BEFORE THE A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION
AT HYDERABAD.
F.A. 1549/2007 against C.C. 775/2006, Dist. Forum-I, Hyderabad.
Between:
1. The Zonal Manager,
LIC of India, South Central Zone Office
Jeevan Bhagya, Saifabad,
Hyderabad-63
2. The Branch Manager,
LIC of India, Medak Branch
Medak *** Appellants/
Ops.
And
Smt Bellam Shanti
W/o Late Seshagiri Rao
Age: 25 years, Occ: Housewife
R/o Machavaram Village,
Medak Mandal & District *** Respondent/
Complainant
Counsel for the Appellants: Mr. A. V. Satyanarayana Rao
Counsel for the Respondent: Mr. N. Ramappa
CORAM:
HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT
&
SRI R.LAXMINARSIMHA RAO, MEMBER
MONDAY, THIS THE EIGHTEENTH DAY OF JANUARY TWO THOUSAND TEN
Oral Order: (Per Hon’ble Justice D. Appa Rao, President)
*****
1) This is an appeal preferred by the insurance company against the order of the Dist. Forum directing it to pay the amount covered under the policy together with interest and costs.
2) The case of the complainant in brief is that she is the widow of late Bellam Sheshagiri Rao. During his life time he had taken Jeevan Mitra Insurance Policy for Rs. 50,000/- for a period of 20 years. He made his wife the complainant, as his nominee. He had paid the premium for 2003-2004 by way of cash. While so, her husband died on 12.5.2004 due to accident.
She had submitted the claim form and also post-mortem certificate, final report etc. After 11 months they sent a cheque for Rs. 3,044/- on the ground that the policy was lapsed. The insurance company having accepted the second yearly premium must be construed that the amount was received and that the policy was not lapsed. Therefore she claimed Rs. 50,000/- together with interest and costs.
3) The insurance company resisted the case. It admitted that late Seshagiri Rao during his life time took Jeevan Mitra insurance policy on 21.1.2003 for Rs. 50,000/- and kept his wife the complainant as nominee. The premium due by January, 2003 was paid. However second premium due by January, 2004 was paid on 14.5.2004 after the death of Seshagiri Rao. By the date of payment it was not aware of the death of the assured Seshagiri Rao. The insured had committed suicide on 12.5.2004 by consuming poison evidenced from FIR, post-mortem examination and other documents. Later she submitted a fake death certificate mentioning that he died on 3.6.2004. In the very claim form she had among other things stated that her husband died on 3.6.2004 by committing suicide. Since the death was within two years from the date of taking policy, as per rules, investigation was conducted. The hospital record maintained by BBR hospital shows that he admitted in the hospital on 12.5.2004 wherein it was diagnosed as ‘Monochroto phosphorous poisoning’, and died on 12.5.2004 while undergoing treatment in the hospital. Suppressing the very fact she must have obtained the death certificate from Panchayat Secretary, G. S. Machavaram of Medak District showing the death as 3.6.2004. She intends to cheat the insurance company by making false claim. Since the premium was received after the death of the assured an amount of Rs. 3,044/- was refunded through cheque by letter Dt. 31.7.2006 which was encahsed by her. Therefore it prayed for dismissal of the complaint with costs.
4) The complainant in proof of her case filed her affidavit evidence and got Exs. A1 to A4 marked while the insurance company filed the affidavit evidence of its Administrative Officer and got Exs. B1 to B9 marked.
5) The Dist. Forum after considering the evidence placed on record opined that there is no evidence that the date of death mentioned in Ex. B7 was incorrect. Admittedly premium due was paid on 14.5.2004 before the death of the assured. Since there is no contra evidence, the death must have been accidental, and opining ‘consumption of poison by mistake is nothing but accident.’ It allowed the complaint directing the insurance company to pay Rs. 50,000/- together with interest @ 9% p.a., from 12.5.2004 with costs of Rs. 2,000/-.
6) Aggrieved by the said order, the appellant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. The Dist. Forum has completely failed to consider the deviation from her own pleadings. During the enquiry she projected the case as as if he died on 3.6.2005, though the entire hospital record and police record show that he died on 12.5.2004. The second premium was due by 21.1.2004 and after the death of the deceased on 12.5.2004, the complainant as an after thought paid the premium; unaware of the same it was received. The death was suicidal and therefore she was not entitled to the amount covered under the policy. Therefore it prayed for dismissal of the complaint with costs.
7) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
8) It is an undisputed fact that the complainant’s husband Bellam Seshagiri Rao had taken a policy for an amount of Rs. 50,000/- wherein she was the nominee. He had to pay yearly premium at Rs. 3,044/- for a period of 20 years, the due date for payment of premium being 21st of every January evidenced under policy Ex. B1. For the premium due for January, 2004 premium was paid on 14.5.2004, after the lapse of the policy. A grace period of one month is allowed for payment of yearly premium.
9) It is also not in dispute that the assured B. Seshagiri Rao died. The complainant alleges that he died on 3.6.2004 evidenced under death certificate Ex. B7 issued by Panchayat Secretary Grade-I, G.S. Machavaram of Medak District, while the insurance company alleges that he died on 12.5.2004 while taking treatment in BBR Hospital, Hyderabad. The insurance company contended that Ex. B7 death certificate was obtained by furnishing false information in order to make the second premium was made well within time. The insurance company received the said payment on 14.5.2004 not knowing the death of the assured on 12.5.2004.
10) At the earliest, the complainant submitted the claim statement under Ex. B2 mentioning that the death was a suicide. She did not mention the date of death. However, in view of the fact that the death was within two years of taking the policy, an investigator was appointed who secured Ex. B2 Medical Attendance Certificate from the R.M.O., BBR Multi Speciality Hospital, Ferozguda, Hyderabad. It was mentioned that B. Seshagiri Rao died at about 1.45 a.m. on 12.5.2004 due to “Cardio-respiratory failure, the cause being “poisoning’. He also obtained Ex. B4 certificate of hospital treatment wherein it was mentioned that the assured has attended casualty on 12.5.2004 at 1.30 a.m. He was in ‘Coma’ at the time of admission. It was diagnosed that he had consumed “Monochroto phosphorous poisoning”. He was expired at 1.45 a.m. on 12.5.2004. The matter was reported to the police by one Bellam Uma Maheswara Rao, a villager of Mahavaram to which the assured belonged to, alleging that on 11.5.2004 at about 10.30 p.m. B. Seshagiri Rao, due to financial distress, consumed poison, fell down and lying on the way side. Immediately he along with father of the assured Venkata Ratnam brought him in an auto to Dr. Suresh at Medak who in turn asked them to take him to Hyderabad. Accordingly they brought him to BBR Hospital, Hyderabad. While taking treatment he died in the hospital on the intervening night of 11/12.5.2004. On receipt of report the police registered a case in Crime No. 176/2004 u/s 174 Cr.P.C. Inquest was conducted on the very same day evidenced under Ex. B8 and the inquestadars were of the opinion that the assured had committed suicide by consuming unknown poison due to financial problems, and heavy loans, and that while he was undergoing treatment at BBR Hospital, Hyderabad he died at 1.45 p.m. on 12.5.2004. Post-mortem was conducted on the very same day by Medical Officer who found that spleen, liver, pancreas were congested vide Ex. B4. He found stomach contains 100 cc brownish fluids, pungent smell present. It was washed with Sodium Chloride. However, the cause of death was not mentioned, in view of the fact that it was sent for FSL report. Later the doctors confirmed that he died due to orange phosphate – an insect-side poisoning.
11) The complainant did not dispute any of these proceedings, right from the registration of the complaint by the police up till Inquest Report and Post Mortem Examination. When voluminous official record maintained by the hospital as well as police authorities was filed, nothing was denied. What all she stated was that having accepted the second premium on 14.5.2004 it must be deemed that they have extended the grace period and waived whatever objections they had. Importantly she did neither dispute that the death of the deceased was suicidal nor the fact of date of death of the deceased on 12.5.2004. She was harping on the date of death mentioned in death certificate Ex. B7 issued by the Panchayat Secretary, G.S. Machavaram of Medak District. It is not known who gave the information to the Panchayat
Secretary as to the date of death. In the teeth of voluminous documentary evidence a mere mention of date of death as 3.6.2004 in Ex. B7 it could not be taken on its face value. The complainant could have sent for the record to prove the information submitted to the Panchayat Secretary for mentioning the date of death as 3.6.2004 is supported by some evidence. The complainant must have given such date under advice.
12) It is contended belatedly without any evidence whatsoever, that the poison was taken accidentally and it was not a suicidal death. At no time, the complainant projected this version. In fact she herself maintained in her ‘Claimant’s Statement’ that the cause of death as ‘Suicide’. No doubt if poison is taken accidentally it cannot be termed as ‘suicide’ whereby she would be entitled to the amount provided the premium was paid within time. It is not known how the Dist. Forum came to the conclusion that he might have taken the poison accidentally. Taking of poison either accidentally or in order to commit suicide was occurred at 10.30 p.m. on 11.5.2004 on a road side. If really the report that was given by one Bellam Umamaheshwara Rao was false immediately she could have informed to the police. The record clearly shows that he committed suicide unable to face the financial constraints and discharge the debts due to others. The complainant did not file the affidavit evidence of any of the villagers to show that he had consumed poison accidentally. There is no positive evidence to show that he had taken poison accidentally. Equally the premium that was paid on 14.5.2004 was after the death of the deceased. The complainant undoubtedly paid the premium after the death of the deceased, in order to get this amount. In the process she obtained Ex. B7 by mentioning wrong date of death. In the light of above facts, we are unable to accept the opinion of the Dist. Forum that the death was accidental and the premium was paid within time. The complainant is not entitled to any more amounts except the premium that was already paid.
13) In the result the appeal is allowed, setting aside the order of the Dist. Forum, consequently complaint is dismissed. No costs.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
Dt. 18. 01. 2010.
*pnr
“UPLOAD – O.K.”
