LIFE INSURANCE CORPORATION OF INDIA REP. BY ITS BRANCH MANAGER Vs. M. VIJAYA LAXMI, W/O LATE MUKKU BHASKASRA RAO

JUDGEMENT

(1.) This appeal is filed against the order dated 29.1.2008 passed in CD 159/2006 by the District Forum, Nellore directing the OPs LIC of India to pay compensation of Rs.18,75,000 with interest thereon and compensation of Rs.50000/- and costs. The impugned order is assailed by the OPs questioning it as erroneous both on question of fact and law and sought to be set aside.

(2.) In nutshell, the complainants are the legal heirs of the deceased policy holder Bhaskara Rao who had taken two polices for Rs.6 lakhs each on 11.6.2002 and according to the complainants the policy holder was healthy at the time of taking policy but died due to Massive Cardiac arrest on 13.2.2003. After investigation of death of the policy holder the complainants have preferred a claim to OP 1 but the same was repudiated on 20.10.2003 informing that they may appeal to Zonal office. The zonal office in turn informed that as the claim was more than Rs.2 lakhs he has no jurisdiction and advised to appeal to the Chairman but the said authority failed to reconsider it.

(3.) OP 1 filed the counter denying the factual aspects and justified its stand in repudiating the claim on the ground that since the contract is a contract of utmost good faith, the facts relating to the health of insured are false and there was suppression of true facts as such the insurer has no liability to pay the insurance claim. It is stated that the claim was an early claim. So as per the guide lines, the corporation had taken up the investigation to find out the actual cause of the death and the malafides involved in taking the policies. As per the hospital record secured, the insured had taken treatment for cancer in Apollo hospital on 17.6.2002 to 19.6.2002 for second cycle chemotherapy . Again from 9.7.2002 to 11.7.200e for third cycle. Again from 2.8.2002 to 4.8.2002 for 4th cycle and 27.8.2002 to 29.8.2002 for 5th cycle from which it is evident that the insured was suffering from cancer and especially it is clear that prior to 17.6.2002 he had taken treatment for first cycle. Thus he was suffering from cancer two years prior to the proposal itself. During that period he had taken treatment from Jakka Sujatammma cancer hospital, Nellore also. Apart from it, the insured had fallen from the steps of the first floor and sustained injuries resulted in fracture on 13.01.99 for which he was admitted in Govt. Hospital ,Nellore and underwent surgery. The said fact was not revealed in the proposal. Had these facts been revealed in the proposal, they would not have issued the policy at all. The insured had signed the declaration also about the facts mentioned there in the proposal. As there was misstatement and suppression of the facts with regard to health condition of the insured the claim was not considered and the corporation has no liability to pay the amount claimed for.