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
Tuesday the 28th day of March, 2006
CC. No.149/2005
Chilukuri Padma,
W/o. Late Ramu,
R/o. Venkateswara Nagaram (V),
Dornipadu (M),
Kurnool Dist. . . . Complainant
-Vs-
1. The Divisional Manager,
LIC of India,
Divisional Office,
Kadapa.
2. The Branch Manager,
LIC of India,
Banaganapalli Branch,
Kurnool Dist..
3. The Branch Manager,
LIC of India,
Rajampeta Branch,
Kadapa Dist. . . . Opposite parties
This complaint coming on 20.3.2006 for hearing in the presence of Sri K. Bhaskar Reddy, Advocate, Kurnool for complainant and Sri I. Anantha Rama Sastry, Advocate, Kurnool for opposite party No.1 to 3 and stood over for consideration till this day, the Forum made the following.
O R D E R
(As per the Sri.K.V.H.Prasad,Hon’ble President)
1. This case of the complaint filed under section 12 of C.P. act seeking direction on the opposite parties for payment of Rs.5,50,000/- with bonus, premiums paid, Rs.50,000/- as compensation, and the interest at 24% per annum from the date of demise of the police holder and costs alleging one Chilkuri Ramu- the deceased husband of the complainant was policy holder of the opposite party No.2 and 3 for policy No.652554741 dated 28-8-2001 and policy no.652336108 of 2 years prior to his demise for assured sum of Rs.5,00,000/- and Rs.50,000/- respectively. As the policy holder died suddenly on 30-6-2002 while the said policies were in force and hence claim forms were submitted by the complainant to the opposite parties but the claims was not settled either way by opposite parties so far but all correspondence addressed to the complainant was taken away by the opposite parties on the pretest of the settling the claim and the non responsive conduct of the opposite parties caused mental agony besides to deficiency of service.
2. In pursuance of the receipt of the notice issued by this Forum as to this case of the complainant the opposite parties caused their appearance through their counsel and contested the matter denying any of its liability to the complainant’s claim and filed a written version admitting the deceased Ramu as policy holder of said two policies and the revival of the policy number 652336108 was done on declaration of good health by policy holder on 18-1-2004 subject to payment of due premiums since 28-6-2000 and waiver of interest. But at the time of said revival the said policy holder suppressed his suffering with “Systemic Lumpus Eryitheralaposis” since last two years to then and treatment he had undergone at OWAISI Hospital and research Centre, Hyderabad and on account of incorrect information furnished by the policy holder in said declaration of good health as to his existing ailments the contract of insurance became nul and void and all the payments of policy holder stands forfeited in favour of corporation under condition No.5 of said policy and under a speaking order dated 30-8-2003 the repudiation of the claim was made on said justifiable grounds under due intimation of same to the complainant and so denies the complaint averments has to alleged keeping in darkness of the matters and seeks dismissal of the case with costs.
3. In substantiation of the contentions while the complainant side has relied up on the documentary record in Ex.A1 and the sworn affidavit of the complainant and reply of the opposite party to the interrogatories of the complainant, the opposite parties side has relied upon the documentary record in Ex.B1 to B7 and sworn affidavit averments of the opposite parties and reply of the complainant to its interrogatories and evidence of RW1 recorded through court commissioner and the Ex.C1 marked during said evidence.
4. Hence the point for consideration is whether the complainant has made out any deficiency of service on the part of the opposite party in settlement of the claims of the deceased policy holder and there by the liability of the opposite parties for the claims made in the complaint.
5. The complainant finds an excuse from placing any material on his side except in Ex.A1 alleging all the relevant documents caused to the claim and correspondence received form the opposite parties to reference to said claims while taken by the opposite parties under pretext of settlement but it was denied by the opposite party.
6. The Ex.A1 being a mere letter addressed to the complainant by the opposite party as to the submission of the said claim files to Central Office at Mumbai through its Zonal office, Hyderabad and their pendency the case is warranting the appreciation of the material placed by the opposite party to find a solution to the case of the complainant..
7. The Ex.B1 is the policy bond with its terms and conditions and the said policy bond relates to Rc.No.652336108 dated 28-6-1999 issued on the name of Chilkuri Ramu (Deceased husband of the complainant) by Rajampet Branch (Opposite party No.3) for an assured sum of Rs.50,000/- showing the complainant as nominee. The Ex.B2 is another policy bond with its terms and conditions it pertains to policy No.652554741 dated 28-8-2001 issued on the name of the same policy holder by Banaganapalli Branch (opposite party No.2) for an assured sum of Rs.5,00,000/- and showing the complainant as nominee. The Ex.B3 is the proposed form furnished by the said policy holder for obtaining policy in Ex.B2. In the Ex.B3 the said policy holder gives answers in negative as to his personal history of any previous ailments questioned in Sl.No.11 and affirming his good health and the Ex.B6 is the medical examiners confidential report given by Dr.R.Siva Reddy of Koilakuntla on examination of said policy holder on 15-9-2001 and ascertaining with the said policy holder as to the answers in question No.4 as to his previous medical history. The Ex.B4 is the declaration of good health the said policy holder has signed and furnished to the opposite party No.3 on 18-1-2001 as to policy concerned in Ex.B1. Hence from the perusal of the above record what appears is that the said policy holder has declared his good health in all the occasions pertaining to the said polices in Ex.B1 and B2. The Ex.B5 a revival quotation as to policy in Ex.B1 says of its revival collecting the necessary amounts as the premiums were due on the said policy since June 2000.
8. The Ex.B7 letter dated 30-8-2003 addressed by the opposite party No.1 to the complainant as to policy No.s in Ex.B1 and B2 alleges of the deliberate mistakement and withholding of material information from them by the policy holder regarding his health at the time of getting policy revive in view of the indisputable evidence to the opposite party to show that the said policy holder (Assured insured) has suffered from Systemic Lumpus Erythelatosis with A.N.A.(+ ve) penpigus vulgaris since two years and the treatment is undergone in hospital and so the said revival is nul and void and all the monies paid towards revival of the policy and subsequent there to belongs to the LIC of India. Even though it gives a liberty to the complainant to make an appeal to Zonal Manager its practically amounts to a repudiation of the claim of the policies in Ex.B1 and B2 from its letter and spirit for suppression by the policy holder in declaration of good health as to the above said diseases which with he was suffering since two years and getting treatment.
9. The opposite parties as to the alleged indisputable evidence as to the policy holder concealed as to earlier ailment and treatment which were concealed by the policy holder in his declaration of good health, places reliance on the Ex.C1 death summary dated 22-8-2003 standing the name of the policy holder issued by OWAISE hospital and Research Centre, Hyderabad and the evidence of RW1 Dr.Mazharuddin Alikhan with whom said policy holder has consulted on 26-6-2002 on undergone treatment. The evidence of said says that on 26-6-2002 at 8.10 PM the patient by name C.H.Ramu s/o Subba Rao R/o Nandyal was admitted with complaint of pain, swelling in right lower limb since two days for which he had primary treatment in Kurnool. The said patient as having multiple problems like Systemic Lumpus Erytherlatosis (S.L.E) Pempugis Vulgaris since two years and A.N.A (+ve). He was scene by general physicians namely Dr.Seroz, Dr. Althaf Basha, Dr.Ishaq, Poulmonlogits namely Dr.Mahmud, Dr.Ashak hassan, Cardiologists namely Dr.Sami Ul Zama, Nefralzist by name Dr.Haz and Dr.Krishnan and Aneasthetist namely Dr.Liyaqath Ali and said patient was put to all possible clinical and hematological investigations, C.E.P, T.S.R, R.B.S B.T.C.T, Blood, Urea, Sirom Criatinina, APTT, PT, IWR, PCG, 2D Echo, repeated APG, x-ray right knee, colour doppler of both lower limbs and was diagnosed as deep vein thrombosis (DVT) with cellulites with SLE with Penphigus Vulgaris and hence he was given all necessary medical and clinical care and treatment to meet the seriousness in situation and was put on ventilator on 30th June 2002 at 7 Am and the said patient died on 30-6-2002 at 9.45 AM due to Cardio Respretary Arrest. His evidence says the detailed previous and present history of the said patient including medicines and medication that was taken by said patient at the time of his admission. He deny the suggestion of complainant side that policy holder was not suffering from the said diseases since past two years. No material was brought out its cross examination either to discredit his evidence or due with any suspicion. By his evidence he is making out the identify of policy holder in unmistakable terms with reference to his name and fathers name. Hence the further point for consideration is if so what is the effect of his evidence on the merits and demerits of the complainant’s case.
10. From the evidence of said Doctor the policy holder was examined by him consequent to his admission on 26-6-2002 at 8.10 PM. He learnt from the patient as to the sufferings the said policy holder since two years. Hence he coming to know of the sufferings of the policy holder dates to 26-6-2002. When the said sufferings of policy holder was since two years to then it dates back to 26-6-2000. The policy in Ex.B1 as commenced from 28-6-1999 there arises no circumstances to believe that by that time the said policy holder was suffering with said complications stated by said doctor. But the said policy on account of default of payment of premiums since 6/2000 was revived on 18-1-2001 on the basis of the declaration of good health in Ex.B4 and revival proceedings in Ex.B5. As the revival of said policy in Ex.B1 took place on 18-1-2001, from the material stated supra as the policy holder is appearing as suffering with said diseases since June 2000 itself the non mentioning of said ailments in said Ex.B4 certainly amounts to intentional omission and a misstatement on the part of said policy holder with incorrect statement as to his health and the said intentional omission on the part of the policyholder attracts the condition No.5 of policy dealing with the forfeitures. Hence there appears any error on the part of the opposite parties in repudiating the claim of the complainant as to the policy in Ex.B1 i.e. policy No.652336108 issued by opposite party No.3.
11. The policy in Ex.B2 (Policy No.652554741) commenced from 28-8-2001 on the basis of proposal in Ex.B5 and B6 dated 15-9-2001. To the questioner in column No.11 of Ex.B5 and in Sl.No.4 of Ex.B6 the policy holder declares of his good health. The Ex.B2 and its basis the Ex.B5 and B6 being in chronological order been sufficiently subsequent to the policy holders alleged sufferings since June 2000, the omission on the part of the policy holder in not mentioning his earlier ailments in said Ex.B5 and B6 amounts to misstatement of policy holder to LIC of India with incorrect information has to his earlier medical history and there by is attracting the forfeiture clause envisaged in condition No.5 of the policy and the relevant stipulation in declaration of the proposal. Consequently there appears any error of deficiency of service on the part of the opposite parties in rejecting the claim of the complainant as to the policy in Ex.B2 vide Ex.B7 letter of repudiation.
12. The decision of Hon’ble National Consumer Disputes Redressal Commission, New Delhi in LIC of India V/s Smt.Promilla Malhotra reported in 2003 (2) ALT page 11 (NC) CPA – cited by the learned counsel for the complainant finds any relevancy to the facts and circumstances of this case as the evidence of RW1 Dr.Mazaharuddin Alikhan and the material in Ex.C1 is satisfactory as to the ailments of the policy holder for which he was treated by RW1 and there is any suggestion to RW1 with any admission on his part that such kind of complications with which the policy holder suffered and had treatment can develop all of sudden without any of his earlier chronic history.
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13. Therefore, in the result the case of the complainant being devoid of any proper cause of action and there by any merit and force creating any liability on the opposite parties to the claim of the complainant the case is dismissed with costs.
Dictated to the stenographer, transcribed by him, corrected and pronounced by us in the Open Forum on this the 28th day of March 2006.
PRESIDENT
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant For the opposite parties
-Nil- -Nil-
List of Exhibits Marked for the complainant:-
Ex A.1 Letter, dt 28.10.2004 addressed by opposite party to the complainant.
List of Exhibits Marked for the opposite parties:-
Ex B.1 Policy bond bearing No. 652336108 for Rs.50,000/- issued by opposite party No.3.
Ex B.2 Policy for Rs.50,000/- issued by Banaganappli Branch.
Ex B.3 Proposal for policy of Rs.5,00,000/-.
Ex B.4 Declaration of good health dt 18.1.2001 by deceased.
Ex B.5 revival quotation dt 18.1.2001.
Ex B.6 Medical examiner’s confidential report dt 15.9.2001.
Ex B.7 repudiation letter, dt 30.8.2003.
PRESIDENT
MEMBER MEMBER
Copy to :-
- Sri . K. Bhaskar Reddy, Advocate, Kurnool.
- Sri I. Anantha Rama Sastry, Advocate, Kurnool.
Copy was made ready on
Copy was dispatched on:
Copy was delivered to parties:
