State Consumer Disputes Redressal Commission
Manupati Sarojana W/O Late Sarangam vs Lic Of India And Another on 5 July, 2013
BEFORE
A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
F.A.No.208
OF 2012 AGAINST C.C.NO.228 OF 2011 DISTRICT FORUM WARANGAL
Between:
Manupati Sarojana W/o late Sarangam
aged 41 years, R/o H.No.4-2-342, Kothur
Subash Nagar, Hanamkonda Post & Mandal
Warangal District
Appellant/complainant
A
N D
1. The Branch Manager
LIC of India, Hanamkonda Branch
Office
1st Floor, Poddutur
Complex,
Hanamkonda (P) & (M) Warangal
Dist
2. The Divisional Manager,
Life Insurance Corporation of
India
Divisional Office, Jeevan Prakash
Near Ambedkar Balasamudram
Hanamkonda-001
Respondents/opposite parties
Counsel for the Appellant M/s Kunamalla Karunakar
Counsel for the Respondent Served(R1)
M/s
K.Venkatesh Gupta (R2)
QUORUM:
SRI R.LAKSHMINARASIMHA RAO, HONBLE MEMBER
AND SRI THOTA ASHOK KUMAR, HONBLE MEMBER THURSDAY THE FIFTH DAY OF JULY TWO THOUSAND THIRTEEN Oral Order (As per Sri R.Lakshminarasimha Rao, Honble Member) ***
1. The appellants husband during his lifetime obtained life insurance policy bearing number 688141318 from the respondent-insurance company for a period of 14 years from 15.5.2008 for sum assured `50,000/- The appellants husband died on 29.07.2008 and after the death of her husband, the appellant lodged claim with the respondent -insurance company. The respondent has not paid the claim amount on the premise that the insured concealed the fact that he was suffering from acute pancreatitis.
2. The respondent -insurance company resisted the claim on the premise that the insured was suffering from acute pancreatitis prior to obtaining the insurance policy and he was treated in Jaya Hospital, Hanamkonda from 29.7.2008. In the hospital record his past medical history was recorded as chronic alcoholic and a case of hepatomegaly. The insured suppressed the material fact of his ill health while submitting the proposal form.
3. The appellant has filed her affidavit and the documents, Exs.A1 to A12. On behalf of the respondent insurance company its Manager (legal & HPF) filed his affidavit and the documents, ExB1 to B5 .
4. The District Forum dismissed the complaint on the premise that the insured concealed the fact of his suffering from acute pancreatitis at the time of submitting the proposal. The District Forum held that the insured had not given clearly the particulars with regard to his health at the time of taking the policy. He was alcoholic and did not give correct answer to the question no.11 (h) (1) in the proposal form. The District Forum held the repudiation of the claim sustainable.
5. Feeling aggrieved by the order of the District Forum, the complainant has filed appeal contending that the District Forum has not considered the evidence on record in correct perspective. It is contended that there is no convincing and direct evidence on record to show that the insured suppressed material information about consuming alcohol and not keeping good health prior to submission of proposal form. It is contended that the District Forum has not considered Ex.A10 wherein it is mentioned that the insured was admitted to the hospital for the first time on 29.7.2008 with pain in abdomen and he was not admitted on any previous occasion.
6. It is contended that in Ex.A9 and B5 the insured was suffering from pain in abdomen five days prior to the admission to the hospital and that the respondent has not filed any medical or chemical examination report to show that the insured was suffering from chronic alcoholism. It is contended that the insured did not know that he was suffering from acute pancreatitis.
7. The learned counsel both the parties have filed written arguments.
8. The point for consideration is whether the respondent is entitled to the benefits conferred by the insurance policy?
9. The facts which do not require much discussion are that on 15.5.2008 the respondent insurance company had issued Life Insurance Policy for a sum assured of `50,000/- in favour of the appellants husband and the insured died on 29.7.2008. The appellant had lodged claim for payment of the sum assured under the policy.
10. The respondent -insurance company repudiated the claim on the premise that the insured suppressed the fact that he was suffering from acute pancreatitis. The appellants husband submitted proposal on 15.5.2008 that he was not suffering from any disease. The contention of the appellant is that her husband was hale and healthy.
11. The Medical Record of the Jaya Hospital would establish the insured suffering from pain in abdomen five days prior to date of his admission i.e., 29.7.2008 and his past history is recorded as chronic alcoholic and loss of appetite, hepato megaly. The insured was administered with medicines such as antibiotics and declared dead while undergoing treatment due to cardio respiratory arrest.
12. The insured had the knowledge of the fact that he was chronic alcoholic by the time of submitting the proposal. The decision to repudiate the claim was taken by the respondent-insurance company based on the medical record. The appellant could not show how the order under appeal could be said to suffer from any infirmity.
13. The learned counsel for the appellant has relied upon the following decisions:
i). Sahara India Life Insurance Co., Ltd., Vs Smt Hansaben Deepak Kumar Pandya in R.P.No.2828 of 2012 decided on 3.9.2012 wherein the Honble National Commission held that the insurance company has to produce concrete evidence in support of its case and examine the doctor who treated the insured prior to submission of the proposal form as also that the insurance company should produce prescriptions for the relevant period.
ii) Another decision relied upon by the learned counsel is in Bajaj Allianz Life Insurance Company Limited vs Mrs Nasi Ban Begum in R.P.No.982 of 2011 decided on 1.8.2012. It is a case where the National Commission had an occasion to consider the impact of Sec.45 of Insurance Act and relevance of the documents for and in support of repudiation of the claim.
iii) The learned counsel placed reliance upon the decision of the Honble National Commission in LIC of India Vs Smt Priya Sharma and others in R.P.lNo.2615 of 2011 decided on 2.11.2012. The National Commission held that the insurance company had not placed relevant evidence on record to prove that the insured was suffering from pre-existing disease at the time of taking the policy and failed to examine the doctors who were still working with DMC & Hospital, Ludhiana as senior Residents.
iv) The learned counsel has also relied upon the decisions of the National in SBI Life Insurance Co., Ltd., Smt Kambala Sandhya in R.P.No.1061 of 2012, LIC of India Vs Kamala Devi CPR (NC) 3 2009 150, LIC of India Ranjit Kaur, III (2011) CPJ 232, LIC of India vs Smt Sudesh in FA 774 of 2006 decided 27.2.2012, LIC of India vs K.Subhadramma, (2009) 3 ALD 790 of the Honble High Court of A.P. The other decision relied upon by the learned counsel for the appellant, P.Venkatnaidu Vs LIC of India and another IV (2011) CPJ 6 (SC) and United India Insurance Company Limited Vs MKJ Corporation 1997 0 AIR (SC) 408 and the order of this Commission in Assistant General Manager, Shriram Life Insurance Company Limited vs Smt Gade Rajani in F.A.No.700 of 2010 decided on 18.1.2012 and Metlife Insurance Company Limited Vs Smt P.Bhagya Lakshmi in F.A.No.285 of 2011 decided on 23.1.2013 have no application to the facts of the case on hand as the facts of those cases and the facts of the case on hand are different and in any of the above said cases concealment of the habit of consuming alcohol by the insured is not subject matter of repudiation of claim in any of the cases.
v) In Life Insurance Corporation of India Vs Smt M Bhavani in R.P.No.649 of 2005 decided on 14.1.2009 in that case the claim was rejected on the premise that the insured did not disclose that he was suffering from Malignant Brain Tumour at the time of renewal of the insurance policy. The National Commission held that;
The certificate issued by the Cancer Institute, Chennai clearly goes to show that the petitioner had undergone medical treatment for Malignant Brain Tumour in the year1993 and while, getting the policy revived in the year 1993 deceased suppressed the fact that he was suffering from Malignant Brain Tumour. Declaration given by him while getting the policy revived was false. Deceased was guilty of suppressing the pre-existing fatal disease from which he was suffering at the time of getting the policy revived. Suppression of pre-existing disease disentitles the claimant to the amount insured under the policy.
vi) The learned counsel for the respondent -insurance company has placed reliance upon the decision of 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.
14. In Satwant Kaur Sandhu vs New India Assurance Company Ltd IV(2009)CPJ 8(SC), it was held that a contract of insurance is one of utmost good faith on the part of the assured. Thus it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for proposer to determine whether the information is sought for is material for the purpose of the policy or not.
15. In the aforementioned decision the repudiation of the claim for non-disclosure of the material facts was held valid and sustainable. The facts of the aforementioned case and those of the present case are similar and as such the ratio laid down therein is applicable to the facts of the case. In the case on hand the insured was suffering from acute pancreatitis and hepato megaly. The insured was a chronic alcoholic. Alcoholism is considered as vital factor involving high risk and having relation to the facts cause damage to the liver and diseases such as hepato megaly and all kinds of liver diseases. The insured had not revealed that he was chronic alcoholic. As alcoholism is considered as platform for liver diseases, we consider the negative reply given by the insured to the question no.11 (h) in the proposal form as concealment of material fact which disentitles the appellant from claiming the sum assured under the insurance policy.
16. In the result, the appeal is dismissed confirming the order of the District Forum. No order as to costs.
MEMBER MEMBER Dt.05.07.2013 కె.ఎం.కె.*