Before the District Forum: Kurnool
Present: Sri K.V.H. Prasad, B.A., LL.B., President
And
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Tuesday the 6th day of October, 2005
CD No. 109/2005
T.Sunkanna, S/o. Sunkanna,
R/o. D.No. 5/67, E. Tandrapadu (V), Kurnool (M) and Dist. . . . Complainant
-Vs-
1. The Branch Manager,
LIC of India, K.G.Road, Atmakur (V), Kurnool Dist.
2. The Divisional Manager,
LIC of India, Divisional Office, Cuddapah. . . . Opposite parties
This complaint coming on 5.10.2005 for arguments in the presence of Sri S.Chand Basha, Advocate, for complainant and Sri L.Hari Haranatha Reddy, Advocate for opposite party No.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, Member)
1. This CD complaint of the complainant is filed under section 12 of CP, Act, 1986, seeking a direction on the opposite parties to pay assured amount of Rs.25,000/- plus bonus with 18% interest per annum from the date of death till realization, Rs.10,000/- as damages for mental agony and costs of the complaint.The brief facts of the complainant’s case is that the complainant’s wife Smt Telugu Yellamma insured her life with opposite party under policy bearing No. 652601656 on 28.9.2001 for Rs.25,000/-under New Janaraksha policy and nominated the complainant as her nominee. The policy holder died due to post delivery complications on 27.9.2003 at Gowri Gopal Hospital, Kurnool. On the claim preferred by the complainant for assured sum the opposite party No.2 repudiated through their letter dt10.3.2004 on the ground of material suppression. The complainant, there after gave a representation to Zonal Office review committee and Insurance Ombudsman to reconsider her claim and they also rejected her claim. Hence, the above said lapsive conduct of opposite parties constrained the complainant to file this complaint before this Forum seeking redressal.
3. The complainant in support of his case relied on his sworn affidavit in reiteration of his complaint averments.
4. In pursuance to the notice of this Forum as to this case of the complainant, the opposite parties appeared through their standing counsel and contested the case. The opposite party No.2 filed its written version and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version of opposite parties denies the complaint averments as not maintainable either in law or on facts, but admits the deceased T. Yellamma has taken a policy vide No. 652601656 for Rs.25,000/- and nominated the complainant as her nominee. The said policy was lapsed on 28.3.2002 due to non payment of premium and the policy holder got the said policy revived by submitting personal statement regarding her health on 28.9.2002 by paying Rs.1,661/- towards two half yearly premiums, therefore the revival of policy is a fresh contract.
6. As the claim was a early claim investigation was conducted which revealed that the deceased was not in good health and was suffering from heart problem and was very weak and cause of death is post delivery with shock and died at Gowri Gopal Hospital, Kurnool.
7. It further submits that the Medical Attendance Certificate dt 16.12.2003 in claim form B given by T.Mala Kondaiah and Certificate of Hospital Treatment given by Dr B. Radhakrishnaiah reveals that the cause of the deceased is Mitral stenosis, Mitral Regurgitation, post delivery Anemia PPH with shock, congestive heart failure and secondary cause is post delivery with severe Anemia shock. The affidavit in Form 5152 of Dr V. Radhakrishnaiah reveals that ailments suffered by deceased was since 5 years and was availing treatment from 1.9.2002 till her death. The deceased has not disclosed the said details of her ill-health prior to revival in the personal statement regarding health and answered all questions negatively, therefore the deceased has suppressed material information about her illness before to the date of revival, therefore the complainant is not entitled to the assured amount of the deceased and seeks for the dismissal of complaint with costs.
8. In support of its case the opposite parties relied on the following documents Viz (1) Attested copy of policy bond No. 652601656 of the deceased life assured T. Yellamma (2) Original personal statement regarding health dt 3.10.2002 submitted by policy holder to opposite parties (3) Original medical attendant’s Certificate(claim Form ‘B’) issued by Dr T.Malakondaiah dated 16.12.2003 (4) Original certificate of Hospital Treatment issued by Dr B.Radhakrishnaiah dated 16.12.2003 (5) Form No. 5152, dated 3.3.2004 given by Dr.B.Radhakrishnaiah, Resident Medical Officer, Gowri Gopal Apollo Hospital, Kurnool(6) Repudiation letter, dt 10.3.2004 addressed to the complainant by opposite party No.2 and (7) Letter dated 2.9.2004 addressed to the complainant by opposite party No.2, besides to the sworn affidavit of opposite party No.2 in reiteration of it written version and the above documents are marked as Ex B.1 to B.7 for its appreciation in this case.
9. Hence, the point for consideration is to what relief the complaint is entitled alleging deficiency of service on part of opposite parties:-
10. It is not in dispute that the wife of the complainant has obtained a LIC policy bearing No. 6501656 vide Ex B.1 and the policy holder died on 27.9.2003 due to post delivery complications. When the complainant put forth a claim as the nominee under the above said policy for assured sum, the opposite party No.2 repudiated the claim vide Ex B.6 dt 10.3.2004, on the ground that the policy holder fraudulently misrepresented and suppressed material facts of her ailments such as Mitral Stenosis, Mitral Regurgitation and has taken treatment at a hospital prior to revival. Hence, the main contention of the opposite parties is that the policy holder suffered from Mitral Stenosis and Mitral Regurgitation prior to revival and the counsel for opposite parties has very forcefully contended that, while submitting personal statement regarding health at the time of revival for entering into contract of insurance, the policy holder concealed the material facts from the opposite parties about her suffering from the said ailments and therefore the opposite parties are absolutely justified in repudiating the claim.
11. The learned counsel for opposite parties relied on Ex B.2 personal statement regarding health submitted by the policy holder to opposite parties answering all questions negatively. From the Ex B.3, Medical Attendants certificate, it is clear that the primary cause for death of policy holder was Mitral Stenosis, Mitral Regurgitation delivery Anemia PPH complaint shock and the ailment the policy holder was suffering from past one week. The Ex B.4 certificate of Hospital Treatment, it envisages that the policy holder was diagnosed as suffering from Mitral Stenosis and Mitral Regurgitation and the said complications were observed only one week back. The Ex B.5 is the questionnaire completed by Dr Radhakrishnaiah, it envisages that the policy holder was suffering from Mistral Stenosis and Mitra Regurgitation since 5 years. From the contents of Ex B.3, B.4 and B.5 relied by the opposite parties does not inspire any confidence about the contents of said document, which can be acted upon. The opposite parties in support of the above exhibits did neither filed the affidavit of the doctors who is alleged to have issued the above certificates nor the said doctor has been examined. Unless the expert evidence of the doctor who has treated the policy holder is produced, such evidence cannot be relied up on and form the basis of a finding that the policy holder has taken treatment for Mitral Stenosis and Mitral Regurgitation prior to revival of the said policy, merely filing Ex B.1 to B.7 by opposite parties, it does not mean that the contents there of are necessarily true, no documents or direct evidence is produced by the opposite parties about the prior existence of Mitral Stenosis and Mitral Regurgitation, mere assertion or oral testimony in respect of prior ailments and suppression of material facts prior to revival neither inspire any confidence nor can be acted upon. Onus is on the opposite parties to substantiate their plea that the policy holder has concealed material facts of her ailments before revival of said policy. Hence, the exhibits filed by the opposite parties cannot be looked into nor it can inspire any confidence.
12. Having regard to over all consideration, there is no hesitation to hold the opposite parties have miserably failed to substantiate that the policy holder before to the revival of said policy suppressed material information about the ailment of Mitral Stenosis and Mitral Regurgitation and has taken treatment from Dr B.Radhakrishnaiah. Therefore, in these circumstances the repudiation of claim by opposite parties is wholly arbitrary, unreasonable and unjust and amounts to deficiency of service on their part and there appears every justification to the claims made by the complainant as the opposite parties by their deficient conduct driven the complainant to forum for redressal the complainant is entitled to interest on the assured amount.
13. In the result the complaint is allowed directing the opposite parties to pay to the complainant the assured sum of Rs.25,000/- with bonus, as per the policy of the deceased T. Yellamma bearing no. 652601656 with interest at the rate of 12% per annum from the date of demise of the deceased till realization along with Rs.1,000/- as costs of this case within a month of receipt of this order.
Dictated to the Stenographer, Transcribed by her, corrected and pronounced by us, in the Open Forum, on this the 6th day of October, 2005.
Sd/-
PRESIDENT
Sd/- Sd/-
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant For the opposite parties
-Nil- -Nil-
List of Exhibits Marked for the complainant:-
-Nil-
List of Exhibits Marked for the opposite parties:-
Ex B.1 Attested copy of policy bond No. 652601656 of the deceased life assured
T. Yellamma .
Ex B.2 Original Personal Statement Regarding Health dt 3.10.2002 submitted
by policy holder to opposite parties
Ex B.3 Original medical attendant’s Certificate (claim Form ‘B’) issued by Dr
T.Malakondaiah dated 16.12.2003.
Ex B.4 Original certificate of Hospital Treatment issued by Dr
B.Radhakrishnaiah dated 16.12.2003.
Ex B.5 Form No. 5152, dated 3.3.2004 given by Dr.B.Radhakrishnaiah,
Resident Medical Officer, Gowri Gopal Apollo Hospital, Kurnool.
Ex B.6 Repudiation letter, dt 10.3.2004 addressed to the complainant by
opposite party No.2
Ex B.7 Letter dated 2.9.2004 addressed to the complainant by opposite party
No.2
Sd/-
PRESIDENT
Sd/- Sd/-
MEMBER MEMBER
Copy to:-
1. Sri S.Chand Basha, Advocate, Kurnool.
2. Sri L. Hari Haranatha Reddy, Advocate, Kurnool
Copy was made ready on:
Copy wad dispatched on:
Copy was delivered to parties:
