BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt.C.Preethi, Hon’ble Lady Member
Friday the 15th day of September, 2006
CC.No. 36/2006
K. Chinna Nagaiah, H/o late K. Venkata Subbamma, Age 43 years,
Meera Puram (V and Post), Banaganapalli (M), Kurnool Dist.
. . . Complainant
Versus
1)Branch Manager,
Life Insurance Corporation Of India Ltd., Banaganapalli (M), Kurnool Dist.
2) Divisional Manager, Life Insurance Corporation Of India Ltd.,
P.B. No. 10, College Road, Kadapa Dist.
. . . Opposite parties
This complaint coming on this day for Orders in the presence of Sri P. Siva Sudarshan Advocate, Kurnool for complainant and Sri M.L. Srinivasa Reddy, Advocate, Kurnool for opposite parties No.1 & 2, and stood over for consideration till this day, the Forum made the following:-
O r d e r
(As per Smt.C.Preethi, Hon’ble Lady member)
1. This consumer complaint of the complainant is filed under section 11 & 12 of CP Act, 1986 seeking a direction on the opposite parties to pay policy amount of Rs.1,00,000/- to the complainant with 24% interest Rs.20,000/- towards mental agony Rs. 2,000/- as costs and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant’s wife K.Venkata Subbamma insured her life with opposite parties under policy bearing No.653044725 for Rs.1,00,000/-. The policy holder died on 17/12/2003 due to Jaundice. On the claim preferred by the complainant the opposite party repudiated through their communication dated 29/03/2004 stating that the policy holder with held correct information regarding her health at the time of taking the policy. But the complainant submits that the policy holder never suffered from any disease and the death of the policy holder was natural one and hence submits that the repudiation of policy by opposite party is deficiency of service towards the complainant.
3. The complainant in support of his case relied on the following documents Viz (1) Attested xerox copy of repudiation letter dated 29.03.2004. (2) Attested xerox copy of policy of the deceased and (3) Attested xerox copy of death certificate, besides to the sworn of affidavit of the complainant it in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A3 for its appreciation in this case. The complainant caused interrogation to the opposite party No.2 and suitablely replied to the interrogation caused by the opposite parties.
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 contested the case. The opposite party No2 filed written version and opposite party No1 adopted the written version of opposite party No2.
5.The written version of opposite parties admits the complainant’s wife has taken a policy on her life for Rs.1,00,000/- under policy bearing No.653044725 under yearly mode with premium of Rs.6884/-. The complainant informed the death of the policy holder on 17/12/2003 and preferred a claim as the claim aroused within 3 months 21 days from the date of commencement of the policy investigation was conducted which revealed that the complainant was suffering from chronic liver disease since one year prior to the proposal and has taken treatment in Government General Hospital Kurnool from 13/11/2003 to 25/11/2003 with I.P.No.37552 and the policy holder did not disclose the above disease in her proposal and answered all questions negatively regarding her personal history. The policy holder has suppressed the material information about her state of ill health before to the date of proposal, hence the contract has became null and void and all monies paid to the corporation shall stand forfeited to the corporation as per policy condition 5 of said policy. Therefore, the repudiation of policy by opposite parties was made on justifiable ground after due application of mind and lastly seeks for the dismissal of complaint.
6. In substantiation of their case the opposite parties relied on the following documents Viz (1) Claim form B1 (form No.3816) (2) proposal of the deceased
Policy holder (3) Policy bond issued to the deceased policy holder (4) Case sheet extract prepared by Salim Baig, Asst. Branch Manager (S) LIC of India Kurnool, and (5) Repudiation letter dated 29.05.2004 of opposite parties addressed to the complainant, besides to sworn of affidavit of the opposite party No2 in reiteration of their written version averments and the above documents are marked as Ex.B1 to B5 for its appreciation in this case.
7. Hence, the point for consideration is so what relief the complainant is entitled alleging deficiency of service on part of opposite parties.
8. The Ex A1/B5 is the repudiation letter dated 29.03.2004 of opposite parties addressed to the complainant, it repudiates the claim of the complainant as the deceased policy holder withheld correct information regarding her health prior to taking of the said policy. There is no dispute that the deceased K. Venkata Subbamma has obtained a LIC policy bearing No 653044725 for Rs.1,00,000/- vide Ex B.3 by submitting a proposal vide Ex B.2 to opposite parties and nominated K.Chinna Nagaiah as her nominee and the policy holder died on 17.12.2003.
9. The main contention of opposite parties is that the policy holder suppressed material information regarding her health and has taken treatment in Government General Hospital from 13.11.2003 to 26.11.2003. The counsel for opposite parties had forcefully contended that while submitting the personal statement regarding her health in the proposal form in Ex B.2 for taking the said policy, the policy holder had concealed the above said material facts from the opposite parties about her treatment in Government General Hospital, Kurnool therefore the opposite parties are absolutely justified in repudiating the claim of the complainant. The opposite parties in support of their case relied on Ex B.1 to B.5, the Ex B.1 is the claim form No. 3816, the Ex B.2 is the proposal of the policy holder dt 25.8.2003, the Ex B.3 is the policy bond issued to the policy holder bearing No. 653044725 for covering the life risk of the policy holder for Rs.1,00,000/- and nominated the complainant as her nominee and the date of commencement of the policy was from 26.8.2003, the Ex B.4 is the case sheet extract prepared by Salim Baig Asst. Branch Manager LIC of India, Kurnool, the Ex B.5 is repudiation letter of opposite party. The Ex B.2 is the proposal for obtaining the policy in Ex B.3 dt 26.8.2003, at question No.11 (i) in Ex B.2 the policy holder answered negatively to all the questions about her personal History of health. The opposite party strongly alleged that the policy holder with held correct information regarding her health in Ex B.2 and further alleged that they have indisputable proof to show that the policy holder had taken treatment for abdominal pain and breathlessness prior to the date of proposal and brought on record Ex B.4 case sheet extract of Government General Hospital. The extract of case sheet in Ex B.4 relied by the opposite party doesn’t inspire any confidence about the contents of the said document which can be acted upon neither any affidavit of any doctor is filed under whose care the said policy holder has taken treatment nor any affidavit of the person who has alleged to have prepared the extract from Government General Hospital is filed nor any affidavit of any medical expert has been produced to show that the policy holder had taken treatment for abdominal pain. No doubt it has been stated in Ex B.4 that policy holder K. Venkata Subbamma was admitted in Government General Hospital for treatment on 13.11.2003 i.e after taking the policy but no substantiating material is placed on record to support the said Ex B.4 extract of case sheet. In the absence of any supporting material to substantiate the contends of Ex B.4 it cannot be said that opposite parties have proved the said Ex B.4. The Ex B.1 says the treatment the policy holder undergone before to her demise and after the policy is taken and no other material is placed to substantiate that the policy holder suffering from abdominal pain prior to the proposal and has taken treatment. Therefore the opposite parties miserably failed to prove their case by placing any supporting material in support of their allegations, which was not done. Hence, the contends of Ex B.4 cannot be looked into nor it can inspire any confidence to act upon.
10. There is no dispute between the parties that no affidavit of the doctor who is alleged to have treated the policy holder in Government General Hospital is filed, the doctor was neither examined nor his affidavit has been brought on record, unless expert evidence of the doctor who has treated the deceased is produced such evidence cannot be relied upon and form the basis of a finding that the deceased was suffering from any ailment before to the date of proposal. Merely by filling Ex B.4 doesn’t mean that the contends there of are necessarily true, mere assertion or oral testimony in respect of treatment before to the proposal neither inspire any confidence nor can be acted upon and relied upon. It is needless to observe that the burden is on the opposite parties to establish that there was suppression of material facts and the policy holder concealed the said material facts before to the date of proposal. The opposite parties did not adduced any evidence to discharge this burden.
11. In the light of the above discussion and material on record not substantiating any suppression of health condition by the policy holder at the time of taking policy and further there appears any substance in the allegations made by the opposite parties and the complainant is certainly remaining entitled to the assured amount under the said policy as nominee.
12. In the result the complaint is allowed directing the opposite parties to pay to the complainant the assured amount under the policy of the deceased policy holder bearing No. 653044725 with 12% interest from the date of filling of this complaint i.e 3.4.2006 till realization along with Rs.2,000/- as costs of the complaint within a month of receipt of this order.
Dictation to the Stenographer, transcribed by her, corrected and pronounced in the Open Forum this the 15th day of September, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties: Nil
List of Exhibits marked for the complainant:-
Ex A. 1 Attested xerox copy of repudiation letter dated 29.03.2004.
Ex A.2 Attested xerox copy of policy of the deceased.
Ex A.3 Attested xerox copy of death certificate.
List of Exhibits marked for the opposite parties:-
Ex A.1 Claim form B1 (form No.3816).
Ex A.2 Proposal form
Ex A.3 Policy bond issued to the deceased policy holder.
Ex A.4 Case sheet extract prepared by Salim Baig, Asst. Branch Manager (S) LIC
of India Kurnool.
Ex A.5 Repudiation letter dated 29.05.2004 of opposite parties addressed to the
complainant.
MEMBER PRESIDENT
Copy to:-
1.Sri P. Siva Sudarshan, Advocate, Kurnool.
2.Sri M.L.Srinivasa Reddy, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
