SHEELA Vs. LIC OF INDIA

JUDGEMENT

(1.) Late Shri Sasidharan K.M. obtained an insurance cover from the LIC of India on his life for a sum assured of Rs.15 lakhs. The proposal for obtaining the life insurance cover was submitted on 29.09.2003 and the policy was issued effective from 04.11.2003. He died on 07.01.2004 within a few months of taking an insurance cover. A claim was lodged by the complainants/appellants for payment of the benefit available in the insurance cover by the deceased. The claim, however, was repudiated primarily on the ground that the complainant had incorrectly answered the questions contained in the proposal, thereby concealing material facts, and in fact he had met with an accident and had taken treatment from hospital. It was further stated that in the repudiation letter that the deceased was diagnosed as IVDP L4-L5 tardy ulnar nerve palsy left, Type II diabetes mellitus.

(2.) Being aggrieved from the rejection of the claim, the complainants approached the concerned State Commission by way of Consumer Complaint. In the said complaint, they impleaded the Development Officer as OP-5 and the agent Mr. K.M. Abdul Asharaf as OP-6. The complaint was filed against the LIC and its officers being the concerned Zonal Manager, Senior Divisional Manager and Branch Manager. The Development Officer filed written version before the State Commission. The agent Mr. K.M. Abdul Asharaf did not file a written version contesting the complaint. It was inter-alia stated in the written version filed by the Development Officer before the State Commission, that the deceased who was a PWD contractor had knowledge of English and that he (the agent) had personally enquired and collected all the details required to fill-up the application form from the deceased himself and then asked him to put his signatures. He denied that the deceased has disclosed of his personal details including state of his health to him and the Development Officer. He also denied that the application form was not read over and explained to the deceased and that the deceased has signed the form on the assurances given by him. He also supported the repudiation of the claim by the insurer. The State Commission having dismissed the Consumer Complaint. The complainants/appellants are before this Commission by way of this appeal.

(3.) The Medical Disability Certificate issued by the Department of Orthopaedics, Medical College, Trichur on 16.07.2003 to the extent the said certificate is relevant, reads as under: