STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA :
At HYDERABAD
FA 110 of 2016
AGAINST
CC No. 29 of 2013, DISTRICT FORUM, KARIMNAGAR
Between:
- The LIC of India
Rep. by its Branch Manager
Vemulawada Branch
Vemulawada, Karimnagar Dist.
- The LIC of India,
Rep. by its Branch Manager
Karimnagar -1
Karimnagar Town and Dist.
- The LIC of India,
Rep. by its Branch Manager
Divisional Office, Karimnagar,
Karimnagar Town and Dist. …Appellants/Ops 1 to 3
And
P. Padmaja, W/o Late P. Sunder Rao,
Aged about : 35 years, Occ : Household
R/o 10-1-30/A, Srihari nagar, Ramnagar
Karimnagar Town and Dist. .. Respondent/complainant
Counsel for the Appellants : Sri K.R. L. Sarma
Counsel for the Respondent : M/s. B. Jagannadha Rao
Coram :
Honble Sri Justice B. N. Rao Nalla … President
And
Sri Patil Vithal Rao … Member
Friday, the Twenty Nineth Day of December
Two Thousand Seventeen
Oral order : ( per Hon’ ble Sri Justice B.N.Rao Nalla, Hon’ble President )
***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the opposite parties praying this Commission to set aside the impugned order dated 02/01/2015 made in CC 29 of 2013 on the file of the DISTRICT FORUM, Karimnagar.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainant, in brief, is that she is the wife and nominee of Peachara Surender Rao, who, during his life time had obtained an LIC’s Jeevan Anurag (with profits) policy bearing No. 684828675 for Rs.2,00,000/- and the policy commenced on 19.04.2007. The said policy was revived on 29.06.2012. Her husband died on 18.07.2012 at his residence due to chest pain. The insurance claim submitted by her was repudiated vide letter dated 25.02.2013 stating that the policy holder suppressed the real facts of his health condition at the time of revival and the policy holder suffered with brain tumor and underwent radiation for the same prior to the revival of the said policy and the said reason is imaginary and intentionally made to repudiate the policy. Hence the complaint to direct the appellants/opposite parties to pay the assured sum of Rs.2,00,000/- along with other benefits and interest and costs.
4) The opposite parties contended that While admitting that the deceased husband of the complainant had taken the LIC policy bearing No.684828675 which commenced on 19.04.2007 under the table & term: 168-20 for a sum assured of Rs.2,00,000/- and with first unpaid premium(FUP) date as 04/2013 and the life assured died on 18.07.2012. Further, the deceased suffered from brain tumor as per the CT-SCAN dt: 09.08.2010 of Apollo Hospital, Hyderabad who also underwent surgery in 2007 and radiation in 2009 prior to the revival of the policy. So the deceased suppressed the material facts regarding his health at the time of revival. Hence the revival is null & void. However, paid-up value is payable as per the terms & conditions of the policy. Hence prayed to dismiss the complaint.
5) During the course of enquiry before the District Forum, in order to prove her case, the complainant filed her evidence affidavit and got marked Ex.A1 to A-3 and the opposite parties got marked Ex. B1 to B4.
6) The District Forum, after considering the material available on record, held and directed the opposite parties jointly & severally liable to pay the sum assured under basic plan etc, as appears on the face of the policy LIC’s Jeevan Anurag (with profits) under schedule Rs.2,00,000/- (Two lakhs) and to pay other entitled benefits as per the special provisions along with 9% interest from the date of complaint i.e., 14.08.2013 till realization and also to pay Rs.5000/- towards costs within one month.
7) Aggrieved by the said order, the opposite parties preferred this appeal before this Commission.
8). Both sides have advanced their arguments reiterating the contents in the appeal grounds, rebuttal thereof along with written arguments. Heard both sides.
9) The points that arise for consideration are,
(i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner?
(ii) To what relief ?
10). Point No.1 :
There is no dispute that the deceased policy holder Peachara Surender Rao, during his life time had obtained an LIC’s Jeevan Anurag (with profits) policy bearing No. 684828675 for Rs.2,00,000/- and the policy commenced on 19.04.2007. The said policy was revived on 29.06.2012. Her husband died on 18.07.2012. There is also no dispute that the insurance claim was repudiated vide letter dated 25.02.2013 on the ground that the deceased policy holder suppressed the disease of brain tumor and underwent radiation prior to the revival of the said policy.
11. On examining the conditions & privileges within referred to under the subject policy, the Clause (2) is the payment of premium which is inclusive of i) installment premium for basic plan, ii) installment accident benefit of premium, iii) installment term assurance rider premium, iv) installment critical illness rider premium and v) installment PWB premium and Clause(3) is the revival of discontinued policies which mentions as, if the policy has lapsed, it may be revived during the life time of the life assured, but within a period of 5 years from the date of the first unpaid premium and before the date of maturity. The revival of a discontinued policy shall take effect only after the same is approved by the corporation and Clause(4) Non-forfeiture Regulations last rider reads as “Not withstanding what is above stated, if after at least five full years premium have been paid in respect of this policy and any subsequent premium be not duly paid, in the event of the death of the life assured within twelve months from the due date of the first unpaid premium, the policy money will be paid as if the policy has remained in full force”. Finally on the last page of the policy under the special provisions, it is mentioned as:
In the event of the death of the life assured prior to the date of maturity the amount equal to the sum assured under the basic plan (specified in the schedule to the policy) shall be payable to the nominee or assignees or Legal representatives of the proposer immediately on admission of claim & further that bonus will continue to accrue for the full terms on the full sum assured and will be paid on the date of maturity along with assured benefits as stated above.
12. The District Forum relying on the decision of the Hon’ble National Commission in Abdul Latheef in LIC of India in RP No.2370/2012 decided on 04.07.2014 opined that the Policy was in full force for more than 5 years at the time of making death claim by the respondent/complainant . The subject policy is a specialized policy with special provisions. So the repudiation of the claim on the specialized policy like the instant one is contrary to the terms & conditions and assurances printed on the policy. Further, Ex.B3 shows Clinical History mentioning surgery in 2007 and radiation in 2009, which proves that these are not prior to obtaining the policy which initially commenced on 19.04.2007. In the absence of specific evidence from appellants /opposite parties and as there is no emphasis on the compulsory declaration of personal health at the time of revival of policy, the contention of opposite party cannot be accepted. Usually the policy is lapsed for non-payment of premium and it will be revived on payment of dues, so it is just a technical process. Counsel for the appellants argued that the District Forum ignored the binding principle that revival of the policy is a fresh contract of insurance, when once the policy was allowed to lapse due to non remittance of the agreed premium as per the policy terms and conditions, and the policy holder must disclose all his material facts regarding his health at the time of revival. Counsel for the respondent/complainant argued that deceased policy holder died due to chest pain and hence death of the deceased has no relevancy to the said alleged ailment. Hence suppression of the said treatment is not a ground to repudiate the claim.
13). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, this Commission is of the view that there is no infirmity or irregularity in the impugned order. There are no merits in the appeal and hence it is liable to be dismissed.
14). Point No. 2 :
In the result, the appeal is dismissed confirming the impugned order dated 02.01.2015 in CC 29 of 2013 passed by the District Forum, Karimnagar. There shall be no order as to costs. Time for compliance four weeks.
PRESIDENT MEMBER Dated : 29.12.2017.
