Present:       Sri D. Chiranjeevi Babu,

                                                President.

                                                Sri N.J. Mohan Rao,

                                                Member

                                               And

Smt. V.J. Praveena,

                                                Member.

 Thursday, the 15^th day of May, 2008.

CONSUMER COMPLAINT NO. 62/2007

Between:

1. Rajaboina Devendra, W/o late Rajaboina Ravi,

    Age: 27 yrs, Occ: Household

2. Rajaboina Soujanya, D/o late Rajaboina Ravi,

    Age: 11 yrs, Occ: Student, minor.

3. Rajaboina Sagarika, D/o late Rajaboina Ravi,

     Age: 9 years, Occ: student, Minor.

4. Rajaboina Meghana, D/o late Rajaboina Ravi,

    Age: 7 years, Occ: Student, Minor.

(The complainants 2 to 4 being minors represented by

  their Natural mother/guardian Complainant No.1).

          All are R/o Dharmaram Village, Geesugonda Mandal,

Warangal District.

                      … Complainants

AND

1. Life Insurance Corporation of India,

     Rep. by its Divisional Manager,

     Divisional Office at Jeevan Prakash,

     Balasamudram,

     Hanamkonda.

2.  Life Insurance Corporation of India,

     Rep by is Branch manager.

     Branch Office at Poddutoori Complex,

     Hanamkonda.                                                             …Opposite parties.

Counsel for the Complainant      : Sri. K.V.Narayana Rao,  Advocate

Counsel for the Opposite Parties          : Sri J.J.Ratnam, Advocate.

This complaint coming for final hearing before this Forum, the Forum pronounced the following Order.

                                            ORDER

    Sri D. Chiranjeevi Babu, President

          This is a complaint filed by the Complainants against the Opposite arties  under section 12 of Consumer Protection Act, 1986 for a direction to pay an amount of Rs.1,00,000/- towards policy amount and Rs.10,000/- towards damages.

          The brief averments contained in the complaint filed by the complainant are as follows:

          The complainant No.1 is the wife, Complainant Nos.2 to 4 are the daughters of Rajaboina Ravi (herein after referred to as the deceased.  The deceased during his life time subscribed Insurance Policy with Opposite party No.2 vide Policy No.682159357 for the sum assured Rs.1,00,000/- payable @ Rs.645/- in monthly instalments on 24-05-2004 and made Complainant No.1 as nominee.  The deceased died on 4-10-2005 due to ill health of Typhoid fever. The complainants being legal heirs made application to Opposite party no.2 for getting policy amount.  The Opposite party No.1 addressed to the complainant No.1 repudiating the claim of the complainants.  As such the complainants filed the present complaint before this Forum.

          Opposite parties filed the Written Version contending in brief as follows:

It is true that the deceased Ravi had taken the insurance policy under the Salary Saving Scheme from Opposite party Corporation and the Policy No.682159357 sum insured Rs.1,00,000/- date of commencement 27-05-04, premium per month Rs.645/-, Nominee R. Devendra Complainant No.1.  The deceased cheated insurance without informing about his disease, i.e., he had suffered from Typhoid fever prior to the commencement of the above said policy and availed sick leave for the period from 15-07-03 to 29-08-03 and the sick leave so availed was confirmed by his employer vide their letter dated 23-3-07 and further Opposite party No.2 stated that even though the cause of death is not directly related to the previous disease suffered by the life assured it will have a bearing on assessment of the associated risks for acceptance of the proposal made by the proposer. Hence, the complaint may be dismissed.

          The complainants in support of their claim, filed the Affidavit of complainant No.1 in the form of chief examination and also marked Exs.A-1 to A-3.  On behalf of Opposite parties one V. Ramachandra filed his Affidavit in the form of chief examination and also marked Exs.B-1 to B-4.

          Now the point for consideration whether the complainants are entitled to get an amount of Rs.1,00,000/- from Opposite parties @ interest 18% p.a. and also entitled for grant of amount of Rs.10,000/- towards damages and compensation and with costs.

          After arguments of both side counsels and after gone through the entire record in this bundle, our reasons are like this:

          The case of the complainant is that the husband of complainant No.1 Rajaboina  Ravi was an employee and died on 4-10-2005 due to ill health. During his life time the deceased Ravi has taken insurance policy with Opposite party No.2 vide Policy bearing No.682193957 for the sum assured Rs.1,00,000/- on 24-05-2004.  After the death of the deceased the complainants being the legal heirs have made an application to Opposite party No.2 claiming the policy benefits covered under the above policy.  Opposite party No.1 addressed a letter dated 31-3-2007 stating that the claim was repudiated on flimsy grounds.  Non settlement of insurance claim and repudiation made by the Opposite parties, amounts to deficiency of service and negligence.  Then the complainants filed this case before this Forum for grant of Rs.1,00,000/- along with benefits covered under the policy @ interest 18% p.a. and also award Rs.10,000/- towards damages and with costs.

          Opposite parties filed the Written Version stating that the deceased Ravi had taken the insurance policy under the Salary Saving Scheme from Opposite party Corporation and the Policy No.682159357 sum insured Rs.1,00,000/- date of commencement 27-05-04, premium per month Rs.645/-, Nominee R. Devendra Complainant No.1.  The deceased cheated insurance without informing about his disease, i.e., he had suffered from Typhoid fever prior to the commencement of the above said policy and availed sick leave for the period from 15-07-03 to 29-08-03 and the sick leave so availed was confirmed by his employer vide their letter dated 23-3-07 vide Ex.B-1 and  Ex.B-2  medical certificate obtained by the deceased life assured from Dr.M.Rajaveeru of Sri Laxmi Nursing Home, Dargah, Kazipet. And further Opposite party No.2 stated that even though the cause of death is not directly related to the previous disease suffered by the life assured it will have a bearing on assessment of the associated risks for acceptance of the proposal made by the proposer. Their main contention is that the deceased disclosed the fact before them that he was suffered with Typhoid fever prior to the taking the policy from the Opposite party, it is bad for law and insurance company is not liable to pay amount to the nominee i.e., complainant NO. 1 and others.

          After gone through the evidence of Pw-1 and the documents filed before this Forum, our reasons are like this:

          As per Ex.B-1 it shows the death of the deceased who expired on      4-10-05.  As per Ex.B-2 Medical Certificate the deceased suffered from Typhoid fever from 15-7-03 to 28-09-03.  As per Ex.B-3 the policy was taken by the deceased on 27-5-04.  In between Ex.B-2 Medical Certificate and the  Ex.B-3 Policy i.e. date of commencement of policy, there is gap of 8 months and further the insurance company they have not proposed any certificate that the deceased died due to typhoid fever. The entire arguments and Written Version goes to show that only their presumption that the deceased died due to typhoid fever. When already the deceased was attacked the typhoid fever from 15-07-2003 to 28-09-2003 on that basis only they are presumptioning  that the diseased might have been died due to typhoid fever but there is no such document from insurance side  about the deceased died due to typhoid fever. Since there is no documentary proof to show that the deceased died due to typhoid fever, We are of the opinion that the deceased died only on accidentally but not died due to typhoid fever. So the Opposite parties are liable to pay the premium amount to the complainants.

The counsel for the Opposite parties Cited number of judgments i.e., AIR 1962 Supreme Court 814

“ Mithoolal Nayak,                              …Appellant 

                              Vs

 Life Insurance Corporation of India   …  Respondent.

(B) Insurance Act (4 of 1938), S.45 – Condition for application of second part of S.45 – Fradulent suppression of material facts – Deliberate concealment of fact that proposer had been treated by doctor few months before policy was taken for serious ailment – policy is vitiated – Contract Act (1872), Ss.17, 19 Explanation – Propose if can take advantage of S.19 Explanation.

          So as per this judgment before taking the policy, if the policy holder has a serious ailment i.e., for few months, policy is vitiated.  But in the present case it is true prior to 8 months of taking policy by the deceased he was attacked Typhoid fever and further he died in the year 2005 October, 4^th.  So nearly 1 year 5 months after taken policy he died.   But the Opposite party has not filed any Medical Certificate to show that the deceased died due to Typhoid fever. So the above cited judgment is not at all applicable to the present case of the facts.  So we answered this point accordingly in favour of complainants against Opposite parties.

Point NO.2: To what relief:  The point NO.1 is decided in favour of complainant against Opposite parties, this point also decided in favour of complainant against Opposite parties.

          In the result the complaint is allowed and we direct the Opposite parties to pay an amount of Rs.1,00,000/- (Rs.One lakh only) to the complainants along with interest @7.5% p.a. from the date of filing of the complaint i.e., 28-06-07 till the date of deposit.  We also direct the Opposite parties to pay an amount of Rs.500/- (Rs.Five hundred only) towards costs.

          So far as the apportionment of the policy amount is concerned, the complainant No.1 is entitled to get an amount of Rs.55,000/- and complainants No.2 to 4 are entitled to get an amount of Rs.15,000/- each being the minors, their respective shares shall be ordered to be kept in any Nationalized bank till they attain majority.

          A month’s time is granted to the Opposite parties for the compliance of the order.

(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum today, the 15^th May, 2008).

                                                               Sd/-           Sd/-               Sd/-

                                                          Member       Member       President,

                                                         District Consumer Forum, Warangal.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

On behalf of Complainant                          On behalf of Opposite Party

Affidavit of complainant No.1 filed                 Affidavit of opposite party filed 

EXHIBITS MARKED

On behalf of complainant

1. Ex.A-1 Xerox copy of Legal heir certificate, dt.26-11-05.
2. Ex.A-2 Letter from Opposite party No.1 to Complainant No.1,       dt.31-3-07.
3. Ex.A-3 Status report of the policy.

On behalf of Opposite party.

1. Ex.B-1 is the letter from Food Corporation of India, Warangal to Opposite party No.1, dt.23-3-07.
2. Ex.B-2 is the attested copy of medical certificate issued by Dr.M.Rajaveeru, dt.29-08-2003.
3. Ex.B-3 Policy of Rajaboina Ravi.
4. Ex.B-4 Proposal for insurance.

                                                                Sd/-

President.