BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Wednesday the 29th day of March, 2006
CD.No.30/2005
P. Venkata Naidu, S/o. P. Venkatappa, Retired Executive Engineer,
R and B, R/o. D.No. 87-536, Upstairs, Srinagar Colony, Kurnool.
. . . Complainant
-Vs-
1. The Branch Manager,
LIC of India, Kurnool.
2. The Divisional Manager, LIC of India, Jeevan Prakash,
College Road, Kadapa.
. . . Opposite parties
This complaint coming on 27.3.2006 for arguments in the presence of Sri S. Siva Ramakrishna Prasad, Advocate, Kurnool for complainant and Sri B. Rama Subba Reddy, Advocate, Kurnool for opposite party No.1 and 2, and stood over for consideration till this day, the Forum made the following.
O R D E R
(As per Sri.K.V.H.Prasad, Hon’ble President)
1. This case of the complainant filed under Section 12 of C.P. Act seeking direction on the opposite parties for payment of Rs.10,00,000/- the amount assured under policy No.653082841 with accrued bonus and interest at 24% per annum from the date of insureds death and costs of the complaint along with other reliefs which the exigencies of the case demand, alleging himself as father and nominee of the insured policy holder P.Srikanth who has obtained aforesaid said policy on 28-9-2001 from the opposite parties and died on 19-12-2003 at 12.30 P.M due to Cardio Rescratory failure while the policy is in force and claim the preferred was repudiated by the opposite party No.2 on 16-4-2004 on the ground of said policy holder secreting his health condition before obtaining the policy and the said repudiation was upheld by Zonal Manger vide repudiation letter dated 8-10-2004 and a further appeal there on to C.O., CRC Mumbai was made and the later has not adjudicated the matter and so the deficiency of the service on the part of the opposite parties to may good of his claim.
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 counsels and the contested the case filing their written version denying any of their liability to the complainants claim alleging the suppression of state of health by policy holder in his answers to question No.11 of the proposal and the attraction of forfeiture condition of the policy in said circumstances and as the death of policy holder was within two years as early claim it was investigated and found the policy holder as was suffering with problems relating to Liver, Heart and Kidney even prior to the commencement of said policy and was inpatient in Gowri Gopal Hospital, Kurnool on 1-11-2001 at 7.20 AM vide inpatient ticket No.2833 and his undergoing several diagnosis such as ECG for three times, lipid profile test for renal ailment and such tests for evaluation of functioning of vital organs such as heart, kidney and liver and he is discharge on 5-11-2001 at 6.30 PM and during said period being under care of Dr.V.Sankar Sarma and was also certified by the said hospital that the policy holder was suffering with right renal calculi, fatty liver, miled hepatonuglary, benign crostattic hiper chrophy and died ultimately on 19-12-2003 as condition become serious and so justify the repudiation of the claim and seeking the dismissal of the complaint with costs.
3. In substantiation of the contention while the complainant side has relied upon the documentary record in Ex.A1 to A5 and the sworn affidavit of the complainant and reply of the opposite parties to the interrogatories of complainant, the opposite party side has taken reliance on the documentary record in Ex.B1 to B4 and the sworn affidavit of the opposite party No.2 and reply of complainant to the interrogatories of opposite parties and evidence of RW1 Dr.V.Sankar Sarma.
4. Hence, the point for consideration is whether the complainant has made out the deficiency of service on the part of the opposite parties to hold their liability to the claim made in the complaint.
5. While the Ex.B3 is the policy bearing No.653082841 with terms and conditions the Ex.A1 is its attested Xerox copy. Its perusal indicates that it was issued by the opposite party No.2 in favour of P. Srikanth (Insured policy holder) for assured sum of Rs.10 lakhs with its commencement from 28-4-2002 nominating the complainant as the nominee for said insured. The Ex.B2 is the proposal form submitted by the policy holder for issued of policy in Ex.B3. The insured who was holder of policy in Ex.B3 answered the question under 11 of said Ex.B2 indicating his good health with no earlier medical antecedents. As the Ex.B4/A5 repudiates the claim of the complainant on the count of suppression of the earlier state of the health by its policy holder, the documentary record in Ex.A2 to A4 finds with any much importance for appreciation and for finding solution to the problem as they merely since of the submissions of LIC claim forms B and B1 to the LIC.
6. The Ex.B1 an attested copy of letter dated 29-2-2004 the original of which was said to have been issued by Resident Medical Officer (RMO) of G.G Hospital, Kurnool. Its perusal indicates the admission of Sri.P.Srikanth S/o complainant in intensive Care Unit G.G. Hospital on 1-11-2001 at 7.20 AM under care of B.Sankar Sarma, MD,DM(G.E) and discharge of said patient on 5-11-2001 at 6.30 AM and the said patient underwent during said period ECG for three times. The opposite party side did not examine said RMO to substantiation of Ex.B1.
7. The evidence of doctor B.Sankar Sarma (RW1) says on the admission of said P. Srikanth in G.G. Hospital at his wish as came with a complaint of Abdominal pain and the said Srikanth was under his care and during his treatment the said Srikanth left for himself on his own accord for better treatment to an higher institution. The evidence of said doctor doesn’t say the line of treatment he has given to said Sri. P.Srikanth. Nor does it say the taking of ECG for three times of said patient as envisaged in Ex.B1. Nor his evidence says of any necessity to said P. Srikanth to have ECG for several times. Nor any case sheet is filed as to the actual complaint with which the said P. Srikanth approached said G.G. Hospital and treatment he has given nor does the evidence of said doctor says the nature of said ailment in medical terms except it alleging the complaint of abdominal pain. Nor does his evidence provides the diagnosis made on said complaint of the patient. Nor his evidence says it as a casual one or chronic one and his diagnosis of said complaint and the medicines he administered to the said patient during his treatment. Nor anything was elicited from said doctor that the alleged complaint with which the said patient P. Srikanth approached underwent treatment was capable enough to cause in due course such a death the said insured met on 19-12-2003 nor his evidence furnishes the age of the said complaint of said patient P. Srikanth to believe of his existence at the time of taking the policy to find the said patient guilty of its omission in the declaration of his good health proposal and questionnaire there in. While such is so the evidence of said doctor B.Sankar Sarma as RW1 says that he has not treated the said insured policy holder Srikanth for any cardiac complaint. In the absence of any other cogent proof as to the said patient earlier heart ailment or other ailments alleged by the opposite parties side it cannot be taken that the said insured policy holder P.Srikanth was a chronic heart patient with great risk to life and that was suppressed by said insured policy holder Srikanth to have an undue advantage in future under that policy. Especially when the electro cardio gram report dated 3-9-2002 of the said insured policy holder P. Srikanth shows no abnormality.
- Hence, the circumstances discussed above there being any cogent material record as to existing ill health of the insured policy holder P. Srikanth by the time of obtaining the policy in question there appears any justification to the opposite parties for repudiating the death claim preferred by the complainant on the Ex.B3 policy of deceased insured P. Srikanth.
9. Consequently, the opposite party No.2 as is remaining liable to honour the risk covered under Ex.B3 policy for assured sum mentioned there in the complaint is allowed directing the opposite party No.2 to pay to the complainant as the nominee of the deceased insured policy holder P. Srikanth the assured sum of Rs.10 lakhs with 12% interest from the date of death of the policy holder along with entitled bonus, and a compensation of Rs.10,000/- towards mental agony and costs of Rs.10,000/- within a period of one month from receipt of this order. In default the opposite party No.2 shall be liable to may good of the ordered amount with 18% interest till realization.
10. The case against opposite party No.1 is dismissed as he is a formal party having no obligation under the policy.
Dictated to the stenographer, transcribed by him, corrected and pronounced by us in the Open Forum on this the 29th day of March 2006.
PRESIDENT
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant For the opposite parties
-Nil- Deposition of Rw1
(Dr. B. Sankara Sharma)
List of Exhibits marked for the complainant :-
Ex A.1 Attested xerox copy of policy No. 653082841.
Ex A.2 Attested xerox copy of letter dt 23.1.2004 of Medical Attendance
Certificate issued by the Superintendent, Govt. General Hospital,
Kurnool.
Ex A.3 Attested xerox copy of Form B.
Ex A.4 Attested copy of Claim Form B.1.
Ex A.5 Attested copy of repudiation letter, dt 16.4.2004.
List of Exhibits marked for the opposite parties :-
Ex B.1 Attested copy of letter dt 29.2.2004 issued by Resident Medical Officer
(RMO) Gowri Gopal Hospital, Kurnool.
Ex B.2 Proposal policy.
Ex B.3 Policy bond No. 653082841.
Ex B.4 Repudiation letter, dt 16.4.2004.
PRESIDENT
MEMBER MEMBER
Copy to:-
1. Sri S. Siva Ramakrishna Prasad, Advocate, Kurnool
2. Sri B. Rama Subba Reddy, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
