BEFORE THE DISTRICT CONSUMER FORUM : WARANGAL
Present: Sri D. Chiranjeevi Babu,
President.
Sri N.J. Mohan Rao,
Member
And
Smt. V.J. Praveena,
Member.
Wednesday, the 21st day of May, 2008.
CONSUMER DISPUTE NO. 89/2004
Between:
Pagidipati Suvartha, W/o Anandam,
Age: 58 years, Occ: Household,
R/o H.No.2-7-155,
Bus stand road, Jangaon,
Warangal District.
… Complainant
AND
Life Insurance Corporation of India,
Rep. by its Branch Manager,
Podduturi Complex,
Hanamkonda,
Warangal District.
… Opposite Party
Counsel for the Complainant : Sri. G.Ravi Kumar, Advocate
Counsel for the Opposite Party : Sri D.Janardhan, 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 complainant P.Suvartha against the Opposite party under section 12 of Consumer Protection Act, 1986 for a direction to pay Rs.5,00,000/- towards policy amount and Rs.1,00,000/- towards damages.
The brief averments contained in the complaint filed by the complainant are as follows:
The complainant is the mother of P. Suresh Babu (herein after referred to as the deceased). The deceased during his life time insured his life for a sum of Rs.5,00,000/- with Life Insurance Corporation of India, Branch Hanamkonda through Jeevan Shree Policy No.682144716. After the death of her son, the complainant submitted claim form and claimed the assured amount. But the Opposite parties repudiated the claim on the ground that the deceased withheld correct information regarding his health at the time of taking the insurance. As such she filed the present complaint before this Forum.
Opposite party filed the Written Version contending in brief as follows:
It is true that the deceased P. Suresh Babu had taken insurance policy bearing No.682144716 for the sum assured Rs.5,00,000/-, proposal date 31-1-02, risk date 28-1-02 mode of payment yearly. Since the claim has occurred within 2 years an enquiry was conducted. In the course of enquiry it has come to light that the deceased was suffering from AIDS during the year 2001. But cause of death was mentioned as Viral Hepatitis. There is no deficiency of service on the part of Opposite party. Hence the complaint is dismissed.
The complainant in support of her claim, filed her Affidavit in the form of chief examination and also marked Exs.A-1 to A-6. On behalf of Opposite party Sri C.V.S.S. Subba Rao filed his Affidavit in the form of chief examination and marked Exs.B-1 to B-9.
Now the point for consideration whether the complaint is entitled for grant of Rs.5,00,000/- towards policy amount and Rs.1,00,000/- towards damages.
No arguments advanced from both side Advocates. This Forum has given number of adjournments to both sides. This is a case of 2004 and it is a long pending case and after gone through the material placed before this Forum in this bundle and after gone through the Affidavits and documents filed by both the parties, our reasons are like this:
The case of the complainant is that even though the deceased i.e, complainant son during his life time has insured his life for a sum of Rs.5,00,000/- with Life Insurance Corporation of Inida, Branch Hanamkonda, Warangal Division through Jeevan Shree Policy No.682144716 and Opposite party also accepted the same policy and after his death when the complainant i.e., mother of the deceased filed claim before Life Insurance Corporation stating that give compensation amount to her an amount of Rs.5,00,000/-, but the Opposite parties repudiated the claim on medical grounds. Thereafter she issued legal notice. Then she filed this case before this Forum directing the opposite parties to grant an amount of Rs.5,00,000/- and also damages 1,00,000/- with costs.
The main contention of the Opposite party is that the deceased died only due to AIDS but not accidental and further he has not informed about his disease at the time of taking policy.
It is true that the deceased was suffering from illness prior to taking the proposal though he knew very well the status of his health at the time of taking his policy, suppressed the fact that giving negative answers to the questions in the proposal form as under which is enclosed the policy before this Forum. As per the policy the deceased was not having any disease. As per question No.1 under the policy i.e., Proposal form, During the last 5 years Did you consult a medical Practitioner for any ailment requiring treatment for more than a week. His answer is “NO”. and further the question is that have you ever been admitted to any hospital or nursing home or general checkup, observation, treatment or operation. Answer is “NO”. Another question Are you suffering from or you ever suffered from ailments pertaining to liver, kidney heart, lungs, brain or nervous system. His answer is “No”. Another question What has been your usual state of health? Answer is good. And another question Have you ever received or at present availing/under going medical active, treatment or tests in connection with hepatitis B or an AIDS related conditon. Answer is NO.
It is evidently mentioned in the proposal form and further when the diseased he himself stated that for the said questions answers No and he has not given answers correctly as per the documents filed by the Insurance as per Ex.B-1. The said Suresh Babu attacked some disease i.e., widal + EST+vE and another receipt shows that Pyrexia. And further the Blood Examination of the deceased Suresh babu is Widal Positive+Vee and another document filed by Opposite party shows that L.F.T.: S Bilirubin (total) 02-1.0 mgs/dl 4.0 mg/dl. And further as per Medical Attendant Certificate i.e., Ex.B-2 the cause of death of the deceased is primary cause is Viral Hepatities. The viral hepatitis disease this nature is not attacked immediately it was attacked so many long back. So as per Insurance it is clear that the deceased not died due to accidental. The diseases are not comes under accidental. The deceased died not accidental, the insurance is not liable to pay the premium amount and further the deceased even though that he was having disease prior to taking policy he has not disclosed the disease before the insurance policy and further it is true the deceased was having AIDS. For this as per Ex.B-9 Bail Petition Order it clearly goes to show that the Petitioner No.1 i.e., P. Suresh Babu in the main order the Petitioner No.1 is suffering with AIDS And he was admitted in NIMS Hospital, report also filed. The order clearly goes to show that the deceased was having AIDS Disease. Certainly the insurance company is not liable to pay the premium amount to the complainant i.e., the mother of the deceased. It is clear cut on the basis of Ex.B-9 that the deceased died only due to AIDS even though the name of the disease i.e., AIDS is not mentioned directly. It
is clear cut that the deceased died only due to AIDS and further prior to taking policy certainly the deceased was having disease, but he suppressed. So it has been held by
“NCDRC New Delhi in LIC Vs Minu Kalita that it is for the Life assured to give the correct information on his health condition. Furnishing of incorrect information, false statement regarding the health would make the insurance contract null and void. As the decision to repudiate all liability on the policy was taken after due consideration of all the facts by the competent Authority, it cannot be said that there is deficiency of service and the complaint is liable tobe dismissed. It cannot be said that there is deficiency of service.
So in this case there is no any deficiency of service because deceased not died due to accidental he died only due to AIDS when he died due to AIDDS and he is not died in an accidental the said insurance is not liable to pay the policy amount. Accordingly we see no grounds to allow this petition. Hence, we answered this point in favour of opposite party against the complainant.
Point NO.2 :To what Relief:- The point NO.1 is decided in favour of Opposite party against the complainant. This point also decided in favour of opposite party against complainant.
In the result there are no merits in the complaint filed by the complainant and accordingly the same is dismissed, but without costs.
(Dictated to the Stenographer, transcribed by her corrected and pronounced by us in the open Forum today, the 21st 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 filed Affidavit of O.P. filed.
EXHIBITS MARKED
On behalf of complainant
- Ex.A-1 Premium receipt of opposite party issued to complainant.
- Ex.A-2 Xerox copy of policy issued by Opposite party.
- Ex.A-3 Status report of policy No.682144716
- Ex.A-4 Letter by Sr.Divisional Manager, LIC to complainant, dt.5-06-2003.
- Ex.A-5 Letter by Sr.Divisional Manager, LIC to complainant, dt.31-12-2002.
- Ex.A-6 Certificate of death issued by Nagar Panchayat, Janagaon.
- Ex.B-1 Prescriptions of Doctor Srihari and report .
- Ex.B-2 Medical Attendant’s Certificate
- Ex.B-3 Certificate of hospital treatment.
- Ex.B-4 Policy.
- Ex.B-5 Proposal for Insurance on own life.
- Ex.B-6 Policy.
- Ex.B-7 First Information Report.
- Ex.B-8 Statement of S.Satyavathi, 14-1-2001.
- Ex.B-9 Order of Hon’ble III Addl.Sessions judge, Warangal.
Sd/-
President.
