BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
and
Smt C.Preethi, M.A., LL.B., Member
Tuesday the 21stday of August, 2007
C.C. No.46/2007
Smt. B. Gurupadammma, W/o Late B. Hari Babu,
Kalvakunta Village, Jagadurthy Post, Dhone Mandal, Kurnool District. … COMPLAINANT
Verses
- Branch Manager, Life Insurance Corporation of India Limited,
Kurnool.
- Divisional Manager, Life Insurance Corporation of India Limited,
P.B.No.10, College Road, Cuddapah-516 004. … OPPOSITE PARTIES
This Complaint coming on this day for orders in the presence of Sri.P.Siva Sudharshan, Advocate, Kurnool, for complainant, Sri.L.Hari Hara Natha Reddy, Advocate, Kurnool, for opposite party No.1 and 2, and upon the perusing the material papers on record, the Forum made the following:-
ORDER
(As per Smt. C. Preethi, Member)
C.C.No. 46/2007
- This Consumer complaint of the complainant is filed U/S 11 and 12 of C.P.Act, 1986 seeking a direction on opposite parties to pay to the complainant the policy amount of Rs.40,000/- with 24% interest per annum, Rs.20,000/- towards mental agony Rs.5,000/- towards cost and any other relief or reliefs which the complainant is entitled alleging deficiency of service.
2. The brief facts of the complainant’s case is that the complainant’s husband B.Hari Babu insured his life with opposite parties under policy bearing No.653299856 for Rs.40,000/- and the policy holder died on 5.5.2004 due to fever and the death is a natural one. On the claim preferred by the complainant it was repudiated by the opposite parties on 12.4.2005 stating that the complainant’s husband with held correct information regarding his health at the time of contract of Insurance and they are repudiating the claim. But the complainant submits that her husband never suffered from any decease and he died due to fever only and alleges deficiency of service on opposite parties for repudiating her claim.
3. In substantiation of her case the complainant relied on following document viz., (1) repudiation letter dated 12.4.2005 of opposite parties addressed to the complainant, besides to the sworn affidavit of the complainant and the above documents are marked as Ex.A1. The complainant caused interrogatories to opposite parties and replied to the interrogatories of 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 filed written version of the opposite party No.2 and adoption memo by opposite party No.1.
5. The written version of opposite parties admits the complainant’s husband B.Hari Babu has taken an Insurance Policy for Rs.40,000/- and a policy bearing No.653299856 was issued to the policy holder. The complainant/nominee informed the death of the policy holder on 5.5.2004 due breathlessness and preferred a claim. As the claim aroused within 5 months from the date of commencement of policy the claim was treated as early claim and investigation was conducted which revealed that the policy holder was admitted in Government General Hospital, Kurnool on 4.5.2004 and expired on 5.5.2004 due to Bilateral Extensive Pulmonary Tuberculosis . The claim form B and B.1 issued by Dr. M. Vijay Bhaskar confirms that a deceased was suffering from ill health for the last 5 years prior to the date of death. The policy holder suppressed the above material as to his ill health in the proposal form and obtain the policy declaring his health as good. The declaration signed by the policy holder makes the contract null and avoid. As per the case sheet of Government General Hospital the deceased life assured was suffering from T.B. Hence the opposite parties repudiated the claim on 12.4.2005 and lastly seeks for the dismissal of complaint with costs.
6. In substantiation of her case the opposite parties relied on the following documents viz., (1) proposal form No.10516 of policy holder (2) original policy bond No. 653299856 along with terms and conditions (3)death certificate dated 16.6.2004 (4) claim form A (claimants statement) (5)claim form B (medical attendance certificate) and (6)claim form B1 (certificate of hospital treatment) , besides to the sworn affidavit of opposite party No.2 and the above documents are marked as Ex.B1 to B6 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and replied to the interrogatories of the complainant. The opposite parties also relied on the deposition of R.W.1(Dr. Vijay Bhaskar).
7. Hence the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties ?.
8. It is not in dispute that the deceased B.Hari Babu has obtained a LIC policy bearing No.653299856 for Rs.40,000/- and nominated the complainant as his nominee and the policy holder died on 5.5.2004, on the claim preferred by the complainant it was repudiated by the opposite parties on the reason that the policy holder suppressed material information of his health at the time of taking policy and had taken treatment for tuberculosis in a Hospital prior to taking the policy.
9. Therefore, the main contention of opposite parties is that the policy holder gave in correct statements in the proposal at the time of taking the policy. The counsel for opposite parties forcefully cotended that while submitting the personal statement regarding his health in the proposal from the policy holder knowingly concealed the above material facts from the opposite parties. Hence, they are absolutely justified in repudiating the claim of the complainant. The opposite parties in support of their repudiation mainly relied on Ex.B5 (Medical Attendant’s Certificate) and Ex.B6 certificate of Hospital treatment, in support of Ex.B5 and B6. RW1 Dr.M. Vijaya Bhaskar was examined. The RW.1 stated that one patient by name Hari Babu was admitted in their unit with complication of Bilateral Extensive Pulmonary Tuberculosis and as per the said patient he was suffering with said complication since 5 years and the said patient died on 5.5.2004 after taking treatment for 10 to 11 hours. The evidence of RW.1 that the policy holder was suffering from TB since 5 years is only a hearsay. It is not he who has earlier examined the policy holder (B. Hari Babu) there no record produced before the RW.1 for the alleged suffering with said complication since 5 years. In the Ex. B5 and B6 the RW.1 written that the said patient was suffering with TB since 5 years in the deposition he stated that illness was disclosed by the policy holder himself, the policy holder was admitted from the first time in Government General Hospital, Kurnool, on 4.5.2004 and there is absolutely no paper on record that earlier he has got any treatment before to 4.5.2004. Hence the policy holder been a patient of TB for the last 5 years and the disease was disclosed to him, he must have got some treatment any where, but the opposite parties could not produce any paper as evidence that any where else he has got any treatment, examination prescription prior to taking the policy.
10. It is also settled principle of law that mere statement at time of admission without actual proof is not admissible in evidence and such casual statement cannot form basis of repudiation. Onus is on the opposite parties to show that the statement was on a material matter or facts has been suppressed by the policy holder which it was material for the policy holder to disclose. The complainant relied on the decision of (1) Uttarnchal State Commission Reported in IV 2004 CPJ Pg 129, it was held that mere statement at the time of admission without actual proof is not admissible in evidence and cannot form basis for repudiation. (2) National Commission between LIC of India VS Kamala Devi Gupta, reported in I(2007)CPJ Pg 226, where in, it was held that when no evidence is placed on record to show that the life assured ever remained/admitted in any Hospital for treatment for cancer prior to obtaining the policy, Insurer is liable.
11. To sum up the above discussion, the mere casual statement, the report of the doctor without formal proof, all goes to show that, such bald allegations cannot form basis of rejection of the claim. At least there no evidence that the insured had got any treatment, examination etc., earlier and in the absence of any such evidence to find a way to repudiate the claim cannot be justified. Hence, the complainant is certainly remaining entitled to the assured amount of her husband B. Hari Babu.
12. In the result, the complaint is allowed directing the opposite parties to pay to the complainant the assured amount Under the policy of B.Hari Babu bearing No.653299856 with 9% interest from the date of filling of this case i.e., 9.4.2007 along with Rs.1,000/- as costs of this case within a month of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced in the open bench this the 21st day of August, 2007.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties:
RW.1. Deposition of RW.1 dated 1.8.07
(Dr.M.Vijay Bhaskar)
List of exhibits marked for the complainant:-
Ex.A1 .Repudiation letter dated 12.4.2005.
List of exhibits marked for the opposite parties :
Ex.B1. Proposal Form (in 4 papers) No.10516.
Ex.B2. Original Policy Bond No.653299856 along with terms
And conditions.
Ex.B3. Death certificate , dated 16.6.2004.
Ex.B4. Claim Form ‘ A’ (Claimant’s statement)
Ex.B5. Claim Form ‘B’ (Medical Attendants Certificate)
Ex.B6. Claim Form ‘B’ I (Certificate of Hospital Treatment)
Sd/- Sd/-MEMBER PRESIDENT
Copy to:-
Sri.P. Siva Sudharshan, Advocate, Kurnool.
Sri.L. Hari Hara Natha Reddy,
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
