BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H. Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B. Com., LL.B., Member
Wednesday the 18th day of January, 2006
C.D.No.58/2005
Smt. K.Gowri Devamma,
W/o Late K.Veera Bhadraiah,
Ramapuram Village,
Owk Mandal, Kurnool,
Kurnool District. . . . Complainant
-Vs-
1.Branch Manager,
Life Insurance Corporation of India Ltd.,
Banaganapalli, Kurnool District.
2.Divisional Manager,
Life Insurance Corporation of India Ltd.,
P.B.No.10, College Road,
Cuddapah - 516004. . . . Opposite parties
This complaint coming on 17.1.2006 for arguments in the presence of Sri P.Sivasudarshan, Advocate, Kurnool for complainant and Sri A.V.Subramanyam, 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 Member)
1. This complaint of the complainant is filed under Section 11 and 12 of C.P.Act 1986, seeking a direction on the opposite parties to pay Rs.50,000/- insured amount with 24% interest per annum from the date of death of deceased till realization, Rs.20,000/- as compensation for mental agony, Rs.2,000/- as cost 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’s husband late K.Veera Badraiah has obtained a policy bearing No.652553200 for Rs.50,000/- and nominated the complainant as nominee under the said policy. The policy holder died on 12-8-2002 due to paralysis and the complainant submitted claim form for insured amount which was repudiated by opposite parties on 31-3-2003 stating that the policy holder withheld correct information regarding his age in answer No.2 in the proposal form by under stating 12 years at the time of assurance. But, the complainant alleges deficiency of service on part of opposite parties in repudiating her valid claim as her husband did not suppress his age in the proposal form and seeks for payment of insured amount.
3. In substantiation of her case the complainant relied on the following documents viz.(1) House Holders Supply Card issued by Department of Civil Supplies to the deceased policy holder K.Veera Badraiah (2) Attested true copy of repudiation letter addressed to the complainant by opposite party No.1 dated 31-3-2003 (3)Attested Xerox copy of policy bond bearing No.652553200 and (4) Certificate of hospital treatment in claim form –B, besides to the sworn affidavit of the complainant and three third party affidavits of B.Ramachandrudu, K.Lakshmi Narasiah and Dr.Radhakrishnaiah. The complainant caused interrogatories to opposite parties and the complainant and the third parties suitabely replied to the interrogatories caused by opposite parties. The above documents are marked as Ex.A1 to A4 for its appreciation in this case.
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 filing written version by 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 denies any of their liability but admits the deceased policy holder (Husband of the complainant) as policy holder of the policy bearing No.652553200 for assured sum of Rs.50,000/- and the complainant was nominated by the deceased as nominee. But it alleges that the claim of the complainant was repudiated on 31-3-2003 as the deceased policy holder K.Veera Badraiah under stated his age by 12 years while taking the policy. The complainant informed about the death of policy holder on 12-8-2002 and preferred a claim as the claim was an early claim investigation was conducted which revealed that the policy holder suppressed his age. It also further submits that the deceased has taken treatment for “HEMI-PLEGIA” at Gowri Gopal Hospital, Kurnool and died due to paralysis on 12-8-2002 and the patient was known HTN and Diabetes Mellitus and in the hospital record the age of the deceased was mentioned as 68 years. Hence, the claim of the complainant was repudiated as per policy condition-5 of the policy, hence, the complainant’s case is not maintainable 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) Original proposal dated 30-6-2001 of K.Veera Badraiah (2) Policy bond bearing No.652553200 of K.Veera Badraiah (3) Attested Xerox copy of Gowri Gopal Hospital treatment record and (4) Repudiation letter addressed to the complainant by opposite party No.2 dated 31-3-2003, besides to the sworn affidavit of opposite party No.2 and the above documents are marked as Ex.B1 to B4 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and to the three third party affidavits and suitabely replied to the interrogatories caused by the complainant.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service and deficient conduct on part of opposite parties.
8. The complainant as the wife and nominee of the deceased policy holder K.Veera Badraiah alleges that her husband died on 12-8-2002 due to paralysis as the death of policy holder aroused within the one month the opposite party conducted investigation and it reveled that the policy holder under stated his age by 12 years in the proposal form and the voters list enumerated on 1-1-2002 of Assembly Constituency reveals that the policy holder age as 67 years. Hence, the opposite parties repudiated the claim of the complainant vide Ex.A2/B4, which dates to 31-3-2003, it repudiates the said claim on the ground that policy holder under stated his age by 12 years and gave a false statement of his age in the proposal form, to substantiate the above contentions the opposite parties relied on the voters list enumerated on 1-1-2002, the particulars given in the voters list has no nexus to prove the age of the voters. The effects of voters list is for registration of a person to vote, wherein he is entitled to vote in an election but to prove the age of the person voters list cannot be an evidence to be relied on. The opposite parties having accepted the insurance coverage to the policy holder under the said policy at the relevant time accepting the age of the policy holder mentioned in the proposal by issuing a policy bond and cannot now take a stand that the policy holder under stated his age by 12 years. To substantiate the above contentions of opposite parties there is absolutely no material placed on record or any documentary record that the policy holder under stated his age, hence, the repudiation by the opposite parties is bad and without any valid reason.
9. Another stand taken by the opposite party is that the policy holder suppressed material information of his health conditions in the proposal form and the policy holder has taken treatment in Gowri Gopal Hospital for “HEMI-PLEGIA” but in the Ex.A2/B4 which repudiates the claim of the complainant does not envisage the above reason for their repudiation. Hence, in the said circumstances the stand taken by opposite parties bears any weight for its consideration.
10. When the death of the policy holder is not in violation of terms and conditions of the policy and when there is no cogent and substantiative material to believe that the policy holder under stated his age by 12 years, the opposite parties has no other go except to honour the terms and conditions of the policy in making its due payment to the nominee/complainant.
11. From the circumstances discussed above there is absolutely no material placed on record by the opposite parties to disbelief the age mentioned in the proposal form as incorrect, in the Ex.A1 house holders supply card the age of the policy holder is mentioned as 49 years in the year 1992 and the three third party affidavits filed by complainant’s side says that the deceased was around 58 years at the time of his death and the hospital record in Ex.B3 also says that the policy holder was 58 years. The citations referred by the complainant of Uttaranchal State Commission between L.I.C of India V/s Bahadur Singh reported in II (2004) CPJ page 74 and another citation of Utteranchal State Commission between L.I.C of India V/s Rajendra Singh reported in I (2005) CPJ page 519, it was held in the above reported decisions that the age mentioned in the Kutumba Registration is more authentic under Panchayat Raj Act and the decision referred by opposite parties reported in 2001 AnWR page 122 of Andhra Pradesh High Court between Seelam Ramanamma V/s Divisional Manager, L.I.C of India, Machilipatnam, is having no relevancy and applicability to this case for want of any similarity in facts with this case.
12. For want of substantiating material in support of opposite parties contentions, the act of repudiating the claim of the complainant by the opposite parties as is remaining without any justifiable excuse, the said conduct of opposite parties is certainly amounting to failure on their part in performing the statutory duty in repudiating the claim and there by amounting to deficiency of service and there by entitling the complainant to the reliefs sought.
13. In the result the complainant is allowed directing the opposite parties jointly and severally to pay insured amount under the policy bearing No.652553200 of K.Veera Badraiah to the complainant with 12% interest from the date of demise of the policy holder till realization along with cost of Rs.2,000/- with in the month of receipt of this order.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open Court this the 18th day of January, 2006.
PRESIDENT
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
Exhibits Marked for the complainant:
Ex.A1 Original House Hold Supply Card issued by Department of Civil Supplies
Ex.A2 True copy attested of repudiation letter, Dt.31-3-2003.
Ex.A3 Attested copy of policy (L.I.C. of India)
Ex.A4 Certificate of Hospital Treatment, claim form B1.
Exhibits Marked for the opposite parties:
Ex.B1 Original Proposal, Dt.30-6-2001.
Ex.B2 L.I.C Policy bond bearing No.652553200. (Original)
Ex.B3 Xerox copy of the Gowri Gopal Apollo Hospitals, Kurnool, record.
Ex.B4 Repudiation order, Dt.31-3-2003. (Policy No.652553200)
PRESIDENT
MEMBER MEMBER
Copy to:-
1. Sri. P.Sivasudarshan, Advocate, Kurnool
2. Sri. A.V.Subrahmanyam, Advocate, Kurnool
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties on:
