BEFORE THE A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION

AT HYDERABAD.

F.A. 879/2007  against C.C.  128/2005, Dist. Forum, Srikakulam     

Between:

1)  The Zonal Manager

L.I.C. of India

South Central Zonal Office

Saifabad, Opp. Secretariat

Hyderabad.          

2)  The Divisional Manager

LIC of  India,

Jeevitha Bheema Road

P.B. No. 411,

Visakapatnam

3)  The Branch Manager

LIC Of India

Near New Women’s College

Srikakulam.                                                ***                         Appellants/

                                                                                                OPs

And

Gurugabelli Padmavathi

W/o. Late  G. Bhaskara Rao

Kalinga Mannayyapeta

Amudalavalasa

Srikakulam Mandal & Dist.                        ***                         Respondent/

                                                                                                Complainant

Counsel for the Appellant:                          M/s. A.V.S. Ramakrishna

Counsel for the Resps:                               M/s. M. Viswanadham                                                                                                  

CORAM:

                          HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT     

&

                                            SRI R. L. NARASIMHA RAO, MEMBER

TUESDAY, THIS THE TWENTY SECOND DAY OF DECEMBER THOUSAND NINE

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

                                                          *****

1)                 This is an appeal preferred by  opposite party insurance company against the order of the Dist. Forum directing it to pay the amount covered under the policy together  with  costs

2)                The case of the complainant in brief is that  she is the wife of Gurugubelli  Bhaskara Rao.  He insured his life for Rs. 90,000/- and Rs. 1,50,000/-  on 28.3.2001 and 15.6.2001 respectively.    Before accepting his proposal  the insurance authorities got him examined through its medical officer.   While so, he attended agricultural operations on  29.7.2001,  however in the early hours of 30.7.2001  he suffered from  diarrhoea.  While she was trying to take him to the hospital he died on 30.7.2001.    When the claim was made the insurance company repudiated the claim on the ground that  he was afflicted  from  HIV positive and suppressed the said fact.   The said fact was not true and repudiation was unjust and therefore she  prayed the amount covered under the policies together with compensation and costs be paid.

3)                 The appellant insurance company resisted the case.  However, it admitted issuance of policies mentioned in the complaint.    It alleged that  the assured had suppressed his illness  and hospitalization in K.G. Hospital at Visakapatnam  when  he had suffered from incurable disease of HIV+.  He was hospitalised for 8 days.   Had the said fact been informed the insurance policies could not have been issued.  The allegation that  he died on 30.7.2001  in the early hours  suffering diarrhoea is  false.  As per the case sheet maintained by the K.G. Hospital, Visakapatnam the assured was diagnosed as  HIV+  infected  with  entrovirus  and admitted in the hospital  on  20.3.2001  and was discharged on  28.3.2001.   Since the material fact in regard to his health was  suppressed the insurance company was not liable to pay any amount.   Therefore it prayed for dismissal of the complaint with costs.

4)                 The complainant in proof of her case filed her affidavit evidence and got Exs. A1 to A8 marked while the appellant  insurance company filed the affidavit  evidence of its Manager (L&HPF)   and did not file any documents. 

5)                 The Dist. Forum after considering the evidence placed on record  opined that the allegation that the assured had suffered from  HIV+ infected  with  entrovirus  was not established  and therefore the complainant being the nominee  is entitled to the amount covered under the policies together with costs of Rs. 1,000/-.

6)                 Aggrieved by the said order, the insurance company preferred the appeal contending that the Dist. Forum did not appreciate the facts in correct perspective.   It ought to have seen that the assured died within a short time after taking of these policies.   The complainant   could not prove that the assured died of diarrhoea.  Since the assured had suppressed his ailment of HIV+ infected  with  entrovirus  it vitiate  the very policies.    Therefore it prayed that the complaint be dismissed. 

7)                 It is an undisputed fact that  the complainant is the wife of Gurugubelli  Bhaskara Rao who had taken  two policies  Ex. A1 policy on  5.4.2001 for Rs. 90,000/-  and Ex. A2 policy  on 19.6.2001 for Rs. 1,50,000/- keeping the complainant as his nominee.    The complainant alleges that  her husband died on  30.7.2001 due to diarrhoea and when the said fact was intimated the insurance company repudiated the claim under Ex. A3 Dt. 21.12.2002 alleging that the assured had suffered from HIV+  infected  with  entrovirus and when he submitted the proposal  he suppressed the said ailment  and therefore the complainant was  not entitled to the amount covered under the policies.  

8)                 The point that arises for consideration  is whether the order of the Dist. Forum is vitiated by mis-appreciation of facts  in  this regard?

9)                 While the complainant asserts that he died of diarrhoea on 30.7.2001, the insurance company asserts that he was admitted in KGH Hospital at Visakapatnam  and he was diagnosed as HIV+  infected  with  entrovirus   and was admitted on  20.3.2001 and was discharged on 28.3.2001.  Having come to know that his life is coming to close he took the policies on 5.4.2001 and 19.6.2001 and did not disclose the fact of his admission in KGH hospital at Visakapatnam.

10)               The fact of death of the life assured is not in dispute.   Since the insurance company positively asserts that the assured had suffered from HIV+ infected  with  entrovirus   and admitted in the hospital  for treatment and still more asserts that the case sheet maintained by  KGH Hospital, Visakapatnam discloses the said fact, it did not file the said record nor substantiated the said plea.   It is not known as to why the insurance company  having taken the plea did not file the case sheet  which it was admittedly having  to substantiate the said fact.   This evidence is crucial.  It determines the entire case.   Suppression of this case sheet  was not explained by the appellant though the said fact was pleaded in the affidavit  When there is absolutely no evidence whatsoever that the assured had suffered from  HIV+ infected  with  entrovirus it cannot be said that  he had suppressed the said ailment in the proposal form.   When the insurance company could not  substantiate the plea raised, it must be held that the appellant had to pay the amount covered under the policies.   In fact the insurance company having taken the plea unable to substantiate it.  We do not see any mis-appreciation of facts  by the Dist. Forum in this regard.

11)               In the result the appeal is dismissed with costs computed at Rs. 2,000/-.  Time for compliance four weeks

1)       _______________________________

PRESIDENT                 

2)      ________________________________

 MEMBER          

                                                          Dt.      22.  12.  2009.

*pnr

“UPLOAD – O.K.”