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
Wednesday the 20th day of August, 2008
C.C. No.79/08
Between:
B. Savithramma, W/o. B. Thimma Raju,
R/o. Budipadu Village, Nagalapuram, Gudur Mandal, Kurnool District. Complainant
Versus
- The Branch Manager, L.I.C of India,
Yemmiganur.
- The Divisional Manager, L.I.C. of India,
Kadapa. Opposite Parties
This complaint is coming on this day for orders in the presence of Sri.E.Srinivasulu , Advocate, for the complainant, and Sri.A.S.Ummer Javid Ali , Advocate for 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.79/08
1. This consumer complaint of the complainant is filed U/s 13 of C.P.Act, 1986, seeking a direction on opposite parties to pay Rs.1,30,000/- with 24% interest p.a, Rs.20,000/- as damages, Rs.30,000/- towards mental agony , 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 one Siva Sankar had obtained policies bearing Nos.653696425 and 653703981 with opposite parties and nominated the complainant as his nominee. The said B. Siva Sankar died on 3-7-2005 due to Jaundies and the complainant submitted necessary papers to the opposite party No.1 for settlement of the claim. The opposite party No.1 did not settle the claim and the complainant got issued legal notice dated 8-7-2007 and opposite party No.1 replied requesting the complainant to submit Medical Attendance Certificate and Certificate of Hospital Treatment from Government General Hospital, Kurnool and Viswa Bharathi Hospital, Kurnool . Thereafter, the complainant waited for three months , as the opposite parties did not settle the claim the complainant resorted to the forum for reliefs as there is deficiency of service on part of opposite parties.
3. In substantiation of her case the complainant relied on the following documents viz., (1) death certificate, (2) un attested claimants requisition for claim form, (3) Xerox copy of attendance certificate , (4) Xerox copy of claimants statement, (5) Xerox copy of identity certificate in form No.3785 , (6) office copy of legal notice dated 8-9-2007 along with acknowledgement and (7) reply of opposite party dated 13-9-2007 , besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex.A1 to A7 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 fats but admits the deceased B. Siva Sankar has taken policies bearing Nos 653696425 for Rs.50,000/- and 653703981 for Rs.30,000/- as the deceased policy holder died early to the commencement of the policies investigation was conducted , which revealed that the life assured was suffering from HIV for last three years before to his death and had taken treatment from Dr. M. Krishna Murthy and admitted at Government General Hospital, Kurnool and at Viswa Bharathi Hospital, Kurnool . The claim form B 1 (3816) submitted by Superintendent Government General Hospital, Kurnool duly filled by Dr. Devanand , M.D., Civil Surgeon , Government General Hospital, Kurnool, discloses that the deceased died due to HIV and not Jaundies as stated in the complaint. It further submits that the contract of insurance is a contract of ut most good faith and the deceased misled the corporation by suppressing the material information about his health in the proposals submitted before to taking the policies. The deceased intentionally suppressed his health status and obtained policies by fraud and as such the contract became null and void and no amount is due under the polices and there is no deficiency of service on part of opposite parties and 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 dated 29-2-2004 , (2) policy bond bearing No.653696425 , (3) proposal form dated 15-3-2005 , (4) policy bond bearing No.653703981 , (5) quotation completed by medical practitioner , (6) letter dated 15-10-2007 of Superintendent Government General Hospital, Kurnool of opposite party No.1 , (7) certificate of hospital treatment in claim form B -1 ,(8) medical attendance certificate in claim form (B) , (9) letter dated nil of complainant to opposite party No.1 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 B9 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 B. Siva Shankar has taken two policies bearing Nos.653696425 & 653703981 for Rs.50,000/- and Rs.30,000/- vide Ex.B2 and B4 by submitting proposal vide Ex.B1 & B3 and nominated the complainant as his nominee . The deceased policy holder died on 3-7-2005 and the complainant as nominee put forth the claim for assured amounts under the above policies. The opposite parties did neither settled the claim nor repudiated it, being vexed the complainant got issued legal notice dated 8-9-2007 vide Ex.A6, the opposite parties vide Ex.A7 dated 13-9-2007 replied requesting the complainant to submit Medical Attendance Certificate and Certificate of Hospital treatment from Government General Hospital, Kurnool. The complainant in this case filed Ex.A3 xerox copy of medical attendance certificate issued by Governmental Unani Hospital, Kurnool and Ex.A4 xerox copy of claimants statement. The opposite parties vide Ex.A7 requested to submitted Medical Attendance Certificate and Certificate of Hospital treatment from Government General Hospital, Kurnool , but Ex.A3 filed by the complainant was from Government Unani Hospital, Kurnool, which is unwarranted.
9. The main contention of opposite parties in their written version averments is that the deceased policy holder was suffering from HIV for last three years before to his death and he suppressed it and had taken the above policies. In substantiation of their contention , the opposite parties relied on Ex.B5, B7 & B8, The Ex.B5 is the questionnaire completed by Dr. M. Krishna Murthy, where in it was stated that a patient came with HIV positive test and he had been suffering from it for past three years and the symptoms of illness was vomitings, fever and weakness. The Ex.B7 is the certificate of Hospital treatment filed by Civil Assistant Surgeon, Government General Hospital, Kurnool , it was stated that the patient by name B.Siva Shankar was admitted into their hospial 28-6-2005 for suddenness of consciousness since four days and the patient was diagnosed as HIV on 4-6-2007 and the same was first observed on 4-6-2007. At column 10 in Ex.B7, the date of first admission it is mentioned as 4-6-2007 and the date of discharge is mentioned as 10-6-2007. The deceased policy holder B.Siva Shankar in this case died on 3-7-2005 . As per Ex.B7 the symptoms of HIV was observed on 4-6-2007, and, the date of admission and discharge is mentioned as 4-6-2007 & 10-6-2007 must later to the date of death of policy holder. The Ex.B8 is the medical attendance certificate filed by Dr. P. Devanand, Civil Surgeon, Government General Hospital, Kurnool he also stated that the deceased policy holder was suffering from HIV and it was first observed on 4-6-2005 and he died on 3-7-2005. The policies in Ex.B2 & B4 was taken on 20-9-2004 & 15-3-2005 the said illness of HIV was first observed on 4-6-2005 i.e, after taking the above said two policies.
10. The opposite parties in support of above exhibits Ex.B5, B7 & B8 did not filed any affidavit of the doctor, who is alleged to have issued the above certificate in Ex.B5, B7 &, B8 nor the said doctor has been examined. Unless expert evidence of the doctor who has treated the deceased is produced , such evidence cannot be relied upon and form the basis a finding that the deceased had been suffering from HIV prior to taking the above policies. Merely filling ExB1 to B9 by the opposite parties does not mean that the contends there of are necessarily true, no documents or any evidence is produced by the opposite parties about the on existence of HIV before to taking the policies, mere assertion is respect of suffering of HIV prior to taking policies neither inspire any confidence nor can be acted upon . Onus is on the opposite parties to substantiate their plea that policy holder fraudulently concealed his illness before taking the policies. Hence, the exhibits filed by the opposite parties cannot be looked into and no cogent material is filed by the opposite parties to prove that the deceased had knowledge that he was suffering from HIV prior to taking the above two policies.
11. Having regard to over all consideration, there is no hesitation to hold the opposite parties have miserably failed to substantiate that policy holder before taking the above policies suppressed material information about his health. Therefore in these circumstances non settlement of the claim, by the opposite parties is wholly arbitrary, unreasonable and unjust and amounts to deficiency of service on their part and the complainant is certainly remaining entitled to the reliefs sought in the complaint.
13. In the result, the complaint is allowed directing the opposite parties jointly and severally to pay to the complainant the assured amount of Rs.50,000/- and Rs.30,000/- under policies bearing Nos. 653696425 & 653703981 along with costs of Rs.1,000/- within one month from the date of receipt of this order. In default, the opposite parties shall pay the above award amount with 9% 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 20th day of August, 2008.
Sd/- Sd/-
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. (un attested)
Ex.A2. Un attested Claimants Requisition for claim form.
Ex.A3. Medical attendance certificate (Xerox )
Ex.A4. Xerox copy of Claimants statement.
Ex.A5. Xerox copy of Identity Certificate in Form No.3785.
Ex.A6. Office copy of legal notice dated 8-9-2007 along with
Acknowledgement .
Ex.A7. Reply of OP dated 13-9-2007.
List of exhibits marked for the opposite parties:
Ex.B1. Proposal form dated 20-9-2004.
Ex.B2. Policy bond. No.653696425
Ex.B3. Proposal form dated 15-3-2005.
Ex.B4. Policy bond No.653703981
Ex.B5. Quotation completed by Medical Practitioner.
Ex.B6. Letter dated 15-10-07 of Superintendent, Government
General Hospital, Kurnool to OP.No.1
Ex.B7. Certificate of Hospital Treatment in Claim form B1
Ex.B8. Medical Attendance Certificate in claim Form B
Ex.B9. Letter of complainant dated nil to OP.No.1
Sd/- Sd/-
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 party.
Copy was made ready on :
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