National Consumer Disputes Redressal
Lic Of India vs C. Venkataramudu on 11 March, 2014
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 2241 OF 2013 (From the order dated 21.02.2013 in First Appeal No. 25/2012 of State Consumer Disputes Redressal Commission, Andhra Pradesh, Hyderabad) Life Insurance Corporation of India Having its Central Office at YOGAKSHEMA Jeevan Bima marg, Mumbai & its CO Legal Cell Delhi office, At H-39, New Asiatic Building, IInd Floor, Backside Connaught Place, New Delhi- 110 001 Petitioner Versus Sh. C. Venkataramudu S/o Sh. K. C. Kottliah R/o 1-11-2-5-C, Kondapur Post Serlingampalli Mandal Ranga Reddy District Hyderabad 500 008 (AP) Respondent BEFORE: HON'BLE MR. JUSTICE J.M. MALIK, PRESIDING MEMBER HONBLE DR. S.M. KANTIKAR, MEMBER For the Petitioner : Mr. Anoop K. Kaushal, Advocate For the Respondent : Mr. C. Venkataramudu, In person PRONOUNCED ON 11th MARCH, 2014 ORDER
PER DR. S.M. KANTIKAR, MEMBER
1. The present Revision Petition is filed under Section 21 (b) of the Consumer Protection Act, 1986 against the impugned order, dated 21.02.2013, passed in FA/25/2012 by the State Consumer Disputes Redressal Commission, Hyderabad (in short, State Commission). The State Commission allowed the Appeal and dismissed the complaint.
2. Facts, in brief, relevant to decide this revision are, that Sh. C. Venkataramudu, the Complainant took Asha DeepII Policy, from Life Insurance Corporation of India, the Opposite Party, for the sum assured Rs.2,00,000/-. That as per the policy conditions, if the life assured is hospitalized, because of cancer, paralysis, heart and kidneys ailment, then the said Insurance Corporation will pay 50% of the sum assured i.e. Rs.1,00,000/- to the policy holder. The proposal form was submitted on 10.05.2002.
3. Complainant paid premium regularly, for two years. On 25.9.2003, complainant had undergone a By Pass Surgery at Sri. Satya Sai Institute of Medical Sciences, and thereafter, filed a claim with the OP. The claim was repudiated on the ground that, the Complainant suppressed the material fact and took treatment after submitting the proposal form, but before paying the first premium. The complainant Suppressed about his consultation with Cardiologist for CAG. Aggrieved by the repudiation, complainant filed a complaint before the District Consumer Disputes Redressal Forum, (in short, District Forum). The District Forum dismissed the complaint.
4. Against the order of District Forum, the complainant preferred an appeal before the State Commission. The State Commission allowed the appeal and set aside the order of District Forum and ordered that the Complainant is eligible for 50% of the sum assured i.e. Rs.1,00,000/- @ 9% p.a., from the date of complaint and costs of Rs.3,000/-.
5. Aggrieved by the order of State Commission, the OP/Petitioner filed this revision.
6. We have heard the parties. The Complainant argued the matter in person and submitted the written argument. The Counsel for the OP vehemently argued that, the complainant had submitted the proposal form, on 10/5/2002, thereafter presented himself before LIC medical examiner, but did not state anything adverse about his health. The Complainant paid first premium, on 31.7.2002. The Complainant/life assured executed the proposal for insurance and underwent medical and other special tests, on 10.05.2002, the reports and other documents were received by the OP Corporation i.e., Insurer (LIC), only on 31.07.2002. The counsel for OP submitted that Complainant paid the premium on 31.07.2002 and prior to this on 25.06.2002, he has consulted a Cardiologist, for Chest Pain. He drew our attention to the Out Patient Report of Department of Cardiology, Sri Satya Sai Institute of Higher Medical Sciences, Puttaparthi, which clearly show that Complainant visited Cardiology Department, on 25/6/2002, investigated by ECHO and diagnosed as AOE CL III, H/O REST PAIN and advised medicines and CAG.
7. We have perused the declaration given by the Complainant, on 28.08.2002. The answers given under the heading of Additional Personal History, have been falsely declared. We are surprised to note that the complainant, being a RMP himself, deliberately suppressed such material fact, about Cardiology Consultation and knowingly, paid First Premium.
8. Therefore, we are of considered view that, under the terms and conditions of the said policy, it was the duty of the proposer to give correct answers to all the questions, in the proposal form with regard to state of health, as the contract of insurance, unlike other contracts, is based on utmost good faith, and in the event of any false statement or concealment of material facts, by the proposer /life assured, the same is rendered, null and void, ab initio. The sole responsibility of filling complete proposal form, is on the proposer. It is also the responsibility of the proposer to read and understand the forms, before signing the same.
9. Therefore, on the basis of foregoing discussion, we set aside order passed by State Commission and dismiss the complaint. The revision petition filed by the petitioner, is allowed. No order as to costs.
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(J. M. MALIK, J.) PRESIDING MEMBER ...
(Dr. S. M. KANTIKAR) MEMBER Mss/12