FA.No.1722/2005 against CD.No.268/2003 District Forum, Kadapa.

Between-

The Branch Manager,

LIC of India, Mydukur Road,

Proddatur, Cuddapah District.

…Appellant/Opp.Party.

And

G.Prameela,

D/o.late Maddika Pulla Reddy,

Konarachapalli Village and Post,

Atlur Mandal, Cuddapah Dist.

…Respondent/Complainant.

Counsel for the Appellant                  -      Mr.Singam Srinivasa Rao.

Counsel for the Respondent              -      Mr.S.Harinatha Reddy.

QUORUM- THE HON’BLE MR.JUSTICE D.APPA RAO, PRESIDENT,

SMT.M.SHREESHA,HON’BLE LADY MEMBER,

AND

SRI G. BHOOPATHI REDDY, HON’BLE MALE MEMBER.

MONDAY, THE SIXTEENTH DAY OF JUNE,

TWO THOUSAND EIGHT.

Oral Order (Per Hon’ble Mr.Justice D.Appa Rao, President)

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Heard both sides.

1.         This is an appeal preferred by the opposite party Insurance Company against the order of the District Forum, Kadapa, dated 03.09.2004 in CD.No.268/2003 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 her husband Late Maddika Pulla Reddy took an endowment policy for Rs.1,00,000/- from the appellant Insurance Company paying the yearly premium of Rs.8,373/- and nominated her as his nominee.  Accordingly, the Insurance Company has given endowment policy commencing from 15.09.2001.  The date of maturity is 15.09.2016.  The insured died on 06.11.2001 due to heart attack.  The said fact was informed to the Insurance Company.  However, the claim was repudiated on the ground that the insured was suffering from pre- existing ailment.  Thereupon, the complainant filed the complaint for recovery of the amount covered under the endowment policy together with interest and costs.

2.         The opposite party did not choose to contest the matter despite the notice being served on it. 

3.         The complainant filed Ex.A.1, terms of the policy and Ex.A.2, death certificate issued by the Mandal Revenue Officer, Atlur.  The District Forum after considering the evidence placed on record allowed the complaint directing the opposite party to pay the amount covered under the policy together with interest and costs.

4.         Aggrieved by the said decision, the Insurance Company preferred this appeal contending that the District Forum ought to have given an opportunity to prove that the insured had suffered with carcinoma of bladder and died on 06.11.2001.  He was a known diabetic, hypertensive and also heart patient  and the said fact was suppressed at the time of taking the insurance policy.  Therefore, it prayed that the complaint be dismissed by allowing the appeal.

5.         The point that arises for consideration is whether the District Forum went wrong in awarding the amount covered under the policy?

6.         It is an undisputed fact that the insured had taken an endowment policy, Ex.B.1 on 15.09.2001 for Rs.1,00,000/- and died on 06.11.2001 due to heart attack.  When admittedly the claim form was sent claiming the amount covered under the policy, the appellant never repudiated the policy stating that the insured had pre- existing ailment nor that he was suffering from any heart ailment.  For the first time, along with the grounds of appeal, the appellant filed the case sheet, said to have been maintained by Bollineni Super Speciality Hospital, Nellore.  The fact that the insured was admitted in the clinic was not informed nor the claim was repudiated on the said ground.  Though no separate application was filed to receive the documents, we have perused the case sheet.  It is not known, who secured this case sheet.  No affidavit of the officer is filed, nor that of the doctor, to confirm that the insured had pre-existing heart ailment.  From the perusal of the report, it shows that his heart condition was good (vide page 12).  Apart from it the insured underwent cystectomy when he had  carcinoma of bladder.  We do not see how the said disease was relevant or cause for the death of the insured due to heart attack.  The operation was conducted as long back as on 21.06.2001   However, he died on 6.11.2001.  We do not see any relevancy or nexus of his death to the operation underwent for carcinoma of bladder.  When there is no evidence, whatsoever, and that too when the policy itself is mediclaim policy, where before issuance of the policy the panel doctor has examined the insured, the repudiation for the first time by way of appeal is not justified.  This is a clear deficiency.  We failed to see any merits in the appeal. 

7.         In the result , the appeal is dismissed with costs of Rs.1,000/-.  Time for compliance four weeks.     

PRESIDENT               LADY MEMBER               MALE MEMBER

Dt-16.06.2008.

Vvr.