Before the District CONSUMERS 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
Wednesday the 11th day of August, 2004
C.D.No.176/2003
P.Bharathi Devi,
W/o Late.P.Chandra Sekhar,
Dr.George B.Pharmach College,
R/o 10-469, 10th Ward,
Markapuram,
Prakasam District. . . . Complainant represented by his counsel
Sri.D.Sreenivasulu, Advocate.
-Vs-
- LIC of India, Nandyal Branch,
Represented by its Branch Manager,
Nandyal,
Kurnool District. . . . Opposite party
- LIC of India, Atmakur Branch,
Represented by its Branch Manager,
Atmakur,
Kurnool District. . . . Opposite party
- LIC of India,
Represented by its Divisional Manager,
Cuddappah. . . . Opposite party No.3represented by his
Counsel Sri.B.Rama Subba Reddy, Advocate
- LIC of India,
Represented by its Zonal Manager,
Hyderabad. . . . Opposite party
ORDER
1. This consumer dispute case of the complainant is field under section 12 of the C.P. Act seeking an award in favour of the complainant from the opposite parties to pay her the assured policy amount of Rs.50,000/- and Rs.5,00,000/- with 12% interest per annum from the date of the claim and Rs.50,000/- as compensation along with Rs.3,000/- towards costs.
2. The brief facts of the complainant’s case are that Late.P.Chandra Sekhar was the husband of the complainant and was a holder of LIC Policy Nos.651958533 and 652827490 for assured sum of Rs.50,000/- and Rs.5,00,000/- respectively commencing from 28-09-1998 and 26-03-2002 on 08-03-1999 the said policy holder underwent Lapro Scopic Cholostectomy Operation and was discharged on 10-03-1999. As the said deceased developed chest pain was admitted in the Medicity Hospital, Hyderabad on 23-08-2002 and underwent necessary operation and after giving treatment was discharged on 07-09-2002 in good health. On 16-10-2002 the said policy holder got again chest pain and was admitted in Gupta’s Hospital, Sanjeeeva Reddy Nagar, Nandyal and there died on the same day due to suspected cardiac heamorage. Hence the death information was given to the Insurance Authority and the claim form was submitted by the complainant along with the relevant document on 13-10-2002 and the said claim was repudiated by the Insurance Company on 31-10-2003 on the ground that the policy holder with held the correct information as to his heath and his suffering to diabetes and undergoing cholostectomy operation in the proposals submitted for the obtaining the said policies. As the said repudiation being not only belated, but also arbitrary as the none of the earlier complaints was the cause of the death of the policy holder. The conduct of the opposite parties in repudiating the claim is amounting to deficiency of service ensuing mental agony to the complainant.
3. In pursuance of the service of the notice of this Forum as to the case of the complainant while the opposite parties 2 and 3 remained exparte by their abstaining to the case proceedings, the opposite party No.3 contested the case by filing its written version denying any of its liability.
4. The written version of the opposite party No.3 even though admit the deceased P.Chandra Sekhar and the husband of the complainant as the holder of the policies as stated in the complainant for the sum assured therein, but allege the suppression of the material facts as to his state of health and the treatment he has undergone prior to the proposing of the second policy and renewing the first policy answering negatively to the questioner in serial No.11 of the proposal form and as per his declaration the untrue averments found in the said proposal form makes the contract of the insurance null and void and forfeiture the corporation all the amounts he paid to the corporation. As the claim of the policy assured amounts, consequent to the demise of the policy holder on 16-10-2002 being within 11 months 16 days and 7 months 10 days from the dates of commencement of those respective policies as they amount to early claims, investigation was taken up and learnt that the said policy holder was unwell earlier to 04-03-1999 for the gall-bladder dis-function and underwent laparoscopic cholostectomy operation on 08-03-1999 and as per the Medicity Hospital, Hyderabad case sheet vide I.P.No.52858/02 dated 23-08-2002 the said policy holder was known diabetic and underwent treatment for the one year for myocardial in faction. Condition No.5 of the policy also makes void the policy for with holding any material information and forfeiture all the amounts paid to the corporation in the consequence of the said polices in favour of the corporation in view of the nature of the contract made on the utmost good faith on the deceased statements and the declarations as the suppression of any material facts makes the policy null and void under Section 45 of the Insurance Act and attracting the forfeiture of the amounts and hence the repudiation of the claim is proper and the action of the opposite parties in the said repudiation of the claim suffers with no deficiency and hence the seeks the dismissal of the complaint with costs.
5. In substantiation of the case averments while the complainant side has relied upon the documentary record in Ex.A1 and Ex.A2 besides to the sworn affidavit of the complainant and the third party affidavit of doctor P.Pamulaty and B.Sreekanth in reiteration of its case the opposite parties side has relied upon the documentary record in Ex.B1 to Ex.B7 and its sworn affidavit in reiteration of its defence.
6. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of service in the conduct of the opposite parties in the repudiation of the claim so as to enable herself to the reliefs sought?
7. The Ex.A7 is the repudiation of the claim of the policy No.651958533 of the deceased assured for Rs.50,000/-. It says that the claim was repudiated as the said policy holder suffered from diabeties and also underwent operation for cholostectomy prior to the revival of the said policy and was suppressed by the said policy holder in the facts relating to his personal statement.
8. The Ex.A1 is the blood examination report of the Chandra Sekhar the deceased husband of the complainant issued on 04-03-1999 by Sri.Venkateswara Lab and X-Ray Clinic, Budhavarpet, Kurnool. It shows the percentage of blood urea 31 mg%, while the normal range is mentioned is at 10-50. Hence the blood urea percentage shown there is appears to be in normal range. The blood sugar percent in the same report is shown as 81% mg. In the absence of any figure showing it as of any abnormal range the said blood sugar percentage cannot be held as an indication of the diabeticness. Hence from the Ex.A1 it is not remaining possible to hold the said policy holder Chandra Sekhar was diabetic. As the opposite party has not placed any other cogent record as to any diabeticness of the said policy holder, the repudiation of the claim of the complainant under the policies of her deceased husband Chandra Sekhar is not remaining proper.
9. The Ex.A2 is the discharged card issued by the Gowri Gopal Hospital for the admission and the discharge of P.Chandra Sekhar (deceased policy holder and the husband of the complainant) on the occasion of his undergoing laparoscopic and cholostectomy operation. It shows the particulars of the date of the admission, operation and the discharge of the said Chandra Sekhar as 08-03-1999, and 10-03-1999 respectively. Ex.B2 is the proposal form of the deceased policy holder Chandra Sekhar for the assured sum of Rs.50,000/- with his declaration dated 28-09-1998 filed with the Insurance Company for the issual of the said insurance policy. The corresponding policy issued in pursuance of the said proposal, is Ex.B4 showing the commencement of the said policy from 28-09-1998 for 20 years with the policy No.651958533. In the Ex.B2 proposal the said policy holder answered all the questions in serial No.11 as to his personal history negative besides stating as to usual state of health as good. As the date of the said laparoscopic cholostectomy operation being 08-03-1999 and the proposal in Ex.B2 being of 28-09-1998 i.e., the said operation is being later to the said proposal in Ex.B2 the said policy holder cannot be held guilty of the suppression of the fact as to the said operation in the said proposal form in Ex.B2.
10. But the said policy issued in Ex.B4 in pursuance of Ex.B2 was said by the Ex.B7, which is not denied by the complainant’s side, that the said policy was allowed to lapse by non-payment of the premium due on 28-03-2000 acquiring no paid up policy and the said policy was revived on 30-10-2001 for the full sum assured on the strength of the personal statement regarding the health made by the said policy holder on 30-10-2001. In the said Ex.B7 the questions put in S.L.No.11 as to the personal history of the policy holder and the answers were given by him were mentioned. The Ex.B5 is filed as to the declaration of good health submitted by the said policy holder on 30-10-2001 to the insurance company at the time of the renewing policy No.651958533 for the assured sum of Rs.50,000/-. The reading of the contents of the Ex.B5 indicates that the said policy holder has answered the questions with answers as mentioned in the Ex.B7 as of good faith and did not suffer any illness or decease requiring treatment for a week or more or operation, accident or injury or his undergoing E.C.G., X-Ray, Scanning of the Blood Urine, since the date of the proposal for the above mentioned policy. As the laparoscopic cholosctomy operation, from the date of operation of 08-03-1999 appearing in Ex.A2 occurred prior to the renewal of the said lapsed policy, the non mention of the deceased policy holder undergoing the said operation is the declaration as to this good health at the time of the renewing that policy amounts to non discloser of the said fact in the answers to the questions as to the declaration of the good health at the time of its renewal and there by the said policy holder remaining guilty of the suppression or withholding the material information as to the said operation he has undergone on 08-03-1999 and within his knowledge. As per the declaration of the said deceased policy holder in Ex.B2 as to this concerned policy was signed on 28-09-1998 and submitted to the LIC any such omission do shall render the assurance invalid and all moneys which shall have been paid in respect there of stands forfeited to the Corporation. Hence in the circumstances stated above as the suppression of the material facts as tot eh health is a material one and the contract of the Insurance being made in the utmost faith on the declaration of the policy holder. Under Section 45 Insurance Act the said contract is null and void entitling the forfeiture of the amounts paid in favour of the Corporation. There appears no error or defect or deficiency of service on the part of the LIC in repudiating the claim made to the complainant under the policy No.651958533 of her deceased husband.
11. Now coming to the repudiation of the other policy of the deceased policy holder bearing No.652827490 for the assured sum of Rs.5,00,000/- which commenced from 06-03-2002 for a tenure of 25 years, is concerned.
12. The Ex.b1 is the proposal submitted by the deceased policy holder along with his declaration as to his health for the issual of a policy for an assured sum of Rs.5,00,000/- commencing from 06-03-2002 and concluding by 06-03-2027. The said Ex.b1 apart from other column as to the other particulars of the policy holder contains a questionnaire Sl.no.11 as to the state of health of the said proposer requiring him to disclose all about him till then in reference to the material required in the said questionnaire. In the said Ex.B1 proposal in questions appearing at Sl.No.11 the said deceased policy holder besides alleging his good health answered all the questions negative. He has also signed in the said Ex.B1 a declaration agreeing to forfeit to the LIC all the money paid in case of any omission or error in the said material, he furnished in the said proposal for the issual of the policy of assurance for Rs.5,00,000/-. As the date of the commencement policy No.652827490 as per Ex.B3 which was issued in pursuance of Ex.B1 being 06-03-2002 and the said policy holder as has undergone laparoscopic cholostectomy operation on 08-03-1999 about 3 years prior to obtaining the said policy they said policy, holder ought to have disclosed of the said facts within his knowledge in the answer to the question in 11-B as the operation he has under gone joining in Gowri Gopal Hospital as mentioned in Ex.A2. The non discloser of the said fact of the operation in answer to the question in 11-B of Ex.B1 certainly amounts to an omission of its discloser on the part of the said policy holder in the said proposal and the contract of the insurance being made under the utmost faith and belief on the declaration made by the complainant any such omission of discloser of the material facts makes null and void the very contract of the Insurance, under Section 45 of the Insurance Act besides forfeiting the amounts paid by the policy holder in favour of the Corporation. In the light of the declaration signed by the said policy holder in Ex.B1 authenticating the correctness of the particulars stated in Ex.b1 the said omission, in the circumstances, appears to be willfull and intentional as he has not disclosed the said facts within his knowledge. As the said declaration stipulates of a willingness on the part of the said policy holder to forfeite the amounts paid till then in favour of the LIC in case of error or omission in a material furnished in the said proposal and the said non discloser of the material facts as to the operation he has undergone prior to the obtaining of the said policy for Rs.5,00,000/-, as amounts to an intentional omission and the suppression of the material facts relating to his personal history within his personal knowledge, is attracting the penal provision mentioned in the said declaration in case of any such omission. Hence, in the circumstances discussed above there appears no error, defect or deficiency on the part of the LIC (opposite party) in repudiating the claim of the complainant preferred on the policy No.652827490 of her deceased husband.
13. Therefore, in conclusion of the above discussion as the case of the complainant is suffering for want of proper cause of action, the complainant cannot have any remedy she sought for from the opposite party.
14. Consequently, there being no merits and force in the case of the complainant, it is dismissed with costs awarding costs of Rs.5,000/- to the contesting opposite party no.3 under Section 26 of the C.P. Act from the complainant for the vexatious claim made. The said costs awarded to the opposite party No.3 has to complied by the complainant within a month of the receipt of this order.
Dictated to the Stenographer, typed to the dictation corrected by us, pronounced in the open Court, this the 11th day of August, 2004.
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MEMBER PRESIDENT MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant:- Nill For the opposite parties:- Nil
List of Exhibits marked for the complainant:-
Ex.A1 Blood report dated 04-03-1999 of Chandra Sekhar given by Sri.Venkateswara Lab & X-Ray Clinic, Kurnool.
Ex.A2 Discharge Card dated 10-03-1999 of P.Chandra Sekhar issued by Gowri Gopal Hospital, Kurnool.
List of Exhibits marked for the opposite parties:-
Ex.B1 Proposal form of deceased dated 20-01-2002 for five lakhs.
Ex.B2 Proposal form of deceased dated 25-09-1998 for fifty thousands.
Ex.B3 Policy No.652827490 of the deceased for Rs.5,00,000/-.
Ex.B4 Policy No.651958533 of the deceased for Rs.50,000/-.
Ex.B5 Declaration of good health regarding to revive of the policy dated 30-10-2001 i.e., Ex.B4.
Ex.B6 Office copy of repudiation letter dated 31-03-2003 for five lakhs for policy No.652827490.
Ex.B7 Office copy of repudiation letter dated 31-03-2003 for Rs.50,000/- for policy No.651958533.
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MEMBER PRESIDENT MEMBER
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