State Consumer Disputes Redressal Commission
1.Jatoth Shanthi, W/O.Late Gopi ... vs 1..The Life Insurance Corporation Of ... on 9 January, 2013
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD. F.A.No. 966/2011 against C.C.No.68/2009, Dist. Forum, Warangal. Between: 1.Jatoth Shanthi, W/o.late Gopi Chand, Aged about 40 years, Occ: House wife. 2. Jatoth Uday Singh, S/o.Late Gopi Chand, Aged about 20 years, Occ: Student. Both are R/o.Parsya Thanda, Post : Ashok Nagar, Mandal: Khanapur, Warangal Dist. Appellants/ Complainants. And 1.The Life Insurance Corporation of India, Rep. by its Branch Manager, Branch Office, Narsampet, Warangal Dist. 2. The Life Insurance Corporation of India, Rep. by its Senior Divisional Manager, Balasamudram , Hanamkonda, Warangal District. Respondents/ Opp.parties Counsel for the Appellants : M/s. V.Gowrisankar Rao Counsel for the Respondents : Mr.K.R.L.Sharma QUORUM: SMT.M.SHREESHA, HONBLE INCHARGE PRESIDENT, And SRI S.BHUJANGA RAO, HONBLE MEMBER.
WEDNESDAY, THE NINTH DAY OF JANUARY, TWO THOUSAND THIRTEEN.
Oral Order : (Per Sri S.Bhujanga Rao, Honble Member).
*** The unsuccessful complainants filed the above appeal against the order dt.29.7.2010 of the District Forum, Warangal made in C.C.No.68/2009.
The claim under the complaint was to pay a sum of Rs.1 lakh towards the policy amount under policy no.687078871 with all benefits, to pay Rs.10,000/- towards damages to complainant no.1, to pay Rs.1,05,000/- towards another policy bearing no.687076306 with all benefits and Rs.10,000/- towards damages to the complainant no.2, with interest at 12% p.a. on the above policies and to pay costs.
For the purpose of convenience the parties are described as they arrayed in the complaint.
The brief case of the complainants as set out in the complaint is as follows:
The complainant no.1 is the wife and the complainant no.2 is the son of the life assured Jatoth Gopi Chand. During his life time, he assured his life with the opposite party vide policy bearing no.687078871, which was issued for a sum of Rs.1 lakh and the complainant no.1 is the nominee under the said policy. The deceased Gopichand also obtained another policy bearing no.687076306 with the opposite party for a sum of Rs.1,05,000/- and the complainant no.2 is the nominee under the said policy. The said Gopichand died on 18.6.2006 at his village. Both the policies were in force as on the date of the death of the policy holder Gopichand.
After the death of the life assured Gopichand, both the complainants preferred separate claims, under the policies mentioned above, being the nominees of their respective policies. After submission of claim forms, the complainants approached the authorities of opposite parties, several times, to settle the claim for which they used to give assurance that the claim would be settled in near future. Subsequently, on 17.3.2007 the opposite party no.2 issued repudiation letter, which was received by the complainants, four months after dispatch. Hence the complaint.
Resisting the complaint, the opposite parties filed written version admitting that the deceased J.Gopichand obtained two policies as mentioned in the complaint and contended that the above policies were revived on 2.1.2006 solely on the basis/strength of personal statement regarding health dt.27.12.2005 under policy no.687078871. The policy no.687076306 was revived on 2.1.2006 solely on the basis of personal statement of the deceased J.Gopichand, regarding his health. The opposite party Corporation under utmost good faith i.e. Uberrimafides, has revived both the above said policies, on the basis of personal statement of the deceased life assured, regarding his life. Revival is treated as novation i.e. a fresh contract as per the contract of life insurance.
The life assured Gopichand died on 18.6.2006 i.e. within a short period of 5 months 16 days from the date of revival of both the policies. As per the opposite parties, the life assured had taken treatment for psychiatric problems and was admitted to Life Line Hospital, Hanamkonda and was treated by Dr.S.Gopinath from 20.2.2004 to 23.2.2004 and was finally diagnosed as a patient of Alcoholic Dependency and the deceased life assured was suffering from the same for two months. Prior to 20.2.2004 i.e. prior to the date of admission to Life Line Hospital for symptoms of sleeplessness, uses filthy language, excited and stubborn behaviour and instability and his habits as per the said hospital admission record, it is proved that he is an Ethanolic & Gutka Chewing.
The deceased life assured submitted a proposal form for insurance dt.30.6.2004 and 31.3.2004. But, for all the questions, he answered No i.e. from questions 11(a) to 11(h) he answered as No and for question no.11(i) he stated Good and also to the question no.11(j) he answered No and also with regard to the personal statement regarding the health, he stated his health as Good. Though, already the deceased had taken treatment in Life Line Hospital, Hanamkonda for his disease, he has not disclosed the same at the time of revival in his proposal form, so it comes under Sec.45 of Insurance Act, so the complainants are not entitled to get the insured amount. The complaint is therefore liable to be dismissed.
During the course of enquiry, on behalf of the complainants, the complainant no.1 filed her evidence affidavit and got marked Exs.A1 to A4. On behalf of the opposite parties, their Manager V.Bhasker filed his evidence affidavit and got marked Exs.B1 to B7.
Upon hearing the counsel for both the parties and on consideration of material on record, the District Forum came to the conclusion that the deceased life assured suppressed taking treatment for his psychiatric problem in Life Line Hospital, Hanamkonda, prior to obtaining the policies and that he did not disclose the same either in the proposal form or in the proposal form submitted at the time of revival of the policies and consequently dismissed the complaint.
Aggrieved by the said order, the complainant preferred the above appeal urging that the order of the District Forum in dismissing the complaint is contrary to law, weight of evidence and probabilities of the case. That the District Forum failed to see that both the policies obtained by the deceased life assured were revived by the opposite party on 2.1.2006.
That the District Forum failed to see that the husband of the first complainant died on 18.6.2006 at his residence. That the District Forum failed to see that the life assured never suffered from the alleged disease Alcoholic Dependency and that he was not treated at Life Line Hospital, Hanamkonda from 20.2.2004 to 23.2.2004. That the District Forum failed to see that both the policies are medical policies and the Panel Doctor examined the insured before issuing the policies and at reviving the policies. If the insured was suffering from Psychiatric problem, that would have been detected by panel doctor. That the District Forum failed to see that the alleged disease of the life assured was not a chronic one. In the column History of previous illness it was mentioned that no past history of significant systematic diseases. Sleeplessness and unrest can be caused for various reasons i.e. economic problems and family disturbances etc. That the District Forum failed to see that the admission record filed by the opposite parties does not relate to the life assured, it is a created one. The insured belongs to Khanapur Mandal of Warangal Dist. That the District Forum failed to see that the opposite parties have not produced the supporting affidavit of doctors who examined the insured and treated.
Finally the appellants/complainants pray to allow the appeal and to set aside the impugned order and allow the complaint filed by them.
We heard counsel for both sides and perused the entire material placed on record.
Now the point for consideration is whether the impugned order of the District Forum is vitiated for misappreciation of fact or law?
It is an admitted fact that the deceased life assured Gopichand obtained two medical policies bearing nos. 687076306 and 687078871 and that both the policies were revived on 2.1.2006. It is also not in dispute that the deceased died on 18.6.2006 at his village and that both the polices were in force as on the date of his death and on the death of the life assured, the nominees of the policies i.e. the complainants herein submitted their claims to the opposite party and the opposite party repudiated both the claims on the ground that the deceased life assured suppressed his taking treatment in Life Line Hospital, Hanamkonda for the symptoms of sleeplessness and excited behavior etc. Exs.A1 and A2 letters dt.19.6.2007 are sent by the opposite party to the complainant no.1, whereunder both the policies obtained by the deceased Gopichand were repudiated on the ground that the said J.Gopichand life assured had a history of Asymptomatic prior to the date of proposal given by the life assured. In support of their case, the opp.parties filed Ex.B1 Discharge Summary, Ex.B2, Diagnosis Report issued by the Life Line Hospital, Hanamkonda and Ex.B3, proposal form signed by the life assured Jatoth Gopichand and Exs.B5 and B7, the personal statements of the life assured regarding his health.
The learned counsel for the appellants/complainants submitted that the insured never suffered from the alleged disease Alcoholic Dependency and that he was never treated at Life Line Hospital, Hanamkonda from 20.2.2004 to 23.2.2004 and that the alleged disease of the insured was not a chronic one and that the word asymptomatic mentioned in the case sheet denotes no symptoms. The learned counsel further submitted that the admission record filed by the opposite parties does not belong to the insured and that it is a created one.
From a perusal of Ex.B1 Discharge Summary and Ex.B2 Diagnosis Report, it appears that they are not forged or fabricated documents. Ex.B1 is a Xerox copy, but Ex.B2 is a original document. We do not think that the hospital authorities would oblige the opposite parties, in creating the documents, especially Exs.B1 and B2. The insurance company has no necessity, to influence the hospital authority to create such documents, to defeat the claim of the life assured persons.
There is no basis for the contention of the complainants that Exs.B1 and B2 do not relate to Jatoth Gopichand, the life assured. The description of the life assured in Exs.B1 and B2 tallies with the description of the life assured in the proposal forms and personal statements given by the life assured. Under these circumstances, we are not inclined to accept the submissions of the learned counsel for the complainants that Exs.B1 and B2 are fabricated and created for the purpose of this case. As seen from Ex.B1, the deceased life assured has taken treatment in Life Line Hospital, Hanamkonda, Warangal as he was admitted on 20.2.2004 and was discharged on 23.2.2004. He has taken treatment for psychiatric problem by Dr.S.Gopinath, during those three days. He was finally discharged as alcoholic dependency. As seen from Ex.B2, the deceased life assured was suffering from sleeplessness, exited and stubborn behaviour, instability and using filthy language etc. since two months prior to 20.2.2004 i.e. prior to the date of admission into Life Line Hospital, Hanamkonda, Warangal.
The said medical record has also proved that the Life assured was Ethanolic & Gutka Chewing.
From the above facts and circumstances, it is proved that the deceased life assured was not having good health prior to the submission of proposal forms for insurance dt.30.6.2004 and 31.3.2004, as he was continuously suffering from psychiatric problem from 20.2.2004 to 11.3.2005 i.e. the prescription date mentioned in Ex.B1 and was on medication for the said health condition.
It is not in dispute that Exs.B3 and B4 original proposal forms regarding the two policies are signed by the deceased life assured. The complainants have also not disputed the facts that Exs.B5 and B7 original statements are signed and given by the deceased life assured at the time of taking the polices. Exs.B3 to B7 disclosed that the deceased suppressed his taking treatment in Life Line Hospital for the above disease, which is prior to the submission of proposal forms to the opposite party insurance company. He has not disclosed his health condition either in the proposal forms or in the personal statement, either at the time of taking polices or at the time of revival of the polices. It is well settled by the Honble National Commission that an insurance being a contract between the two parties, is to be interpreted and settled strictly as per the agreed terms and conditions stated in the insurance proposal form/insurance policy documents.
It is well settled through number of judgements including the Honble Apex Court that an insurance policy between two parties is based on the principle of utmost good faith and breach of the same is justified repudiation of the insurance claim. In the instant case, by suppressing the material facts regarding his pre existing disease, the insured breached the principle of utmost good faith and also the terms and conditions of the policy.
In view of the above facts and circumstances of the case, we do not find any irregularity or illegality in the order of the District Forum to interfere with it.
In the result, the appeal is dismissed confirming the impugned order of the District Forum, but in the circumstances of the case without costs.
INCHARGE PRESIDENT MEMBER Pm* Dt.
9.1.2013.