BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt.C.Preethi, Hon’ble Lady Member
Wednesday the 23rd day of August, 2006
CD No. 24/2006
N. Salamma, W/o. Deva Raju, Aged 50 years,
Ulinda Konda (V), Kallur (M), Kurnool.
. . . Complainant
-Vs-
1.The Branch Manager,
LIC of India, Kurnool.
2.The Divisional Manager,Divisional Office,
LIC of India, College Road, Kadapa.
. . . Opposite parties
This complaint coming on this day for Orders in the presence of Sri C. Ramana Reddy, Advocate, Kurnool for complainant and Sri I. Anantha Rama Sastry, Advocate, Kurnool for opposite parties No.1 and 2, and stood over for consideration till this day, the Forum made the following:-
O R D E R
(As per Smt C.Preethi, Member)
1. This consumer complaint of the complainant is filed under section 12 of CP Act, 1986 seeking a direction on opposite party to pay assured amount of Rs.1,00,000/- with benefits and interest at 18%, Rs.10,000/- as compensation, 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 is the mother of Late N. Vijaya Bhaskar, who insured his life with opposite parties under policy bearing No. 653391991 for Rs.1,00,000/- and nominated the complainant as his nominee. The insured died due to Jaundice at his Village Uppalapadu. After the death of insured the complainant submitted claim form along with all relevant documents claiming assured amount, but the opposite party repudiated the claim on the ground that the insured had suffered from HIV positive from 4.8.2003 to 4.11.2003 and had suppressed the said fact at the time of taking proposal. But the complainant submits that the insured never suffered from the alleged disease muchless HIV positive, therefore, the repudiation by opposite party on the alleged ground amounts to deficiency of service to the complainant.
3. In substantiation of her case the complainant relied on the following document Viz (1) Repudiation letter dt 23.1.2006 addressed by opposite party to the complainant, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above document is marked as Ex A.1 for its appreciation in this case and caused interrogatories to the opposite party and suitablely replied to the interrogatories caused by the opposite party.
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 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 complainant’s son N.Vijaya Bhakar has taken a policy bearing No.653391991 for Rs.1,00,000/- and nominated the complainant as his nominee, but alleges suppression of material facts as to his State of health and the treatment he has undergone prior to proposing of the policy and answering negatively to the questionaire in serial No. 11 (1) of the proposal form and as per his declaration the untrue averments found in the said proposal form makes the contract of the insurance null and void and forfeiture the corporation all amounts he paid to the corporation. As the death claim arouse with in 2 years from the date of commencement of policy, the claim was treated as early claim, investigation was taken up and learnt that the policy holder got himself treated for HIV at VCTC and KMC at Kurnool and took treatment from Counseling and Drop-in, centre Maria Nilayam social service society, Gargeyapuram, Kurnol from 4.8.2003 and undergone laboratory tests in Voluntary Counseling and Testing Centre, Department of Microbiology, Kurnool Medical College, Kurnool for AIDS (HIV+) on 4.8.2003. The diagnostic chart of treatment reveals that deceased has taken treatment from 4.8.2003 till his death in the same service society for AIDS till his death on 26.11.2004, due to AIDS. Hence, the policy holder was quite unwell prior to the above policy for insurance on his life and condition No.5 of the policy also makes the policy void for with holding any material information and forfeiture of all the amount paid to the corporation, in view of the contract made on utmost good faith on the deceased statements and the declaration as the suppression of any material facts makes the policy null and void under section 45 of Insurance Act and attracting the forfeiture of the amounts and hence the repudiation of the claim is proper and the action of opposite parties in repudiating the claim suffers with no deficiency of service and hence seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite parties filed the following documents Viz (1) Proposal form dt 22.12.2003 of the deceased (2) Original policy bond with terms and conditions (3) claim enquiry report of Investigation Officer and (4) Notarised Affidavit of third party, besides to the sworn affidavit of opposite party in-reiteration of its written version as defence and the above documents are marked as Ex B.1 to B.4 for its appreciation in this case. The opposite party also relied on the deposition of RW1 and documents marked as Ex X.1 to X.3. The opposite party caused interrogatories to the complainant and suitablely replied to the interrogatories filed by the complainant.
7. Hence, the point for consideration is to what relief the complainant is remaining entitled alleging deficiency of service on part of opposite parties:-
8.The Ex A.1 is the repudiation of the claim of the policy of the deceased bearing No. 653391991 for Rs.1,00,000/-. It says that the claim was repudiated as the said policy holder suffered from HIV positive during the period from 4.8.2003 to 4.11.2003 and took treatment from a Hospital prior to the date of proposal of the above policy and was suppressed by the said policy holder as to the said facts relating to his personal statement.
9. The Ex X.1 is the Laboratory report form dt 4.8.2003 issued by Voluntary Counseling and Testing Centre it envisage a PID No. Kml/3/1537, aged 30 years had given a sample on 4.8.2003 for testing and after first, second and third test reveals that the said patient was suffering from HIV-1 (reactive). The deposition of RW1 says that one Vijaya Bhaskar S/o. Devaraj has brought a laboratory report form (Ex X.1) and joined their counseling and drop in centre and took treatment for H.I.V reactive from 4.8.2003 to 18.11.2004. The Ex X.2 is the assessment and counseling issued by Counseling and Drop-in centre to Vijaya Bhaskar. The Ex X.3 is the treatment sheet issued by Counseling and Drop-in center of the said patient i.e Vijaya Bhaskar. On the perusal of said Ex X.3 it is clear the Vijaya Bhakar S/o. Devaraj aged 30 years was under continuos treatment under the care of Counseling and Drop-in center from 5.8.2003 to 18.11.2004 and the deposition of RW1 clearly says that the said Vijaya Bhaskar was suffering from HIV and had taken treatment in their unit. Therefore, it is clear that Vijaya Bhaskar was taking treatment for HIV from 5.8.2003 in the said unit.
10. The Ex B.1 is the proposal form of the deceased for Rs.1,00,000/- dt 22.12.2003 filed by opposite party for issual of Insurance Policy. The corresponding policy issued in pursuance of the said proposal is Ex B.2 showing the commencement of the policy from 22.12.2003 for 20 years with policy bearing No. 653391991. In the Ex B.1 the proposal for the above policy, the policy holder answered all the questions negatively in the Sr No. 11 of the personal history statement stating as to usual state of health as good. The treatment sheet in Ex X.3 and deposition of RW1 says that the patient Vijaya Bhaskar was suffering from HIV from 5.8.2003 and the proposal in Ex B.1 being of dt 22.12.2003 i.e the said treatment for HIV by the policy holder is being prior to the said proposal in Ex B.1. The deceased also signed in Ex B.1 a declaration agreeing to forfeiture to the LIC all the money in case of any omission or error in the material, he furnished in the said proposal for the issual of policy. The policy holder ought to have disclosed of the said facts within his knowledge in the answer to the question in 11 b as he was suffering from HIV. The non-discloser of the said facts in answer to the question in 11 b of Ex B.1 certainly amounts to an omission of its non-discloser on the part of the said policy holder in the said proposal and the contract of insurance being made under the utmost good faith and belief and the declaration made by the complainant and such omission of non-discloser of the material facts makes null and void the very contract of the insruance under section 45 of Insurance Act, besides forfeiting the amounts paid by the policy holder in favour of the corporation. The non-discloser of material facts as to the suffering from HIV prior to obtaining of the said policy as amounts to intentional omission and the suppression of material facts relating his personal history within his personal knowledge is attracting the penal provision mentioned in the said declaration in case of any such omission. Hence, in the circumstances discussed above there appears no error defect or deficiency on the part of LIC (opposite parties) in repudiating the claim of the complainant preferred on the policy bearing No. 653391991.
11. The only other contention of the complainant is that the Ex X.1 does not bear the policy holder’s name, but the deposition of RW1 says that the patient Vijaya Bhaskar has brought the Ex X.1 and as per Ex X.2 he was given treatment at their unit, hence the contention of complainant is rejected.
12. The opposite party also relied on the claim enquiry report of K. Sateesh, Branch Manger, Kurnool vide Ex B.3, in support of Ex B.3, the said K. Sateesh has given his sworn affidavit stating that during his investigation in the Village Uppalapadu, in which the deceased policy holder died, he got information that deceased was suffering from HIV +and had taken treatment at Mercy Home and Counseling and Drop-in center and the policy holder died after prolonged illness due to HIV.
13. To conclude from the above discussion as it has been established that the policy holder Vijaya Bhaskar was suffering from HIV+ and has taken treatment for HIV, hence, there is suppression of material facts on part of policy holder, therefore, there is no deficiency of service on part of opposite parties in repudiating the claim of the complainant and the complainant cannot have any remedy as sought from the opposite parties.
14. Consequently there being no merit and force in the complainant it is dismissed.
Dictation to the Stenographer, transcribed by her, corrected and pronounced in the Open Court this the 23rd day of August, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties
RW1 depositionof(Sister Samestha),
Dt.21.7.2006.
List of Exhibits marked for the complainant:-
Ex A.1 Repudiation letter dt 23.1.2006 addressed by opposite party to the
Complainant.
Ex X.1 Laboratory report forum.
Ex X.2 Assessment and counseling.
Ex X.3 Treatment sheet.
List of Exhibits marked for the opposite parties:-
Ex B.1 Proposal form dt 22.12.2003 of the deceased.
Ex B.2 Original policy bond with terms and conditions.
Ex B 3 claim enquiry report of Investigation Officer.
Ex B.4 Notarised Affidavit of third party.
MEMBER PRESIDENT
Copy to:-
1. Sri C. Ramana Reddy, Advocate, Kurnool.
2. Sri I. Anantha Rama Sastry, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
