BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt.C.Preethi, Hon’ble Lady Member
Friday the 22nd day of December, 2006
C.C. No.109/2006
E.Lakshmi Devi, W/o. E.Hanumanna,
H.No.1/3307/S.M.T. Colony, Opp. Old Welfare Office, Yemmiganur, Kurnool District.
…Complainant
-Vs-
1.The Branch Manager,
L.I.C. of India, Branch Office, YEMMIGANUR.
2.The Senior Divisional Manager, L.I.C. of India, Divisional Office,
Jeevan Prakash, College Road, KADAPA.
…Opposite parties
This complaint coming on this day for orders in the presence of Sri. M.Shivaji Rao, Advocate, Kurnool for complainant and Sri. A.V.Subramanyam, Advocate, Kurnool for opposite Parties 1 and 2 and stood over for consideration till this day, the Forum made the following:-
ORDER
As per Sri. K.V.H. Prasad, Hon’ble President
1. This case of the complainant is filed U/S 12, of C.P. Act., seeking a direction on the opposite parties jointly and severally to pay her the insured amount of Rs.1,00,000/- with 24% interest, per annum, Rs.20,000/- towards mental agony and costs of the complaint alleging deficiency of service of the opposite parties in repudiating wrongly her claim as nominee preferred on account of the demise of policy holder E.Hanumanna, who was her husband, with heart attack on 04-11-2004.
2. In pursuance of the receipt of the notice of this forum as to this case of the complainant, the opposite parties caused their appearance through their counsel and contested the case filling a written version denying their liability to the complainant’s claim alleging suppression by the policy holder as to his earlier ailments i.e., Asthma, and Cardic problems and treatment for them at Govt., General Hospital Kurnool in his statement declaration as to health in the proposal form and such a suppression of early state of health of him in proposal voids the policy U/S 45 of insurance Act., r/w condition No.5 of the policy forfeiting all the benefits there in of the policy holder in favour of L.I.C. and in view of suppression of previous health record as to his earlier treatments, the repudiation of claim by the opposite parties is justified and so seeks dismissal of the case with costs.
3. In substantiation of the contentions while the complainant’s side taken reliance on documentary record in Ex.A1 to A3 besides to her sworn affidavit in reiteration of its case and replies of the opposite parties to its interrogatories, the opposite party side has taken reliance on documentary record in Ex.B1 to B4 besides to its sworn affidavit in reiteration of its defense and the evidence of R.W1 and replies of the complainant to its interrogatories.
4. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of service on the part of the opposite parties and thereby their liability to the complainant’s claim.
5. The Ex.A1 is the letter dt:30-07-2005 of the opposite party No.2 repudiating the claim preferred on policy No.652156700 which was issued by opposite party on the life of E.Hanumanna. The reason assigned there in for repudiating the claim is “the withholding of correct information regarding his health by the said policy holder at the time of effecting the assurance with the L.I.C.” The Ex.A1 says that it is having indisputable proof to show that the said life assured was suffering with Asthma, and Cardic ailments and he has under gone E.CHO cardiogram revealing global by Prokilesic of L.V., Bio Chemical Examination of blood on 13.07-2002, E.S.R. prior to taking policy and these were not declared in his health declaration statement.
6. The Ex.A2 is letter dt:21-08-2005 of the complainant addressed to opposite party No.1 preferring appeal on the repudiation made in Ex.A1 alleging her husband was hail and healthy prior to taking the policy and the repudiation was made on concoected, fabricated and untrust worthy documents and so requesting for cancellation of the repudiation and for allowing her claim and the Ex.A3 is a letter dt:07-03-2006 of opposite party NO.1 intimating the upholding of the repudiation made in Ex.A1 by the opposite party No.2.
7. Hence the whole crux of the case lies in appreciation of the material of the opposite party side as to their so called indisputable proof as to the earlier ailments and treatment the policy holder said to have suppressed in his declaration of health.
8. The Ex.B1 is the proposal for insurance dt:29-07-2004 pertaining to the said deceased policy holder E.Hanumanna. It was pressed into the service by the opposite party side to take the attention of this forum to the answers the policy holder has given to the questions in serial No.11 as to his personal history where in he stated his health as good and at denice all other querries relating to any earlier ailments and the other contingencies telling upon his health. This Ex.B1 shall have relevancy as to the answers given by the said policy holder if there is any cogent material discrediting the truth in the said answers given by him. Hence a probe into such material for finding any justifiability for said repudiation is remaining essential to adjudicate the matters in question.
9. As to the alleged earlier ailments and treatments the policy holder has under gone is concerned, the opposite party side, who boasts in the Ex.A1/B3 repudiation that it has indisputable proof, has not placed any such cogent proof except examining Dr.P.Chandrasekhar Professor Cardiology Govt., General Hospital Kurnool, as R.W1 who says to have issued form No.5152 to L.I.C. of India Kadapa Division on 18-05-05 as to treatment given by him on 13-07-2002 to a patient by name E.Hanumanna holder of policy No.652154501/652156700 for dilated Cardio Myopathy with Hyper tension and history of Breathlessness and chest pain since one week to then and the said patient under going investigations on same day, as to Urine, Blood, and E.Cho cardiogram (Scanning of heart Ultra sound of heart) and said investigation revealed dilated cardio Myopathy i.e., primary Heart Muscle Decease to said patient and his advising said patient for salt reduction and of drugs which releaves the symptoms and the possibility for 50% mortality to said patient in two years if the advise and treatment was not complied properly. But neither the said prescriptions, investigation report on which he has given advises and treatment on said 13-07-2002 or any Hospital record in substantiation of said circumstances nor the said form No.5152 which he claims to have filled and furnished to the opposite party No.2 has been placed by that opposite party side for its appreciation by this forum in adjudication of this matter.
10. The Rw1 says that the Xerox copies of prescriptions and investigation report were enclosed by the superintendent of hospital along with said certificate (form No.5152) for being filled by him. Even though the original prescriptions and investigation report were said to have been given to said patient at the time of his leaving him, the non presentation of said Xerox copies of prescriptions and investigation report which must have followed said certificate in form No.5152, leaves any amount of doubt on the bonafidies of the solitary and uncorroborated evidence of R.W1 which was given without referring to any such documents. Thereby the said evidence of R.W1 is remaining hard for laying any reliance as to the earlier state of health of the deceased policy holder especially when the complainant and written version Ex.B2, Ex.A1/B3 allege a single policy No.652156700 to the deceased policy holder E.Hanumanna the evidence of R.W1 assigns to said deceased policy holder two policy numbers i.e., 652154501 and 652156700.
11. In the absence of cogent documentary material proof from opposite parties side as to the deceased’s earlier alleged treatment for the alleged decease at the time of or prior to filling of proposal form the deceased policy holder cannot be held guilty of suppression of material facts as to his health, as per the decision of Hon’ble Rajasthan State Consumer Disputes Redressal Commission at Jaipur in Hemalatha Vs L.I.C. of India reported in III (2006) C.P.J page 240.
12. In the circumstances stated above the so called indisputable proof which the opposite parties says as holding to justify the repudiation of claim is nothing but a myth and so the repudiation of claim of the complainant, on the policy of her deceased husband, consequent to the demise of said policy holder, appears to be purely a whimsical of the opposite party without any cogent material for justifying it.
13. Consequently the repudiation of the complainant’s claim, preferred by her as nominee of the deceased policy holder consequent to laters demise, during the coverage period of the policy, being not justifiable and on the other hand the said repudiation as appears to be arbitrary the complaint is allowed holding the liability of the opposite parties to make good of the claim under said policy to the complainant as nominee of the said deceased policy holder.
14. As the opposite parties by their deficient conduct of improper repudiation of the claim driven the complainant to the forum for the legal remedy besides causing mental agony, the opposite parties jointly and severally liable to compensate for said mental agony and costs of this litigation also to the complainant.
15. Consequently, the case of the complaint is allowed directing the opposite parties 1and2 jointly and severally to pay to the complainant as the nominee of the said deceased policy holder, the assured sum of Rs.1,00,000/- payable on the contingency of the demise of the insured during coverage period of the said insurance, and Rs.2,000/- as costs and Rs.2,000/- as compensation for mental agony with in a month of the receipt of this order.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open bench on this the 22nd day of December, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the Complainants: Nil For the Opposite Parties
Rw1 Deposition of Dt: 21-11-06
(Dr.P.Chandrasekhar)
List of Exhibits marked for the complainant:-
Ex.A1 Repudiation letter, dt:30-07-05 (No.s in 2)
Ex.A2 Appeal, dt: 21-08-05 submitted by complainant to Zonal Manager, L.I.C.
of India, Hyderabad.
Ex.A3 The decision, Dt:07-03-06 of Senior Divisional Manager, L.I.C. of India,
on the appeal of the complainant.
List of Exhibits marked for the opposite parties:-
Ex.B1 Proposal for Insurance pertaining to the deceased Policy holder Dt:29-07-
2004 (No.s in 3).
Ex.B2 Original policy bond No.652156700 Dt:28-06-04 pertaining to policy
holder.
Ex.B3 Office copy of repudiation Dt:30-07-2005 (Ex.A1) in two papers.
Ex.B4 Office copy of letter, Dt:07-03-2006 addressed to complainant.
MEMBER PRESIDENT
Copy to:
1. Sri. M.Sivaji Rao, Advocate, Kurnool.
2. Sri. A.V.Subramanyam, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
