BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt.C.Preethi, Lady Member
Thursday the 14th day of December, 2006
C.C. No.99/2006
Smt.V. Sudhamani alias E.Chandrakala, W/o. Late E. Seshaiah Setty, aged about 29 years,
H.No. 10-33-9, Kothapeta, Dhone, Kurnool District.
…complainant
-Vs-
1. The Branch Manager,
L.I.C of India Ltd., Dhone, Kurnool district.
2. The Divisional Manager, L.I.C of India Ltd.,
P.B.No.10, College Road, Kadapa-516 004. …opposite parties
This complaint coming on this day for orders in the presence of Sri. P. Siva Sudarshan, Advocate, Kurnool for complainant, Sri I.Anantha Rama Sastry Advocate, Kurnool for opposite Parties No.1 and 2, and stood over for consideration till this day, the Forum made the following:-
ORDER
(As per Smt. C. Preethi, Hon’ble Lady Member)
1. This consumer complaint of the complainant is filed under section 11&12, of C.P. Act, 1986, seeking a direction on the opposite parties to pay policy amount of Rs.25,000/- with benefits and with 24% interest per annum from the date of death till realization, Rs.20,000/- towards mental agony, Rs.2,000/- towards cost of the complainant and any other relief or reliefs which the complainant is entitle in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s husband late E. Seshaiah Shetty insured his life for Rs.25,000/- under policy bearing no. 651989536 from opposite parties. The policy holder E. Seshaiah Setty died on 19-11-03 due to headache, and vomitings and it is a natural one. After the death of the policy holder the complainant submitted claim form as nominee under above said policy to opposite parties. The opposite parties did not settle the claim inspite of several requests but repudiated the claim of the complainant vide letter dt: 22-02-05 stating that the policy holder with held correct information regarding his health at the time of revival of the policy. The complainant submits that her husband never suffered from any decease such as pnemonitis, as alleged by opposite parties in the repudiation letter and there no connection with the alleged deceased to the policy holder and the opposite parties without any reasonable reason repudiated the claim of the complainant. The above said lapsive conduct of opposite parties constrained the complainant to resort to the forum for redressal.
3. In substantiation of her case the complainant relied on the following documents Viz.,1) Repudiation letter dt: 22-02-05 issued by the opposite parties No.2 to the complainant and 2)death certificate of the deceased E.Seshaiah Setty, besides to the sworn affidavit of the complainant in reiteration of her complainant averments and above documents are marked as Ex.A1 and A2 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitablely replied to the interrogatories caused by the opposite parties.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties appeared through their sanding counsel and contested the case. The opposite party No.2 filed written version and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version of opposite parties admits the deceased E.Seshaiah Setty has taken a policy for Rs.25,000/- vide policy bearing No.651989536 and nominated the complainant as his nominee the nominee/complainant informed the death of the policy holder on 19-11-03 due to fever, headache and vomitings and preferred a claim. As the claim aroused with in two years from the date of revival of the policy investigation was conducted, which revealed that the policy holder was not keeping in good health and was effected by H.I.V. and died due to ill health and it is also revealed that the deceased life assured under gone treatment at Gowri Gopal Hospital, Kurnool from 08-04-03 for pnemonitis and had under gone various clinical test at the above hospital, claim form B dt:25-01-04 reveals that the deceased policy holder was diagnosed as H.I.V.+ve, cerebral malaria old case of T.B. Meningitis. The Gowri Gopal Hospital, Kurnool report dt:08-04-03, claim form B and laboratory reported of voluntary counseling and testing centre, Micro Biology Department, Kurnool Medical College shows that the deceased had under gone treatment for ill ness and the above details are not mentioned in the personal statement of health dt:29-08-03 while reviewing the policy. The policy holder answered question No.2 (a to c) about his health as negative and stated his health as good. As the revival of the lapsed policy is a fresh contract and the contract of insurance is a contract of utmost good faith and the non declaration of the treatment, the policy holder under went in the personal statement amounts to non declaration of facts. Therefore, all the amounts paid have been forfeited and no amount what so ever is payable towards the policy amount. As the contract itself became null and void the opposite parties are not liable to pay any amount except the allowed paid up value accrued under the above policy, as there is no deficiency of service on part of opposite parties seeks for the dismissal of complaint with costs.
6. In support of their case the opposite parties relied on the following documents Viz., 1) Original policy bond bearing number 651989536 2) personal statement regarding health dt:29-08-03,3)revival quotation dt:29-08-03, 4)report of chest, X-ray (P.A.view) of E.Seshaiah dt:08-04-03, issued by Gowri Gopal Hospital, Kurnool 5) certificate of hospital treatment in claim form B1 6) discharge card issued by Gowri Gopal Hospital, Kurnool 7) laboratory report dt:21-10-03 issued by voluntary counseling and testing centre 8) attested copy of case sheet and claim statements in claim form A, besides to the sworn affidavit of the opposite party No.2 in reiteration of his complaint averments and the above documents are marked as Ex.B1 to B9 for its appreciation in this case. The opposite parties also relied on the deposition of Rw1 Dr. B. Radhakrishnaiah and Rw2 Dr.T. Malakondaiah. The opposite parties caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:?
8. It is not in dispute that the deceased E.Seshaiah Setty has obtained a L.I.C. policy bearing No.651989536 for Rs.25,000/- vide Ex.B1 and nominated the complainant his wife as nominee and the deceased E.Seshaiah Setty died on 19-11-03 due to headache and vomitings. On the claim preferred by the complainant vide Ex.B9, the opposite parties repudiated vide Ex.A1.
9. The main contention of opposite parties in their repudiation (Ex.A1). is that the policy holder suppressed material information regarding his health and has taken treatment for pnemonitis in a Hospital prior to revival of the lapsed policy. The counsel for opposite parties had forcefully contended that while submitting the personnel statement regarding his health (Ex.B2) at the time of revival of the said policy, the deceased has concealed the above material facts from the opposite parties. The policy holder prior to the revival was not keeping good health and was affected by H.I.V and died due to ill health and the policy holder had taken treatment from pnemonitis on 08-04-03 from Gowri Gopal Hospital, Kurnool. Therefore, the opposite parties are justified in repudiating the claim of the complainant.
10. The opposite parties is support of their case relied on Ex.B1 to B9, the Ex.B1 is policy bond bearing No.651989536 for Rs.25,000/-, the Ex.B2 is the personnel statement regarding health dt:29-08-03 for getting revival of the lapsed policy of the deceased policy holder wherein the policy holder answered negatively to all the questions. The opposite parties strongly alleged that the policy holder withheld correct information regarding his health in Ex.B2 and further alleged that they have indisputable proof to show that the deceased had under taken treatment for pnemonitis in a Hospital and was effected by H.I.V and died due to ill health. The opposite parties in support of their contentions relied on Ex.B4 to B8. The Ex.B4 is the chest, x-ray, (P.A.view) of the policy holder dt:08-04-03, issued by Gowri Gopal Hospital Kurnool, which says that chest, x-ray (P.A.view) of the policy holder and nothing is clear about the treatment taken by the policy holder. Hence, the opposite parties cannot rely on the said Ex.B4 as the contents are neither legible enough to read about the practice followed nor any affidavit of the doctor is filed under whose care the policy holder has taken treatment. In support of said Ex.B4 no doctor has been examined nor any affidavit of any medical expert has been produced to show that the policy holder deceased was suffering from pnemonitis, and had taken treatment. Merely filling Ex.B4 doesn’t mean that the contents there of are necessarily true. Hence, the allegation that the policy holder has taken treatment prior to revival has not been substantiate by the opposite parties. No doubt it has been stated in the Ex.B5, B6, and B8 that the policy holder was admitted in Gowri Gopal Hospital, Kurnool for treatment and was diagnosed as H.I.V+ve. The Ex.B7 is the laboratory report form dt:22-10-03, issued by Department of Micro Biology, Kurnool Medical College, Kurnool stating that the patient was diagnosed as H.I.V-1 reactive. The Exhibits B5, B6, B7 and B8 relied by opposite parties are all after the revival of lapsed policy of the policy holder. Hence, the opposite parties cannot rely on the said documents.
11. The deposition of Rw1 and Rw2 Dr.B.Radhakrishnaiah, and Dr.T.Malakondaiah, submits that the patient E.Seshaiah Setty was admitted in Gowri Gopal Hospital, Kurnool, on 19-10-03 i.e., after the revival of the policy. Hence what appears is that the exhibits and deposition of Rw1 & Rw2 relied by opposite parties are after the revival of the lapsed policy i.e., 29-08-03. There no piece of evidence produced by opposite parties on record, primary or secondary regarding the treatment of the policy holder before to the submission of Ex.B2 personal statement for revival of lapsed policy, it cannot be set that the opposite parties have proved on record that the policy holder has taken treatment for any ailment prior to submitting of Ex.B2. Therefore, the opposite parties miserablely failed to prove their case by placing any relevant, cogent, supporting material, which was not done. Hence, the contents of Ex.B4, B5, B6, B7, and B8 cannot be looked in to nor can inspire any confidence to act upon. It is needless to observe that the burden is on the opposite parties to establish that there was suppression of material facts and the policy holder has concealed the said material facts before to the revival of the lapsed policy. The opposite parties did not adduce any evidence to discharged this burden.
12. To sum up, in the light of the above discussion and material on record not substantiate any suppression of health condition by the policy holder while reviving the said lapsed policy and further there appears any substance in the allegations made by the opposite parties. Hence, the complainant is perfectly remaining entitled to the assured amount under the said policy.
13. In the result, the complaint is allowed directing the opposite parties jointly and severally to pay to the complainant the assured amount under the policy bearing No.651989536 of E.Seshaiah Setty with 9% interest from the date of filling of this complaint i.e, 29-06-06 along with cost of Rs.1,000/- with in a month of receipt of this order.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open bench on this the 14th ay of December, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the Complainants: Nil For the Opposite Parties
Ex.Rw1 Deposition of Dt:01-11-06
(Dr.B.Radhakrishnaiah).
Ex.Rw2 Deposition of Dt:01-11-06
(Dr.T.Malakondaiah).
List of Exhibits marked for the complainant:-
Ex.A1 Repudiation letter, Dt:22-02-2005 (policy No.651989536).
Ex.A2 Attested xerox copy of Death Certificate.
List of Exhibits marked for the opposite parties:-
Ex.B1 Original Policy Bond policy No.651989536.
Ex.B2 Personal statement regarding health Dt:29-08-2003.
Ex.B3 Revival quotation Dt:29-08-2003.
Ex.B4 Report of Chest, X-Ray (P.A.view) of E.Seshaiah Setty Dt 08-04-2003
issued by Gowri Gopal Hospital, Kurnool.
Ex.B5 Certificate of hospital treatment (claim form-B1).
Ex.B6 Discharge card issued by Gowri Gopal Hospital.
Ex.B7 Laboratory Report form Dt:22-10-2003 issued by voluntary counseling
& testing centre.
Ex.B8 Attested copy of case sheet of the complainant.
Ex.B9 claimant statement (claim form ‘A’)
MEMBER PRESIDENT
Copy to:
1. Sri. P. Sivasudarshan, Advocate, Kurnool.
2. Sri.I. Anantha Rama Sastry, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
