3

heart desease before commencement of policy. The deceased life assured was

reported to have admitted on 5-12-2004 at G.S.R heart care center, Kadapa and

was discharged on 10-12-2004. Again he joined in Sri Mahavir Cardiovascular

Center, Hyderabad on 5-1-2005 and on the same day coronary angiogram was done

to him. The said treatment prior to proposal was not disclosed in the proposal form

dt. 19-3-2005. If the deceased life assured had disclosed the factual state of health,

the proposal for insurance on his life would not have been accepted. Since the

insurance contract is of utmost good faith and the deceased had not disclosed the

material facts of his heart disease at the time of effecting the assurance in terms of

declaration executed by him, the contract was declared null and void and all

monies was forfeited. The proposal was considered under non medical and the life

assured made false statement at the time of entering in to the contract as such R2

prayed to dismiss the case against him in the interest of justice.

4. R1 filed a memo adopting the counter of R2 in all material facts.

5. On the basis of the above pleadings the following points are settled for

determination.

i. Whether the complainant is entitled for the relief as prayed for?

ii. Whether there is any deficiency of service on the part of the

respondents 1 & 2?

iii. To what relief?

6. On behalf of the complainant Ex. A1 to A3 were marked and on behalf

of the respondent Ex. B1 to B8 were marked. Oral arguments were heard from

both sides.

7. Ex. A1 is the original letter dt. 31-3-2008 of the Senior Divisional

Manager, Life Insurance Corporation of India addressed to the complainant

repudiating the claim. Ex. A2 is the Xerox copy of death certificate of the deceased

husband of the complainant dt. 6-6-2007 issued by Dr. C.N. Rangasinha of

Mydukur. Ex. A3 is the Xerox copy of death certificate of the deceased issued by

Panchayat Secretary, Mydukur. Ex. B1 is the original proposal for insurance on

4

own life of B. Prakash Rao, dt. 12-3-2005. Ex. B2 is the original L.I.C policy bond

in the name of the husband of the complainant for Rs. 1,00,000/-. Ex. B3 is the

Xerox copy of cash bill issued by G.S.R. Heart Care Center, Kadapa dt. 5-12-2004

in the name of husband of the deceased. Ex. B4 is the Xerox copy of medical

certificate issued by G.S.R Heart Care Center, Kadapa dt. 10-12-2004 in the name

of the husband of the complainant. Ex. B5 is the Xerox copy of 2D Echo

cardiogram report dt. 7-12-2004 in the name of the husband of the complainant

issued by G.S.R. Heart care Center, Kadapa Ex. B6 is the Xerox copy of discharge

summary report dt. 6-1-2005 in the name of the husband of the complainant

issued by Sri Mahavir Cardiovascular Center, Hyderabad. Ex. B7 is the Xerox copy

of case sheet in the name of husband of the complainant issued by Sri Mahavir

hospital and Research Center, Hyderabad dt. 6-1-2005 and Ex. B8 is the original

letter of Senior Divisional Manager, Life Insurance Corporation of India addressed

to the complainant.

8. Point Nos. 1 & 2 As could be seen from the oral documents on record

the husband of the deceased took a policy in question for Rs. 1,00,000/- with effect

from 28-2-2005 which has triple benefit. It is a salary deducting scheme from the

employer in which Rs. 567/- p.m was deducted from the salary of the husband of

the deceased. Ex. A2, death certificate issued by the local doctor of Mydukur in

which it is stated that the deceased was brought to his hospital on 6-6-2007 at 3.45

p.m with chest pain, swetting etc., On examination he found him dead at 4.00 p.m

on 6-6-2007. According to him, the death is due to Myocardial infraction (severe

heart attack). Ex. B1, the proposal form of the policy in question in which answer

to question No. 10 family history and question No. 11 personal history of the

deceased husband of the complainant was filled up indicating that he possess good

health. The contention of the complainant is that the proposal from Ex. B1 was

filled up by the agent of the Life Insurance Corporation and that the deceased

husband of the complainant is not aware of the terms and conditions printed on Ex.

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B1 in English. But at page 6 of Ex. B1, the deceased husband of the complainant

signed in English certifying that the contents of the document (Ex. B1) have been

fully explained to him by R. Bhaskar Reddy Life Insurance Corporation agent and at

the end of para – 6 of Ex. B1, the husband of the complainant certified in English

stating that the answers to question Nos. 10 onwards on Ex. B1 have been correctly

recorded. The deceased husband attested his signature in English underneath the

said endorsement. Ex. B3 is the cash bill in the name of the husband of the

complainant which indicates he was admitted in a private hospital at Kadapa on

5-12-2004 and he was in ICCU for two days. Ex. B4 indicates that the husband of

the complainant was admitted on 5-12-2004 in G.S.R Heart Care Hospial, Kadapa

for his heart disease with Inferior post RVMI, Post STR, Moderate LV dysfunction

etc,. This document shows that the husband of the deceased was having heart

problem and at the time of his discharge he was advised medicine pertaining to

cure of heart disease only. Ex. A5 is the Echo report of the husband of the

complainant dt. 7-12-2004 that indicates that he was having heart problem to the

reasonable extent. Ex. B8 discharge summary issued by Mahavir Cardiovascular

Center, Hyderabad dt. 6-1-2005 indicates that the husband of the complainant was

having RVMI post stoke on 5-12-2004 and he was having moderate LV dysfunction

with 40% pumping capacity, RV Dysfunction etc and the angiogram report

indicates 2 vessel disease (LAD & LC) and slow flow in distal RCA that means as on

5-1-2005 the husband of the deceased was having two vessel blocks in the arteries

and his pumping capacity of the heart was 40% and he was a smoker and alcoholic

Ex. B7 case sheet of the husband f the complainant indicates that he was admitted

on 5-1-2005 and discharged on 6-1-2005. Thorough scrutiny of angiogram report

and other tests indicates a severe heart problem to him and at the time of discharge

he was advised the medicines for the treatment of his heart problem. The

contention of the learned counsel for the complainant that there is no signature of

the doctor in the case sheet Ex. B7 is incorrect because there is a initial of the

doctor above the hospital seal against “discharge today”. Ex. B8 is repudiation

6

letter in which R2 repudiated the claim of the complainant on the ground that the

husband of the complainant stated all the answers in the proposal form were false

and that he has suffered from coronary artery disease, old interior wall myocardial

infraction and had taken treatment in the hospital prior to the date of proposal

that he did not disclosed all these facts in his proposal form instead he gave false

answers to all the questions. Ex. A2 death certificate of the deceased issued by a

local doctor also indicates that he died at Mydukur du e t o coronary artery

infraction that strengthen the contention of the respondents and this (Ex. A2) will

support the case of respondents. It is a fact that the husband of the deceased was

admitted on 5-12-2004 at G.S.R. Heart Care Center, Kadapa for heart problem and

was discharged on 10-12-2004. Again he joined at Mahavir Cardiovascular Center,

Hyderabad on 5-1-2005 on the same day coronary angiogram was done to him.

Coronary angiogram report revealed that the deceased husband of the complainant

was suffering from the heart problem with two blocks in the coronary arteries that

he failed to disclose his heart problem in the proposal from Ex. B1. The contention

of the learned counsel of the complainant that the proposal form Ex. B1 was filled

up by the LIC agent will not stand on sound footing for the reason that the

deceased himself signed in English admitting the contents of Ex. B1 was fully

explained to him by the agent and he understood the significance proposed contract

and then signed. The learned counsel for the complainant contended that the

deceased never had heart problem and he died of sudden heart attack on 6-6-2007

has no legs to stand before the truth.

9. The learned counsel for the complainant relied on the following

citations. 1) 1997 STPL (CL) 373 NC a case between Alia Begum Vs. Life Insurance

Corporation of India in which insurance claim was repudiated on suppression of

material regarding illness – No evidence led by insurance company alleged trivial

ailments were material particulars which the deceased was supposed to disclose

they could not be construed as fraudulent suppression of material facts so as to

7

repudiate the contract of insurance. In the result, the appeal was allowed in

favour of the complainant. 2) 2007 STPL (CL) 951 NC a case between New India

Assurance Co. Ltd., Vs. Kaushalya Devi and others in which their lordship held

that the insured suffered epileptic fit before he fell in Kuhal and died due to

asphyxia as a result of drowning. Burden of proof not discharged by petitioner O.P.

that before fall insured had an epileptic fit. Basis for forming the aforesaid opinion

not disclosed by the petitioner nor any evidence led that insured received any

treatment for epilepsy at any time prior to his death – orders of the State

Commission allowing the claim of the respondent upheld. 3) 1995 STPL (CL) 608

NC a case in between Life Insurance Corporation of India Vs. S. Hymavathi in which

their lordship held that section 21 of C.P. Act 1986 – Insurance – Suppression of

Material Facts – Burden of proof – claim repudiated on ground of concealment of

facts – Burden of proof lie on insurance company to prove it. The facts of this case

is that the deceased policy holder underwent Mitral Valvectomy operation of heart

15 years back and that it must be a congenital defect cured by undergoing

operation that subsequently the policy holder worked on the tedious a strenuous

job of a driver of A.P.S.R.T.C vehicle for a least 8 hours a day without any complaint

for 15 years and it is an indication of the health of the policy holder. In the result

the petition was dismissed. The facts of the above three decisions relied by the

learned counsel for the complainant are quite different with that of the facts and

circumstances of the present case for the reasons that the deceased husband of the

complainant was admitted on 5-12-2004 in a local Heart Care Center of Kadapa for

his heart problem and was discharged on 10-12-2004. Again he was admitted at

Sri Mahavir Cardiovascular Center, Hyderabad on 5-1-2005 and was discharged on

6-1-2005. Coronary angiogram was done indicating the blockage of two coronary

arteries and that at the time of discharge he was adviced to take medical

management by prescribing the medicines for curing the heart problem. He took

the LIC policy in question on 19-3-2005 which was commenced from 28-2-2005

and in Ex. B1 proposal form he willfully suppressed his health conditions and also

8

the habit of smoking and taking alcohol. On account of these facts on record the

respondent No. 2 rightly repudiated the claim. The complainant failed to prove her

case at any point of time as such she deserves no consideration in her favour.

10. Point No. 3. In the result, the complaint is dismissed without costs.

Dictated to the Stenographer, transcribed by him, corrected and

pronounced by us in the open Forum, this the 19

MEMBER MEMBER PRESIDENT

APPENDIX OF EVIDENCE

Witnesses examined.

For Complainant : NIL For Respondent : NIL

Exhibits marked for Complainant : -

Ex. A1 Original letter dt. 31-3-2008 of the Senior Divisional Manager,

LIC, Hyderabad addressed to the complainant repudiating the claim.

Ex. A2 X/c of death certificate of the deceased husband of the complainant

dt. 6-6-2007 issued by Dr. C.N. Rangasinha of Mydukur.

Ex. A3 X/c of death certificate of the deceased issued by Panchayat Secretary,

Mydukur.

Exhibits marked for Respondent : -

Ex. B1 Original proposal for insurance on own life of B. Prakash Rao,

dt. 12-3-2005.

Ex. B2 Original policy bond in the name of the husband of the complainant

for Rs. 1,00,000/-.

Ex. B3 X/c of cash bill issued by G.S.R. Heart Care Center, Kadapa

dt. 5-12-2004 in the name of husband of the deceased.

Ex. B4 Xc of medical certificate issued by G.S.R Heart Care Center, Kadapa

dt. 10-12-2004 in the name of the husband of the complainant.

Ex. B5 X/c of 2D Echocardiogram report dt. 7-12-04 in the name of the

husband of the complainant issued by GSR Heart care Center, Kadapa

Ex. B6 X/c of discharge summary report dt. 6-1-2005 in the name of the

husband of the complainant issued by Mahavir Cardiovascular Center,

Hyderabad.

Ex. B7 X/c of case sheet in the name of husband of the complainant issued by

Mahavir hospital and Research Center, Hyderabad dt. 6-1-2005.

Ex. B8 Original letter of Senior Divisional Manager, Life Insurance Corporation

of India addressed to the complainant.

MEMBER MEMBER PRESIDENT

Copy to :-

1) Sri G. Vijaya Narsi Reddy, Advocate.

2) Sri K. Sireesha Reddy, Advocate.

1) Copy was made ready on :

2) Copy was dispatched on :

3) Copy of delivered to parties :

B.V.P. - - -