| Complaint Case No. CC/10/38 |
| | | | 1. Smt.Bhukya Samini ,W/o. late Bhukya Ramdas ,R/o. Bhudharam Viallage ,Garla Mandal,Khammam. | | Smt.Bhukya Samini ,W/o. late Bhukya Ramdas ,R/o. Bhudharam Viallage ,Garla Mandal,Khammam. | | Khammam | | Andhra Pradesh |
| ...........Complainant(s) | |
| Versus | | 1. Life Insurance Corporation of India ,rep by its Branch manager ,Wyra Road ,Khammam. | | Life Insurance Corporation of India ,rep by its Branch manager ,Wyra Road ,Khammam. | | Khammam | | Andhra Pradesh | | 2. Life Insurance Corporation of india ,rep by its Divisional manager ,Divisional Office , | | Life Insurance Corporation of india ,rep by its Divisional manager ,Divisional Office , | | Warangal | | Andhra Pradesh |
| ............Opp.Party(s) |
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| ORDER | | BEFORE THE DISTRICT CONSUMERS FORUM AT KHAMMAM Dated this, the 29th day of April, 2011 CORAM: 1. Sri Vijay Kumar, B.Com., LL.B., President 2. Sri.R.Kiran Kumar, B.Sc., LL.B., Member C.C.No.38 of 2010 Between: Smt.Bhukya Samini, w/o. late Bhukya Ramdas, age: 28 years, occu: Household, r/o.Budharam village, Garla Mandal, Khammam District. …Complainant and 1. Life Insurance Corporation of India rep. by its Branch Manager, Wyra Road, Khammam, Khammam District. 2. Life Insurance Corporation of India, rep. by its Divisional Manager, Divisional office, Jeevan Prakash, Balasamudram, Hanmakonda-506001. …Opposite parties This C.C. is coming on before this Forum for final hearing in the presence of Sri.P.Madhava Rao, Advocate for complainant and of Sri.A.V.Ramanuja Charyulu, Advocate for opposite parties No.1 & 2; upon perusing the material papers on record; upon hearing the arguments, and having stood over for consideration, till this day, this Forum passed the following:- ORDER (Per Sri.Vijay Kumar, President) This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the complainant is the wife of the deceased, Bukya Ramdas, during his life time, the husband of the complainant obtained insurance policy from opposite party No.1 vide policy bearing No.688183643 on 23-1-2008. The deceased was hale and healthy at the time of obtaining policy. Suddenly, the deceased suffered vomiting and motions, died intestate on 25-6-2008 leaving behind the complainant. Immediately having come to know about the policy held by the deceased, the complainant submitted claim form along with all requisite formalities to release the amount of Rs.1,00,000/- i.e. the amount assured under the policy in lieu of death of her husband. The men of the opposite parties enquired and thereafter repudiated the claim of the complainant on flimsy grounds stating that the deceased had history of Tuberculosis disease. It is further submitted that there are political rivalries in the village, due to which the person who are enemies to the complainant’s family said to have misled the opposite parties. Basing on the said flimsy grounds, the opposite parties have repudiated the claim of the complainant, which is not maintainable either in law or on facts. This act on the part of opposite parties amounts to deficiency in service in settling the claim of complainant. Therefore, the opposite parties are liable to pay an amount assured under the policy, apart from payment of Rs.25,000/- towards pain, suffering and mental agony. Hence, this complaint. Apart from the complaint, the complainant got filed the proposal form, repudiation letter got issued by the opposite parties, dt.22-8-2009 and also death certificate, dt.10-7-2008. On receipt of the notice, opposite parties appeared through their counsel and filed written version. In the written version, they admitted that late Bhukya Ramdas, the deceased has taken Jeevan Anand policy for Rs.1,00,000/- commencing from 25-1-2008. They also admitted that the complainant is the nominee of the deceased. They also admitted that the deceased died on 25-6-2008, since the death occurred within 5 months from the date of commencing of the policy, treating the said claim as very early claim, as investigation was caused into the bonafides of the claim. During the said investigation, it came to light that the deceased had suffered with bilateral pulmonary tuberculosis i.e. TB and underwent revised national tuberculosis control programme (RNTCP) course category III from the District TB control Society, Khammam under the TB No.1257/07 with specimen ID No.290/Neg/22-9-2007/5.10/07. The TB identity card and treatment card are filed, which clarify that the deceased suffered with direct positive cogent evidence that the TB was detected and treatment started only prior to the date of submission of his proposal i.e. on 23-1-2008. On this ground only the management decided to repudiate the claim under the above said policy for suppression of material facts and communicated the same on 22-8-2009, which was acknowledged by the complainant. It is further submitted in the counter that the deceased has given questions in the proposal form question No.11, negative answers regarding the health condition. Especially he said No to question No.11 regarding suffering from TB. In fact he was suffering with TB prior to the date of proposal form. Therefore the opposite parties have rightly repudiated the claim. It is further submitted that Hon’ble Supreme Court vide judgment in Civil Appeal No.1682/2004 directed all courts and consumer for a in the country not to entertain the said complaints and prayed to dismiss the complaint. On behalf of the complainant, no evidence is adduced, no written arguments filed. On behalf of the opposite parties, the following documents were filed and marked as Exs.B.1 to B.3. Ex.B.1 - Proposal Form, dt.23-1-2008 Ex.B.2 - TB Identity card bearing No.1257/07 Ex.B.3 - Treatment card The opposite parties filed a memo, to treat the contents of counter as written arguments. Upon perusing the oral and documentary evidence, now the points that arose for consideration are, 1. Whether the repudiation of claim of the complainant is justified and the complainant is not entitled to the claim covered under the policy? 2. To what relief? Point No.1: It is not in dispute that the husband of the complainant by name, Bhukya Ramdas had obtained a policy for a sum of Rs.1,00,000/-, vide policy bearing No.688183643 on 23-1-2008. It is also not in dispute that the deceased died on 25-6-2008 leaving behind the complainant as his legal heir. It is also not in dispute that the complainant is a nominee of the deceased, Bukya Ramdas. The only dispute is regarding the health condition of the deceased, Bhukya Ramdas. The learned counsel for the opposite parties contended that since the death of the deceased occurred within 5 months from the date of commencing of the policy, treating it as a very early claim, investigation was caused into the bonafides of the claim and during the said investigation, it came to light that the deceased suffered with TB and taken treatment. On this aspect of the case is concerned, the learned counsel for opposite parties, refers to TB identity card bearing No.1257/07, which is marked as Ex.B.2 and treatment card, which is marked as Ex.B.3 and also refers to proposal form, dt.23-1-2008, which is marked as Ex.B.1. On a careful perusal of Ex.B.1, it reveals that the deceased has given negative answers regarding the health condition. He has clearly stated in question No.11 of proposal form as No, whether he suffered with TB from the last 5 years. On the basis of Exs.B.1 to B.3, the opposite parties have repudiated the claim on the ground of concealment of material facts regarding his health condition. On a careful perusal of Ex.B.1, it appears that all the columns of Ex.B.1, proposal form have been filled in by a person other than the deceased, because Ex.B.1 contains only left thumb mark of the deceased. It can be clearly presumed that the deceased was an illiterate man. He has not acquainted with the English language. All the columns of Ex.B.1 appeared to be proforma columns. The burden lies on the opposite parties to establish that all the contents of Ex.B.1 have been explained to the deceased in the language known to him and having understood the same, the deceased had put his thumb impression on the proposal form. In the instant case, no such evidence is forthcoming on behalf of the opposite parties to presume that all the contents of Ex.B.1 have been explained to the deceased in the language known to him. Therefore, it cannot be said that the deceased has deliberately concealed regarding his health condition in the proposal form and moreover TB is a disease, which can be revealed by any doctor of the panel of the opposite parties. The opposite parties cannot throw mud on the deceased and state that there is deliberate concealment of material facts by the deceased. This cannot be a ground for repudiation of the claim of the complainant. Therefore, we are of the opinion that the deceased being an innocent and illiterate is not expected to understand the contents of proposal form. This alone cannot be a ground for repudiation of the claim and moreover it is for the opposite parties to establish that all the contents of proposal form, Ex.B.1 have been explained to him. In the light of the aforesaid reasons, we are of the opinion that the repudiation of the claim by the opposite parties is not justified. Therefore, the complaint is fit to be allowed. Point No.2: In the result, the complaint is allowed, directing the opposite parties to pay an amount of Rs.1,00,000/- (Rupees one lakh only) covered under the policy bearing No.688183643 together with interest at 9% P.A. from the date of repudiation of the claim i.e. 22-08-2009 till the date of deposit. The opposite parties are further directed to pay an amount of Rs.2,000/- towards costs of the litigation. Dictated to the steno, transcribed by her, corrected and pronounced by us in the open forum on this the 29th day of April, 2011. PRESIDENT MEMBER DISTRICT CONSUMERS FORUM KHAMMAM APPENDIX OF EVIDENCE Witnesses examined for complainants: -None- Witnesses examined for opposite party -None- Exhibits marked for complainants: -Nil- Exhibits marked for opposite parties: Ex.B.1 - Proposal Form, dt.23-1-2008 Ex.B.2 - TB Identity card bearing No.1257/07 Ex.B.3 - Treatment card PRESIDENT MEMBER DISTRICT CONSUMERS FORUM KHAMMAM | |
