ABDUL LATHEEF vs LIFE INSURANCE CORPORATION OF INDIA

THE present Revision Petition has been filed before this Commission under Section 21(b) of the Consumer Protection Act, 1986 against the impugned order dated 7.2.2012 in Appeal No. 3775 of 2010 passed by the State Consumer Disputes Redressal Commission (in short, ''State Commission''). The State Commission dismissed the Appeal. The Appeal was filed against the orders passed by the District Consumer Disputes Redressal Forum, (in short, ''District Forum'') in Complaint No. 234/2009, whereby the complaint was also dismissed. The relevant facts in brief are that, on 28.3.2006, the deceased Zeenath obtained a Bima Gold Policy from the LIC of India (OPs) bearing No. 624377885 for Rs. 2,00,000. She paid the 1st and 2nd premium. During the subsistence of the policy, she died on 12.11.2007 due to Carcinoma Larynx. The Petitioner/Complainant Nos. 1 to 4 are the nominees and beneficiaries under the said policy, and the Complainant No. 1 lodged a claim with the LIC of India (OP -2). The claim was repudiated by OP -2 stating that, the deceased had withheld material information regarding her health at the time of filling up the proposal form. Alleging that, repudiation of claim by the OPs was not correct which amounts to deficiency, the Complainant filed a complaint before the District Forum seeking direction against the opposite parties to pay Rs. 2,00,000, the sum assured, along with interest @ 18% p.a.

THE District Forum dismissed the complaint. An appeal was filed by the complainants, which too, was dismissed by the State Commission. Against the impugned order of State Commission, this revision petition arose.

WE have heard the Counsel for both the parties, perused the medical records on file. The Counsel for OP contended that, while obtaining the policy, the policy holder suppressed the material facts, while answering all the questions in the proposal form. In fact, just 15 days'' prior to filling the proposal form, Smt. Zeenath, the deceased, was suffering from Bipolar Mood Disorder for which she had consulted doctors in KMC Hospital, Attavar, Mangalore, Venlakh Hospital, Bangalore, Justice K.S. Hegde Charitable Hospital, Deralakatte, Mangalore and further stated that, she was admitted to the KMC Hospital with a history of aggressiveness and agitation. The deceased was treated with appropriate medication and counselling. It is argued that, had the life assured declared the particulars of treatment taken at the time of obtaining the policy, the OPs would not have issued the policy. Hence, the Counsel for OP contended that the repudiation is just and valid, because material fact has been deliberately suppressed relating to her health at the time of filling her proposal form.

THE Counsel for the petitioner argued that, Zeenath died due to Cancer, and there is no nexus between the Bipolar Mood Disorder and the cause of death. It is not a disorder; it is trivial in nature, which appears during pregnancy and abnormal menstruation, hence it is not a material fact, which need any disclosure. It is further contended that, the deceased, Zeenath, never required treatment for more than a week. There was no abnormal behaviour. The life assured was medically checked by the doctor of OP, and the proposal form was filled up at the instance of the LIC agent. Policy holder, Zeenath had a lower educational level and unable to understand the questionnaire in the proposal form. She never knew about the ailment of the carcinoma, it was the 1st time when she was informed by the doctors at KMC on 22.5.2006. The present cause of death is no way having nexus with the earlier treatment taken by the policy holder Zeenath. We have perused the documents, the Hospital records from Venlakh Hospital, KMC Hospital and find that the deceased life assured had consulted the doctor in a Psychiatric Department of KMC Hospital on 11.3.2006 and had taken treatment from 13.3.2006 to 16.3.2006 for Bipolar Mood Disorder (Mania) and thereafter took a Policy on 28.3.2006. She had paid second premium and thereafter, within one year she died due to Carcinoma Larynx, which was also confirmed by Dr. Suresh Mankar. We have perused the proposal form, the question under item 11 was answered as "during the last 5 years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week, the answer given was "No". To the question at item No. 11(b) that have you ever been admitted to any hospital or nursing home for general check up, the answer is "No".

THE next very important question which decides the fate of this Revision Petition is, "Whether, the non -disclosure of bipolar mood disorder was a material fact? And whether it has any relevance with the Carcinoma Larynx which was the cause of death? We have referred the medical literature upon the bipolar mood disorder; accordingly it is seen commonly in women, during abnormal menstrual cycles or during pregnancy. Therefore, as such, it is a condition of mind and not to be called as disease. The Doctor''s Certificate Exbs. at C -26, dated 5.12.2009 clarifies this matter. This certificate by the Doctor''s view is reproduced as follows: "Doctor Certificate - -Highland Hospital Research & Diagnostic Centre

Date: 5.12.2009

Mrs. Zeenath w/o Abdul Latheef died on 12.11.2007 at 3.15 p.m. due to carcinoma of larynx and secondaries on the neck.

She was treated for aggressiveness and irritability during 2004 and 2006 during her pregnancy and menstrual cycle. These symptoms can occur during stress conditions like pregnancy and menstrual cycle. She recovered well with the treatment.

The above mentioned symptoms have no relations to carcinoma of Larynx.

She died due to carcinoma of Larynx with secondaries and not due to behavioral disorders."

ADMITTEDLY , the life assured took treatment just 15 days before taking the proposed policy. Even otherwise, this view of the OP is not supported by the answer given under the Item 11(a) of the proposal form, the patient was admitted for only 3 days and not for more than a week. Also, the question in item 11(b) the patient answered "No", because the bipolar mood disorder was a frequent and repeated episode, which appears to be a trivial one. Therefore, it was not a material fact and not a fraudulent suppression. Therefore, the Judgment of Hon''ble Supreme Court in Satwant Kaur''s case is not applicable in this case. It will be unfortunate, if the insurance companies try to repudiate genuine death claims on such technical and flimsy grounds. Most of the innocent insured will be victims and the beneficiaries will be deprived of the fruits of life insurance. Therefore, we are of the considered view that the deceased, Zeenath, an illiterate woman, did not suppress any material fact with any fraudulent intention. There is no nexus at all between the bipolar mood disorder and the carcinoma of larynx. No doubt, the bipolar mood disorders may lead to suicidal tendencies and the death, but, it will never be a cause for any cancer in the human body. It is unfortunate that on one hand the LIC raises the voice of "Utmost good faith" but, in contrast, the faith will be lost while not settling the genuine claims for some or other reasons. It is the exploitation of the policy holders. The consumers are literally under fear or dilemma that, whether, after death, the beneficiaries ever certainly get any fruits from the LIC.....!!!. Therefore, we set aside the orders of both the Fora and allow this Revision Petition and direct the OP to pay a sum of Rs. 2,00,000 with interest @ 9% p.a. from the date of death of Smt. Zeenath, within 90 days, from the date of receipt of this order, otherwise, it will carry interest @ 18% p.a., till its realization. No order as to costs.