BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.<br /> <br /> COMPLAINT NO. DCFR. 102/06.<br /> <br /> THIS THE 20th DAY OF FEBRUARY 2007.<br /> <br /> P R E S E N T<br /> <br /> <br /> <br /> 1. Sri. N.H.Savalagi, B.A.LLB. (Spl) PRESIDENT.<br /> 2. Sri. Pampannagouda, B.Sc.LLB. (Spl) MEMBER.<br /> <br /> 3. Smt. Kavita Patil, B.A. MEMBER.<br /> <br /> COMPLAINANT :- Smt. Narayanamma W/o. Sri Narasayya, Aged <br /> about 58 years, Occ: House wife, R/o. Tippu Sultan Road, Manvi. Dist. Raichur. <br /> <br /> //VERSUS//<br /> <br /> OPPOSITE PARTIES :- 1.Life Insurance Corporation of India, Divisional <br /> Office, Represented by its Divisinal Manager, Jeevan Prakash, P.B. No.43, Station Road, Raichur. <br /> <br /> 2. The Manager, Life Insurance Corporation of India Branch Manvi, Dist. Raichur.<br /> <br /> CLAIM :- For direction to the Ops for payment of policy <br /> amount of Rs. 2,00,000/- with accrued bonus and other benefits in-respect of the policy No. 660572995 along with interest at 18% p.a. from 12-08-04, the date of death of Yellappa till realization and also for payment of compensation of Rs. 50,000/- for un-justified repudiation & towards damages along with cost.<br /> <br /> Date of institution :- 18-07-06.<br /> Date of disposal :- 20-02-07.<br /> <br /> Complainant represented by Sri. Keshavarao, Advocate. <br /> <br /> Opponent No 1 & 2 represented by Sri. N.R. Malagi, Advocate.<br /> <br /> -----<br /> This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.<br /> <br /> JUDGEMENT<br /> <br /> This is a complaint filed U/s. 12 of Consumer Protection Act by the complainant Smt. Narayanamma against OP.No-1 Divisional Manager-Life Insurance Corporation of India, Divisional Office Raichur and OP.No-2 Manager Life Insurance Corporation of India, Branch Manvi. The brief facts of the complaint are as under:-<br /> <br /> Complainant’s son Yellappa was holder of two Insurance policies bearing policy No. 660572995 for sum of Rs. 2,00,000/- and policy No. 660507897 for sum of Rs. 50,000/- respectively. He died on 12-08-04. The daughter-in-law of complainant i.e, wife of said deceased Yellappa had pre-deceased him on 21-12-03. The two minor children of Yellappa by name Kum. Keerti aged about (15) years and Karthik aged about (13) years are in the care and custody of the complainant.<br /> <br /> After the death of her son Yellappa, the complainant lodged a claim for the policy amount under two policies. Ops have secured all the relevant documents executed by the complainant for processing the claim. Thereafter on repeated enquiries the Ops have paid only policy amount under 2nd policy No. 660507897 and they have paid only paid-up value of Rs. 15,130/- in-respect of first policy No. 660572995 which was for assured sum of Rs. 2,00,000/-. The repudiation of her claim under policy No. 660572995 is un-justified and illegal and amounts to deficiency in service. Hence for all these reasons the complainant has sought for direction to the Ops for payment of policy amount of Rs. 2,00,000/- with accrued bonus and other benefits in-respect of the policy No. 660572995 along with interest at 18% p.a. from 12-08-04, the date of death of Yellappa till realization and also for payment of compensation of Rs. 50,000/- for un-justified repudiation & towards damages along with cost.<br /> <br /> 2. The Ops 1 & 2 appeared through counsel and filed written statement of OP.No-1 adopted by OP.No-2 as under:-<br /> The life assured Yellappa died on 12-08-04 at Hyderabad and his wife Jayalaxmi-nominee in the policy has pre-deceased him. The date of commencement of policy No. 66057995 for assured sum of Rs. 2,00,000/- is on 28-12-98 and the date of commencement of another policy No. 660507897 for assured sum of Rs. 50,000/- is on 28-03-98. The policy No. 660507897 was fully satisfied in-favour of the complainant and an amount of Rs. 90,842/- is paid to the complainant by waiving the production of the succession certificate and guardianship towards the minor children of deceased Yellappa.<br /> <br /> The Policy No. 660572995 for Rs. 2,00,000/- was in lapsed-condition and the deceased Yellappa got revived the policy and gave personal statement regarding his health on 31-07-04 stating that his health was in good condition. In the said form at Sl.No.2 he had answered to the questions (a) (b) (c) as ‘no, no, no’. After the death of life assured, the OP.No-1 caused inquiry into the bonafides of death of Yellappa as his death was occurred within (11) days after the revival of policy. The inquiry was based on information submitted by the complainant. It revealed that deceased Yellappa was hospitalized from 03-06-03 to 04-06-03 for infected abscess of Right thigh as per Medical Certificate of Dr. Rohini.J.Manvikar of Srinivas Nursing Home Manvi dt. 30-03-05. The basic Principle of insurance contract is “UTMOST GOOD FAITH” is violated abinito. Late Yellapa in his revival policy dt. 31-07-04 gave false information regarding his health condition. The life assured was admitted to Rajiv Gandhi Super Speciality Hospital, Raichur and thereafter he was referred to Hyderabad for higher treatment and he died on 12-08-04 due to kidney problem. The OPEC Hospital records and the records & reports of Hyderabad Hospital shows that the life assured Yellappa was in knowledge of the disease which he was suffering and knew fully well that he will not survive for a long period, as such he has revived the policy which was in lapsed condition by paying late fee so that his legal representatives may get benefit of lapsed policy. The life assured with a malafide intention of causing wrongful loss to the Ops and wrongful gain to his family has revived the policy. Hence the life assured has suppressed the material facts of his taking treatment in Srinivas Nursing Home Manvi. The life assured taking treatment before revival of policy is a material fact which if he had stated so, then the life assured would have been referred to Higher Medical check-up for revival of his policy. The life assured had mis-lead the Ops while reviving the policy.<br /> <br /> The Ops after due application of mind and keeping in-view of legality of matter has settled the policy No. 660507897 in-favour of the complainant and death claim of policy No. 660572995 settled for notional paid-up value of Rs. 15,130/- and the complainant after receiving the amount has given a discharge of death claim dt. 22-03-05 and received the said amount by discharging the OP from payment of the policy amount as such she has accepted the notional paid up value of the policy in full and final settlement and discharge of all claims and demands regarding above said policy. As such the complainant cannot file the present complaint against the said policy. The complainant’s statement and certificate of Hospital Statement by Dr. K.G. Rajaram and Medical Attendant’s Certificate and the case sheet of Rajiv Gandhi Hospital Raichur and Hyderabad Kidney Laproscopic Centre show that the life assured Yellappa died on 12-08-04 due to kidney problem and that he has revived the said policy on 31-07-04 and has suppressed material facts regarding his health at the time of revival of policy.<br /> <br /> The claim of the complainant was partially Repudiated on the ground of suppression of material facts and on going through all the records and after due application of mind has partially repudiated the policy. The complainant is not a nominee of the said policy and as such she cannot file this complaint. There is no cause of action to file the present complaint as the policy is fully discharged by the Ops and complainant has accepted the same and so there is no deficiency in service by the OP.No-1. So the question of payment of interest and compensation does not arise. Hence for all these the Ops have sought for dismissal of the complaint with heavy cost.<br /> <br /> 3. During the course of enquiry the complainant has filed sworn-affidavit by way of examination-in-chief. In rebuttal the Ops have filed sworn affidavit of Divisional Manager as RW-1 and sworn affidavit of one Dr. Rohini J. Manvikar as RW-2. The complainant has got marked (10) documents at Ex.P-1 to P-10. In-rebuttal the Ops have got <br /> marked (11) documents at Ex.R-1 to R-11.<br /> <br /> 4. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:<br /> 1. Whether the complainant proves deficiency in service by <br /> the Respondents as alleged.?<br /> 2. Whether the complainant is entitled for the reliefs sought <br /> for?<br /> <br /> 5. Our finding on the above points are as under:-<br /> 1. In the Affirmative. 2. As per final order for the following.<br /> <br /> REASONS<br /> <br /> POINT NO.1:-<br /> <br /> 6. There is no dispute that late Yellappa had taken two policies in-question and he died on 12-08-04 and his wife-Jayalaxmi pre-deceased him. There is also no dispute that complainant being mother of deceased Yellappa had applied claim under two policies for benefit of the children of late Yellappa and that policy bearing No. 660507897 for assured sum of Rs. 50,000/- was fully satisfied in-favour of the complainant and only paid up value amount was paid in-respect of policy No. 660572995 for assured sum of Rs. 2,00,000/-. <br /> <br /> 7. The Ops contend that the policy No. 660572995 for assured sum of Rs. 2,00,000/- dt. 28-12-98 was in-lapsed-condition and deceased Yellappa got revived the policy and gave personal statement regarding his health on 31-07-04 stating that his health was in good condition by answering the questions (a) (b) (c) at Sl.No.2 of the form as ‘no, no, no’. After his death the OP.No-1 caused inquiry into the bonafides of the death of Yellappa as his death occurred (11) days after reviving of policy. Inquiry was based on the information submitted by the complainant. It reveled that deceased Yellappa was hospitalized from 03-06-03 to 04-06-03 for infected abscess of Right thigh as per Medical Certificate of Dr. Rohini J. Manvikar of Srinivas Nursing Home Manvi dt. 30-03-05. The life assured was also admitted to Rajiv Gandhi Super Specialty Hospital, Raichur and thereafter he was referred to Hyderabad for higher treatment and he died on 12-08-04 due to kidney problem. The OPEC Hospital records and the records & reports of Hyderabad Hospital shows that the life assured was in knowledge of the disease which he was suffering and knew fully well that he will not survive for a long period as such he has revived the policy which was in lapsed condition by paying late fee so that his legal representatives may get benefit and lapsed policy. Hence the late Yellappa in his revival policy dt. 31-07-04 gave false information regarding his health condition and has suppressed material facts of taking treatment in Srinivas Nursing Home Manvi. The life assured taking medical treatment before revival policy is a material fact which if he had stated then the life assured would have been referred to higher medical check-up for revival of his policy. So the life assured has mis-lead the Ops by reviving policy. Hence the Ops have settled for notional paid up value of Rs. 15,130/- and the complainant after receiving this amount has given a discharge of death claim dt. 22-03-05 for full and final settlement and discharge of all claims under the policy.<br /> <br /> 8. The complainant has produced (10) documents namely: Four premium receipts at Ex.P-1 to P-4. Ex.P-5 is the Letter of OP addressed to Yellappa in-respect of policy No. 660572995. Ex.P-6 is the application of the complainant-Narayanamma dt. 12-04-05 addressed to Ops. Ex.P-7 is the letter dt. 31-03-05 by OP to the complainant. Ex.P-8 is the death certificate of deceased Yellappa showing his date of death as 12-08-04. Ex.P-9 is the Death Certificate of Jayalaxmi (the wife of late Yellappa) showing her date of death as on 21-12-03. This shows that late Jayalaxmi, the wife of Yellappa pre-deceased the assured Yellappa. Ex.P-10 is the Medical Examiner’s Confidential Report dt. 31-07-04 regarding medical examination of late assured Yellappa issued by Dr. K.M. Ganesh Babu Manvi. This Ex.P-10 a perusal of which shows that at the time of revival of policy No. 660572995 the assured Yellappa was examined by Dr. K.M. Ganesh Babu and the assured was introduced by Insurance Agent K.Ramesh. In this report Height, weight, chest and pulse rate etc., are shown as normal. The general appearance of health is shown as “Yes”. Sub-questions in question No-4 have been answered as ‘No’ and question No-5 to 16 have also been written as ‘No’ meaning thereby the health of life assured was in-good-condition and he was not subjected to any kind of disease. This Ex.P-10 also shows certificate of the doctor which reads as under:<br /> “I hereby certify that I have, this day, examined the above life to be assured personally, in private and recorded in my own hand (i) the true and correct finding (ii) the answers to Question No.4, as ascertained from the person examined.<br /> I declare that the person examined has signed (affixed his/her thumb impression) in the space earmarked below, in my presence and that I am not related to him/her or the Agent or the Development Officer”.<br /> Dated at Manvi on the 31st day of July 2004.<br /> <br /> Sd/- Sd/-<br /> Signature of the life to be assured Dr.K.M. Ganesh Babu<br /> MBBS.MS.FRSM<br /> Consulting General Surgeon Sai Krishna Hospital MANVI.<br /> <br /> 9. The Ops have filed in all (11) documents namely: Ex.R-1 is the Original policy in-question. Ex.R-2 is the Personal Statement Regarding Health furnished by life assured Yellappa on 31-07-04. Ex.R-3 is the Medical Certificate dt. 30-03-05 issued by Dr. Rohini J. Manvikar of Srinivas Nursing Home at Manvi certifying that one Yellappa had admitted in her hospital on 03-06-03 for infected disease and he was discharged on 04-06-03. Ex.R-4 Claimant’s Statements. Ex.R-5 is the Certificate of Identity And Burial or Cremation of deceased Yellappa. Ex.R-6 is the Certificate of Hospital Treatment issued by Dr. K.G. Rajaram (Neprology) dt. 22-12-04. Ex.R-7 is the Medical Attendant’s Certificate issued by Dr. K.G. Rajaram dt. 22-12-04. Ex.R-8 is Discharge of Death claim under policy No. 660572995 for the paid up value of Rs. 15,130/- full and final settlement issued by complainant-Narayanamma. Ex.R-9 is Patient Pre-operative Check List/ case sheet of the patient Yellappa containing (5) pages in-respect of Yellappa issued by Dr. V.B. Malipatil Rajiv Gandhi Super Specialty Hospital, Raichur dt. 09-08-04. Ex.R-10 is the letter of OPEC Hospital Raichur to General Surgeon/physician Apollo Hospital Hyderabad. Ex.R-11 is the case history sheet of Hyderabad Kidney and Laparoscopic Center Hyderabad dt. 12-08-04 containing (18) pages.<br /> <br /> 10. OP contend that policy-holder the deceased Yellappa got his policy revived by giving personal statement regarding his health on 30-07-04 stating that his health was in-good-condition and he died on 12-08-04. According to the Ops the deceased policyholder has suppressed material fact of his health while submitting personal statement regarding his health on 31-07-04 for revival of lapsed policy. Ex.R-2 is the personal statement regarding health furnished by policyholder Yellappa dated 31-07-04. In this personal statement he has answered sub-questions (a) (b) (c) of question No-2 as ‘No’ ‘No’ ‘No’ meaning thereby he had not suffered from any illness/disease requiring treatment for a week or more. Ex.P-10 is the Medical Examiner’s Confidential Report issued by Dr. K.M. Gangesh Babu dt. 31-07-04. It appears that after furnishing personal statement of health by Yellappa vide Ex.R-2 he was medically examined by the panel doctor of the OP namely Dr. K.M. Ganesh Babu who has issued Medical Examiner’s Confidential Report vide Ex.P-10. In this report at Ex.P-10 also all the questions regarding adverse-health has been answered in the ‘Negative’ meaning thereby the policyholder Yellappa was in good health on 31-07-04 while he was examined by the panel doctor and this panel doctor has certified that he has examined the life assured Yellappa personally, in private and recorded in his own hand. So from a close perusal of Ex.R-2 Personal Statement of Health furnished by Yellappa and Medical Examiner’s Confidential Report of health of Yellappa furnished by the panel doctor at Ex.P-10 are of on same day, dated 31-07-04 and thereby it shows that after Yellappa furnished his personal statement vide Ex.R-2 he was subjected to Medical examination by the panel doctor Dr. K.M. Ganesh Babu who has furnished Medical Examiner’s Confidential Report at Ex.P-10 stating the good health of Yellappa. Therefore it does not lie in the mouth of the OP that the deceased Yellappa had suppressed true facts and if deceased had furnished true facts of his health then they could have referred the life assured for Medical check-up for revival of policy. The Ops have not disputed Medical Examination Confidential Report at Ex.P-10 issued by panel doctor. It would be more so when this Ex.P-10 has been produced by the Ops when they were called-for by the complainant U/s 13(4)(ii) of C.P. Act. So from Ex.P-10 it is crystal clear that at the time of furnishing personal statement of his health for revival of the policy by the deceased Yellappa, he was in good health which has been supported by the Medical Examiner’s Confidential Report issued by panel doctor of the OP at Ex.P-10.<br /> <br /> 11. The Ops have relied on Ex.R-3 the Medical certificate dt. 30-03-05 issued by Dr. Rohini J. Manvikar of Srinivas Nursing Home Manvi stating that deceased Yellappa had taken treatment in her hospital from 03-06-03 to 04-06-03 for infected abscess of Right thigh. This Ex.R-3 has been marked “Subject to proof” like by examining the said Dr. Rohini.J.Manvikar or by producing Medical Records to substantiate the Medical certificate since this certificate is dt. 30-03-05 for the so-called treatment given by her on 03-06-03. However this certificate discloses that deceased Yellapa had taken treatment on 03-06-03 and he was discharged on 04-06-03. Even assuming that he had taken treatment for one day in the hospital of Dr. Manvikar at Manvi, it does not mean that the deceased had given false statement of his health while furnishing personal statement of his health as per Ex.R-2. Because the question No-2(a) in the personal statement at Ex.R-2 is with regard to treatment taken for “a week or more” and so this question has been answered in the Negative. Therefore the Medical certificate of Dr. Rohini.J.Manvikar at Ex.R-3 is of no avail to the Ops even it has been marked subject to proof. The Ops have further relied on Claimant’s statement at Ex.R-4. Certificate of Hospital treatment of deceased Yellappa at Ex.R-6, Medical Attendant’s Certificate at Ex.R-7, patient-pre-operative check-list issued by Rajiv Gandhi Super Specialty Hospital/OPEC Hospital, Raichur at Ex.R-9 and Case History Sheet of Hyderabad kidney and laproscopic Center Hyderabad at Ex.R-11. These documents are also not helpful to the Ops for simple reason that these documents pertains to the admission of deceased Yellappa in the hospital from 10-08-04 in the Rajiv Gandhi Super Specialty Hospital with history of High grade of fever and painful swelling to left leg since (4) days. Further the Ops have not examined the doctor of Rajiv Gandhi Super Specialty Hospital Raichur and the doctor of Hyderabad kidney and laparoscopic center Hyderabad to say the age of the said disease said to have been suffered by Yellappa. Hence for all these reasons we are not in agreement with the contention of the Ops and the arguments advanced by their counsel that the deceased Yellappa has suppressed material facts regarding health in his personal statement while reviving the policy. So the Repudiation of the claim by the Ops itself amounts to deficiency in service and therefore we hold that the complainant has proved deficiency in service by the Ops and so Point NO-1 is answered in the Affirmative.<br /> <br /> POINT NO.2:-<br /> <br /> 12. The complainant has sought for direction to the Ops to pay policy amount of Rs. 2,00,000/- with accrued benefits along with interest at 18% p.a. from the date of death of deceased Yellappa till realization and also for payment of compensation of Rs. 50,000/- for un-justified repudiation of claim after lapse of much time and for payment of cost of litigation. In-view of our discussion and finding on Point NO-1, we pass the following order:<br /> <br /> ORDER<br /> <br /> The complaint of the complainant is allowed in part.<br /> <br /> The Ops shall pay the complainant the policy amount of Rs. 2,00,000/- with its accrued benefits minus the paid up value amount if received by her. The Ops shall also pay a global compensation of Rs. 15,000/- including cost of litigation.<br /> <br /> The OPs shall comply this order within (6) weeks from the date of receipt of copy of this order.<br /> <br /> Office to furnish certified copy of this order to both the parties forth with free of cost.<br /> <br /> (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 20-02-07)<br /> <br /> Sd/-<br /> Sri. N.H. Savalagi<br /> President<br /> Dist.Consumer Forum-Raichur.<br /> <br /> Sd/-<br /> Sri.Pampannagouda <br /> Member.<br /> Dist.Consumer Forum-Raichur.<br /> <br /> Sd/-<br /> Smt.Kavita Patil <br /> Member.<br /> Dist.Consumer Forum-Raichur.<br /> <br />