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
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Monday the 8th day of August, 2005
C.D.No.57/2005
Y.Subramanyam,
S/o. Y.Rangappa,
H.NO. 80/76/G4,
Krishna Nagar, Kurnool,
Kurnool Dist. . . . Complainant.
-Vs-
1.Branch Manager,
LIC of India Ltd,
Kurnool.
Kurnool Dist.
2.The Divisional Manager,
LIC of India Ltd,
P.B.No.10, College Road,
Cuddapah. . . . Opposite parties
This complaint coming on 6.8.2005 for arguments in the presence Sri P.Sivasudarshan, Advocate for complainant and Sri P. Sivaprasada Reddy Advocate, for opposite parties1 and 2 and stood over for consideration till this day, the Forum made the following
O R D E R
(As per Smt C.Preethi, Member)
1. This CD complaint of complainants is filed under section 11&12 of C.P. Act, 1986, seeking a direction on the opposite parties to pay to the complainant policy amounts under policy bearing No.’s 652679426, 652678911 and 652679249 with 24% interest per annum, Rs. 20,000/- towards compensation for mental agony, Rs.2,000/- as costs of the complaint and any such other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant is that husband of deceased policy holder Y.Shankaramma, who insured her life with opposite parties under three policies bearing No.s 652679426 for Rs. 50,000/- , 652679249 for Rs.50,000/- and 652678911 for Rs. 50,000/-. On 26.8.2001 the policy holder died due to chest pain and the death is a natural one. As the nominee under the above said three policies, the complainant putforth a claim for policy amounts before the opposite parties. But the opposite parties did not pay the policy amount and replied falsely alleging that the complainant’s wife withheld correct information regarding her health at the time of contract of insurance and repudiated the claim. Thereafter, the complainant made several representations to reconsider the said repudiation. Hence, the said repudiation by opposite parties constrained the complainant to seek redressal in this Forum.
3. In substantiation of her case the complainant relied on the following documents Viz (1) repudiation letter dt 31.3.2003 addressed to the complainant (2) death certificate issued by registrar of Births and deaths, dated 5.10.2001 (3) certified copy of policy bearing No. 652678911 dated 19.7.2001 (4) certified copy of policy bearing no. 652679426 dated 6.8,2001 and (5) certified copy of policy bearing No. 652679249 dated 6.8.2001, besides to the sworn affidavit of complainant in reiteration of his complaint averments and the above documents are marked as Ex A.1 to A.5 for its appreciation in this case, the complainant suitably replied to the interrogatories caused by the opposite parties and caused interrogatories to 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 by filling written version of opposite party No.2 and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version of opposite parties questions the maintainability of complainant’s case either in law or on facts, and admits the deceased Y. Shankaramma insured her life under the above said three policies for Rs. 50,000/- each. On the demise of said Y.Shankaramma on 26.8.2001 due to Chest pain, the complainant putforth a claim for insured amount. As the death aroused within 1 year of taking policies investigation was conducted. Which revealed that the deceased was suffering from Carcinoma of Oesophagus and she took treatment at GGH, Kurnool on 2.7.2001 vide OP No. 24646, prior to taking the above said policies and the deceased suppressed the above facts of her ill health and has taken the above said three policies. When the above facts were brought before the notice of the complainant, he voluntarily admitted and submitted a disclaimer on 3.4.2003 stating that there was suppression of material facts about the health of deceased and also agreed for relinquishment of his claim under the above said three policies, the said disclaimer/ relinquishment letter is duly attested by the Notary. It lastly submits that the deceased died due to Carcinoma of Oesophagus only and the complainant is not entitle to the policy amount of the deceased. Hence, there is no deficiency of service on part of opposite parties and seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite parties relied on the following documents Viz (1) proposal form dt 29.6.2001 (2) proporsal form dt 12.7.2001 (3) proposal from dt 22.7.2001 (4) policy bond bearing No.652678911 for sum assured of Rs.50,000/- (5) policy bond bearing No. 652679426 for sum assured of Rs.50,000/- (6) policy bond bearing No. 652679249 for sum assured of Rs.50,000/- (7) repudiation letter dt 31.3.2003 addressed to the complainant and (8) relinquishing claim form dated 3.4.2003, besides to sworn affidavit of opposite party No.2 in reiteration of his written version as defence and the above documents are marked as Ex B.1 to B.8 for its appreciation in this case. The opposite party No.2 suitablely replied to the interrogatories caused by the complainant and caused interrogatories to the complainant.
7. Hence, the point for consideration is to what relief the complainant is remaining entitled alleging deficiency of service and deficient conduct on part of opposite parties:-
8. It may be stated at the outset that the dispute involved in this case centers round the claim of the complainant for insured amounts of Rs. 50,000/- each under three policies bearing No.s 652678911, 652679426 and 652679249 and the dispute of the same is raised by the opposite parties by simply putting the complainant to strictly prove the material allegations of the complaint averments. The material facts that emerge from the averments, the contents of documents are that the complainant is the nominee of the deceased Y.Shankaramma, who insured with opposite parties under the above said three policies. The deceased Y.Shankaramma died on 26.8.2001 due to chest pain. The complainant informed the death of deceased to the opposite parties and submitted claim form to the opposite parties for insured amounts. But the opposite parties repudiated the claim of the complainant vide Ex A.1/B.7. It dates to 31.3.2003. It repudiates the claim made by the complainant for the above said three policies on the reason that the deceased policy holder suppressed material information regarding her health prior to submitting the proposal forms in Ex B.1, B.2 and B.3 and alleged that the deceased was suffering from Carcinoma of Oesophagus. There is no doubt that the onus is on the opposite parties to prove that the deceased Y.Shankaramma was suffering from Carcinoma of Oesophagus, but no material or any direct evidence showing that the deceased actually taken treatment for any decease has been put on the record by the opposite parties. In the absence of any documents, any evidence produced on record primary or secondary regarding the treatment of the deceased before the submission of proposal form, it cannot be said that the opposite parties has proved on the record that the policy holder was suffering from such decease prior to submitting proposal forms. Therefore, the opposite parties have miserablely failed to prove the case by placing any original documents or by placing on record the certified copies of its original, which has not been done. Therefore, in these circumstances the repudiation of claim by opposite parties is wholly arbitrary, unreasonable unjust and amounts to deficiency of service.
9. The opposite parties relied in support of their case on Ex B.8 i.e DISCLAIMER/ relinquishing claim form dt 3.4.2003, alleged to have been submitted by the complainant, who has relinquished the claims under the above said three policies by executing it on 3.4.2003, the proforma in which Ex B.8 was prepared from its columns requires to be taken in the presence of Magistrate, Notary of an officer empowered to administrator oath. The said relinquishing form in Ex B.8 alleged to have been signed by the complainant on 3.4.2003, but the complainant disputes the said Ex B.8 as not signed by him before any Notary and further submits that he never ever signed on oath any disclaimer/ relinquishing claim form and submitted to the opposite parties. Further, from the contents of Ex B.8, it appears to be an obligatory one, as to a certificate to the extent that the contents of said declaration were explained by its certifying officer in vernacular to the person, who has given the said declaratory statement. As the said column is blank, the Ex B.8 statement is remaining devoid of merit on that aspect also. The signatures in the said Ex B.8 and the complainant’s signatures in the complaint and in the sworn affidavit are not tallying and no other material is placed by the opposite parties in support of Ex B.8, when the said exhibit is disputed by the complainant, hence from there it appears that the Ex B.8 relied by the opposite parties does not inspire any confidence about the contents of the said exhibit which can be acted upon. Moreover, the opposite parties in repudiating the claim of the complainant vide Ex A.1/B.7, stated that the deceased suppressed material information and that she was suffering from Carcinoma of Oesophagus, but there is no whisper of the said disclaimer / relinquishing claim form (Ex B.8) in the said repudiation letter. Hence, it appears that it is an after thought of the opposite parties to disclaim the valid claim of the complainant. Hence, the said Ex B.8 bears no binding force for being acted upon by the opposite parties, especially when the said declaration was denied by the complainant and no other material is placed by the opposite party to substantiate the alleged Carcinoma of Oesophagus suffered by the deceased policy holder. Therefore, when the Ex B.8 is not carrying any force, the opposite parties in not paying the policy amounts to the complainant basing on the said Ex B.8 remains not justifiable.
10. Hence, in the circumstances discussed above the burden is upon the opposite parties to show that there is suppression of material facts and the opposite parties miserably failed to prove that there was really any suppression and when there is no suppression there is no necessity for the complainant to submit disclaimer/ relinquishing form to the opposite parties, disclaiming his entitleness to the policy amounts. Hence, the opposite parties cannot rely on the said Ex B.8 to discharge its liability. Therefore, what follows is that there was no suppression of material information by the deceased and hence, the repudiation by the opposite parties is arbitrary, untenable and unreasonable.
11. Having regard to over all consideration there is no hesitation to hold opposite parties have miserablely failed to substantiate that the deceased suppressed material facts about her health condition before taking the policy and that the complainant submitted disclaimer knowing fully aware of the consequences arising there of signed the disclaimer. Therefore, in the said circumstances the repudiation of claim by opposite parties is wholly arbitrary and unjust and amounts to deficiency of service on their part and the complainant is perfectly remaining entitled to the insured amount.
12. In the result, the complaint is allowed directing the opposite parties to pay to the complainant the assured amounts under policies bearing No.s 652679426, 652679249 and 652678911 with 12% interest per annum from the date of demise of deceased till realization along with Rs. 5,000/- as costs within a month of receipt of this order.
Dictated to the Stenographer, Typed to the dictation corrected by us, pronounced in the Open Court this the 8th day of August, 2005.
Sd/-
PRESIDENT
Sd/- Sd/-
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 Repudiation letter dt 31.3.2003 addressed to the complainant.
Ex A.2 Death certificate issued by register of Births and deaths, dated
5.10.2001.
Ex A.3 Certified copy of policy bearing No. 652678911 dated 19.7.2001.
Ex A.4 Certified copy of policy bearing No. 652679426 dated 6.8.2001.
Ex A.5 certified copy of policy bearing No. 652679249 dated 6.8.2001.
List of Exhibits marked for the opposite parties:-
Ex B.1 Proposal Form dated 29.6.2001.
Ex B.2 Proposal Form dated 12.7.2001.
Ex B.3 Proposal Form dated 22.7.2001.
Ex B.4 Policy bond bearing No. 652678911 for sum assured of Rs.50,000/-
Ex B.5 Policy bond bearing No. 652679426 for sum assured of RS.50,000/-.
Ex B.6 Policy bond bearing No. 652679249 for sum assured of Rs.50,000/-.
Ex B.7 Repudiation letter dt 31.3.2003 addressed to the complainant
Ex B.8 Relinquishing claim form dated 3.4.2003.
Sd/-
PRESIDENT
Sd/- Sd/-
MEMBER MEMBER
Copy to:-
- Sri P.Sivasudarshan, Advocate, Kurnool for complainant.
- Sri P.Sivaprasada Reddy, Advocate, Kurnool for opposite party 1 and 2
Copy was made ready on :
Copy was dispatched on :
Copy was delivered to parties:
