Andhra Pradesh

Nellore

CC/11/2016

Mannam Padmaja, wife of Manikyarao alias Manikyala Rao,S/o Kotaiah - Complainant(s)

Versus

1. The Branch Manager, L.I.C. of India - Opp.Party(s)

Eduru Bhaskaraiah

23 Aug 2017

ORDER

 

 

Date of Filing     :21-01-2016

                                                                                                Date of Disposal:23-08-2017

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM:NELLORE

Wednesday, this the  23^rd day of   AUGUST, 2017

 

          Present: Sri Sk.Mohd.Ismail, M.A., LL.B., President

                         Sri K. Umamaheswara Rao, M.A., B.L., Member

                         Sri M. Subbarayudu Naidu, B.Com., B.L., LL.M., Member

 

C.C.No.11/2016

Mannam Padmaja,

W/o.Manikyarao @ Manikyala Rao,

S/o.Kotaiah, Resident of 19/144,

Kamati Street,

Chinna Bazar, Nellore City.                                                             ..… Complainant   

                                                                           Vs.

 

1.	The Branch Manager, L.I.C. of India, City Branch-1, Dargamitta, Nellore.
2.	The Divisional Manager, L.I.C. of India, Dargamitta, Nellore.                                                                                     ..…Opposite parties

                                                              .  

            This complaint coming on 18-08-2017 before us for hearing in the presence of                Sri Eduru Bhaskaraiah, advocate for the complainant and                                                          Sri A.V. Murali Krishna,  advocate for the opposite parties  and having stood over for consideration till this day and this Forum made the following:

 

ORDER

                       (ORDER BY  Sri.Sk.MOHD.ISMAIL, PRESIDENT)

 

 The complainant filed this complaint under Section-12 of  Consumer Protection Act, 1986  to direct the opposite parties   for payment of Rs.5,00,000/- towards the assured sum  due under the said policy No.843279549,  dated 28-08-2008 along with  bonus  and interest @ 12 % p.a.  over the said amount from the date of the death of the insured i.e., 26-04-2011 and also  damages and compensation of Rs.1,00,000/- jointly and severally  and  for costs of the complaint and submits to allow the complaint with costs.

 

2.         The brief averments of the complaint  are as follows that;  the complainant is the wife  of Late Mannam Manikya Rao  and the said  Manikya Rao obtained three policies bearing Nos.843279549 on 28-08-2008, No.843296891 on 14-07-2010 and No.843298724 on 16-08-2010 for  Rs.5,00,000/- each  by paying  necessary premiums and the opposite party have issued valid policies in favour of the said Manikya Rao.  Under the said three policies, the name of the complainant is shown as nominee.

3.         The complainant submits that while the said policies are inforce, the said Manikya Rao died on  26-04-2011  at Nellore due to heart attack.  After his death, the complainant  submitted original of three policies, death certificate and also the family members certificate before the  1^st opposite party for payment of the amount covered under the said three policies.  The 1^st  opposite party has been postponing the payment covered under the said three policies on some pretext or the other.  The complainant has been  approaching the office of both the opposite parties  for policies amount. Three days prior  to 23-05-2015, the 1^st opposite party   had orally  informed the complainant that the complainant is not entitled for the said amounts and they failed to give any letter repudiating the claim of the complainant. Thus there is  a clear deficiency of service on the part of opposite parties and failed to render the services properly. The complainant   issued legal notice on 23-05-2015 to opposite parties 1 and 2 calling upon them to pay the assured sum of Rs.5,00,000/- each under the said three policies, bonus alongwith interest  at 12% p.a. from the date of the death of insured Mannam Manikya Rao on 26-04-2011 and also  for damages and inspite of receiving of the notice, the opposite parties failed to pay the policy amount of Rs.5,00,000/- under the policy No.843279549, hence the complainant filed this complaint claiming  sum under the policy bearing No.843279549, dated 28-08-2008  with bonus and interest from the date of the death of the insured,  for awarding of damages and for costs of the complaint and submits to allow the  complaint with costs.

 

4.         The opposite party No.2 filed written version and the opposite party No.1 filed memo adopting written version filed by the opposite party No.2 with the following averments:

 It is true that the deceased / life assured Mannam  Manikya Rao had obtained the policy bearing No.843279549 on 28-08-2008  during his life time for a sum assured  Rs.5,00,000/-  with the  1^st opposite party branch, that with half yearly mode on payment of premium, that the deceased nominated his wife / complaint Smt.M. Padmaja as nominee of the said policy that he died on 26-04-2011.   This opposite parties submit  that the above said policy was  lapsed due to non-payment  of premium  due to 28-08-2009 and the same has got revived on 27-10-2010 by paying premium on the  strength of personal statement regarding health dated 06-07-2010 and also medical reports.  Based on the declaration by the life assured, lapsed policy has revived.

5.         The policy holder / life  assured Manikya Rao died on 26-04-2011 i.e.,  the death occurred within two years i.e., 5 months 29 days from the date of revival                     (27-10-2010) i.e., an early death the opposite  parties  investigated and came to know that the deceased  life assured admitted in SVIMS, Tirupathi on 08-06-2006 and  diagnosed with “Carcinoma Cacum”  and also undergone “Hemi Colectony” operation on                  10-06-2006 and discharged on 26-06-2006 and also treated in the said hospital from            04-07-2006 to 08-07-2006 .  These  material facts with regard to health was not disclosed at the time of proposal dated 28-08-2008 i.e., prior obtained to the policy.

 

6.         The opposite parties  further submits that the  deceased life assured had taken treatment as out patient on 19-08-2008 in Narayana Medical College and Hospital, Nellore  as  inpatient from 08-09-2008 and  discharged on 12-09-2008.  The said material facts with regard to health was also not disclosed even at the  time of revival                        (27-10-2010) of the said policy in his personal statement with regard to health declaration on 06-07-2010. Thus the above the life assured Manikya Rao (deceased)  suppressed the material facts regarding health at the time of revival of the said policy and also at the time of taking  of policy i.e., on 28-08-2008.   The opposite party submits that  as the insured suppressed the material facts, the policy issued in favour of  the insured was repudiated and intimated the same to the complainant under registered  post dated 28-03-2015 and hence as there is no deficiency of service  and as the policy was repudiated,  they  submits for  dismissal of the complaint against the opposite parties 1 and 2 and submits for the dismissal of the complaint with costs. 

 

7.         On behalf of the complainant, P.W.1 was examined and Exs.A1 to A6  marked.

 

8.         On behalf of the opposite parties R.W.1 was examined and Exs.B1 toB5 marked.

9.         The complainant was  examined as P.W.1 and  on behalf of the opposite party No.2 R.W.1 was examined. 

Ex.A1 is photo copy of policy bearing No.843279549, Ex.A2 death certificate of Mannam Manikya Rao, Ex.A3 photocopy of family  member certificate, Ex.A4 is photo copy of Aadhar card, Ex.A5 is office copy of legal notice dated 23-05-2015, Ex.A6 is the served postal acknowledgements of opposite  parties 1  and 2,  Ex.B1 is photo copy of proposal form, Ex.B2 is photocopy of  personal statement of regarding health  (Revival of lapsed policies both the medical and non-medical basis), Ex.B3 is  photo copy of history of premium transaction, Ex.B4 is  photo copy of reply notice dated 28-03-2015, Ex.B5 is photocopy of discharge summary issued by Narayana Hospital, Chinthareddypalem, Nellore.

 

 

 

10.       On behalf of both parties written arguments filed.  Perused the written arguments filed on behalf of  both parties.

 

11.       Arguments on behalf of learned counsels for  both parties heard.

 

12.       Now the points for consideration are:

1. Whether the act of opposite parties 1 and 2 in repudiating the policy bearing No.843279549 is amounts to deficiency of service?
2. Whether the complainant is  entitled for policy amount of Rs.5,00,000/- with interest at bonus  as prayed for?
3. To what relief, the complainant is entitled?

 

          13.    POINTS No.1 AND 2 :  Both these two points are taken up together for our consideration as both points are interrelated.

 

       The learned counsel for the complainant submits  by  relying upon Exs.A1 to A6 that the husband of the complainant  was taken  three policies from the opposite parties and died on 26-04-2011 and  inspite of issuing of legal notice on 23-05-2015, the opposite parties 1 and 2 did not pay the policy amount  and hence as the opposite parties repudiated the claim, there is  deficiency of service on the part of opposite parties 1 and 2 and hence  the  complainant filed this complaint against  opposite parties 1 and 2 for recovery of policy amount and  submits to allow the complaint with costs.

                  On the other  hand, the learned  counsel for the opposite parties 1 and 2 submits  by  relying  upon Exs.B1 to B3  that the insured join in policy on 28-08-2008 and before joining the insured took treatment  in SVIMS, Tirupathi in the month of June, 2006  and the husband of the complainant was diagnosed  with Carcinoma Cacum and operated for  Hemi Colectomy in the month of June, 2006 and the  husband of the complainant also undergone Chemotherapy in SVIMS Hospital, Tirupathi  and the  said policy  bearing No.843279549 was lapsed  on 28-08-2009 and the said policy was revived on 27-10-2010 and  inspite of undergone surgery, the husband of the complainant  did not mention the same as on 28-08-2008 or  as on the date of revival of policy   on                   27-10-2010  and as the assured was suppressed  the material fact that he undergone surgery in SVIMS Hospital, Tirupathi and also further treatment in Narayana                       Hospital, Chinthareddypalem, Nellore,  the policy of the assured was                          repudiated and hence the complaint filed by the complainant    is not maintainable

 

against the opposite parties 1 and 2 and submits for the dismissal of the complaint with costs.

              In view of the arguments  submitted by the learned counsels for the   both parties and as seen from the contents of Ex.B2 Personal Statement  in column No.4, it is shows as  “Good” and the said policy was filled on 06-07-2010.  As on the date of the Ex.B2, the  assured Mannam Manikya Rao was undergone  surgery in SVIMS Hospital, Tirupathi and also undergone treatment  in Narayana Hospital, Chinthareddypalem, Nellore.  Ex.B5 discharge summary shows as follows:

 “Past history of  carcinoma ascending colon diagnosed and treated  at SVIMS (Rt. Hemicolectomy and chemotherapy.  Last Chemotherapy on  09-12-2006”.

            In Ex.B5,  the final diagnosis  is noted as follows:

         “Post operative carcinoma ascending colon”.

            The contents of Ex.B5 discharge summary shows that the assured was undergone chemotherapy on 09-12-2006 in SVIMS hospital, Tirupathi even  prior to join in policy on 28-08-2008.  The policy, which was issued in the name of the assured bearing No.843279549 dated 28-08-2008 was lapsed on 28-08-2009 and the same was  revived on 27-10-2010 but even as on the date of the revival, the assured did  not inform the same about the health condition of the assured at the time of the revival  of the policy.

            By relying upon the contents of Ex.B5 discharge summary, we are of the opinion that  the assured suppressed the material  facts and he did not mention about  his treatment either  as on the date of  Ex.A1 policy or as on the date of the revival of the policy.  As the assured suppressed the material facts,   the opposite parties 1 and 2 repudiated the policy of the assured as he  suppressed the ill-health of the assured Manikya Rao. In

LIC of India Vs. Yogender Mittal reported in II (2012) CPJ 556 (NC)

            Wherein the Hon’ble National commission held that  Insuree was detected with cancer prior  to approval of the policy, claim was repudiated.

 

	In, Nokul (Minor) and another Vs. LIC of India and another  reported in II (2012) CPJ 68 (N.C.),
	In, P.C. Chacko and another Vs. Chairman, LIC of India reported in AIR 2008  S.C.  424, and
	In, Satwant Kaur Sandhu Vs. New India Assurance Company reported in  IV (2009) CPJ 8 (SC)

            Wherein the  Hon’ble Apex Court and Hon’ble National Commission held that  in a case where there was proof  that the insured person was suffering from certain diseases and had a received  treatment before making the proposal for insurance, but suppressed the said fact in the declaration given by him in the proposal  form, the repudiation of the claim was justified.

Following the above  decisions, we are of the opinion that as the  assured Manikya Rao (deceased) suppressed the material facts not only as on the date of the policy and also on the date of  the revival of the policy  hence the policy of the late Manikya Rao was  repudiated on the ground of suppression of material fact. by the opposite parties            1 and 2.  Hence by relying upon  the above decisions and the discussion made  above, we are of the  opinion that the complaint filed by the complainant against the opposite parties 1 and 2   for the recovery of the amount  under the policy  is not maintainable. Further we are of the opinion that there is no deficiency of service by the opposite parties 1 and 2  in repudiating the policy of late Manikya Rao.  By relying upon   the above discussion,  we answered points 1 and 2  against the complainant and in favour of the opposite parties              1 and 2.

 

            14.       POINT No.3:  In view of our   answering on points No.1 and 2 against   the complainant and in favour of  the opposite parties 1 and 2,  the complaint filed by the complainant against the opposite parties 1 and 2 has to be dismissed.

            In the result, the complaint  is dismissed but in the circumstances no costs.

 

            Dictated to Stenographer, transcribed by her corrected  and pronounced by us in the open  Forum, this the  23^rd  day of  AUGUST, 2017.

 

          Sd/-                                                 Sd/-                                         Sd/-

      MEMBER                                MEMBER                                PRESIDENT

 

                                                APPENDIX OF EVIDENCE

 

Witnesses Examined for the complainant

 

P.W.1  -

17-11-2016

Smt.  Mannam Padmaja, W/o.Late Manikya Rao @ Manikyala Rao, Nellore (Chief affidavit filed).

 

Witnesses Examined for the opposite parties

 

R.W.1  -

17-11-2016

Sri S. Raghunath, S/o.S. Sreerama Sarma, Working as Administrative Officer, D.O.LIC of India, Nellore (Chief affidavit filed).

 

 

 

                             EXHIBITS MARKED FOR THE COMPLAINANT

 

Ex.A1  -	02-09-2008	Photostat copy of policy No.843279549, dated 28-08-2008 in favour of complainant  issued by the opposite pasrty.
Ex.A2  -	07-05-2011	Photostat copy of Death Certificate in favour of  Mannam Manikya Rao.
Ex.A3  -	25-08-2011	Photostat copy of Family Members Certificate in favour of Late Mannam Manikya Rao, S/o.Kotaiah.
Ex.A4  -		Photostat copy of  aadhar  No.4149 9828 8875 in favour of complainant.
Ex.A5  -	23-05-2015	Photostat copy of legal notice from complainant’s advocate to the opposite parties.
Ex.A6  -	25-05-2015	Photostat copies of two served postal acknowledgements received from opposite parties sent by the complainant’s advocate.

 

                         EXHIBITS MARKED FOR THE OPPOSITE PARTIES

 

Ex.B1  -		Attested copy of  Proposal for Insurance on own life  in favour of Mannam Manikya Rao
Ex.B2  -		Attested copy of Personal Statement Regarding Health in favour of Mannam Manikya Rao in policy No.843279549 issued by the opposite parties.
Ex.B3  -		Photostat copy of History of Premium Transaction in policy No.843279549 in favour of  Mannam Manikya Rao.
Ex.B4  -	28-03-2015	Photostat copy of  letter from opposite party to the  complainant.
Ex.B5  -	12-09-2008	Photostat copy of Discharge Summary  in favour of Manikya Rao M. issued by the Narayana Hospital, Chinthareddypalem, Nellore.

 

 

                                                                                                                                   Id/-

                                                                                                                     PRESIDENT

 

Copies to:

 

1.	Sri Eduru Bhaskaraiah,  Advocate, Opposite to State Bank of India, Achari Street, Nellore-524 001.
2.	A.V. Murali Krishna, Advocate, B.V. Nagar, A.K.Nagar (P.O.), Nellore.

 

Date when free copy was issued: