BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Sri R.Ramachandra Reddy B.Com., LL.B., Member
Tuesday the 30th day of May, 2006
C.D.No.70/2005
B.Lakshmi Devi,
W/o B.Surendra Reddy,
Aged 25 years, H.No.49-50A,87A,B4,
Lakshmi Nagar, Near Church (Assembly
Parthana Mandera), Kurnool. . . . Complainant
-Vs-
1. Life Insurance Corporation of India,
Rep. by its Divisional Manager,
Kadapa.
2. The Branch Manager,
Life Insurance Corporation of India,
Atmakur Branch,
Kurnool District.
3. G.Venamma W/o G.Venkata Reddy,
aged about 45 years,
R/o Konedala (V) Nandikotkur(M),
Kurnool District.
4. V.Kalpalatha W/o V.Surendra Reddy,
aged about 22 years,
R/o H.No.77/188-A6 Shareen Nagar,
Kallur (M), Kurnool District.
5. G.Prapulla D/o Late G.Venkata Reddy,
aged 20 years, R/o Konedala (V),
Nandikotkur (M), Kurnool District. . . . Opposite parties
This complaint coming on this day for Orders in the presence of Sri A.Prabhakar Reddy, Advocate, Kurnool for complainant and Sri. G.Md.H.Rahiman, Advocate, Kurnool for opposite parties 1 and2 and Sri.V.Venkateswara Reddy, Advocate, Kurnool for opposite parties 3 to 4, and stood over for consideration till this day, the Forum made the following.
O R D E R
(As per Sri.R.Ramachandra Reddy, Hon’ble Member)
1. This Consumer Dispute case of the complainant is filed under Section 12 of C.P. Act 1986, seeking an award in favour of the complainant from opposite party No.1 and No.2 to pay her the assured policy amount of Rs.1,50,000/- with benefits with 24% interest per annum from the date of death of the complainant’s father, Rs.10,000/- as compensation and to grant costs of the complaint.
2. The brief facts of the complainant’s case are that she is the daughter of Late G.Venkat Reddy, he insured his life with the first and second opposite parties under the policy bearing No.652592847 for Rs.1,50,000/-. It is an Endowment Assurance Policy, with profits and with Accident benefit. It came into force on 28-4-2000. This sum assured was Rs.1,50,000/- with half yearly premium of Rs.4,967/- was payable by assured and it was paid till the death of her father. The period of insurance was 16 years starting from 28-4-2000. She is the nominee of the said policy and entitled to receive the said assured amount. On 11-6-2003 her father died due to high fever. She submitted claim form in the month of June 2003 along with all required documents. She has been approaching the first and second opposite parties for settlement of claim since the date of submitting claim form. But the first and second opposite parties have been postponing the settlement on some pretext or other, though the claim form was submitted about 1 year 9 months back. Due to this she got issued legal notice dated 28-3-2005 demanding that claim made in the complaint. Though the notice is received by the first and second opposite parties, they did not give any reply. As the said negligent, arbitrary attitude of the said opposite parties in not settling the claim of complainant even after submission of the claim form as back as in the month of June 2003 along with all required documents, this conduct of the opposite parties No.1 and 2 is certainly amounting to deficiency of service ensuing mental agony to the complainant.
3. In pursuance of the service of the notice of this Forum as to the case of the complainant the opposite party No.1 filed its written version and sworn affidavit and the same was adopted by the opposite party No.2 and denied any of its liability as the assured suppressed the pre-existing disease. Subsequently the opposite parties 3 to 5 are added and neat copy of the complaint filed by the complainant on 8-3-2006 and opposite parties 3 to 5 filed its written version and sworn affidavit in reiteration of its case and that they entitled ¾ share in the total insured amount and compensation amount payable towards the policy bearing No.652592847 of the complainant’s father.
4. The written version of the opposite party No.1, the same was adopted by opposite party No.2 admitted that the deceased life assured G.Venkat Reddy took a policy bearing No.652592847 with 28-4-2000 as date of commencement from its branch office, Atmakur (K) on his own life, for sum assured of Rs.1,50,000/- under plan and term 14-16 and opted to pay the premia of Rs.4,967/- under Half-yearly mode by nominating his daughter Smt. B.Lakshmi Devi as nominee and further submits that the deceased life assured allowed the policy to lapse due to non payment of half yearly premium at Rs.4,967/- from 28-4-2002 and sought for revival of the same by submitting a personal statement regarding health dated 6-5-2003 by payment of an amount of Rs.15,648/- towards three half yearly premiums due from 4/2002 to 4/2003 of the policy. The deceased life assured affirmed that he never under went any operation and suffered from any ill ness nor he advised to go in for any treatment or taken X-ray, ECG, Pathological and other tests while seeking revival of his lapsed policy. Revival is a fresh contract, when once the policy was allowed to lapse due to non remittance of the agreed premia, as per policy conditions. Basing on his declaration of good health and medical report dated 6-5-2003 the policy was revived on 14-5-2003. As per his personal statement regarding health dated 6-5-2003 and answered negatively all the questions in column No.4 of the Medical Examiner, put forth by the doctor, on 6-5-2003, as regards his health and that he did not suffer for any ill ness or ailments and was not hospitalized. The medical examination basically depended on the statements and replies to the queries given by the deceased to the doctor. Unless and until the person under going the medical examination reveals all the true and factual state of his health and illness or disease, he suffered prior to the proposal. During the course of investigation, it was revealed that the deceased life assured was suffering from Asthama and cardiac ailments since 2 years prior to his death. The deceased life assured was died on 1-6-2003 on the date of revival of policy is on 14-5-2003. The DLA died with a duration of 1 month 22 days only from the date of revival of the policy. The deceased life assured had not disclosed the details of sickness prior to revival, in the personal statement regarding health submitted for revival of lapsed policy. The deceased life assured has answered questions 2 (a), (b) and (c) enquiring about his health in the negative and stated that his usual state of health has been good in answer No.4. It is further submitted that the opposite party No.1 has got evidence to show that the deceased life assured had suffered from Asthama and had taken treatment with a medical man viz. Dr. Kullayappa and Dr.Rajasekhar since 2 years prior to revival. He did not however disclose these facts in his personal statement regarding health. As the said ailment fell prior to date of revival and he was in not good in health. The deceased life assured being fully aware of his own ill health, deliberately given declaration that he is in good health and at the time of revival and this amounted to non discloser of material facts regarding his health prior to revival. Had the deceased life assured disclosed the true and correct information at the time of revival of policy, the decision of the opposite party No.1 would have been affected and the opposite party No.1 has good grounds for repudiation of the above policy and same is referred to the standing committee of the said opposite parties for decision in the above claim. Hence, it is prayed that the Hon’ble Forum be pleased to dismiss the petition with costs in the interest of justice.
5. The written version of the opposite parties 3 to 5 submits that the complainant and this opposite parties are legal heirs of Late G.Venkat Reddy. He insured his life with the first and second opposite parties under the policy bearing No.652592847. On 11-6-2003, the insured died due to high fever. But the complainant filed the complaint with intent to take total amount under the policy as nominee and did not complaint for their benefit. The nominee is entitled to receive the amount on behalf of the all legal heirs. These opposite parties and complainant are the class one heirs of Late G.Venkat Reddy. Thus all of us are equally entitled to receive the insurance claim and as such they entitled to ¾ share in the total insured amount and compensation amount payable towards the above said policy by the first and second opposite parties and prayed to allot the equal shares to them and to the complainant in the total insured amount with interest and compensation in the interest of justice.
6. In substantiation of the case averments while the complainant side has relied upon the documentary record in Ex.A1 to A5 and third party affidavit dated 19-7-2005 besides to the sworn affidavit of the complainant in reiteration of its case, the opposite party No.1’s side has relied upon the documentary record in Ex.B1 and B2 besides to the sworn affidavit of the opposite party No.1 in reiteration of its case. Further the complainant and opposite party No.1 and 2 exchanged between them interrogatories and their replies along with written arguments of the complainant referring citation, the written argument of opposite party No.1 and 2 and the written argument of opposite parties 3 to 5 referring citation for the appreciation of their case.
7. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of service in the conduct of the opposite parties towards her entitling her for the reliefs sought?
8. The Ex.A1 is the legal notice of office copy dated 28-3-2005 issued by the complainant’s counsel to the opposite parties No.1 and 2 wherein it is requested to settle the complainant’s claim as it has been postponing settlement on some pretext or other, though the claim form was submitted about 1 year 9 months back, otherwise his client approaches Hon’ble District Forum for getting redressal of her remedy. In that event, the opposite parties are liable to bear costs and consequences. The Ex.A2 and Ex A3 are the registered postal receipts of the said legal notice (Ex.A1) issued to the opposite party No.1 and 2 respectively and the Ex.A4 and Ex.A5 are the acknowledgements in token of receipt of the said legal notice i.e. Ex.A1 by opposite party No.1 and 2 respectively.
9. The Ex.B1 Personal Statement Regarding Health obtained by the opposite party No.1 of the complainant’s father in the policy No.652592847 on 6-5-2003 in the presence of the insurance agent of opposite party No.1. The Ex.B2 which is said to have been given by one Smt.C.Veena Kumari in the presence of three witnesses on 13-10-2003 stating that the complainant’s father, G.Venkat Reddy is known to her since 2 years as he was used to reside in his daughter’s house (complainant) and his age was 43 years at the time of his death and since 2 year, he was suffering with Asthama and used to get treatment for the said ailment from the doctors viz. Dr.Kullayappa and Dr.Rajasekhar Reddy. Here, the alleged statement was given before the Notary on 13-10-2003. The said Notary is none other than the counsel of opposite party No.1 and No. 2. Further it is observed that there are number of corrections in the said statement. The complainant filed third party affidavit of B.Balaramudu S/o Sanjanna who is the witness No.3 of the said Notarized statement i.e. Ex.B2 submits that in the month of August two persons came to Smt. Veena Kumari claiming as Insurance Officials and stated that they are paying the insurance claim payable to the complainant for the death of her father and for paying the amount they need her statement. So saying, they dictated statement. She wrote according to their dictation and signed in it, the said document now filed by the opposite parties is seen by him and it is the same document which was written by Smt. Veena Kumari to the dictation of persons claiming to be Insurance persons and the said Veena Kumari protested saying that what is dictated is not true but they insisted to write the same as it will be useful to the complainant, thus they mislead her to write the said statement and misused the same before this Hon’ble Forum. Either he himself or Veena Kumari did not go to NOTARY and did not sign in the presence of NOTARY. He has not seen the NOTARY by name HABIBU RAHIMAN. The above said material appeared in the Ex.B2 with the sworn affidavit of the third party of the complainant who is third witness of the said document, it creates doubt in the circumstances existed and it is very difficult to take into cognigence in the adjudication of this case. If the opposite parties are confident of said material mentioned in the said document (Ex.B2) would have filed the sworn affidavits of said two doctors mentioned there in and concerned record and material of the treatment if any pertaining to the complainant’s father and further if at all the opposite parties are so certain about the said treatment by the said two doctors to the complainant would have summoned to give their evidence in support of their pleas taken in their written version and sworn affidavit. But the opposite parties are miserably failed to prove their case by adducing the said evidence in adjudicating the matters in this case. Further, as seen from the Ex.B1 as to Personal Statement Regarding Health on 6-5-2003 which reveals to the policy No.652592847 dated 28-4-2000 which was revived on 14-5-2003 as per the averments of the opposite party No.1 in its written version at para 4 on payment of an amount of Rs.15,648/- towards three half yearly premiums due from 4/2002 to 4/2003 i.e. after 3 years and 8 days of the policy i.e.28-4-2000. The complainant’s father died on 11-6-2003 i.e. after 3 years 1 month 13 days after taking the said policy i.e. on 28-4-2000. In the event of above said circumstances and in support of the complainant’s case there is a judgment which was reported in AIR 1989 A.P 39 LIC of India, Bombay – Appellant V/s Vesasi Bharathi, Respondent (a) Insurance Act 4/1938 Section 45 regarding the applicability and avoidance of the policy, calling the policy in question on the ground of his statement, period of two years provided in section 45 must be counted from the date of the original policy and not from the date of the revival of the policy (b) Insurance Act (4/1938) section 45 in regard to revival of lapsed policy conditions of the repudiation of the policy, stated - crucial thing is the existing state of health on the date of revival, if corporation satisfies that on the date of revival of policy health is normal, he is entitle to revival irrespective of fact whether he fell sick or not prior to the date of revival. In another decision of the Karnataka High Court 1992 (3) CCC 540 para 9 and 10 Mrs.Prabavathi Gangadar Shanbag V/s LIC of India decided that “Insurance Act, 1938 Section 45 challenged Life Insurance Policies - Plea of fraudulent suppression of material facts – the burden of proof rests heavily on the party alleging fraud – from the answers given by the insured in his personal statement it cannot be inferred that he deliberately suppressed the facts of his health and thus committed fraud. The corporation has also has not produced any reliable material to show that the deceased was as matter of fact suffering from a disease. The corporation cannot escape its obligation under the policies merely stating that the deceased insured has suppressed material facts. Further in another judgment reported in AIR 1995 Alahabad 299 Aqueela, Applicant V/s Oriental Fire and General Insurance Company Ltd., Lucknow and another opposite parties it was decided that the Insurance Act IV of 1938 section 39 the insurance claim, the nominee under the policy is entitled to receive the payment without obtaining succession certification and payment un-fairly delayed by the insurance company, the said company saddled with costs.
10. In support of the complainant’s case her counsel cited along with the written argument, a judgment of National Commission 2003 (2) ALT II (NC) (CPA) wherein it was observed that the appellant – insurer repudiated the claim on the ground, deceased concealed material facts at the time of taking policies whereas the onus of proving the facts lies with insurer but insured died two years after taking policies.
11. The opposite parties 3 to 5’s counsel filed written argument and cited a judgment of Supreme Court AIR 1984 S.C 346 wherein the Hon’ble Supreme Court observed that the nomination only indicates the hand which is authorized to receive the amount, on payment of which the insurer gets a valid discharge of its liability under the policy. The amount however can be claimed by heirs of the assured in accordance with the law of succession governing them. In this case also the opposite parties 3 to 5 can claim the legitimate share in accordance with the law of succession only on the receipt of the claim amount by the complainant. Due to the said legal position, this Hon’ble Forum cannot entertain the claim of the opposite parties 3 to 5. Hence, the petition of the said opposite parties is dismissed.
12. In the light of the above decisions and cogent material placed on record by the complainant and in the result of the above discussion the complainant is entitled to the policy amount of the deceased G.Venkat Reddy on the contingency of his death and the opposite parties No. 1 and No. 2 by their avoiding conduct put the complainant to the mental agony and also driven her to seek the redressal in this Forum the complainant is not only remaining entitled to the said policy of Rs.1,50,000/- with benefits of the deceased policy holder with interest at 9% per annum from the date of demise of the policy holder but also to pay Rs.10,000/- as compensation and Rs.1,000/- as costs.
13. Therefore, the opposite parties 1 and 2 jointly and severally are directed to pay the award amount of Rs.1,50,000/- with benefits with 9% interest per annum, Rs.10,000/- as compensation and Rs.1,000/- as costs to the complainant. In default, the opposite parties 1 and 2 jointly and severally are liable to pay the above said award amount with 12% interest per annum from the date of the said default till the date of realization.
Dictated to the stenographer, transcribed by him, corrected and pronounced by us in the Open Forum on this the 30th day of May 2006.
PRESIDENT MEMBER
APPENDIX OF EVIEDNECE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of exhibits marked for the complainant:
Ex.A1 Legal notice, Dt. 28-3-2005.
Ex.A2 Postal receipt No.3505, Dt.28-3-2005.
Ex.A3 Postal receipt No.3504, Dt.28-3-2005.
Ex.A4 Acknowledgement, Dt.31-3-2005.
Ex.A5 Acknowledgement, Dt.31-3-2005.
List of exhibits marked for the opposite parties:
Ex.B1 Personal statement regarding health.
Ex.B2 Notary affidavit of C.Veena kumari.
PRESIDENT MEMBER
Copy to:
1.Sri A.Prabhakar Reddy, Advocate, Kurnool
2.Sri. G.Md.H.Rahiman, Advocate, Kurnool.
3.Sri. V.Venkateswara Reddy, Advocate, Kurnool
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
