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
Thursday the 15th day of July, 2004
C.D.No.127/2003
Smt L.Subba Lakshmamma,
W/o. Late L.V.Ramana Prasad,
C/o. Govindappa,
Yallur (V), Allagadda (M),
Kurnool Dist. . . . Complainant represented by his
Counsel C.Ramana Reddy.
-Vs-
1. L.I.C of India
Rep by its Branch Manager,
Nandyal.
2. L.I.C of India
Rep by its Divisional Manager,
Cuddapah. . . . Opposite party No.1&2 represented
by their counsel Sri S.Viswanatha Reddy
O R D E R
(As per Smt C.Preethi, Member)
1. This CD complaint of the complainant is filed under sec. 12 of C.P.Act, 1986 seeking a direction on the opposite party to pay policy amount of Rs.1,00,000/- with all benefits, along with 18% interest per annum from the date of death of the insured, Rs.20,000/- towards damages and mental agony, costs of the case and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complaint of the complainant is that the complainant’s husband L.V.Ramana Prasad insured his life with opposite parties for Rs.1,00,000/- vide policy No. 65266027 in March 2001 and nominated his wife as nominee. On 20.7.2001 the insured died due to heart attack in his village Yallur. Thereafter the complainant submitted claim form along with necessary relevant documents to opposite party No.1 for the insured amount of her husband. The opposite party No.2 addressed a letter to complainant dt 10.12.2001 stating that the death of insured arose within three months 22 days from the date of the policy and the investigation also reveals that the insured suffered from Tuberculosis, Bronchial Asthama etc and requested the complainant to furnish the particulars of admission of insured in hospital etc. Then complainant wrote a letter on 20.1.2002 to opposite party No.2 stating that her husband never suffered with any disease and he did not take any treatment in any hospital and he died due to heart attack only. There after the opposite parties did neither settled the claim nor repudiated claim of the complainant. As the claim of the complainant is not settled even after the lapse of sufficient time, there arises deficiency of service on part of opposite parties.
3. The complainant in substantiation of its case relied on the documents, office copy of letter dt 20.1.2002 addressed to the opposite party No.2 by the complainant and the above is marked as Ex A.1 for its appreciation in this case besides to her sworn-affidavit in support of its case, in-reiteration of her complaint averments.
4. In pursuance to the notice of this Forum as to his case of the complainant the opposite parties appeared through its standing counsel and contested the case by filling written version, denying the complaint as not maintainable either in law or on facts and admits the deceased L.V.Ramana Prasad insured his life with opposite parties for Rs.1,00,000/- vide policy bearing No. 652666027 and the policy commenced from 28.3.2001 and the deceased nominated his wife L.Subbalakshmma as nominee. It also admits the complainant informing the death of the insured on 20.7.2001, due to heart attack and submitting death certificate of the insured. As the claim aroused within a short period, the complainant was requested to submit claim forms A, B, B1, and C and investigation was caused to ascertain, the bonafides of the claim of the complainant. The complainant submitted claim form A&C and returned B and B1 as her husband did not avail any treatment from any doctor and died due to heart attack. But the investigations revealed that the deceased was suffering from advanced stage of Tuberculosis, Ischemic Heart Disease and was unwell for the last 4 to 5 years prior to death, and the deceased was expired in Govt. General Hospital Kurnool. During his life time the deceased availed treatment from Dr, BSC.Murthy of Purna Nursing Home, Nandyal, and from Dr Shaik Igbal Hussain and Dr P.Y.Nagendrudu of Yallur Village for complaint of respiration, bronchial Asthama and Cardial problems for last 3 to 4 years.
5. It further submits that the insured suppressed material information about his ill-health prior to the date of proposal dt 29.3.2001. The cause of death as stated in the medical attendant certificate dt 10.11.2001 is bilateral pulmonary TB and ischemic heart disease, hence the opposite parties have rightly repudiated the claim of the complainant through their speaking Order dt 11.9.2002 and the same is communicated to the complainant by Registered post and there by, there arises no deficiency of service on part of the opposite party and seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite party sides relied on the documents marked as Ex B.1 to B.11 and Ex X.1 besides to its sworn affidavits insupport its defence and deposition of RW.1
7. Hence the point for consideration is whether the complainant proved her case alleging deficiency of service and deficient conduct on part of opposite parties?:-
8. There is no dispute that the deceased L.V.Ramana Prasaed has insured his life with opposite parties for Rs.1,00,000/- vide policy No. 652666027 and nominated his wife L. Subbalaxmamma as nominee. There is no dispute that the death of the deceased occurred on 20.7.2001 and the complainant submitting claim form to the opposite parties for insured amount.
9. The only dispute is the cause of death of the insured, the complainant alleges that her husband died, due to heart attach in his village Yallur but the opposite parties submits that the deceased suppressed material information regarding his health at the time of taking policy and the cause of death of deceased is due to bi-lateral pulmonary TB and ischemic heart disease and died in Govt. General Hospital Kurnool. It would be necessary to have a glance at the material placed on the record of the case. The opposite party placed on record of the complaint documentary evidence in Ex X.1 case sheet of the deceased, with regard to the treatment taken by the insured in Govt. General Hospital, Kurnool.
10. A bare perusal of said Ex X.1 case sheet of the deceased Ramana Prasad indicates treatment taken by the deceased in the said hospital and on page No.1 shows the patient Ramana Prasad was admitted in TBCD ward on 15.7.2001 at 6.30 P.M, vide IP No.23645, under the care of Dr.Kullayappa and the patient was declared dead at 2.45 A.M on 20.7.2001, on page 2 of the said Ex X.1, the head of the unit, makes a mention that the patient was suffering from cough for 2 days and underwent lobectomy at Bangalore, 10 years back and known patient of diabetic and Hypertension and on page 5, out patient ticket goes to show the above said complications and also makes a mention that the patient is known T.B patient.
11. The proposal for insurance was submitted to opposite party on 29.3.2001, it is an admitted fact that the insured did not disclose the existence of the ailment and the facts with regard to having taken treatment prior to the date of making proposal for insurance. He positively stated that he did not suffer from any ailment and he was healthy.
12. In support of the above exhibit the opposite party examined Dr.Kullayapa, professor in TB and chest disease as RW.1 who treated the deceased Ramana Prasad in Govt. General Hospital Kurnool. The said deposition of R.W.1 says that the patient Ramana Prasad was admitted as inpatient on 15.7.2001 in T.B and chest ward with a diagnosis of pulmonary TB with chronic abstractive Pulmonary disease and with acute exacerpation. He further says that the said patient was suffering from maximum breath lessness and cough and under went lobectory 10 years back at Bangalore and on further investigation during his inpatiency, the patient was found suffering from Right Heart failure also i.e carpulmonale. He further says Right Heart failure will occur only due to existence of lung pulmonary problems (lung problems), as lobectomy done 10 years ago, it presupposes lung problems even prior to that, while such is so with the above, the case sheet of the hospital treatment of patient Ramana prasad and deposition of R.W.1 primafacie indicated that the insured L.V. Ramana prasad was admitted to the Govt. General Hospital on 15.7.2001, while suffering from Pulmonary T.B with chronic abstractive pulmonary disease from which the insured suffered for a period of 10 years prior to his admission. Upon admission of the insured to the hospital, treatment for C.O.P.D was given and further investigations during his in patiency found to be suffering from Right Heart failure also. Thus, on the date on which the proposal was submitted to the opposite party, admittedly the insured has been suffering from the afore said ailments 10 years prior to the date of admission in the said hospital. It also appears that lobectomy was done 10 years back, it pre supposes lung problems even prior to that.
13. But as against to it the complainant alleges that Ex X.1 case sheet is of one Rama Prasad and not that of L.V.Ramana Prasad and the opposite parties converted the case sheet of Rama Prasad to Ramana Prasad to suit the needs of the case. In the absence of any cogent substance in support of supra stated contentions of the complainant, the contentions of the complainant cannot be accepted. Subsequent to taking treatment in Govt. General Hospital, Kurnool, the said statement of the complainant on this aspect not only remaining highly inconsistence but also there by un-trust worthy and as committing of any bonafidies of the complainant in that regard. Therefore what follows is that the complainants husband has taken treatment for pulmonary T.B in Govt. General Hospital, Kurnool, under the care of Dr.Kullayappa and died as in patient on 20.7.2001, hence there appears any bonafides on part of the complainant in his hesitation in that regard.
14. Hence, it is classic case of suppression of material facts about the existence of serious disease and knowledge there of on the part of the insured, when the proposal for insurance was moved, when the insured done lobectomy 10 years back. Suppression of information itself violates the terms of the contract-utter most good faith is the tenet of insurance policy, which was not observed by the insured in the instant case as per the decision of Punjab State Commission reported in I (2003) CPJ Pg 15.
15. Hence there remaining no deficiency of service on part of opposite party towards the complainant. The complainant except alleging defaultive and non-settling the claim of the complainant and filing the Ex A.1 did not substantiate her bonafides and malafides of the opposite party by substantiating the same by any accepting and corroborative material.
16. Hence in the said circumstances discussed above as there is no deficiency of service on part of the opposite parties side in not paying the insured amount to the complainant, on the demise of complainant’s husband, as it has been established by the opposite parties that insured L.V.Ramana Prasad had suppressed material information about the state of ill health before the date of proposal for taking the policy. Hence the complainant is not remaining entitled to any of the reliefs sought.
17. In the result, the complaint is dismissed for want of merit and force.
Dictated to the Stenographer, Typed to the Dictation corrected by us pronounced in the Open Court this the 15th day of July, 2004.
Sd/-
Sd/- PRESIDENT sd/-
MEMBER MEMBER
