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
Thursday the 10th day of July, 2008
C.C.No. 180/07
Between:
Smt. C. Sanjamma, W/o. Late C.Vykuntavasulu,
R/o. H.No.45/178-1, N.R.Nagar, Kurnool. … Complainant
Versus
Life Insurance Corporation of India, Represented by its Branch Manager,
Kurnool. … Opposite party
This complaint is coming on this day for orders in the presence of Sri.C.P.Maddilety, Advocate, for the complainant, and Sri.I.Anantha Rama Sastry, Advocate, for the opposite party 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.180/07
1. This case of the complainant is filed U/s 12 of C.P.Act, seeking direction on the opposite party to pay to the complainant the insured amount under the policy No.653422575 with interest at 24% from the date of claim , Rs.10,000/- towards mental agony and Rs.5,000/- towards costs alleging the deficiency of the opposite party in repudiating the claim made by her as nominee on the demise of the policy holder on 13-11-2005 due to heart attack and not even responding to the legal notice dated 18-4-2007 and the ensual of mental agony at the deficient conduct of the opposite party.
2. In pursuance of the receipt of the notice of this Forum as to this case of the complainant the opposite party caused its appearance and contested the case by filling written version seeking dismissal of the complainant denying its liability to the complainant’s claim as the policy holder has suppressed the facts relating to his earlier state of health and suffered ailments policy .
3. In substantiation of the contentions while the complainant side has relied upon the documentary record in Ex.A1 to A5 and the sworn affidavit of the complainant in reiteration of its case, the opposite party side has relied upon the documentary record in Ex.B1 to B11 and its sworn affidavit in reiteration of its defence.
4. Hence, the point for consideration is , whether the complainant has made out the liability of opposite party for the complainants claim.
5. The Ex.A1 is the first premium receipt for the policy No.653422575. The issual of very policy being not disputed by the opposite party the said Ex.A1 which precedes for issual of policy remains proved. The Ex.A2 is a letter of repudiation as to policy No.653422575 consisting of the answers of the policy holder to the questions in proposal form regarding his health. The said answers not only denies of any earlier ill health or treatment for it but also says as good as to his usual state of health. The Ex.A2 says that it has evidence and reasons to believe that the said life assured policy holder was suffering form Asthma, Hypertension and Enteric fever prior to the date of acceptance of the policy as per Hospital records and in the said proposal statement as the assured policy holder has given false answers that claim was repudiated and all the moneys that have been paid in consequence there off stands for fited . The opposite party except alleging as such in Ex.A2 repudiation letter- did not file any hospital record as to the treatment undergone by the policy holder for Asthma, Hypertension and Enteric-fever prior to the acceptance of the policy , except filling the Ex.B3 to B6.
6. The Ex.B3 is application for commuted leave submitted by C.Vykuntavasulu as employee of Food Corporation of India , District Office, Raichur, to his employee on medical grounds for the period 17-11-2003 to 22-11-2003 . The Ex.B3 except alleging grounds leave on which leave applied was medical did not specify the actual ailment with which he is suffering and for treatment of which the said leave is applied.
7. The Ex.B4 is an attested Xerox of medical certificate and fitness dated 22-11-2003 issued by a Physician and Surgeon named Dr. P.Sarvothama Rao certifying his treatment to Sri.C.Vykuntavasulu from 17-11-2003 to 22-11-2003 for hypertension and his fitness on 22-11-2003 for duty as recovered from said illness .
8. The Ex.B5 is an attested Xerox of a commuted leave application on medical grounds applied by C. Vykuntavasulu for the period 21-9-2004 to 28-9-2004 . The Ex.B6 is attested Xerox of medical certificate and fitness issued by Dr.P. Sarvothama Rao as to the suffering of C.Vykuntavasulu with Enteric- fever (typhoid) from 21-9-2004 to 28-9-2004 and treatment of said during period and the fitness of the said person from 29-9-2004 on wards for duty as recovered from said illness. Except these medical certificate there is anything to show that if the insured was suffering from the said decease, he has got any treatment , he has got any prescription or has made any medical claim of any treatment in his department.
9. The opposite party neither appears to have examined the said Dr. P. Sarvothama Rao during the claim enquiry before to repudiation nor during the course of enquiry of this case before this forum as to its on Ex.B4 and B6 as earlier suppressed ailments of the policy holder. In the absence of adducing said doctor’s evidence in proof of the alleged ailments of the policy holder and treatment for that, the mere marking of the Ex.B4 and B6 does not amount to proof of said fact to hold the policy holder as suppressed his earlier health. Further the opposite party has not placed any such cogent material which establishes a nexus in between the so called suppressed ailments of the policy holder and the heart attack with which the policy holder died on 13-11-2005, and the said suppression as not only material but also fraudulent .
10. In the light of the above circumstances the Ex.B8 and B9 which appears to be a matter purely in between the opposite party and its agent as to his conduct as agent remains of any relevancy for appreciation in this case to which the said agent is not a party.
11. The Hon’ble Uttaranchal State Consumers Disputes Redressal Commission , Dehradun in LIC of India Vs. Sunil Kumar reported in II (2004) CPJ 636 , relied by the counsel for the complainant , says in the absence of proof of fraudulent suppression of material fact as to health and death not connected to the alleged earlier ailment mere taking leave on medical ground is no ground to hold that the insured was actually ill and took treatment and thereby holds company’s liability under policy.
12. The Hon’ble Rajsthan State Disputes Redressal Commission, Jaipur in Hemalatha Vs LIC of India reported in III (2006) CPJ 240 holds the deceased policy holder not guilty of suppressed material facts when no document proof to prove that the deceased taken treatment for alleged decease at the time of or prior to filling of proposal form and so the repudiation of claim as un justified.
13. The Hon’ble Uttaranchal State Consumers Disputes Redressal Commission , Dehradun in LIC of India Vs. Rukmani Dharamshaktu reported in II (2004) CPJ 146 holds when the decease has no nexus with death of the insured every decease is not material and so even if not disclosed, claim can not be rejected.
14. The learned counsel for the respondent has placed for appreciation the decision of Hon’ble National Commission in LIC of Inida and others Vs Vijay Chopra (Smt) reported in II 2008(2008) CPJ 269 NC wherein the order of the State Commission was set aside upholding the dismissal of the complaint made by the District Forum. In the said case the claim was repudiated by Insurance Company as consultation with doctor and taken treatment of the policy holder as proved. But in the present case no such proof being there except the EX.B4 and B6 – Fitness Certificate for joining duty after to treatment which does not envisage the line of treatment, medicine prescribed and diagnosis made. Hence this decision is having an applicability and relevancy for appreciation in this case.
15. The leaned counsel for the respondent also cited a decision of Hon’ble National Commission in Smt. Prema and others Vs LIC of India reported in Legal Digest January, 2007 in Pg.No.10. This decision as more delt with the concept of principle of “Uberrima fides” in insurance contracts and no where dispenses with the proof of the suppression material as to earlier ailment of the policy holder and does not merely empowers the repudiation of contract on that score. In the circumstances of the present case where the proof of treatment for earlier alleged decease of policy holder was not proved, this decision cited by the leaned counsel for the respondent is having any relevancy for its appreciation in this case.
16. In the light of the above decisions what follows is that every decease which has any nexus with the death need not be disclosed and the earlier suppression of material fact as to the health must be with a fraudulent intention and rejection of claim without satisfactory proof of earlier treatment is not proper.
17. In the absence of proof of treatment for alleged earlier deceases the leave applications in Ex.B3 and B5 of the deceased policy holder appears to be as mere application for obtaining leave or for regularization of his absent period of the duty when he could not get the leave otherwise.
18. As per the discussion in supra paras as the suppression of earlier deceases with any fraudulent intension and the treatment for it was not proved by the opposite party and the mere leave applications without substantiation of the alleged treatment are not sufficient to reject the claim, there appears any justification for the repudiation of the claim by the opposite party.
19. The said conduct of the opposite party as not only remains deficient but also sufficient enough to ensue mental agony to the complainant besides to the costs of litigation being drived to the forum for redressal, there appears bonafidees in the claim of the complainant for the assured amount under the policy and for compensation for mental agony and cost of the litigation.
20. consequently, the complaint is allowed directing the opposite party to pay to the complainant the assured amount of Rs.50,000/- under policy No.653422575 with entitled dividends and bonus and Rs. 5,000/- as compensation for mental agony and Rs.2,000/- as cost of this case within a month of receipt of this order . In default the supra stated award amount shall be payable by the opposite party to the complainant with 9% 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 10th July, 2008.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. First premium Receipt.
Ex.A2. Repudiation Letter, dated 13-3-2007.
Ex.A3. Office copy of legal notice, dated 18-4-2007 along with
two postal receipts and one acknowledgement.
Ex.A4. Reply to Ex.A3.
Ex.A5. Letter, dated 9-1-2006 of Food Corporation of India, Kurnool
addressed to complainant.
List of exhibits marked for the opposite parties:
Ex.B1. Claim form B
Ex.B2. Claim form B1.
Ex.B3. Commuted leave sanction.
Ex.B4. Medical certificate of fitness.
Ex.B5. Commuted leave granting application from 21.9.04 to 28.9.04
Ex.B6. Medical fitness certificate.
EX.B7. Claim form E.
Ex.B8. Letter, dated 3-4-2007 of Manager (claims) to LIC agent.
Ex.B9. Agents confidential report.
Ex.B10. Proposal form.
Ex.B11. Medical Examiner’s confidential report (No.in 3 papers)
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite party.
Copy was made ready on :
Copy was dispatched on :
Copy was posted on :
