- (1.) THE complainant s wife is Krishna Lakshmi. The complainant immediately after his marriage had insured the life of his wife with the first opposite party on the following policies: Sl. No. Policy No. Receipt No. Date Policy Amount Thiru Justice A. Raman, PresidentThe complainant s wife is Krishna Lakshmi. The complainant immediately after his marriage had insured the life of his wife with the first opposite party on the following policies: Sl. No. Policy No. Receipt No. Date Policy Amount 1. 741001988 28.3.1992 Rs.25,000/ - 2. 320048599 20.6.1994 Rs.75,000/ - 3. 23883 25.7.1994 Rs.50,000/ - 4. 320059103 29.7.1994. Rs.50,000/ -
(2.) THE first complainant s wife died suddenly on 9.8.1994. As the nominee, the first complainant made claims upon the first opposite party for payment. The second opposite party sent a Form and required the first complainant to get it filled from his Doctor at Puliankudi. Accordingly the complainant sent the same. Afterwards the complainant made several demands to which there has been no reply at all. Thus there has been deficiency in service. Hence, this complaint.
(3.) IN the version filed by the opposite parties, they contended as follows: The complaint relates only to the Life Insurance Policy No. 741001988 on the life of P. Krishna Lakshmi. The other three are only proposals submitted to the first opposite party for insurance. At the time of filing of this application, the decision regarding the admissibility of the claim could not be taken for want of hospital records relating to the treatment given to the deceased, Krishnalakshami. After the orders of the lower Forum, the records were received and based upon them, the opposite party have repudiated their liability under Policy No. 741001988. As regards the other three proposals, no liability could be fixed on the Corporation since the proposals never resulted into policies and thus there was no concluded contract of insurance. The complaint is not maintainable. It has been held by the Supreme Court that acceptance of proposal is complete only when it is communicated to the offeror and that silence or receipt and retention of premium cannot be construed as acceptance. Further if a claim is vitiated on the grounds of fraud and suppression of material facts, it is not admissible. It is no doubt true under the Policy No. 741001988, the first complainant is the nominee and the premiums were paid upto 28.3.1992. Premiums due from September 1993 onwards were not paid and, therefore, the said policy stood lapsed. On 18.6.1994, the deceased Krishna Lakshmi submitted a personal statement of revival. Believing her statement regarding her continued insurability and on the basis of the declaration contained in the personal statement, the policy was revived after receiving all arrears of premiums together with interest. The first opposite party did receive three numbers of proposals dated 21.6.1994, 27.7.1994 and 29.7.1994 from the deceased Krishna Lakshmi seeking an insurance cover of Rs. 75,000/ -, Rs. 50,000/ - and Rs. 50,000/ - respectively. Even though the insurer had underwritten two proposals and assigned policy numbers, no concluded contact of insurance has come into operation. Thus the proposals only remain as proposals and have not become enforceable policies. As regards the proposal dated 27.7.1994 which was received on 29.7.1994, for want of certain requirements, it has not been underwritten by the first opposite party. Thus it also remains only as proposal. On the receipt of death intimation from the first complainant, who is the nominee under the policy No. 741001988, certain requirements regarding the bona fide also, the first opposite party caused an investigation to be made since the death has resulted in within two months from the date of its revival. It was found that the deceased Krishna Lakshmi prior to the submitting DGH on 18.6.1994 and also prior to the signing of three proposals had suffered major ailments, which could not be ascertained from Tirunelveli Medical College Hospital where the deceased/policy holder was admitted in coma stage. The Hospital Authority refused to give copy of the case -sheet and finally they were obtained through Court. From the case sheet, we find that she was suffering from Mucocutaneous Ulceration and also had a history of diabetic. The assured failed to disclose the vital information. If any untrue averment is contained, the contract shall become null and void and all the moneys which shall have been paid in respect thereof shall stand forfeited. The insured had made incorrect statement. Further the revival being a novatio , it is a new contract and since the assured failed to disclose her suffering from diabetic and Mucocutaneous Ulceration and was in death bed on the date of revival, it was rightly repudiated. She could not have signed the DGH on 18.6.1994 as she was in death bed and as the signature varies vastly. Thus there is suppression of truth and fraud. The insurance being a contract of good faith and there being breach of conditions, it was rightly repudiated by the opposite parties the complainant cannot complain of delay because the opposite parties were forced to defer their position on account of indifferent attitude shown by the physician at Puliankudi in supplying information on treatment given by him besides the non -supply of case sheet of Tirunelveli Medical College Hospital. There is no deficiency of service. There is utter lack of good faith on the part of the complainant. The proposals having been made in quick succession would show that the lack of bona fides in the claim. The Supreme Court has held that mere silence does not denote consent and no binding contract emerges until the person to whom an offer is made says something to signify acceptance. Equally mere receipt and retention of premiums until and after the death of the applicant or mere preparation of the policy document is not acceptance and it is complete until it is communicated to the offeror. The deceased was having history of diabetics with blood sugar level at 350 mg. She was having two months old history of Mucocutaneous Ulceration. Therefore, these three proposals have not been initiated in a genuine manner. Therefore, rightly the opposite parties treated them as null and void. The lower Forum accepted the complaint in part and directed the opposite parties to pay a sum of Rs. 25,000/ - relating to the insurance policy bearing No. 741001988 to the first complainant with interest and Rs. 5,000/ - as compensation for mental agony and a cost of Rs. 500/ -.;