BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Friday the 5th day of September, 2008
C.C.No. 42/08
Between:
Smt. P. Mohana Bai, W/o. late P. Bhaskar Rao,
H.No.7/441, Tarakarama Nagar, Dhone, Kurnool District. … Complainant
Versus
1. The Branch Manager,LIC of India,
Dhone, Kurnool District.
2. The Senior Divisional Manager,LIC of India, Divisional Office,
College Road, Kadapah.
3. The Zonal Manager,S.C. Zonal Office, L.I.C. of India,
Secretariat Road, Saifabad, Hyderabad.
… Opposite parties
This complaint is coming on this day for orders in the presence of Sri. M. Sivaji Rao, Advocate, for the complainant, and Sri. I. Anantha Rama Sastry, Advocate, for the opposite parties and upon perusing the material papers on record, the Forum made the following
ORDER
(As per Sri. K.V.H.Prasad, President)
C.C.No.42/08
1. This case of the complainant is filed U/S 11 and 12 of C.P.Act seeking direction on the opposite parties to pay to the complainant Rs.1 lakh towards assured amount under the insurance policy along with interest at 12% p.a , Rs.25,000/- as compensation for mental agony and hardship suffered at the deficient conduct of the opposite parties and cost of this case alleging that the complainant’s husband covered under insurance policy No.653296238 issued by the opposite parties with effect from January , 2004 during the subsistence of said policy died on 29-11-2006 due to heart attack and the insurance claim of the complainant as nominee of the policy holder under the said policy was repudiated by the opposite parties vide its letter dated 31-3-2007 / 11-4-2007 and on appeal the opposite party No.3 admitted the insurance claim to paid up value of Rs.14,012/- and the opposite parties inspite of receipt of demand legal notice dated 16-11-2007 did not responded and the repudiation of the opposite party being wrong, caused mental agony and hardship and constrained the complainant for this case.
2. In pursuance of the receipt of the notice of this forum as to this case of the complainant the opposite parties 1 to 3 caused their appearance through their counsel and contested the case denying their liability to the complainant’s claim and seeking dismissal of the complainants case filling written version of opposite party No.2 and its adoption by opposite party No.1 and 3 .
3. The written version of the opposite party No.2 even though admits the deceased as policy holder and the complainant as his nominee and insurance claim of complainant on demise of the policy holder and its repudiation as it was early claim after revival of the policy on 21-11-2006 but as investigation revealed the demise of policy holder under went treatment for disseminated malignancy prior to revival of the policy and
the said was suppressed in answers to the questions in statement as to the health mentioned in proposal submitted for revival and so allege no deficiency on their part in repudiation or in admitting the claim for paid up value of Rs.14,012/- and so any cause of action for the complainants case.
4. In substantiation of the contentions while the complainants side relied upon documentary record in Ex.A1 to A6 and its sworn affidavit in reiteration of its contents , the opposite party side has taken reliance on documentary record in Ex.B1 to B8 and the sworn affidavit of the opposite party No.2 in reiteration of its defence.
5. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of the opposite parties in repudiation or in admitting the claim for paid up value and there by any of their liability to the complainants claim.
6. The Ex.A1 is the Xerox copy of the policy No. 653296238 . It envisages the commencement of said policy from 13-1-2004 for a period of 16 years with a quarterly premium of Rs.2089/- covering risk of the insured P. Bhaskar Rao for an assured sum of Rs.1 lakh and the complainant as nominee of said insured . The Ex.A2 is the death certificate issued by Commissioner Municipality, Dhone certifying the demise of P. Bhaskar Rao on 29-11-2006. These two documents are envisaging the facts not in dispute and so they need any further appreciation than what they stand for and denote.
7. The Ex.A3/B7 is a communication dated 31-3-2007 /11-4-2007 of the opposite party No.2 addressed to complainant covering there in the questions and answers of the policy holder given in his personal statement as to his health and the revival proposal dated 21-11-2006 and the said revival of the policy as void for suppression of the said fact of treatment of the policy holder for disseminated malignancy under gone prior revival of policy and there by repudiating the claim . The complaint and sworn affidavit of the complainant say of the alleged revival of the lapsed policy by policy holder on 21-11-2006 . The Ex.B1 attested Xerox copy of ordinary revival quotation dated 21-11-2006 submitted by the policy holder to the LIC also confirm the same. The Ex.B2 personal statement regarding health given by the deceased policy holder on 21-11-2006 while seeking revival of the policy and the policy holder in his declaration signed by him affirms the truth of the statements made therein and agrees to forfeit to the corporation all moneys which shall have been paid in respect there of and if there is any omission including that of his health . Hence, if there is any suppression of material facts including as to the state of his health will enable the insurance corporation not only to hold the revival as void but also to forfeit the amounts paid by the policy holder.
8. As the opposite party has availed that the contingency in repudiating the insurance claim of the complainant on the ground that the deceased policy holder suppressed the treatment he had under gone prior to revival as to complaint of disseminated malignancy the further point remaining for consideration is whether the opposite parties has substantiated the same for justifying the repudiation of complainants insurance claim.
9. The Ex.B3 is said to be an extract of case sheet relating to P.Bhaskar Rao in patient No.7391 dated 28-2-2005 of Government General Hospital, Kurnool. It envisages that the said patient was admitted on 28-2-2007 with complaints of block colour vomitings (haematomia) and weekness and giddimess since last 10 days to them and with a past history of under going “Ant . GT for cancer stomach at Kidwai Cancer Hospital one month ago and the said patient under going surgery on 16-3-2005 from 10.00 A.m to 5-00p.m laprotomy sub total gastrectomy + GJ + JJ and discharged on 2-4-2005 .
10. The entries at Sl.Nos.8 and 12 of Ex.B4 – claim enquiry report – takes mention of the policy holder under going treatment for 18 days taking admission on 1-3-2005. The said enquiry report recommends for having a details of case sheet or treatment and the care relating to the policy holder .
11. The Ex.B5 medical attendance certificate said to have been signed and issued by Dr. G. Mallukarjuna Rao – General Surgeon (MS) Government General Hospital says he was medical attendant to said Bhaskar Rao since 1 year 8 months and prior to consulting him the said patient was treated by Dr.Sankar Rao – Radio Therapist , Kurnool and the death of the said patient Bhaskar Rao was with primary cause of Carcinoma stomach and secondary cause of disseminated malignancy leading to Cardio respiratory failure and the last consultation of patient to him was on 1-3-2005 .
12. The Ex.B6 certificate of hospital treatment signed and issued by Associate Professor of Surgery , Government General Hospital on 22-1-2007 says the said patient P. Bhaskar Rao was admitted on 29-11-2006 at 12-15 p.m vide in patient No.46854 and absconded from hospital at 2-00 pm of 29-11-2006 and the earlier ailments history of the patient was told to the doctor by P. Mohana Bai the wife of said Bhaskar Rao and the patient was diagnosed as “ disseminated malignancy of jaundices and anohorea ‘”.
13. Except placing the above said record the opposite party side did not substantiate as to the said patient’s earlier under going treatments prior to revival of the policy , by examining the doctor who is acquainted with said fact and treatment rendered to said patient in the period prior to revival and its nexus to the ultimate demise of patient on 29-11-2006 .
14. When claim of insurance was repudiated on the score of suppression material of fact alleged, the Hon’ble APSCDRC , Hyderabad in A. Venkata Ravi Kishore Vs LIC of India and another reported in IV (2007) CPJ 244 holds that the onus to prove fraudulent suppression of material facts is on insurance company and mere production of doctor certificate without examining the doctor not prove that the insured suffering from deceases and suppressed them and so insurance company liable under policy.
15. The Hon’ble NCDRC – New Delhi in LIC of India Vs Smt. Promila Malhotra reported in I (2004) CPJ 91 (NC) also holds the liability of insurance company under policy ,when onus to prove fraudulent suppression not discharged by company.
16. The Hon’ble APSCDRC, Hyderabad , in Kommana Veera raju and other Vs LIC of India and another reported in IV ( 2007) CPJ 163 also holds the liability of the insurance company to pay policy amount with interest when no substantial evidence supported by the affidavit of the doctor , who treated the deceased , filed on record to prove the fraudulent suppression of material facts .
17. In the light of the facts and decisions discussed above as the opposite party not proved as required the alleged fraudulent suppression of material facts as to the earlier treatment said to have undergone by said deceased policy holder prior to revival of the policy , there appears any justification either in repudiating the insurance claim or in settling for ex-gratia payment for paid up value and so said deficient conduct of the opposite parties holds their joint and several liability for not only to the payment of assured amount but also their joint and several liability for compensating the mental agony suffered by the complainant at their deficient conduct and also to the cost of the case as driven the complainant to the forum for redressal of her grievances .
18. Consequently, the case of the complainant is allowed directing the opposite parties 1 to 3 with joint and several liability to pay to the complainant Rs.1 lakh as assured amount under policy of her deceased husband, Rs.10,000/- as compensation for mental agony suffered by the complainant at the deficient conduct of the opposite parties and Rs.5,000/- as cost of this case within a month of receipt of this order. In default the opposite parties 1 to 3 shall jointly and severally liable to pay the supra award amount with 9% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 5th day of September, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Xerox copy of policy No.653296238.
Ex.A2. Xerox copy of death certificate.
Ex.A3. Letter of OP declaring the revival of policy as void.
Ex.A4. Letter dated 18-05-2007 of complainant to Zonal
Manager , Hyderabad.
Ex.A5. Letter of OP dated 9-10-2007 to complainant admitted
for paid up value.
Ex.A6. Office copy of legal notice dated 16-11-2007 along with
Postal acknowledgement and receipt.
List of exhibits marked for the opposite parties:
Ex.B1. Attested Xerox copy of ordinary revival quotation
dated 21-11-2006.
Ex.B2. Attested Xerox copy of personal statement regarding health.
EX.B3. Extract of case sheet of policy holder.
Ex.B4. Claim enquiry report.
Ex.B5. Medical attendance certificate.
EX.B6. Certificate Hospital treatment.
EX.B7. Letter dated 11-04-2007 addressed to complainant by OP.
EX.B8. True copy of claimants statement.
Sd/- Sd/-
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
