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
Friday the 5th day of December, 2008
C.C.No. 105/08
Between:
Smt. E.Kavitha, W/o.Late E.Venkateswarulu, D/o. Ediga Venkataswamy,
Santhaakota Village and Post, Nandikotkur Mandal, Kurnool District.
… Complainant
Versus
1.The Branch Manager, L.I.C of India,
Reverview Colony, Kurnool.
1. The Senior Divisional Manager,L.I.C of India,
Divisional Office, College Road, Kadapah.
.. Opposite parties
This complaint is coming on this day for orders in the presence of Sri. M. Sivaji Rao , Advocate, for the complainant, and Sri. L.Hari Hara Natha Reddy , 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.105/08
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 an assured amount of Rs.1 lakh with 24% interest p.a, Rs.25,000/- as compensation for 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 the complainants husband E.Venkateswarulu has taken a policy from opposite parties for an assured amount of Rs. 1 lakh and nominated the complainant as his nominee. On 08-05-2004 all of a sudden that policy holder fell sick due to fever and jaundice and thereafter died . On the claim preferred by the complainant the opposite parties repudiated on 23-10-2007 on the ground that the deceased suffered from Tuberculosis prior to the date of proposal . But the complainant submits that the policy holder never suffered with any decease and the repudiation is on baseless grounds and alleges deficiency of service on part of opposite parties .
3. In support of her case the complainant relied on the following documents viz., (1) Xerox copy of policy No.653400856 , (2) Xerox copy of death certificate dated 25-05-2004 and (3) repudiation letter dated 23-10-2007 , besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as EX.A1 to Ex.A3 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 admits the deceased E.Venkateswarulu taking a policy for Rs. 1 lakh and nominated the complainant as his nominee . The policy holder died on 08-05-2004 due to breathlessness and the death claim arised within 45 days from the date of commencement of the policy, the claim was treated as early claim and investigation was conduced , which revealed that the policy holder was admitted in Government General Hospital , Kurnool and cause of death was reported as Pulmonary Tuberculosis and the policy holder was taking treatment for past three months and the policy holder was known Tuberculosis patient . The policy holder in replies to the questions 11 (a) ,(d) and (e) negatived and stated his health as good. As the declaration signed by the policy holder makes the contract null and void in the event of with holding of information of his health. As the policy holder died due to pulmonary Tuberculosis and HIV with Hemoptesiss prior to the proposal and the policy holder has suppressed correct information regarding his health., hence the opposite party is not liable to pay any amount to the complainant as per the terms and conditions of 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) policy bond bearing No.653400856 , (3) claim form A , (4) letter dated 23-08-2007 of Superindent , Government General Hospital, Kurnool to opposite parties , (5) authorization of Divisional Manager in favour of A.Uday Shankar, , besides to the sworn affidavit of opposite party No.2 in reiteration of their written version averments and the above documents are marked as Ex.B1 to B5 for its appreciation in this case and the opposite party also relied on the deposition of Dr.G.Bhavani Prasad and Ex.X1 case sheet 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 the case of the complainant that her husband E.Venkateswarulu has taken a policy from opposite parties for Rs.1,00,000/- vide Ex.B2 /A1 and nominated the complainant as his nominee. The Ex.B1 is the proposal form for taking the policy in Ex.B2. On 08-05-2004 the policy holder died due to fever and jaundice and a claim was preferred by the complainant vide Ex.B3 and it was repudiated by opposite parties vide Ex.A4. The Ex.A4 is the repudiation letter dated 23-10-2007 of opposite parties to the complainant, where in it, repudiates the claim of the complainant on the ground that the policy holder suffered from Tuberculosis and has taken treatment in a hospital, and the policy holder withheld this information regarding his health.
9. The only contention of opposite parties is that the policy holder E.Venkateswarulu suppressed material information regarding his health and has taken treatment for TB and HIV prior to taking the policy. The counsel for opposite parties forcefully contended that while submitting proposal (Ex.B1) for taking the policy in Ex.B2/A1 the policy holder concealed the above said material facts of his treatment for TB & HIV. Therefore, the opposite parties are absolutely justified in repudiating the claim of the complainant . The opposite parties in support of their case relied on the deposition of Dr.G.Bhavani Prasad and Ex.X1 case sheet. The evidence of RW.1 Dr.G.Bhavani Prasad says that he has treated the said patient Venkateswarulu on 07-05-2004 for Pulmonary Tuberculosis with HIV positive and the said patient died on the next day. But the opposite parties in their repudiation says that they have indisputable proof to show that the policy holder has taken treatment prior to taking the policy , the policy in Ex.B2/A1 was issued on 28-03-2004 and the RW.1 treated the policy holder on 07-05-2004 i.e., must later to taking the policy , hence the evidence of RW.1 relied by the opposite party does not support the contentions of the opposite party.
10. The opposite parties also relied on the case sheet in Ex.X1 the case sheet ,dated 08-05-2004 , the patient there in was admitted on 07-05-2004 and expired on 08-05-2004, this treatment is after to taking the policy. Hence the evidence of RW.1 And Ex.X1 case sheet does not support the case of the opposite parties and cannot be relied upon for repudiating the claim of the complainant. In the absence of any supporting material to substantiate Ex.A3 repudiation letter , it cannot be said that the opposite parties have proved the Ex.A3 to repudiate the valid claim of the complainant. There is nothing on record to show that the policy holder has taken treatment in a hospital for tuberculosis before to taking the policy in Ex.B2/A1, neither the affidavit of the doctor under whose care the deceased has taken treatment is filed nor any supporting documents are filed regarding the treatment taken by the policy holder before to the taking the policy. Therefore the opposite parties miserablely failed to prove their case by placing any supporting material in support of their allegations. Therefore, in the said circumstances the repudiation of claim by the opposite parties is wholly arbitrary unreasonable and unjust and amounts to deficiency of service on their part.
11. To sum up, the above discussions the opposite parties can not escape their liability from settling the claim of the complainant and in not doing so without any justifiable material as amounts to deficiency of service on part of opposite parties and the complainant is perfectly remaining entitled to the assured amount under the policy in Ex.A1/B2 as nominee of said policy holder.
12. As the opposite party by its lapsive conduct not only caused mental agony but also constrained the complainant to seek the forum for redressal of her bonafide consumer grievances, the opposite party is liable to compensate the suffered mental agony of the complainant and cost of this litigation.
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.1,00,000/- under policy bearing No. 653400856 along with Rs.3,000/- as compensation for mental agony suffered at the deficient conduct of the opposite parties , and Rs.2,000/- as costs of this case. In default the supra stated award shall be payable by the opposite parties jointly and severally with 12% interest p.a 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 5th day of December, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :
RW.1 Deposition of Dr.G.Bhavani Prasad
List of exhibits marked for the complainant:-
Ex.A1. Xerox copy of policy No.653400856.
Ex.A2. Xerox copy of death certificate dated 25-05-2004.
Ex.A3. Repudiation letter date 23-10-2007.
List of exhibits marked for the opposite parties:
Ex.B1. Proposal form
Ex.B2. Policy bond 653400856.
Ex.B3. Claim form (A).
Ex.B4. Letter dated 23-08-2007 of Superintendent Government
General Hospital to opposite parties.
Ex.X1. Case sheet.
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 parties
Copy was made ready on :
Copy was dispatched on
