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KERALA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, THIRUVANANTHAPURAM
Hon’ble Mr. Justice P.K. Shamsuddin, President & Prof. K. Madhuri Latha, Member
DIVISIONAL MANAGER, L.I.C. OF INDIA—Appellant
versus
SARAMMA VARGHESE—Respondent
Appeal No. 1115 of 1997—Decided on 3.2.1998

Counsel for the Parties :
For the Appellant :Mr. R.S. Kalkura & Mr. S. Reghukumar, Advocates.
For the Respondent:Mr. R. Gireesh Babu, Vanchiyoor, Tvm., Advocate.

Headnote:Consumer Protection Act, 1986 - Sections 2 and 14 - Insurance Claim - Endowment policy issued on 8-7-1996 - First premium was paid on 8-5-1996 - Insured, complainants husband, died on 14-7-1996Claim repudiated for violation of policy condition - Doctors certificate showing that insured was suffering from disease - Failure on part of insured to intimate the change of health before issue of policy - Violation was to render policy invalid No deficiency in service in repudiation of claim. (Para 7)

       Result: Appeal allowed.

       IMPORTANT POINT

       Repudiation of insurance claim on the ground of violation policy condition docs not constitute deficiency in service.

ORDER

Mr. Justice P.K. Shamsuddin, President— This appeal is directed against the order passed by the District Forum, Malappuram, in O.P. No. 152/1997. Opposite party is the appellant.

2. The complainant is the wife of deceased N. Varghese, who took an endowment policy for Rs. 50,000/- from the opposite party. The first premium was paid on 8.5.1996. Second instalment of premium was paid on 4.6.1996. Ext. Bl which is the proposal. The policy was issued on 8.7.1996. The complainant’s husband died on 14.7.1996. The complainant filed a claim but the opposite party repudiated the claim. Hence the complaint.

3. The opposite party filed a version stating the claim was repudiated for violation of policy conditions.

4. On behalf of the complainant Exts. Al to A3 were marked. On behalf of the opposite party Exts. Bl to B5 were marked.

5. The District Forum took the view that there is no valid ground to repudiate the claim and in that view passed an order directing the opposite party to pay Rs. 50,000/- together with cost of Rs. 500/-.

6. Feeling aggrieved by the said order this appeal has been preferred.

7. In this appeal, learned Counsel invited our attention to the proposal Ext. Bl which is dated 4.6.1996. In column 11(a) to a question “during the last 5 years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week?” The answer given is, No. Learned Counsel also invited our attention to Ext. B2 certificate issued from the Medical College Hospital by Dr. K. Sunny Varghese on 9.9.1997. It was on a request made by the Insurance Company that certificate was issued. We find from this two months before the issue of certificate he was suffering from the disease. However we find initially it was written as 5 days and it was struck and written as 2 months before admission. We also find in Ext. B3 which is also a certificate issued by the very same doctor in answer to the question when was the first observation. He has written five days before admission on 3.7.1996. In view of this we are unable to rely on these materials. However in the proposal form we find there is a statement which reads as follows :

“And I further agree that if after the date of submission of the proposal but before the issue of the First Premium Receipt (i) any change in my occupation or any adverse circumstance connected with my financial position or the general health of myself or that of any members of my family, occurs or (ii) if a proposal for assurance or an application for revival of a policy on my life made to any office of the Corporation has been withdrawn or dropped, deferred or accepted at an increased premium or subject to a lien or on terms other than as proposed I shall forthwith intimate the same to the Corporation in writing to reconsider the terms of acceptance of assurance. Any omission on my part to do so shall render his Assurance invalid and all monies which shall have been paid in respect thereof forfeited to the Corporation.”

Thus it can be seen if there is failure to intimate the change of health before the issue of policy, it would render the policy invalid. In this case there is such failure. Learned Counsel appearing for the respondent/complainant submitted the first premium was paid by them on 8.5.1996. This is not disputed by the appellant also. But what is specified in the declaration is failure to intimate change of health before the issue of policy. In the circumstances in our view there is a violation of the policy condition which renders the policy invalid. Thus viewed, there is no deficiency on the part of opposite parties in repudiating the claim. We accordingly allow the appeal, set aside the order of the District Forum and dismiss the complaint.

Appeal allowed.





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