O R D E R
(By Sri S. Bhaskara Rao, Member on behalf of the Bench)
1. The complainant filed the present complaint requiring the opposite parties to pay assured sum of Rs.10,00,000/- for the death of her husband.
2 The case of the complainant in brief is that her husband Manne Veera Venkata Satyanarayana was conductor in A.P.S.R.T.C., Kakinada Depot. During his life time he obtained policy for Rs. 10,00,000/- from the opposite party which was commenced from 28.02.2011. The said policy was obtained at the age of 56 years. After full medical checkup only the 1st opposite party issued policy in favour of the deceased and the yearly premium was Rs.1,16,911/-. The 1st opposite party also collected extra premium from the deceased. The date of maturity of the policy is 28.02.2025. The deceased fulfilled all the requirements as stated by the opposite parties. The complainant is nominee of the deceased for the above said policy.
3 The husband of the complainant died naturally on 15.09.2011 at Kakinada. The complainant approached the 1st opposite party for settlement of the amount and she is entitled to Rs. 10,00,000/- from the opposite party. She also submitted an application along with original documents and when there is no reply from the opposite party she also approached the 2nd opposite party who informed her, the complaint was registered and they are verifying the same. Subsequently the opposite parties have rejected her claim on the ground the deceased suppressed the facts and obtained policy. The said rejection is unreasonable and thus there is deficiency of service on the part of the opposite parties.
4 Resisting the claim of the complainant the 2nd opposite party filed its written version disputing the claim of the complainant mainly on the ground of suppression of fact by the deceased. According to them the assured did give correct answers to the questions and proposal regarding health conditions and according to their enquiries he died at Apollo Hospital, Kakinada with cardiac arrest. According to them the assured was availing sick leaves for a continuous period of 4 ½ months from 29.11.2010 to 19.04.2011. Thus according to them suppressing the health conditions the deceased obtained policy.
5 Now the points for determination are:
- Whether there is any deficiency of service on the part of the opposite parties?
- If so, whether the complainant is entitled for the assured amount of Rs.10,00,000/- claimed by her?
- To what relief?
6. Point No.1: There is no dispute the husband of the complainant who was conductor in APSRTC, Kakinada obtained policy from the opposite parties at yearly premium of Rs. 1,16,911/- and the maturity of policy is 28.02.2025. The death of deceased on 15.09.2011 at Kakinada is also not disputed. Though in the complaint it is averred that the policy holder died naturally, the complainant did not choose to disclose the death of the deceased at Apollo Hospital, Kakinada with cardiac arrest.
7 Here the bone of contention of opposite parties is that suppressing material fact with regard to health condition of the deceased he obtained the policy. Thus they rightly repudiated the claim of the complainant.
8 To prove her claim the complainant filed her chief affidavit and got marked 4 documents. Ex.A1 is premium receipt, Ex.A2 is the death certificate of the deceased, Ex.A3 and A4 are letters from the opposite parties repudiating the claim of the complainant.
9 On the other hand the Manager, Divisional Office of the opposite party had given his chief affidavit in support of their case of the opposite parties and they got marked as many as 7 documents. Ex. B1 is form obtaining medical opinion from D.M.R. in respect of claims cases, Ex.B2 is office copy of repudiating claim proceedings by the 2nd opposite party, Ex.B3 is the standing committee proceedings, Ex.B4 is the certificate by employer issued by APSRTC, Kakinada Depot with regard to sick leave of deceased, Ex.B5 is letter of proceedings submitted by Senior Medical Officer, APSRTC addressed to LIC, Ex.B6 is copy of admission and discharge record of deceased, Ex.B7 is copy of report of Department of Cardiology, Apollo Hospital, Kakinada.
10 As seen from the medical records submitted by the opposite parties the deceased died of Dialtic Cardiomyopathy with Severe Left Ventricular Dysfunction.
11 It is pertinent to mention here that the opposite party mainly contends while deceased was on sick leave he obtained the policy. To buttress their contention they marked Ex.B4 which is the certificate issued by the employer i.e. Depot Manager, APSRTC, Kakinada with regard to the sick leave availed by the deceased. Even according to complainant the policy was commenced from 28.02.2011. As seen from the Ex.B4 the deceased was almost on sick leave since February, 2008 till September, 2011. It is no doubt true the nature of sickness is not mentioned in the certificate but as seen from the medical records the deceased died of Dialtic Cardiomyopathy with Severe Left Ventricular Dysfunction. Thus when the deceased obtained policy admittedly he was on medical leave and this factum of his availing medical leave was not disclosed by the deceased. Ex.B2 fortifies the version of the opposite party. For their questions with regard to any ailment the deceased answered them in negative. Thus what is manifest is by suppressing material fact with regard to health condition the deceased obtained the policy and as such the opposite party rightly repudiated the claim of the complainant. Hence there is no deficiency of service on the part of the opposite parties. Thus this point is answered accordingly.
12. Point No.2: In view of the finding rendered under point No.1 the complainant is not entitled for any amount.
13. Point No.3: In the result the complaint is dismissed in the circumstances without any costs.
Dictation taken by the Steno, transcribed by her, corrected and pronounced by us, in open Forum, this the 04th day of February, 2015.
Sd/- xxxx Sd/- xxxxxxx
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For complainant :
PW1: Smt. Manne Padma Kumari [Complainant ]
For opposite parties:
RW1: Sri K. Suryanarayana, Manager, Life Insurance Corporation of India, Rajahmundry
DOCUMENTS MARKED
For complainant:-
Ex.A1 Premium receipt
Ex.A2 Copy of death certificate of the deceased
Ex.A3 Letter from the opposite party repudiating the claim of the complainant.
Ex.A4 Letter from the opposite party repudiating the claim of the complainant.
For opposite parties:-
Ex. B1 Form obtaining medical opinion from D.M.R. in respect of claims cases
Ex.B2 Office copy of repudiating claim proceedings by the 2nd opposite party [original]
Ex.B3 Standing committee proceedings [original]
Ex.B4 Certificate by employer issued by APSRTC, Kakinada Depot with regard to health period of deceased [original]
Ex.B5 Letter of proceedings submitted by Senior Medical Officer, APSRTC addressed to LIC [original]
Ex.B6 Photostat copy of admission and discharge record of deceased
Ex.B7 Photostat copy of report of Department of Cardiology, Apollo Hospital, Kakinada.
Sd/- xxxx Sd/- xxxxxxx
MEMBER PRESIDENT
