BEFORE THE DISTRICT FORUM:KURNOOL
PRESENT:-SRI K.V.H.PRASAD,B.A.,LLB.,PRESIDENT
AND
SMT C.PREETHI,M.A.,LL.B.,MEMBER.
SRI R.RAMACHANDRA EDDY,B.COM.LL.B.,MEMBER
FRIDAY 17TH DAY OF JANUARY,2003.
C.D.NO.07/2002
Smt A.Lakshmi Devi,
W/O Late A.Venkata Krishna Reddy,
Pedda Ananthapuram(V),
Atmakur(Tq),
Kurnool District…..complainant represented by her counsel
Sri P.Siva Sudharshan.
-Versus-
- The Branch Manager,
L.I.C of India,
Atmakur ,
Kurnool District.
- The Divisional Manager,
L.I.C of India,
P.B.No.10,College Road,
Cuddapah-516 004….. opposite parties are represented by
Their counsel Sri T.Satyanarayana.
O R D E R
This complaint is filed on behalf of complainant under section 11&12 of C.P. Act, 1986 seeking direction against the opposite parties to pay her the due amount under three policies with @24 % per annum, RS.20,000/- towards mental agony and RS.2,000/- cost of the complaint
2. Briefly the facts of the complaint are that one Ambati Venkata Krishna Reddy got three life policies in his favour commencing from 10.9.1997 for RS. 50,000/-, second one from 10.8.1999 for RS.1,00,000/-, and third one from 28.9.1999 for RS.1,00,000/- with the opposite parties, bearing policy No.s 651953501, 652345506, 652346444 respectively and the insured nominated his wife A.Lakshmi Devi for the above three policies. The insured died on 21.3.2000, due to jaundice and the said death is natural one. There after the complainant submitted, all necessary claim forms, to the opposite parties, as she is the nominee of the insured but the opposite parties did not pay the policy amounts. Hence the complainant got issued a lawyer's notice to the opposite parties on 14.10.2001 and the opposite party No.2 replied falsely alleging that the complainant's husband with held the correct information regarding his health at the time of entering the policy. Hence they did not considered the claim of the complainant.
- The complainant further submits that her husband never suffered with any chronic diseases and the demise of her husband was due to Jaundice and the opposite parties are not having any reasonable and lawful cause for not paying the due amount to her under said policy. Hence the conduct of the opposite party in not paying the policy amount to the complainant is deficiency of service.
- The opposite parties after receiving notice filed objection statements denying the averments of the complaint and admitting the diseased assuring his life with three policies in his name and nominated the complainant his wife Smt A.Lakshmi Devi. The complainant informed the opposite parties about death of her husband, by a letter and it was received by the opposite parties office on 17.5.2000 and subsequently the complainant sending all the required claim forms except duly filling claim forms with 'B' and 'B'1 to the opposite party No.1on being asked to that effect. But the complainant left blank the claim forms 'B' and 'B' 1as the assured deceased was treated by a quack at Nandyal and not by any qualified doctor.
5. The opposite parties further submits that the claim investigation
Was done as the claims are early claims and the investigation reveals that the life assured was unwell to the date of all the three proposals and took treatment at various hospitals and he did not disclosed about his illness in his proposals and because of said concealment of material facts relating to his ill health the claim amount was not paid and as such the claim is still under investigation and consideration, and the opposite parties are obtaining evidence in this regard and hence prays for the dismissal of the complaint in view of the pending investigation on the above policy claims.
6. The complainant filed the xerox copies of three policy certificates, Office copy of Lawyer's Notice dt 14.10.2000, reply of opposite party No.2 dated 19.10.2001 and they are marked as Ex.A.1 to Ex.A.5 for their appreciation in this case. The complainant filed a sworn affidavit re-iterating the averments of the complaint. The opposite parties filed all originals blank claim forms 'B' and 'B'1, affidavit in lieu of claim form'B', proposal forms of life assured dt 3.1.1997, 4.8.1999 and 13.10.1999,office copy of reply notice dated 19.10.2001, and they are marked as Ex B.1 to Ex.B.7 for their appreciation in this case and an affidavit on behalf of the opposite parties was also filed in re-iterating of its defence.
7. Hence the point for consideration is to what relief the complainant is entitled to?-
8. It is the case of the complainant that she is the nominee of the insured Amabati Venkata Krishna Reddy ,who holds three life policies in his name for RS.50,000/- on 10.9.1997,RS.,1.00 lakh on 10.8.1999 and RS.1.00 lakh on 28.9.1999 with the opposite parties ,bearing policy No.s 651953501, 652345506, 652346444 respectively. On the claims preferred by her as nominee the opposite parties did not pay the policy amounts on the pretext/the deceased insured withheld the information regarding his ill health at the time of taking policy.
9. The opposite parties admits that the insured hold three policies in his favour and nominated his wife in all the three policies, and the insured dying on 21.3.2000 due to jaundice and after the death of the insured the opposite parties not paying the policy amounts to the complainant as the insured death is not due to jaundice but on account of other ailments with which the deceased was suffering even at the time of taking those policies, and the insured did not disclose in the proposal form of his health conditions and the complainant not duly filling forms 'B' and 'B'1 as such the claim is under investigation and consideration. Regarding the so called investigation no documentary material is placed on record to show their deligency at the matters nor submitted any such investigation report. Hence the so-called investigation appears to be a pretext adopted by the opposite party to avoid payment. The other allegations of the opposite parties that the complainant did not fill the forms 'B'and 'B'1 does not appear to be worthy of any credit as the insured was not treated by any qualified doctor, but was treated by a quack at Nandyal, and supporting the claim form's' an affidavit of third party has also been filed, to show that the insured died due to fever and jaundice and he was not treated by any qualified doctor and was treated by a quack doctor at Nandyal.
10. The other aspects of the opposite parties that the insured did not disclose intentionally or fraudulently suppressed of material facts as to health is not proved as no material brought on to record where from it can be inferred that there was intentional or fraudulent suppression of facts by deceased as to health. On the other hand the complainant in her sworn affidavit re-iterating her claim submits that her husband never suffered from illness nor with any chronic diseases.
11. The complainant relies on the following rulings;
- Branch Manager,L.I.C of India and others -Vs- Smt Asha Singh,U.P.S.C.D.R.C,1,2002 C.P.J page 403,wherein it was held that where the contention, that deceased was suffering from heart dicease, not disclosed the said contention not remains avoidable contention not applicable, burden to prove heart ailments lies on L.I.C, and there is no document, produced in support of said contentions, Insurance Company remains failed to discharge the said burden, and hence L.I.C is held liable to make payment with 18% interest.
- L.I.C of India -Vs-Charanjeeth Kaur, 2001, C.T.J,135 (CP) S.C.D.R.C where in the claim preferred by the widow of deceased life assured was repudiated on the ground that the deceased/insured gave incorrect answers in the proposal form and deliberately and intentionally withheld the materiel information about the State of his health it was held the in the absence of placing of such evidence to that effect, the appellants remains to have failed to prove that the deceased suppressed his previous ill health in the proposal form.
- Smt Maina Devi Bairalia -Vs-L.I.C (N.C) C.P.R page 399,(2) 1993
Where in it was held that long abnormal delay of 13 years on the part of the L.I.C in making amounts of the life policy is gross negligence and deficiency in service on the part of the L.I.C and claimant is entitled to interest on the policy amount and compensation for harassment.
- Smt B.Chinnamma -Vs- Divisional Officer, L.I.C of India &
Others,1997, NCJ, 33 wherein it was held that no due or proper application of mind was made by the L.I.C to the material facts and circumstances of the case before the proceeding to repudiate the claim.
12. In light of the rational of the above decisions and material on record not substantiating any suppression of health conditions of deceased while taking policy or there after not only further appears any substance in the objections of the opposite parties, the complainant entitleness to the policy amounts, as the conduct of the opposite parties in not paying the amounts is amounting to deficiency of service to the complainant by the opposite party.
- Therefore on careful consideration of material on record and legal position and the aspects involved we are of the considered view that the complaint a nominee of deceased policy holder his entitled to the issued amount of policy and there is no justification in the opposite parties conduct in not making payment due under this policy's to the complainant and there by the conduct is amounting to deficiency of service.
14. Hence the point is held in favour of the complainant.
15. In the result, the complaint is allowed directing the opposite parties to pay the amount under the three policies i.e RS.50,000/-,RS.1,00,000/- and RS.1,00,000/-to the complainant with interest of 9% per annum from the date of filing of the case till the date of realization and as the opposite parties driven the complainant to seek redressal in the Forum, to pay to the complainant a sum of RS.1,000/- and RS.500/- towards compensation and costs respectively and the opposite parties are granted one month time from the date of receipt of this order for compliance.
Pronounced in the Open Court, this the 17th day of January,2003.
PRESIDENT
MEMBER. MEMBER.
