .842128587 and 842128637 on 26.11.2009 and 09.11.2009 and that he died on 07.08..2011 within two years from the date of taking the policies. According to the complainant in spite of requests and legal notice got issued by the complainant, Ops failed to pay the assured amounts of Rs.3,75,000/- so also, additional bonus etc and hence she was constrained to file the complaint. Whereas, the contention of the opposite parties that the deceased life assured suppressed material facts regarding his health and obtained the policies even though he had undergone treatment. It is also contended by the Ops that the deceased had availed medical leave prior to taking of the policy but did not mention the same and on the other hand answered negative for it and therefore righty the claim basing on the said two polices was repudiated. Very specifically the Ops pleaded that the deceased life assured was suffering from Type II DM with DKA alcoholic Ketosis and that he was admitted as inpatient in SVIMS, Tirupati on 6.8.2001 and took treatment till 13.08.2001 and thereafter from 4.92.008 to 9.9.2008 and that the same was suppressed by him while submitting the proposal forms for issuance of the policies in question. In support of the said contention Ops filed Ex. B6 certificate of hospital treatment. The said Ex. B6 reveals that the deceased policy holder was got admitted in SVIMS on 4.09.2008 with the complaint of Type II diabetes for the last six years the complainant herself pleaded in the complaint that her husband died of heart attack and thus we find nexus between the said suppressed ailment of diabetes and the heart attack. The District Forum did not consider Ex. B6 on the ground that concerned doctor did not file affidavit in support of the certificate basing on the decision reported in II (2005) CPJ 9 (NC ). But the HONble Supreme Court of India in CDJ 2009 SC 1391 between Satwanth Kaur Sandhu Vs. New India Assurance Company Limited even though evidence affidavit of the doctor was not filed it was held that there was clear suppression of material fact in regard to the health of the insured and therefore the insurer was fully justified in repudiating the insurance contract. Their Lordships further observed that they did not find any substance in the contention of the learned Counsel of the Appellant therein that reliance could not be placed on the certificate obtained by the respondent from the hospital where the insured was treated and thus in the said Apex Courts judgment , findings of the District Forum, State Commission and Honble National Commission were reversed accepting the contention of the insurer. Therefore, merely because, affidavit of the concerned doctor was not filed it is not desirable to discard Ex. B6 it is much more so when the same was not disputed or contended by the complainant for the complainant that it was manipulated. In the evidence affidavit of the complainant, she did not depose that her husband was not suffering from any such previous ailment and that did not suppress the same or that the said Ex. B6 was fabricated.
In such circumstances, it can be safely held that the complainant did not dispute the plea of the Ops that the deceased life assured suppressed his previous ailment and took policies. Whereas, Ops pleaded the same touching suppression of the said material facts regarding health of the deceased as marked in the said documents. In the said circumstances, there is no necessity to examine the doctor who issued Ex. B6. It is common experience that there is no permanent cure to the diabetes and at the best the sugar levels can be controlled either by giving tablets or insulin further suggesting exercises like walking, yoga etc. therefore it is difficult to believe that the said decease which was in existence in the year 2001 was cured and that the deceased was enjoying good health at the time of taking of the policy. Therefore, the finding of the District Forum in the said context also could not be appreciated. The complainant did not dispute that her husband obtained medical leave. The opposite parties marked Ex. B4 certificate issued by employer of the deceased life assured so also Ex. B5 medical attendance certificate. Ex B 4 discloses that from 2.9.2008 to 23.9.2008 the deceased was on commuted medical leave and there is another document in Ex. B5 to say that from 6.8.2001 to 13.08.2001 so also from 4.9.2008 to 9.9.2008 the deceased was treated preceding his last illness. The medical authorities and employer of the complainant had to reasons to issue false certificates obliging the opposite party.
The complainant did not dispute the said documents also therefore it has to be believed even in the absence of evidence from the employer and concerned medical officer that the deceased was hospitalized and took treatment for the ailments and that he also obtained commuted medical leave in connection with his ailments . Admittedly the deceased was an employee in TTD, Tirupati and also educated person and therefore there is no possibility to believe that he did not give answers in Ex. B1 and B2 with regard to his health conditions etc. In Ex. B5 it is mentioned that the deceased was a known case of T2 DM since 2001 and the said certificate was issued on the basis of record available in the hospital by Casualty Medical officer, SVIMS, Tirupati. The Honble Apex court in between P.C. Chako another Vs Chairman, Life Insurance Corporation of India and others reported in 2008 (1) SCC321 held that contract of insurance including the contract of life assurance are contracts of ubrimafides and every fact of material must be disclosed otherwise there is a ground for recession of the contract. The complainant did not impeach the defence of the opposite parties by any convincing means therefore in the circumstances of the case we are satisfied to hold that the deceased obtained the policies in question by suppressing material facts and as such claims under the said policies are not sustainable and that rightly the opposite parties repudiated the claim and as such the impugned order is liable to be set aside. Therefore, impugned order is not sustainable.
11. In the result, the appeal is allowed and the order of the District Forum is set aside and consequently the complaint stands dismissed. Parties shall bear their own costs throughout.
I/C PRESIDENT MEMBER DATED : 10.06.2013.