Before the District Forum: Kurnool
Present: Sri K.V.H. Prasad, B.A., LL.B., President
And
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Tuesday the 23rd day of November,2004
C.D.No.30/2004
G.Rathnamma,
W/o. Late G. Sanjeeva Reddy,
H.No.25/84,
Sanjeevanagar,
Nandyal,Kurnool Dist. . . . Complainant represented by his counsel
Sri C. Ramana Reddy.
-Vs-
1.LIC of India,
Rep by its Branch Manager,
Kurnool.
2.LIC of India,
Rep by its Divisional Manager,
Divisional Office,
College Road, Kadapa. . . . Opposite party No.1&2 represented by their
Counsel Sri I Anantha Rama Sastry
O R D E R
(As per Smt C.Preethi, Member)
1. This C.D complaint of the complainant is filed under section 12 of C.P. Act, 1986 seeking a direction on the opposite party to pay assured amount of RS. 3,00,000/- with all benefits along with 18% interest per annum from the date of death of insured, Rs.10,000/- as compensation for mental agony, costs of this complaint and any such other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The gist of the complaint of the complainant is that the complainant’s son by name G.Maheswara Reddy took a L.I.C Bima Kiran Policy bearing No.652289942 on his life for Rs.3,00,000/- from opposite party No.1. On 13.2.2001 the insured died at his house due to viral hepatitis. Immediately, the complainant sent claim form with all necessary documents to the opposite party No.1, on 7.10.2002 and the opposite party No.2 repudiated the claim of the complainant on the ground that prior to taking the policy, the insured suffered from haemoptsis decease and consulted a medical man and suppressed the above decease at the time of submitting proposal, but the complainant submits that the insured died due to viral hepatitis which he was suffering since one month prior to his death only and never suffered with Haemoptsis prior to taking this policy. The complainant being vexed with the attitude of the opposite party issued legal notice dt 8.1.2003 requesting to settle the claim and the opposite party replied denying their liability. Hence the complainant approached the Forum seeking redressal.
3. The complainant in support of its case placed reliance on the following documents Viz (1) legal notice dt 8.1.2003 issued by complainant’s counsel to Senior Divisional Manager LIC of India (2) reply dt 16.1.2003 by Senior Divisional Manager LIC of India, Cuddapah and (3) repudiation letter dt 16.12.2002 addressed by Sri Divisional Manager to the complainant, besides to his sworn affidavit in reiteration of his complaint avernments and the above documents are marked as Ex A.1 to A.3 for its appreciation in this case.
4. In pursuance of the service of the notice of this Forum as to the case of the complainant, the opposite parties appeared through their standing counsel and contested the case, the opposite party
No.2 filed written version denying any of its liability and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version of opposite parties even though admit the deceased G.Maheswar Reddy, son of the complainant as the holder of policy as stated in the complaint for the assured sum of Rs.3,00,000/- and nominated her mother Smt G.Rathnamma as nominee but allege suppression of material facts as to his state of health and the treatment he has undergone prior to the proposing the said policy and answering negatively to the questionnaire in serial No.11 of the proposal form and as per his declaration the untrue avernments found in the said proposal form makes the contract of insurance null and void and forfeiture the corporation all the amounts he paid to the corporation. As the claim of policy for assured amount, consequently the demise of the policy holder on 13.2.2001 being within 3 months 11 days from the date of commencement of the policy, as they amount to early claim, investigation was taken up and learnt that the said policy holder was un well earlier to 27.10.2000 and took treatment for bilateral Tuberculosis, Viral Hepatitis, Haemoptsis, loss of weight, loss of Appetite, weakness from Dr Mohammad Ali Condition No.5 of the policy also makes void the policy for with holding any material information and forfeiture all the amounts paid to the corporation in the consequence of the said policies infavour of the corporation in view of the nature of the contract made on the utmost god faith on the deceased statement and the declarations as the suppression of any material facts makes the policy null and void under section 45 of Insurance Act and attracting the forfeiture of the amounts and hence the repudiation of the claim is proper and the action of the opposite parties in the said repudiation suffers with no deficiency and hence seeks the dismissal of complaint with costs.
6. In substantiation of its, the opposite party filed the following documents Viz (1) proposal for Insurance of G.Maheswar Reddy (2) policy bond No.652289942 of Bima Krian Policy (without profits) of G.Maheswar Reddy, (3) Bunch of 12 medical prescriptions (4) questionnaire completed by Dr M.Mohammad Ali dt 24.10.2002 (5) medical attendants certificate issued by Dr M.Mahammad Ali ( 6) certificate of hospital issued by Dr M.Mohammad Ali (7) letter addressed by Dr.K.Pullanna to the Branch manager LIC of India, Kurnool and (8) repudiation letter dt 16.12.2002 of Sri Divisional Manager, LIC of India Cuddapha, besides to the sworn affidavit of opposite party No.2 in reiteration of its written version as defence and the above documents are marked as Ex B.1 to B.8 for its appreciation in this case.
7. Hence the point for consideration is whether the complainant has made out the alleged deficiency of service in the conduct of opposite parties in the repudiation of claim so as to enable herself to the reliefs claimed?:-
8. It is not in dispute that the deceased by name G.Maheswar Reddy has taken Bima Kiran Policy by submitting proposal form on 27.10.2000. It is not in dispute that the complainant /nominee put forth the claim for as insured amount under the policy, the claim was repudiated by the opposite parties vide Ex B.8. The Ex B.8 envisages the repudiation of the claim of the policy bearing No.652289942 of the deceased G.Maheswar Reddy. It says that the claim was repudiated as the said policy holder suffered from Haemoptsis, and also consulted a medical man and taken treatment from him and was suppressed by the said policy holder in the facts relating in his proposal form.
9. The Ex B.3 is the bunch of original medical examination reports and medical receipts, th counsel for complainant has very forcefully contended that said Ex B.3 are original reports and
receipts which are supposed to be in the custody of the deceased, but the opposite parties did not rebut the said contention of the complaint by placing any material as nor there is any avernments in the written version of the opposite party as to how they received the said original receipts and reports, therefore the opposite parties failed to prove the said Ex B.3 as to its possession, so it neither inspires any confidence nor can be acted upon nor relied upon. Hence, the said Ex B.3 cannot be looked in to.
10. From the contends of Ex B.4 questionnaire completed by Dr M.Mohammad Ali, B.5 medical attendants certificate Ex B.6, certificate of hospital and B.7 letter of Dr K. Pullanna, which does not inspire any confidence about the contents of the documents, which can be acted upon. The opposite parties in support of the above exhibits did neither filed the affidavit of the doctor who is alleged to have issued the above certificates nor the doctor has been examined. Unless the expert evidence of the doctor who has treated the complainant is produced, such evidence cannot relied upon and form the basis of a finding, that the complainant has taken treatment for Haemoptsis, prior to submitting of proposal form. Merely filing Ex B.1 to B.8 by opposite parties, it does not mean that the contends there of are necessarily true, no documents or direct evidence produced by the opposite parties about the prior existence of Haemoptsis, mere assertion or oral testimony in respect of treatment prior to taking of policy neither inspire any confidence nor can be acted upon. Onus is on the opposite parties to substantiate their plea that the complainant has concealed material facts of his treatment before taking policy or at the time of submitting proposal form. Hence the exhibits filed by the opposite parties cannot be looked into nor it can inspire any confidence.
11. Having regard to over all consideration, there is no hesitation to hold the opposite parties has miserably failed to substantiate that the complainant before taking the policy or at the time of submitting proposal form suppressed material information about taking treatment for Haemoptsis, from Dr M.Ahmed Ali. Therefore in these circumstances the repudiation of claim by the opposite parties is wholly arbitrary, unreasonable and unjust and amounts to deficiency of service on their part.
12. The written version o f opposite parties contends that the complainant negatively answered to the questionnaire in serial No.11 of the proposal form makes the contract of insurance null and void and condition No.5 of the policy also makes the policy void for with holding material information, hence the repudiation of the claim was made in good faith having regard to the facts and circumstances of the case and after proper investigation. This contention is equally devoid of merit and force as it has been already held that repudiation is arbitrary and untenable and the claim of the complainant should not have been rejected as per the decision of Himachal Pradesh State Consumer Disputes Redressal Commission, reported in 1999 Consumer cases reporter Pg 416. Hence there appears every justification to the claim made by the complainant as the opposite parties by their deficient conduct driven the complainant to Forum for redressal.
13. Therefore, in conclusion of the above discussion and following the aforementioned decision, having regard to such circumstances, the complainant is certainly remaining entitled to the reliefs made in the complaint.
14. In the result, the complaint is allowed, directing the opposite parties to pay to the complainant the insured amount as per the policy of the deceased G.Maheswar Reddy bearing No.652289942 with interest at the rate of 9% per annum from the date of the filling of this complaint till realization along
with Rs.10, 000/- as costs of this case, within one month from the date of receipt of this order.
Dictated to the Stenographer, Type to dictation, corrected by us, pronounced in the Open Court this the 23rd day of November, 2004
Sd/-
PRESIDENT
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MEMBER MEMBER
