BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
and
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Monday the 19th day of September, 2005
CD No. 07/2005
Smt V.Sujatha, W/o. Late Chandra Sekhar,
H.No. 15-100, Kadakpura, Kurnool.
. . . Complainant
-Vs-
1. Branch Manager,
LIC of India, Kurnool.
2.The Divisional Manager, LIC of India,
P.B No.10, College Road, Cuddapah - 516004.
. . . Opposite parties
This complaint coming on 15.09.2005 for arguments in the presence Sri P.Siva Sudarshan, Advocate, for complainant and Sri A.S. Ummer Javid Ali, Advocate for opposite parties 1 and 2 and stood over for consideration till this day, the Forum made the following.
O R D E R
(As per Smt C.Preethi, Hon’ble Lady Member)
1. This CD complaint of the complainant is filed under section 11 and 12 of CP Act, 1986, seeking a direction on the opposite parties to pay policy amount with bonus and benefits to the complainant with 24% interest per annum from the date of death of deceased till realization, Rs.20,000/- towards mental agony, Rs.2,000/- as costs of the case and any such other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s husband late Chandra Shekar insured his life on 10.9.2000 for Rs.1,00,000/- vide policy bearing No. 652289073 ( Jeevan Mitra Double Cover Policy). On 25.12.2000 the policy holder died due to Jaundice and a claim form was submitted by the complainant as nominee for insured amount, the opposite party No.2 through their communication dt 12.4.2002 repudiated the claim stating that the policy holder with held correct information regarding his health at the time of contract of insurance. But the complainant submits that her husband never suffered from any Cirrhosis of liver disease before taking policy. The opposite parties without any proper reasons wontedly did not pay the policy amount to the complainant. Hence, the said non payment of policy amount by the opposite parties is held deficiency of service on the part of opposite parties to the complainant, which constrained the complainant to resort to the Forum for redressal.
3. In support of her case the complainant relied on the following documents Viz (1) letter dated 12.4.2002 of opposite parties to the complainant (Repudiation letter) and (2) Death certificate of the deceased, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex A.1 and A.2 for its appreciation in this case. The complainant caused interrogatories to opposite parties and sutablely replied to the interrogatories caused by opposite parties.
4. In pursuance to the notice of this Forum as to this case of the complainant, the opposite party No.2 appeared before the Forum and filed its written version and contested the case.
5. The written version of opposite parties denies the complaint as not maintainable either in law or on facts, but admits that the deceased V. Chandra Shekar has taken a policy vide No. 652289073 on his life for Rs.1,00,000/- and nominated the complainant as his nominee. The nominee informed the death of life assured on 25.12.2000 and preferred a claim. As the death aroused within 3 months 10 days investigation was conducted, which revealed that the life assured was suffering from Chronic of liver disease since long time and availed leaves on medical grounds from 1.8.2000 to 10.8.2000 for fever, which is not disclosed in proposal form and the life assured has taken treatment at Government General, Hospital for liver disease four times from 27.2.2000 to 10.8.2000 vide IP No. 24162 and was again admitted into the Hospital on 11.12.2000 vide IP NO. 42316 .
6. The life assured in the proposal form gave negative answers to the question 11 (a), (b),(c) and (d) about his state of health and suppressed the material information about his state of health before the date of proposal and violated condition No.5 of the policy, hence the contract was declared null and void by speaking order dt 12.4.2002. Therefore, the repudiation of the opposite parties was made on justifiable grounds and seeks for the dismissal of complaint with costs.
7. In substantiation of its case the opposite parties relied on the following documents Viz (1) policy bond No. 652289073 of the deceased V.Chandra Shekar (2) certificate of employer dt 21.6.2001 in claim form ‘E’ (3)Proposal form of deceased policy holder, dated 10.9.2000 (4) Medical certificate issued by Dr M.Krishna Murthy, dated 10.8.2004 (5) Medical certificate issued by Dr M.Krishna Murthy dated, 18.9.2000 (6) leave letter applied by the deceased from 1.12.2000 to 31.12.2000 (7) Medical certificate for leave issued by Asst. Surgeon Govt. General Hospital, Kurnool and (8) Leave availed particulars of Late V.Chandra Sekhar Sr. Asst. issued by D.E.E, R.W.S (P.R) Sub Division, Nandikotkur, besides to the sworn affidavit of opposite party No.2 in reiteration of his written version as evidence and the above documents are marked as Ex B.1 to B.8 for its appreciation in this case. The opposite party caused interrogatories to the complainant and replied suitablely to the interrogatories caused by the complainant.
8. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:-
9. It is not in dispute that deceased life assured V.Chandra Shekar has taken Jeevan Mitra Double Cover Endowment Policy covering his life for Rs.1,00,000/-. It is not in dispute that the complainant/ nominee put forth a claim for assured amount under the policy, and the claim was repudiated by opposite parties vide Ex A.1. The Ex A.1 envisage, the repudiation of the of the policy bearing no. 652289073 of the deceased life assured V. Chandra Shekar. It further says that the claim was repudiated as the life assured suffered from Cirrhosis of Liver and consulted a medical man and had taken treatment from a hospital and was on medical leave for 10 days from 1.8.2000 to 10.8.2000 and the same was not disclosed by the life assured in the facts relating in his proposal form.
10. The only disputes is whether the insured died a natural death or due to cirrhosis of liver and whether he has concealed any information in proposal form (Ex B.2) or not. The main contention of the opposite parties is that the life assured concealed material information of his ill health and was on medical leave for 10 days. Reliance was placed on the leave availed particulars issued by the employer of the life assured vide Ex A.8, it was argued by the opposite parties that the life assured was regularly on medical leave. It was further alleged that the period 1.8.2000 to 10.8.2000, 13.9.2000 to 18.9.2000, 13.10.2000 to 23.10.2000 and 1.12.2000 to 25.12.2000, the life assured availed medical leaves on producing medical certificates vide Ex B.4, B.5 and B.7. It is settled principle of law that taking of medical leave is no ground to presume that the insured was suffering from any decease. Government employees offen take medical leaves when no other leaves are available to them, when an employee has exhausted ordinary leaves, he takes medical leave, which is ordinarily granted, to Government servants, that is of one year in the whole services. If he finds no other means to take leave, he collects a medical certificate from some doctor on payment of Rs.10/- or 20/- and gets a medical leave. This has become the general method of taking leaves, where leaves are not granted liberally by the department. This illness is for medical leave only.
11. The Ex B.4 & B.5 dt 10.8.2000 and 18.9.2000 medical certificate issued by Dr M. Krishna Murthy, to the deceased life assured as he was suffering from fever and he was advised treatment and rest from 1.2.2000 to 10.8.2000 and 13.9.2000 to 18.9.2000. The Ex B.7, dt 23.7.2000 medical certificate issued by Asst. Surgeon, Govt. General Hospital,Kurnool to the deceased life assured as he was suffering from Chronic liver disease. The Ex B.4, B.5 and B.7 relied by the opposite parties doesn’t inspire any confidence, as there is no statement of Dr M. Krishan Murthy or Asst Surgeon, Govt. General Hospital Kurnool, that they actually examined the life assured and has given any treatment to him. There is nothing on the record to show that the insured had got any prescription, treatment, medicine etc from any doctor for this alleged disease. There is also no evidence that he charged any amount of his treatment from his department for this illness. All these medical certificates and pretended illness has been only to take leave and it is not at all necessary that such pretended illness and leaves should be disclosed at the time of taking policy. There is neither willful suppression nor any illness, nor any material fact, which has been suppressed. As said above there is absolutely no evidence of any admission in any hospital, taking any treatment, purchasing any medicine else. Therefore, mere taking of leaves on medical ground is no ground to presume that the insured was actually suffering from cirrhosis of lever, as alleged by opposite parties in Ex A.1, repudiation letter.
12. In the Ex B.4 and B.5 the disease suffered by the life assured was fever, which the deceased suffered before taking the policy this desease was not a material decease, therefore, this was not a material fact, which was to be disclosed in the proposal form. Ordinary, illness or pain, fever, cold, cough which a person ordinarily suffers is not such a disease, which should be mentioned in the proposal form. Only those facts which are very material for that only the insured can be held guilty, if he has suppressed. Therefore, the claim could not have been repudiated on that ground.
13. The learned counsel for complainant referred the following citation of II (2005)CPJ Pg 114, Uttaranchal, State Commission, between LIC of India Vs Nandi Devi, where in, the agent did not inform the life assured that he has to explain medical certificates and pretended illness for taking leaves when no other alternative is there, hence there is no willful suppression by life assured, the other citation is of III (2005) CPJ Pg 544, Uttaranchal, State Commission, between LIC of India Vs Dayawati, wherein, it has been specifically held that taking of medical leaves is no ground to presume that the insured suffering from any disease, and there is no evidence place by opposite parties on record that the life assured taken treatment, hence, the opposite parties cannot escape from its liability. The learned counsel for complainant further referred the following citations of II (2004) CPJ Pg 582 Ultaranchal State Commission, between LIC of India Vs Mrs Laxmi Karnatka, wherein, it was held that employees after take leave on medical ground off and on to consume leaves, mere taking medical leave is no ground to presume that the insured suffering from appendicites. The other decisions referred are IV (2004) CPJ pg 612, AP, State Commission, between Y. Vijayalaxmi and LIC of India, wherein it was held that burden of proof is on the insurer, when suppression is not proved, opposite parties are liable to pay insured amount, IV (2004) CPJ Pg 131, Chattigarh State Commission, between, LIC of India and Anr Vs Radhika Madhaiya, wherein, the burden to prove that diseased had the knowledge of disease at the time of proposal, when it is not proved opposite parties are liable, II (2004) CPJ Pg 636, Ultaranchal State Commission, between LIC of India Vs Sunil Kumar, wherein, it was held that merely taking leave on medical ground, no ground to hold that the insured was actually ill, opposite parties are liable under the policy and IV (2004) CPJ Pg 293, Andhra Pradesh State Commission, between LIC of India and Ors Vs Rehana Begum, wherein there was no nexus between alleged suppression and actual cause of death opposite parties are liable.
14. To sum up of the above discussions and following the aforementioned citations, it cannot believed that if a person taken leave on medical certificates can not be a ground to presume that the insured suffered from the said disease. Keeping the facts and circumstances of the present case in view which are similar to the facts of the above cited citations, there was no justification for the opposite parties to repudiate the claim of the complainant and there arises deficiency of service on part of opposite parties to the complainant and the complainant is perfectly remaining entitled to the insured amount of the life assured V.Chandra Shekar.
15. In the result, the complaint is allowed directing the opposite parties jointly and severally to pay the policy amount under the policy bearing No. 652289073 with bonus and benefits to the complainant with 12% interest from the date of demise of the deceased life assured V.Chandra Shekar along with Rs.5,000/- as compensation with in a month of receipt of this order.
Dictation to the Stenographer, Typed to the dictation corrected by us, pronounced in the open Court this the 19th day of September, 2005.
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant For the opposite parties
-Nil- -Nil-
List of Exhibits Marked for the complainant:-
Ex A.1 Letter dt 12.4.2002 of opposite parties to the complainant repudiation letter).
Ex A.2 Death Certificate of the deceased.
List of Exhibits Marked for the opposite parties:-
Ex B.1 Policy bond No. 652289073 of the deceased V.Chandra
Shekar.
Ex B.2 Certificate of employer letter dt 21.6.2001 in claim form ‘E’.
Ex B.3 Proposal form of deceased policy holder, dt 10.9.2000.
Ex B.4 Medical certificate issued by Dr M.Krishna Murthy, dated
10.8.2000.
Ex B.5 Medical certificate issued by Dr M.Krishna Murthy, dated
18.9.2000.
Ex B.6 Leave letter applied by the deceased from 1.12.2000 to
31.12.2000.
Ex B.7 Medical certificate for leave issued by Asst. Surgeon Govt.
General Hospital, Kurnool dated 23.10.2000.
Ex B.8 Leave availed particulars of late V. Chandra Sekhar Sr. Asst.
Issued by D.E.E, R.N.S (P.R) Subdivision, Nandikotkur.
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
- Sri P. Siva Sudarshan, Advocate, Kurnool.
- Sri A.S.Ummer Javid Ali, Advocate, Kurnool
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
