F.A.No.1516 OF 2007 AGAINST C.D.NO.101 OF 2005 DISTRICT CONSUMER FORUM-II TIRUPATHI

Between

Smt.P.Radha Jananeswari W/o.late P.V.Sudarsana

Prasad, Hindu, aged 40 years, Occ:Household

R/o.D.No.10-9-332, Giridhar Das Street,

Tirupathi, Chittoor District.                                                                                         Appellant/

Complainant

          A N D

1. The Zonal Manager, LIC of India, South

     Central Zonal Office, Jeevan Bhagya,

     Secretariat Road, Saifabad, Hyderabad.

2. The Divisional Manager, LIC of India,

    Divisional Office, Nellore

3. The Branch Manager, LIC of India,

    Puttur Branch, Puttur, Chittoor District.

4. The Branch Manager, LIC of India,

    Branch II Narasimhatheertham Road, Tirupathi.

                                                                                                                    Respondents/opposite parties

Counsel for the Appellant               Mr.Aravala Rama Rao

Counsel for the Respondents         Mr.AV.S.Ramakrishna

QUORUM:            SMT M.SHREESHA, PRESIDING MEMBER

&

SRI K.SATYANAND, MEMBER

WEDNESDAY, THE THIRTIETH DAY OF SEPTEMBER

TWO THOUSAND NINE

Oral Order( As per SMT.M.SHREESHA, Member)
***

Aggrieved by the order in C.C.No.101/2005 on the file of District Forum-II, Tirupathi, the complainant preferred this appeal.

The brief facts as set out in the case are that the complainant’s husband, who was working in T.T.D. press, Tirupathi had taken policy bearing No.841318166 for an assured sum of Rs.10,00,000/- on 28-4-2003 by paying a premium of Rs.5,680/- and another policy bearing No.842050325 on 20-3-2003 for Rs.1,00,000/- by paying a premium of Rs.948/- and yet another policy bearing No.841963699 dated 8-7-2003 for an amount of Rs.50,000/- by paying a premium of Rs.477/-.  The complainant submitted that her husband i.e. P.Sudarasana Prasad never suffered serious ailment during his life time and he died suddenly on 11-9-2003.  The complainant submits that after his death, she made a claim on the foot of the policies to the opposite parties and they repudiated the claim on the ground that there was suppression of material facts and that her husband was of unsound mind.  The complainant submitted that as per the information given by the Press Manager at her husband’s work place, i.e. T.T.D. Press on 7-4-2004, the life assured had ‘absconded’ from duties but never applied for ‘sick leave’.  The complainant also got issued a legal notice on 6-9-2005 objecting to the repudiation by the opposite parties dated 5-2-2005, 31-3-2004 and 12-4-2004 respectively.  Opposite party No.2 gave a reply to the legal notice justifying the repudiation.  Hence the complaint seeking directions to the opposite parties to pay the amounts covered under the three policies with interest and other consequential benefits.

Opposite party No.2 filed a counter on behalf of all the four opposite parties admitting the issuance of the three policies to late P.Sudarsana Prasad.  Opposite party No.2 submitted that the deceased, P.Sudarasana Prasad, had suppressed the information regarding his health.  They contended that he was of unsound mind as per the letter given by the complainant herself to TTD dated 29-1-2001 and also as per the Employer’s certificate that the life assured had absconded from duties from 15-2-2000 to 13-4-2000 and likewise on several occasions till 16-8-2003 i.e. about 25 days prior to his death.  They contend that all these circumstances evidence that the deceased had frequently absconded from his duties due to ill health or unsound mind as stated by the complainant.  They contend that this absconding from duties had taken place prior to the date of proposals on 20-3-2003 and he did not disclose the same in his proposal.  They also contend that the complainant herein had not informed the death of her husband soon after the death and submitted her claims after a belated period of 10 months after the date of death of her husband and contended that their repudiation is justified since the life assured had taken all the three policies suppressing his health condition of unsound mind and hence there is no deficiency of service on their behalf and prayed for dismissal of the complaint with costs.

      The District Forum based on the evidence adduced i.e. Exs.A1 to A12 and B1 to B3 held that there was no deficiency in service on behalf of the opposite parties and dismissed the complaint.

     Aggrieved by the said order, the complainant preferred this appeal.

     The facts not in dispute are that the complainant’s husband, P.Sudarsana Prasad, had taken three policies bearing  No.841318166 for an assured sum of Rs.10,00,000/- on 28-4-2003 by paying a premium of Rs.5,680/- and another policy No.842050325 on 20-3-2003 for Rs.1,00,000/- by paying a premium of Rs.948/- and yet another policy No.841963699 dated 8-7-2003 for an amount of Rs.50,000/- by paying a premium of Rs.477/-. Thereafter on 11-9-2003 the complainant submitted that her husband died of natural death.  It is the case of the complainant that inspite of making claims and submitting all the relevant documents, the opposite parties repudiated the claim merely relying on Exs.B1 to B3 i.e. a letter written by the Employer i.e. T.T.D. Press stating that the life assured had absconded from duties.  The leaned counsel for the appellant/complainant submitted that the life assured never suffered from any unsound mind and did not avail any sick leave and merely absconded from duties as on the dates given in the letter dated 7-4-2004.  The learned counsel for the respondents drew our attention to Exs.B1 to B3 and contended that the life assured had absconded from duties for an inordinate period of time because of unsound mind.  That Ex.B1 did not mention anything about unsound mind, it merely stated that the complainant’s husband had not availed any sick leave and absconded on those relevant dates.  The learned counsel for the respondents also relied on Ex.B2, which is a letter purported to have been addressed by the complainant to the employer dated 29-1-2001 in which she stated that late P.V.Sudarshana Prasad had absconded from duties for the last six months due to unsound mind.  We observe from the record that this letter is dated 29-1-2001 and has been filed before the District Forum on 5-1-2006 and the policies are all dated 2003 and 2004 and it is filed 4 years after issuance of the purported letter.  It is also pertinent to note that the complainant had filed her affidavit before the District Forum on 16-11-2005 and we observe that the opposite party never confronted the complainant with respect to the document since it was filed subsequently after the filing of the affidavit.  The learned counsel for the respondents also drew our attention to Ex.B3, which is a certificate of hospital treatment and is dated 21-2-2004 in which it is stated that the life assured was brought to the causality on 11-9-2003 and was unconscious with chest pain and he had chest pain for the last two days and he was brought dead on 11-9-2003.  This document also does not state anything about the patient being mentally unsound, it only states that the patient was unconscious and was suffering from chest pain for the last two days and ultimately died on 11-9-2003.  None of the documents filed by the opposite parties substantiate their contention that the complainant’s husband suffered from unsound mine.  In the absence of any material on record to establish that the life assured had suppressed his health condition wilfully prior to the  taking of the policies, there is no justification for the repudiation.  To reiterate, Ex.B2 is dated 29-1-2001 two years prior to the issuance of the policies.

  In the result the appeal is allowed and the order of the District Forum is set aside directing the respondents to pay the sum assured covered under policies bearing Nos.841318166, No.842050325 and No.841963699 with interest at 6% p.a. from 5-2-2005 till the date of realization together with costs of Rs.2,000/-.  Time for compliance six weeks.

                                                                                                                                            Sd/-

Member.

                                                                                                                                            Sd/-

Member.

JM                                                                                                                                      Dt.30-9-2009