CLAIM CAN’T BE GIVEN IN CASE OF THE SUICIDE MATTER NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION (D.B.) LIFE INSURANCE CORPORATION OF INDIA V/S VEENA AND ORS Date of Decision: 14 March 2014 ________________________________________ Honble Judges: K S Chaudhari, B C Gupta Appeal Type: Revision Petition Appeal No: 1184 of 2008 Final Decision: Petition allowed Advocates: Harvinder Kaur CASES REFERRED : LIFE INSURANCE CORPORATION OF INDIA VS. KRISHAN CHANDER SHARMA, 2007 2 CPJ 51 ________________________________________ Judgement Text:- K S Chaudhari, Presiding Member [1] This revision petition has been filed by the petitioner against the order dated 19.11.2007 passed by the Karnataka State Consumer Disputes Redressal Commission, Bangalore (in short, the State Commission) in Appeal No.223 of 2007 The LIC of India Vs. Veena & Ors. by which, while dismissing appeal, order of District Forum allowing complaint was upheld. [2] Brief facts of the case are that complainant No. 1/respondent No. 1s husband and Complainant Nos. 2 & 3/Respondent Nos. 2 & 3s father Manje Gowda was an agriculturist and was hale and healthy. He took insurance policy for Rs.1,00,000/- on 27.4.2001 from OP petitioner. On 14.4.2003, the insured untimely expired. Claim submitted by the complainants was not settled by OP. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that death occurred within 2 years from the date of policy and on investigation it was found that assured suffered from Ischemic heart disease about one year and 10 months before issuance of policy and underwent treatment in different hospitals, but he suppressed this fact in the proposal form. On account of fraudulent suppression of material facts, claim was repudiated and prayed for dismissal of complaint. Learned District Forum after hearing both the parties allowed complaint and directed OP to pay Rs.1,00,000/- with 10% p.a. interest and further awarded Rs.5,000/- for mental agony and Rs.2,000/- towards cost of litigation. Appeal filed by the petitioner was dismissed by learned State Commission vide impugned order against which, this revision petition has been filed. [3] None appeared for respondents even after service and they were proceeded ex-parte. [4] Heard learned Counsel for the petitioner and perused record. [5] Learned Counsel for the petitioner submitted that on account of fraudulent suppression of previous disease and treatment in the proposal form and as assured died within two years of obtaining policy, claim was not payable even then District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal; hence, revision petition be allowed and impugned order be set aside. [6] It is not disputed that assured Manje Gowda obtained insurance policy from OP on 27.5.2001 and he died untimely on 15.4.2003 i.e. within 2 years of obtaining policy. Perusal of proposal form reveals that - Personal History: (a) During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week? - No b) Have you ever been admitted to any hospital or nursing home for general check-up, observation, treatment or operation? - No (c) Have you remained absent from place of work on grounds of health during the last five years? - No (d) Are you suffering from or have you ever suffered from ailments pertaining to Liver, Stomach,Heart, Lungs, Kidney, Brain or Nervous system? - No Queries from (a) to (d) were replied in negative, whereas documents on record reveal that assured consulted doctor on 6.7.1999 and he was found Ischemic heart disease on 7.7.1999. He consulted Cardiologist on 5.8.1999 and took treatment for this disease. Again on 14.12.1999, he was admitted in KMC Hospital, Manipal and was discharged on 20.12.1999 with the final diagnosis of Ischemic heart disease, moderate L.V. dys-function etc. Again he was admitted in Nanjappa Hospital on 18.4.2000 and was discharged on the same day and on 3.5.2001, he underwent Echo Cardiography at Subbaiah Hospital, Shimoga. On 26.5.2001, he visited Sri Basaveshwara Hospital and took treatment. Insured has given wrong declaration in reply to the questions in paragraph 11 (a) to (d) and has given false answers and obtained policy fraudulently. Petitioner has not committed any error in repudiating claim. [7] Learned District Forum allowed complaint and learned State Commission observed in the order that insured committed suicide and there was no nexus between the cause of death and treatment taken by the insured and on this basis dismissed appeal of the petitioner. [8] Complainant has not pleaded in the complaint that insured committed suicide and in such circumstances, it cannot be inferred that insured died on account of suicide. In the complaint, only this fact has been mentioned that he died untimely. Apparently, it appears that on account of heart disease, insured collapsed. Even if it is presumed that that cause of death had no nexus with the disease suffered by the insured, complainants were not entitled for any claim as held by this Commission in Life Insurance Corporation of India Vs. Krishan Chander Sharma, 2007 2 CPJ 51 as there was clear suppression of material facts regarding insureds health. [9] Complainant mentioned in the complaint that insured was an agriculturist and hale and healthy whereas record reveals that he was suffering from heart disease. Thus, it becomes clear that complainants have not come with clean hands and on this count also complaint was liable to be dismissed and learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal and revision petition is to be allowed. [10] Consequently, revision petition filed by the petitioner is allowed and impugned order dated 19.11.2007 passed by the Karnataka State Commission, Bangalore in Appeal No.223 of 2007 The LIC of India Vs. Veena & Ors. and order of District Forum 19.12.2006 passed in C. NO. 124/04 - Veena & Ors. Vs. The LIC of India are set aside and complaint stands dismissed with no order as to costs.
Posted on: Sat, 15 Mar 2014 15:19:52 +0000
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