BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Thursday the 18th day of December, 2008
C.C.No. 126/08
Between:
Smt. P. Sumithramma, W/o. Late P.C.Venkata Reddy,
H.No.3/102, Seetharamapuram, Bethemcherla Mandal, Kurnool District 518 599. … Complainant
Versus
- Life Insurance Corporation of India Limited, Represented by its Branch Manager,
H.No.8-85-4-1, Kothapeta, Dhone, Kurnool District.
2. Senior Divisional Manager, Life Insurance Corporation of India,
P.B.No.10, College Road, Cuddapha-516004. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri.P.Siva Sudharshan , Advocate, for the complainant, and Sri.G.Md.Habeebur Rahiman, Advocate, for the opposite parties and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. C.Preethi, Lady Member)
C.C.No.126/08
1. This consumer complaint of the complainant is filed U/S 11 and 12 of C.P.Act, 1986 seeking a direction on opposite parties to pay policy amount of Rs.30,000/- with 24% interest, Rs.10,000/- towards mental agony, Rs.2,000/- towards cost of the complaint and any 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 P.C. Venkat Reddy has insured his life under the policy bearing No. 653295135 for Rs.30,000/- with opposite parties and nominated the complainant as his nominee . On 04-11-2006 the policy holder died due to heart attack , as nominee the complainant submitted claim form to opposite parties . Inspite of several requests the opposite parties did not pay the assured amount under the policy and on 28-03-2007 the opposite party repudiated the claim of the complainant on the ground that the policy holder with held correct information regarding his health and has taken treatment for CAD & LV Dysfunction with renal failure, but the complainant submitted that the policy holder never suffered with any decease and the opposite parties without any reason repudiated the claim of the complainant and alleges deficiency of service on part of opposite parties .
3. In support of her case the complainant’s side relied on the following documents viz., (1) death certificate of P. Chinna Venkat Reddy and (2) repudiation letter dated 28-03-2007 ,besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex.A1 and A2 for its appreciation in this case and replies to the interrogatories exchanged.
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 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 as not maintainable either in law or on facts and admits that the policy holder P.C.Venkat Reddy has taken a policy bearing No. 653295135 for Rs.30,000/- and nominated the complainant as his nominee. The policy lapsed on 28-12-2003 due to non payment of premium and it was renewed on 06-10-2006 by submitting declaration of good health. The policy holder died on 04-11-2006 within 28 days from the date of revival , hence the claim was entrusted for investigation, which revealed that the policy holder was admitted on 28-09-2006 in Gowri Gopal Hospital for treatment of fever , joint pains , breathlessness , loss of appetite and was diagnosed as CAD with LV Dysfunction with renal failure and was discharged on 08-10-2006 and the said treatment was before to the revival of the policy . As the policy holder did not reveal the true state of health in the declaration of good health dated 06-10-2006 the revival being a “Novatio” and it has been canceled for deliberately suppressing the health prior to revival and the contract was declared as null and void and nothing is payable under the policy and lastly seeks for the dismissal of complaint with costs.
6. In support of their case the opposite parties relied on the following documents viz., (1) proposal form, (2) agents confidential report , (3) policy bond No. 653295135 , (4) personal statement regarding health , (5) claimants statement in claim form – A, and (6) certificate of hospital treatment in claim form – B, besides to the sworn affidavit of the opposite party No.2 in reiteration of his written version averments and the above documents are marked as Ex.B1 to B6 for its appreciation in this case and replies to the interrogatories exchanged.
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 by name P.C.Venkat Reddy has taken a policy bearing No. 653295135 vide Ex.B3 by submitting proposal form vide Ex.B1.It is also not in dispute that the complainant / nominee put forth the claim for insured amount under the policy, and it was repudiated by opposite parties vide Ex.A2 . The Ex.A2 envisages the repudiation of the claim of the policy bearing No. 653295135 of the deceased P.C.Venkat Reddy . It says that the claim was repudiated as the said policy holder has taken treatment for CAD with LV Dysfunction with Renal failure in a hospital and the same was suppressed by the said policy holder in the facts relating to his health personnel statement regarding health vide Ex.B4.
9. The Ex.B5 in the claimants statement in claim form A, where in , it was stated that the policy holder P.C.Venkat Reddy was suffering from fever with pains causing chicken guniya . The Ex.B6 is the certificate of hospital treatment of policy holder P.C.Venkat Reddy issued Gowri Gopal Hospital . Where the policy holder was admitted on 28-09-2006 for fever breathlessness for the last one week and was diagnosed as CAD and LV Dysfunction with renal failure . The opposite parties in substantiation of their case relied on Ex.B5 and B6, but in support of the above exhibits did neither filed the affidavit of the doctor who is alleged to have issued the above documents nor the said doctor has been examined . Except relying on Ex.B5 and B6 the opposite parties have not filed the case sheet pertaining to the treatment underwent by the policy holder in Gowri Gopal Hospital nor the affidavit of the doctor is filed who lend the treatment to the policy holder in Gowri Gopal Hospital, inspite of denial from the complainants side of undergoing treatment in Gowri Gopal Hospital. Unless the expert evidence of the doctor who has treated the policy holder is produced ,such evidence cannot be relied upon and form the basis of a finding that the policy holder has taken treatment for CAD and LV Dysfunction with renal failure prior to submitting of personnel statement regarding health for revival of the policy. Mere filling of Ex.B5 and B6 does not mean that the contends there of are necessarily true, no document or direct evidence is produced by opposite party about the prior existence of CAD and LV Dysfunction. Mere assertion or oral testimony in respect of treatment prior to revival of policy neither inspires any confidence nor can be acted upon. Onus is on to opposite parties to substantiate their plea that the policy holder concealed material facts of his treatment before to the revival and it is not done by the opposite parties .
10. In the absence of such material it cannot be said that the policy holder was in the knowledge of the disease and willfully suppressed the fact. The Apex Court in LIC of India Vs. Smt. Asha Goel reported in 2001 SLT Pg.89 =2001 2 SCC Pg.160, it lays down that the suppressed material must be of such material with ought to have been disclosed and that the policy holder might have played fraud. The burden of proving false representation and suppression of material facts lies on the insurance company. In this case the insurance company / opposite parties did not placed any material to show that the policy holder concealed material facts of his health. The other decision relied by the complainant is that of our State Commission reported in IV 2005 CPJ Pg 205, where in it was held that, the alleged suppression of material facts is not proved and the burden is on the insurance company to prove false representation and suppression . In this case the opposite parties miserablely failed to prove that the policy holder had suppressed material information regarding his health before to revival of the policy.
11. Having regard to over all consideration there is no hesitation to hold the opposite parties have miserablely failed to substantiate that the policy holder before to revival of the policy have suppressed material information about his health. Therefore, in their circumstances the repudiation of claim by the opposite parties in wholly arbitrary , unreasonable and unjust and amounts to deficiency of service.
12. As the opposite parties 1 and 2 by its lapsive conduct not only caused mental agony but also constrained the complainant to seeks the forum for redresssal of her bonafidess consumer grievances, the opposite parties 1 and 2 are liable to compensate by paying Rs.2,000/- for the suffered mental agony by the complainant and Rs.1,000/- as costs of this case , besides to assured amount of Rs.30,000/- as mentioned in the EX. B3 policy.
13. In the result, the complaint is allowed directing the opposite parties 1 and 2 jointly and severally to pay to the complainant the assured amount of Rs.30,000/- under the policy bearing No. 653295135 of PC.Venkat Reddy along with Rs.2,000/- as compensation for mental agony and Rs.1,000/- as costs of the case within one month from the date of receipt of this order. In default the opposite parties 1 and 2 jointly and severally shall pay the supra award with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 18th day of December, 2008.
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MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Death certificate of P. Chinna Vaenkata Reddy.
Ex.A2. Claim repudiation letter dated 28-03-2007.
List of exhibits marked for the opposite parties:
Ex.B1. Proposal form.
Ex.B2. Agents confidential report.
Ex.B3. Policy bond 653295135.
Ex.B4. Personal statement regarding health.
Ex.B5. Claimants statements in claim form A.
Ex.B6. Certificate of hospital treatment in claim forum B-1.
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MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
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