State Consumer Disputes Redressal Commission
Challagonda Vijaya Laxmi vs L.I.C. Of India on 28 November, 2012
BEFORE THE A BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. FA 1085 of 2011 against CC 150/2008, Dist. Forum, Warangal Between: 1) Challagonda Vijaya Laxmi W/o. Late Bhaskar Reddy 2) Challagonda Vikram Reddy S/o. Late Bhaskar Reddy 3) Challagonda Vinesh Reddy S/o. Late Bhaskar Reddy All R/o. H.No. 4-4, Gopalapuram Village Via Thogarrai village, Duggondi Mandal Warangal Dist. *** Appellants/ Complainants And L.I.C. Of India Rep. by its Branch Manager Narasampet Branch Narasampet Warangal Dist. *** Respondent/ Opposite Party Counsel for the Appellants: M/s. V. Gourishankara Rao Counsel for the Respondent: M/s. Hari Rao Lakkaraju CORAM: HONBLE SRI JUSTICE D.APPA RAO, PRESIDENT SMT. M. SHREESHA, MEMBER & SRI S. BHUJANGA RAO, MEMBER WEDNESDAY, THE TWENTY EIGTH DAY OF NOVEMBER TWO THOUSAND TWELVE ORAL ORDER:
(Per Honble Sri Justice D. Appa Rao, President) ***
1) Appellants are un-successful complainants.
2) The case of the complainants in brief is that complainant No. 1 is the wife and complainants Nos. 2 & 3 are children of late Bhaskar Reddy. During his life time he obtained two policies one for Rs. 1, 50,000/- and another for Rs. 1 lakh commencing from 25.7.2003 and 28.8.2004 respectively.
Complainant No. 1wife is nominee under the policies. He unfortunately died on 9.3.2007. When claims were made followed by legal notice they were not settled. Therefore they claimed Rs. 4,50,000/- being the triple benefit under first policy together with bonus and additional bonus and Rs. 1 lakh with additional bonus with regard to second policy and also claimed compensation of Rs. 50,000/- towards mental agony in all Rs. 7,81,000/-.
3) The respondent insurance company resisted the case. While admitting issuance of policies, it alleged that said policies were lapsed on failure of payment of premia, and upon submission of health declaration the policies were revived on 14.2.2006 and 28.11.2005 respectively. On the death of the assured on 9.3.2007 the claims being early , on investigation it came to learn that he had suffered and taken treatment for multiple liver abscess since 29.12.2001, and was hospitalized at Satya Hospital, Warangal and was admitted on 30.12.2011 and was discharged on 3.1.2002 evident from discharge summary. This is all evident from prescriptions dt. 2.1.2002 of Satya Hospital, Warangal. Ultrasonography of abdomen confirms small liver abscess in the right robe and was taking treatment from B. Murali Krishna a doctor from Warangal. Since he suppressed the said facts in his personal statement regarding his health while reviving the policies the claims could not be processed. Therefore, it prayed for dismissal of the complaint with costs.
4) The complainants in proof of their case examined complainant No. 1 as PW1, D. Kishan, a neighbour as PW2, Chidduri Rajaiah, village secretary as PW3 and E. Raju, tractor driver as PW4 and got Exs. A1 to A6 marked while the insurance company filed the affidavit evidence of its Manager and examined Dr. B. Murali Krishna as RW2 and got Exs. B1 to B20 marked.
5) The Dist. Forum after considering the evidence placed on record opined that the assured had suppressed the ailment as well as treatment. He himself was an LIC agent, and had taken policies supressing his ailment both at the time of taking the policies as well as at the time of revival evident from evidence of RW2 besides the documents Exs. B1 to B10 and opined that the suppression was material and therefore dismissed the complaint.
6) Aggrieved by the said order, the complainants preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that the deceased never suffered any ailment much less multiple live abscesses even though he was having the same disease on 29.12.2001. The repudiation was without any basis, and therefore prayed that the complaint be allowed.
7) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
8) It is an undisputed fact that the assured Bhaskar Reddy an LIC agent as well as an agriculturist obtained two policies on 25.7.2003 and 28.8.2004 evidenced under Exs. A1 & A2. It is also not in dispute that on non-payment of premia, they were lapsed. The deceased got them revived on 14.2.2006 and 28.11.2005 respectively. Neither at the time of taking of the policy nor at the time of revival in 2005-2006 the deceased did disclose any ailment in the personal statement regarding health pertaining to coloumn No. 2 which reads as follows :
Q: Since the date of your proposal for above mentioned policy :
a) Have you ever suffered from any illness/disease requiring treatment for a week or more?
b) Did you ever have any operation, accident or injury?
c) Did you ever undergo ECG. X-Ray, Screening, Blood, Urine or Stool examination?
he mentioned No for all the questions.
He positively mentioned that his health condition was good vide Exs. B8 & B9. Even while reviving the policy under Exs. B10 and B11 he reiterated that he was hale and hearty. Obviously, basing on his own statement the policies were revived. Since his death on 9.3.2007 was within two years of revival and by virtue of Section 45 of the Insurance Act claim being early, the insurance company investigated about his health condition.
9) RW2 Dr. B. Murali Krishna who treated him filed Exs. B1 to B7 prescriptions and various diagnostic reports to show that the assured was treated for multiple liver abscess. In fact, he was admitted in the hospital on 30.12.2001 and was discharged on 3.1.2002 as an in-patient in Satya Hospital at Warangal. The complainant did not dispute, about the ailment. What all suggested was that it was not a fatal disease. In fact, in the grounds of appeal, the complainant mentioned that he never suffered any multiple lever abscesses even though he was having the same disease on 29.12.2001. The contention is suffering from said ailment is altogether different from taking treatment for the said ailment even as an in-patient. It is difficult to accept such a contention.
10) For the reasons not known, for the first time in the evidence, complainant No. 1 wife of the deceased, alleged that her husband committed suicide by hanging. However, neither police report was filed nor any post-mortem examination was conducted on him. This was repeated by neighbours D. Kishan (PW2), Chidduri Rajaiah, village secretary (PW3) and E. Raju, tractor driver (PW4). This sudden shift of stand of suicide is strange, more so, when complainant No. 1 neither pleaded while issuing legal notice Ex. A3 nor in the complaint filed before the Dist. Forum. Obviously they might have thought that if the plea that the deceased did not succumb to ailment and died of committing suicide is introduced the repudiation would be unjust.
This evidence is undoubtedly introduced to get over plea of the insurance company that he suffered from multiple liver abscesses in the right lob and other organs as evidenced from Ex. B5 and other documents besides the evidence of RW2. When the doctor who treated him had sworn on oath and deposed that the deceased had suffered from multiple liver abscess right from 2001 vide Ex. B5 and the said fact was not mentioned either in the proposal form or at the time when he intended to revive the lapsed policies, we agree with the finding of the Dist. Forum that the deceased had suppressed his ailment and also his admission as in-patient in Satya Hospital at Warangal. In view of irrefutable documentary evidence besides the oral evidence of RW2 doctor who confirmed that the insured had the disease, which he suppressed both at the time of taking of the policies in the proposal form as well as at the time of revival of lapsed policies, we are of the opinion that the repudiation was just.
11) The Honble Supreme Court in P. C. Chacko Vs. Chairman, LIC of India reported in III (2008) CPJ 78 (SC) held :
The purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law.
12) Later in the case of Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. reported in (2009) 8 SCC 319 in unequivocal terms has clearly held that when there is a suppression of material fact by the life assured in relation to his health, the insurance company cannot be compelled to pay the insurance amount to the nominee.
13) In the light of above, we do not see any mis-appreciation of fact or law by the Dist. Forum in this regard. We do not see any merits in the appeal.
14) In the result, the appeal is dismissed.
However, no costs.
1) _______________________________ PRESIDENT
2) ________________________________ MEMBER
3) ________________________________ MEMBER 28/11/2012 *pnr UP LOAD O.K.