BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
And
Sri. M.Krishna Reddy, M.Sc.,M.Phil., Male Member
Wednesday the 24th day of June, 2009
C.C.No. 187/2008
Between:
Smt. M. Ramanamma,
W/o. Late M. Prabhudas,
H.No.7-2-11-1, Nehur Nagar,
Dhone Post,
K urnool District. 518222. … Complainant
Versus
1. Life Insurance Corporation of India Limited,
Represented by its Branch Manager,
H.No.8-85-4-1, Kothapeta,
Dhone,
Kurnool District. 518222.
2. Senior Divisional Manager,
Life Insurance Corporation of India Limited,
P.B.No.10, College Road,
CUDDAPAH – 516 004. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri. P. Siva Sudharshan , Advocate, for the complainant, and Sri. A.S.U. Javid Ali, Advocate, for the opposite party No. 1 and 2 and upon perusing the material papers on record, the Forum made the following
ORDER
(As per Sri. K.V.H.Prasad, President )
C.C.No.187/08
1. This case of the complainant is filed U/S 11 and 12 of C.P. Act , 1986 seeking direction on the opposite parties to pay to the complainant the policy amount of Rs.50,000./- with 24% interest from the date of the demise , Rs.20,000/- towards mental agony and Rs.5,000/- as costs of this case alleging the deficiency on the part of the opposite parties in repudiating the claim without any reasonable and lawful excuse in spite of the demise of the policy holder – the husband of the complainant occurred on 29-03-2006 due to heart attack and any suppression of material facts as to his health at the time of obtaining the policy .
2. In pursuance of the notice of this forum as to this case of the complainant the opposite parties caused their appearance through their counsels and contested the case filling written version of the opposite party No. 2 and a memo of its adoption by opposite party No. 1 , denying any of their liability to the comnplianants claim and seeking dismissal of the complainants case.
3. The written version of the opposite party No. 2, even though admits the issual of the policy No. 653291226 for a sum of Rs.50,000/- with effect from 08-08-2003 in favour of Prabhudas and submission of claim on his demise , allege the said policy holder under went treatment from 07-02-2003 to 10-02-2003 in Gowri Gopal Apollo Hospital , Kurnool as in-patient No. 3670 for HTN stroke and hypertension and the said fact was not revealed by the policy holder in the proposal form while obtaining the policy and the contract of insurance being a contract in utmost good faith and the said policy holder by suppression of said fact mislead the insurance company the obtaining of the policy and its revival was by fraud and thus makes the very contract of insurance under said policy as null and void leaving any liability on the insurance company is a terms of declaration mentioned and condition No. 5 of the policy and therefore there is any illegality or irregularity in repudiation of claim amounting to any deficiency of service and there by any of their liability to the complainants claim .
4. In substantiation of the contentions while the complainant side has taken reliance on documentary record in Ex.A1 and A2 besides to its sworn affidavit , the opposite party side has taken reliance on documentary record in Ex.B1 and B2 and the Ex.X1 in reference to the evidence of RW.1 and the sworn affidavit of the opposite party No. 2.
5. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of the opposite parties and there by any of their liability to the complainants claim.
6. The demise of the policy holder and the policy holder obtaining the policy No. 653291226 being not disputed by the opposite party , the Ex.A2 – death certificate as to demise of the policy holder and the Ex.B1 policy bond does require any further appreciation than what they stand for.
7. The Ex.A1 is the repudiation letter dated 20-03-2007 issued by opposite party No. 2 repudiating the claim made under policy covered under Ex.B1 it alleges that the said policy holder suffered with HTN and stroke prior to the date of acceptance of the policy as per the hospital records and the said fact was not disclosed in the proposal giving false answers there in and by the said suppression was with holding correct information regarding his health the insurance company is not liable for payment under the said policy and the money paid there under by the policy holder stands forfeited in favor of the insurance company and so the claim made is repudiated .
8. In support of said contentions as to the previous ailments of the policy holder the opposite party has taken reliance on the evidence of Dr.N. Rama Chandra Rao ( RW.1) in reference to the Ex.X1 case sheet pertaining to the treatment rendered to said policy holder
( Prabhudas) . The evidence of RW.1 and the entries in Ex.X1 case sheet reveal that the said Prabhudas undergoing treatment from 07-02-2003 to 10-02-2003 as in- patient for the compliant of Hemiplegia ( weakness of the one side of the body) and the said was due to smoking , alchololisn and hypertension. The treatment mentioned in Ex.X1 case sheet as per RW.1 , was done to Prabhudas under the supervision of said doctor , even though the said case sheet was signed by House Surgeon of his unit one . The said evidence of RW.1 in reference to Ex.X1 remained unimpeached . But the sworn affidavit of the complainant goes to the extent of denying the very said fact even . Hence there appears every doubt on the bonafides of the complainant as to the earlier treatment the policy holder has undergone prior to obtaining the policy .
9. In the above circumstances even though the policy holder appears to have not disclosed the above said earlier treatment in Ex.B2 – personal statement regarding health given on 30-09-2004 by answering the questionnaire given in Sl. No. 2 (a) in negative form , the further point remaining for consideration is whether the said suppression amounts to playing fraud on the opposite party and there by the very contract of insurance as null and void ceasing the liability of the opposite parties for the assured amount of said policy forfeiting the same in favor of insurance company .
The questionnaire in 2( a) of Ex.B2 runs as under
“ Have you ever suffered from any illness / disease requiring treatment for a week or more .” ?
10. As the period of treatment of the deceased policy holder in reference to Ex.X1 and evidence of RW.1 being from 07-02-2003 to 10-02-2003 and there by the said period of treatment being less than a weak or more contemplated under that questionnaire the deceased policy holder who has answered the said question in negative manner does not appear to have violated the spirit and sense of said questionnaire that too with an intention to play any fraud on the insurance company .
11. If the intention of the insurance company in posing said question is to ascertain as to any mere earlier treatment the policy holder undergone within a period of two years prior to obtaining the policy the said question must be in a plain form of ascertaining as to mere treatment undergone without specifying the days of treatment .
12. As per Ex.B1 the policy of insurance under policy No. 653291226 in the name of the policy holder M. Prabhudas commenced from 08-08-2003 . The opposite party has not placed either the proposal from or the personal statement regarding health given by said policy holder at the time of obtaining the Ex.B1 policy . In the absence of them the policy holder cannot be accused of suppression of any material fact as to his earlier health prior to obtaining the said policy in Ex.B1 especially when the said Ex.B2 is a personal statement regarding health given by said policy holder on 30-09-2004 sufficiently after to obtaining the policy under Ex.B1 .
13. In the above state of circumstances there being any intentional suppression on the part of the policy holder as to his earlier ailment and treatments as contemplated in the spirit and sense of 2 (a) of Ex.B2 , there appears any justification in the repudiation of the complainants claim by the opposite parties .
14. The very conduct of the opposite parties in repudiating the claim of the complainant without any justification not only ensuing considerable mental agony to the complainant but also to the cost of this case as the complainant being driven for redressal of her grievances to the forum .
15. Consequently , the case of the complainant is allowed directing the opposite parties in their joint and several liability to pay to the complainant the assured amount under the policy in Ex.B1 and Rs. 10,000/- as compensation for mental agony and Rs.5,000/- as cost of this case within a period of one month from the date of receipt of this order . In default the supra stated award shall be payable by the opposite parties in their joint and several liability to the complainant with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 24th day of June, 2009.
Sd/- Sd/- Sd/-
LADY MEMBER PRESIDENT MALE MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :
RW.1 Deposition of RW.1 dated 07-05-2009 (N.Rama Chandra Rao)
List of exhibits marked for the complainant:-
Ex.A1. Repudiation letter dated 20-03-2007.
Ex.A2. Death certificate dated 22-04-2006.
List of exhibits marked for the opposite parties:
Ex.B1. Policy Bond No. 653291226.
Ex.B2. Personal Statement regarding health.
Ex.X1. Case sheet of Mr.Prabhudas of Gowri Gopal Hospital,
Kurnool.
Sd/- Sd/- Sd/-
LADY MEMBER PRESIDENT MALE MEMBER
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
