District Consumer Forum, Bokaro.
Consumer Case No. 09 of 2007
Cyprian Baxla s/o late Simon Baxla
R/o Qr. No.-2-063, Sector-II/A,
Bokaro Steel City. Dist.- Bokaro.
Versus
1. The Zonal Manager, Life Insurance Corporation of India, Eastern Zonal Office, Hindustan Building, 4 C.R. Avenue, Kolkata-700072.
2. Branch Manager, L.I.C. of India Ltd. Branch No.II, Bokaro Office, Sector-IV, B.S. City, Dist.- Bokaro.
Before-
S.M.Alam, President
Vijay Bahadur Singh, Member
Shabnam Praveen, Member
Date of Judgment-: 29 May, 2009
Date of case filing-: 01 February, 2007.
-: Judgment:-
The complainant has filed this case against the
opposite parties and sought direction of this Forum against them to pay death claim worth Rs. 50000/- with 18% interest since 17.03.2003 till payment, besides Rs. 50000/- as compensation and Rs. 10000/- as cost of litigation to the complainant.
2 Brief facts of this case is that the wife of the complainant had taken a LIC Policy vide Policy No. 540123500 dated 15.01.2001 and sum insured was Rs. 50000/- on the basis of half yearly premium of Rs. 4580/- from the opposite party No.2 and the complainant was made nominee of the said policy. The date of maturity of the policy was 15.01.2007. Prior to taking policy wife of the complainant was physically and mentally fit and she was not suffering from any major disease or ailment. The premium was paid by her and receipts were granted in her name. But in the first week of June, 2002 she felt some health problem for which she was admitted in BGH on 18.06.202 and died on 04.07.2002. The complainant being nominee of the said policy of his wife filed death claim in the office of the opposite party No.2 with all relevant documents but the complainant was very much surprised to receive a letter dated 17.03.2003 by which Divisional Office of the opposite party repudiated her genuine claim, it was stated by the opposite party in his letter dated 17.03.2003 that at the time of taking policy she suppressed her ailment like diabetes mellitus tpy-2 and hypertension and on account of that the claim has been repudiated on account of that the claim has been repudiated. But as a matter of fact wife of the complainant was not suffering from such ailments prior to the said policy and the opposite party intentionally repudiated the valid death claim of the complainant. The complainant made several representation against the decision of the repudiation and ultimately he also sent a legal notice but the opposite party did not take any step against the said policy. Therefore, the above facts and circumstances it is clear that there is deficiency in service on the part of the opposite parties and on account of deficiency of the opposite parties the complainant is entitled to get claim and compensation from the opposite parties.
3 Upon issuance of notices the opposite party/LIC appeared and filed their written statement disputing the claim of the complainant on various grounds that the complainant has not filed the complaint in proper manner and the cause of action is not valid etc. The opposite party further stated that the deceased concealed the material fact/information regarding her health in view to defraud the opposite party for wrongful gain. As a matter of fact the deceased was suffering from much chronic disease like diabetes, hypertension etc. before taking the policy and she intentionally concealed this fact before obtaining the insurance policy which was detected by the doctor of BGH and admitted by her husband. The life assured died on 04.07.2002 just after one year 5 months for taking such policy. The life assured deliberately suppressed the fact to take the advantage of insurance and she violated the basic condition of good faith of insurance contract. Therefore, after due enquiry and investigation the Divisional Office of the Corporation repudiated the claim of the complainant on 17.03.2003 as per the ground set forth above and the repudiation by the opposite parties is legal and not unlawful. There is no deficiency in service on the part of the opposite parties as alleged by the complainant and the complainant is not entitled to get compensation and damage for physical and mental agony as falsely claim by the complainant and in view of the above facts complaint case is fit to be dismissed.
4 We have heard both the parties and have perused the entire case records and documents filed on behalf of the parties. While going through the medical attendant certificate issued by the concerned doctor and the certificate of hospital treatment also issued by the concerned doctor in respect of the insured deceased it is observed that patient was suffering from diabetes mellitus and hypertension. As per both the above certificates the deceased insured was in the knowledge of the above diseases since 7 years prior to the date of death in respect of D.M. and since 3 year prior to the date of in respect of hypertension. The LIC policy in question was obtained on 15.01.2001 and the date of death was 04.07.2002. In view of the above it is concluded that there has been suppression of facts regarding her dieses of D.M. and hypertension by the deceased insured at the time of taking of policy in question, since these facts were in the knowledge of the deceased insured at the time of taking her LIC Policy. As such there is no reason for our interference in the matter of repudiation of the complainant’s claim by the opposite parties LIC. We, therefore, do not hold the opposite parties negligent and deficient in service towards the complainant while repudiating the claim. The opposite parties are held not liable to pay any relief to the complainant.
5 Under the facts and circumstances of the case, no merit is found in the complaint case; hence the same is dismissed hereby accordingly.
Member (lady) Member President
Tags: Bokaro, LIC of India