Full Judgment
A. Venkatarami Reddy, President:
1. This is a complaint filed under Section 17(1)(a) r/w Section 12 of the Consumer Protection Act. The averments in the complaint are briefly stated as follows :
2. One Kashaiah, the husband of the complainant obtained three Jeevan Mitra Life Insurance Policies with numbers 680236238 for a sum of Rs. 50,000/- on 3.12.88, 680241404 for a sum of Rs. 30,000/- on 16.2.89 and 680241303 for a sum of Rs. 50,000/- on 20.2.89 and was paying the premiums regularly. But the said Kashaiah died suddenly due to heart attack on 13.3.91. The complainant being the wife of the said Kashaiah and being the nominee under the said policies preferred a claim to the Branch Manager, Life Insurance Corporation of India, Karimnagar Branch, opposite party No. 1 and the Divisional Manager of Life Insurance Corporation of India, Warangal, opposite party No. 2, for payment of the amounts due under the said policies. The second opposite party in their letter dated 26.3.92 informed the complainant that they decided to repudiate their liability to pay the policy amounts on the ground that her husband late Kashaiah withheld information regarding his health and also regarding obtaining another Policy No. 680236238 and also because the total sum exceeded Rs. 1,00,000/- in violation of the scheme of Jeevan Mitra Plan. The reasons assigned by the opposite party No. 2 in repudiating the complainants claim are arbitrary, unreasonable and unsustainable. The complainants husband Kashaiah sustained injury to his right knee on 26.7.88, but the said injury was neither serious nor did it lead to his death. He died suddenly due to heart attack only. He did not intentionally suppress the fact of obtaining another Policy No. 680236238. In addition to three policies in question, late Kashaiah obtained two more Policies Nos. 60898336 and 680026705. His employer used to deduct the premiums for the policies and remit the same to the Life Insurance Corporation of India, for apportioning towards the respective policies and the opposite parties are receiving the said amounts without any protest. The opposite parties never informed the said Kashaiah that the policies under Jeevan Mitra plan should not exceed Rs. 1,00,000/-. There is no statutory condition that the Jeevan Mitra Policy should not exceed Rs. 1,00,000/-. The medical certificate issued by Dr. I. Sridhara Rao of Karimnagar shows that the knee injury of late Kashaiah would not have endangered his life. After the death of Kashaiah the opposite parties paid a sum of Rs. 54,638.60 ps. by Cheque No. 111608 dated 31.3.92 towards the Policy No. 680026705 of late Kashaiah. Similarly, the opposite parties paid a sum of Rs. 184.30 ps. by Cheque No. 952626 dated 3.2.92 towards the balance amount due under the Policy No. 60898336 of late Kashaiah after deducting the house loan. The opposite parties never objected to payment of the said amounts after the death of the complainants husband. Hence, the opposite parties are estopped contending that the husband of the complainant suppressed some facts regarding his health. They cannot adopt double standards. Hence the complainant is entitled to the amounts due under the three policies mentioned above together with interest at 24% per annum. The opposite parties committed deficiency of service. Hence, a direction has to be issued to the opposite parties to pay the total sum of Rs. 2,60,000/- under the three Jeevan Mitra Policies Nos. 680236238, 680241404 and 680241303, to pay interest on the said amount at the rate of 24% per annum from 13.3.91, that is, the date of the death of the complainants husband till the date of realisation and also pay compensation of Rs. 50,000/- with costs of the litigation.
3. The authorised signatory of the Life Insurance Corporation of India filed counteraffidavit on behalf of the opposite parties, stating that he is the Secretary of the Life Insurance Corporation and that late Kashiah the husband of the complainant took five policies from the Corporation whose details are mentioned thereunder. They are policies under Jeevan Mitra Scheme, under which the maximum limit is Rs. 1,00,000/- irrespective of number of policies. An individual is entitled to a total amount of Rs. 1,00,000/- under the Jeevan Mitra Scheme even if he takes many policies under the said scheme. While taking the Policy No. 6802362 dated 3.12.88, late Kashaiah suppressed that he was already holding the Policy No. 60898336 for a sum of Rs. 25,000/- during the year 1985, but he only gave the Policy No. 680026705 for a sum of Rs. 25,000/-. Therefore, the Policy No. 680236238 for a sum of Rs. 50,000/- which was issued in pursuance of his proposal dated 3.12.88 became void and no amount is payable thereunder. The deceased Kashaiah was also not entitled to make the proposal dated 16.2.89 for another Policy No. 680241404 for a sum of Rs. 30,000/-, since he had already taken three policies and the total amount exceeded to Rs. 1,00,000/-. He also suppressed the fact of his obtaining Policy No. 680026705 for a sum of Rs. 25,000/- issued to him during the year 1987 and also the Policy No. 680236238 issued in the year 1988. Therefore there is suppression on the part of the complainants husband in regard these policies. Even otherwise, the amount assured under three policies during the years 1985,1987 and 1988 exceeded the limit of Rs. 1,00,000/-, under T. 88 and he was not entitled to make the proposal on 16.2.88 for a sum of Rs. 30,000/-. Thus the policy has become void. It is further submitted that the complainants husband took one more policy No. 680241303 on 20.2.89 for a sum of Rs. 50,000/-/ He did not disclose that he had sent a proposal on 16.2.89 and it was under consideration of the opposite party. While answering the question No. 10 he was bound to disclose that his proposal dated 16.2.89 for a policy of Rs. 30,000/- was under consideration. He also suppressed the fact of obtaining the Policy No. 680236238 for a sum of Rs. 50,000/-. Which he took during the year 1988. He was in the habit of suppressing the existence of previous policies under Jeevan Mitra plan and making different proposals under Jeevan Mitra Scheme to make a renewal given in violation of the terms of the scheme. To appreciate the contention of the opposite parties, the contents of the declaration given by the complainants husband have to be looked into. The declaration made by the complainants husband is false. It is also stated that the complainants husband was suffering from leg injury which was diagonised as Hemothrouis by Dr. I. Sridhar Rao of Karimnagar and he was on medical leave from 26.7.88 to 10.8.88 for medical treatment. He gave false answers to the questions in the proposal form relevant to his health condition. Therefore, the policies in question have become void as per Condition No. 5 of the policies. The Policies Nos. 680026705 and 60898336 were settled by the opposite parties because the suppression of facts regarding previous policies and regarding his knee injury occurred after taking the said two policies. All the three policies in question viz. 680236238 dated 3.12.88 for a sum of Rs. 50,000/-, 68024140 dated 16.2.89 for a sum of Rs. 30,000/- and 680241303 dated 20.2.89 for sum of Rs. 50,000/- became void by reason of the complainants husband suppressing the true facts regarding his health condition and obtaining of the policy earlier than the said three policies. Therefore, the opposite parties are entitled to repudiate the claim of the complainant. The complainant is not entitled to any amount much less the interest claimed by her. The complaint is liable to be dismissed.
4. No oral evidence was adduced by either party. Exs. A-1 to A-4 were marked on behalf of the complainant and Exs. B-1 to B-13 were marked or behalf of the opposite parties.
5. Ex. A-1 is the letter dated 26.3.92 written by the opposite party to the complainant informing that the opposite parties decided to repudiate their liability under the Policy No. 680236238 for a sum of Rs. 50,000/- of her husband, since her late husband in the proposal dated 3.12.88 for assurance gave false answers to the question Nos. 17, 20, 21, and 22(a) as per the information received by them during investigation. Ex. A-2 is another letter of repudiation by the opposite parties in regard to the Policy No. 680241404 for a sum of Rs. 30,000/- and Ex. A-2 is the another repudiation letter of the opposite parties in regard to the Policy No. 680241303 for a sum of Rs. 50,000/- of the husband of the complainant. Ex. A-4 is the copy of the representation of the complainant to the opposite parties requesting them to pay the policy amounts. This does not throw any light on the case of the complainant. There is no dispute by the opposite parties that late Kashaiah the husband of the complainant obtained three Jeevan Mitra Policy No. 680236238 for a sum of Rs. 50,000/- another Policy No. 680241404 for a sum of Rs. 30,000/- and also a Policy No. 680241303 for a sum of Rs. 50,000/-. The contention of the opposite parties is that late Kasaish the husband of the complainant obtained a Jeevan Mitra Policy No. 60898336 commencing from 14.9.85 for a sum of Rs. 25,000/- and another Policy No. 680026705 commencing from 17.7.87 for a sum of Rs. 25,000/- that when he was asked at the time of subsequent proposal about the previous insurance policies, he gave a false answers saying âNo and that thereby he made a false declaration with regard to his taking insurance policies earlier to the policies in question. The learned Counsel for the opposite parties upon the entries made in Ex. B-1 proposal form dated 3.12.88 made by late Kashaiah for obtaining the Jeevan Mitra Policy for a sum of Rs. 50,000/- wherein the question No. 10 soliciting information as to whether he had previous insurance, late Kashaiah stated âNo. Admittedly, late Kashaiah obtained two Policies Nos. 60898336 with effect from 14.9.85 and 680026705 with effect from 17.7.87. Therefore, it follows that he gave false answers with regard to his information as to his taking of Jeevan Mitra Policies earlier than 3.12.88 on which date he made a proposal for another policy for a sum of Rs. 50,000/. The next contention of the opposite parties is that while making proposals for the three policies in question, on 3.12.88, 16.2.89 and 20.2.89 late Kashaiah gave a false statement with fraudulent intention with regard to his health with the knowledge that it was false. It is pointed out for the opposite parties that the complainants husband met with an accident on 26.7.88 and sustained serious injury to his knee and took medical treatment for about 16 days from 26.7.88 to 10.8.88 as revealed from Ex. B-11 and B-12 certificates issued by Dr. Sreedhar Rao, Orthopaedic Surgeon and that late Kashaiah suppressed the said fact while make the proposals for the three policies in question. Ex. B-1 is the proposal dated 3.12.88 in regard to the Policy No. 6802362387 for a sum of Rs. 50,000/- Ex. B3 is the proposal dated 16.2.88 for the Policy No. 680241404 for a sum of Rs. 30,000/-. Ex. B-5 is the proposal Dated 20.2.89 for the Policy No. 680241303 for a sum of Rs. 50,000/-. In all these three proposals, late Kashaiah answered âNo to the Question No. 20 requiring him to say whether he has consulted a medical Practitioner within the last five years for any ailments requiring treatment for more than a week, to Question No. 21 requiring him to say whether he has remained absent from his place of work during the last five years and Question No. 22 requiring him to say whether he had any operation, accident or injury or whether he has been in any hospital, asylum or sanatorium for check-up, observation, treatment of any operation. These answers were given by late Kashaiah on 3.12.88, 16.2.89 and 20.2.89 Exs. B-11 and B-12 medical certificates show that late Kashaiah took medical treatment for knee injury that is, Hemothrouis from 26.7.88 to 10.8.88 from Dr. Sreedhar Rao, Orthopaedic Surgeon. The complainant also admits that her husband late Kashaish met with an accident and sustained injury to his right knee on 26.7.88. Obviously late Kashaiah gave false answers to the questions relating to the accident and injury and thereby suppressed the true facts regarding his health. It is, therefore, argued for the opposite parties that in view of Section 45 of the Insurance Act, the opposite parties are entitled to repudiate the claim of the complainant. On the other hand, it is argued for the complainant that late Kashaiah died due to heart attack and not of the knee injury and that, therefore, the fact that late Kashaiah did not disclose in the proposal form submitted by him that he suffered from any injury and took medical treatment for about 16 days for the said injury cannot be made a ground to repudiate the complainants claim. We are not inclined to agree with this contention. There is material to show that late Kashaiah sustained injury to his knee on 26.7.88 prior to his proposals in regard to these three policies in question and he gave false answers in regard to his medical treatment earlier to his making the proposals. He also suppressed the fact of his taking two Jeevan Mitra Policies earlier to his proposal for the three policies in question. We are, therefore, of the opinion that the opposite parties have applied their mind in all aspects of the case and repudiated the claim of the complainant for payment of the amounts due under the three policies in question and they are justified in doing so. If the complainant is aggrieved, she may go to Civil Court for appropriate reliefs.
6. In the result, the complaint is dismissed, but without costs in the circumstances of the case. This order, however, will not preclude the complainant from approaching the Civil Court for appropriate reliefs, if so advised.
Complaint dismissed.