BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Monday the 28th day of November, 2005
CD No. 79/2005
Boya Ulva Naidu,
S/o Pedda Thimmaiah,
R/o Erraguntla (V),
Dhone (M),
Kurnool District. …… Complainant
-Vs-
1.Life Insurance Corporation of India,
Rep. by its Divisional Manager,
Kadapa.
2.The Branch Manager,
Life Insurance Corporation of India,
Dhone Branch,
Kurnool District. ….. Opposite Parties
The complaint coming on 22-11-05 for arguments in the presence of Sri. A.Rama Subba Reddy, Advocate, Kurnool for complainant, Sri. I.Anatha Rama Sastry, Advocate, Kurnool for opposites parties, and stood over for consideration till this day, the Forum made the following.
O R D E R
(As per Smt C.Preethi, Member)
1. This CD complaint of the complainant is filed under section 12 of C.P. Act, 1986, seeking a direction on the opposite parties to pay assured amount of Rs.39,000/- with bonus and interest at the rate of 24% per annum from the date of death, Rs.10,000/- as compensation, costs of the complaint and any such other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that complainant is the husband of Late Boya Ulava Varalakshmi, who insured her life with the opposite parties 1 and 2 under policy bearing No.653022676 for Rs.39,000/-. On 9.9.2003 the policy holder died due to fever and heart pain. The complainant informed the opposite parties about the death of the policy holder and submitted claim form on 2.1.2005 and complied all formalities, but the opposite parties wrote a letter dt 16.3.2005 requesting the complainant to send affidavit in lieu of B and B1 forms. Thereafter, on 25.3.2005 the complainant sent a letter through her advocate stating that the policyholder was not hospitalized and B and B1 forms cannot be sent and there was no response from the opposite parties. Inspite of submitting all required documents the opposite parties did neither settled the claim nor repudiated. Hence, there arises deficiency of service on part of opposite parties.
3. In substantiation of his case the complainant filed the following documents Viz (1) legal notice dated 11.3.2005 issued by the complainant’s counsel addressed to opposite party No.1 and (2) reply notice dated 16.3.2005 of opposite party No.2 to the legal notice of complainant, besides to the sworn affidavit of the complainant and five third party affidavits and caused interrogatories to opposite parties and the complainant and third parties suitably replied to the interrogatories caused by the opposite parties.
4. In pursuance to the notice of this Forum as to the case of the complainant the opposite parties appeared through their standing counsel and contested the case. The opposite party No.1 filed its sworn affidavit and opposite party No.2 adopted the sworn affidavit of opposite parties.
5. The written version of opposite parties questions the maintainability of the complainant’s case either in law or on facts, but admits the complainant’s wife Late Boya Uluva. Varalakshmi insured her life with opposite parties, under policy bearing No. 653022676 for assured sum of Rs.39,000/- and nominated the complainant as her nominee. The complainant informed the death of policy holder on 9.9.2003 due to typhoid and submitted claim form along with documents for consideration of death claim to opposite party No.2. It also further submits that the complainant submitted claim forms B and B1 with blanks.
6. As the claim was an early claim with duration of 9 months and 11 days from the date of commencement investigation was conducted which revealed that the policy holder was not maintaining good health prior to commencement of the policy and he was taking treatment at Government General Hospital, Kurnool for cancer as in patient for one month prior to her death and she was discharged from the Hospital just five days prior to her death. It lastly submits the complainant has to be submitted claim form B and B1 in case the policy holder has taken any treatment in any hospital and in case of no treatment was taken in any hospital the complainant has to submit an affidavit in lieu of claim Form B and B1. As the complainant failed to submit claim form B and B1 the complainant submitted affidavit on 26.4.2005 stating that the policy holder died due to fever suffering from chest pain for two days before take her to hospital. The above said treatment taken by the policy holder at Govt. General Hospital was suppression by the policy holder hence, there is no deficiency of service on part of opposite parties in not paying the policy amount.
7. The opposite parties in support of its case relied on the following documents Viz (1)Notarised affidavit of complainant (2) claimant’s requisition for claim forms for consideration of death claim (3) Medical attendant’s certificate (4)Certificate of Hospital Treatment and (5) claim enquiry report, besides to the sworn affidavit of opposite party No.1 in reiteration of its written version and caused interrogatories to complainant and third party suitably replied to the interrogatories of the complainant and the above documents are marked as Ex B.1 to B.5 for its appreciation in this case.
8. Hence, the point for consideration is to what relief the complainant is remaining entitled alleging deficiency of service on part of opposite parties:-
9. It is not in dispute that the policy holder B. Varalakshmi has taken a policy bearing No. 653022676 for Rs. 39,000/- and nominated the complainant as nominee and the said policy holder died on 9.9.2003 due to heart pain. On the claim preferred by the complainant, the opposite parties requested the complainant to file claim forms B and B1, if hospitalized else an affidavit in lieu of B and B1 forms has to be submitted. The complainant, thereafter on 26.4.2005 submitted an affidavit in lieu of B and B1 forms, even after, that the opposite parties did not pay the assured amount to the complainant.
10. The written version of opposite parties submits that the deceased was suffering from cancer and has taken treatment in Government General Hospital, Kurnool, as in patient and discharged just 5 days prior to her death, it is needless to observe that the burden is on opposite parties to establish that there was suppression of material facts. In support of the above said contentions any Doctor has been examined or any affidavit of medical expert has been provided to show that the deceased was suffering from cancer and has taken treatment in Government General Hospital. The opposite parties did not adduce any evidence to discharge their burden, as opposite parties failed to establish any suppression of material facts by the policy holder, hence, they are liable to pay the insured amount to the complainant. In the light of the above discussion and material on record not substantiating any suppression of health conditions by the policy holder prior to taking the said policy and further there appears any substance in the allegations of the opposite parties. Hence, the complainant is entitled to the policy amount as the conduct of opposite parties in not paying the assured amount, amounts to deficiency of service. Therefore, on careful consideration of material on record and legal position and the aspects involved, the complainant as nominee of the policy holder is entitled to the assured amount of his wife B. Varalakshmi and there is no justification in the opposite parties conduct in not paying the assured amount under the said policy to the complainant. The five third party affidavits filed on behalf of the complainant submit that they were never enquired by the officials of opposite parties in connection to the death of policy holder.
11. Therefore, in the result the complaint is allowed directing the opposite parties to pay to the complainant the assured amount of Rs.39,000/- to the complainant with 12 % interest from the date of legal notice i.e 14.3.2005 till realization along with Rs.1,000/- as costs of the case within a month from the date of receipt of this order.
Dictated to the Stenographer, Transcribed by her corrected and pronounced in the open court this the 28th day of November, 2005.
PRESIDENT
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties: Nil
List of Exhibits Marked for the complainant
A1 Legal notice, Dt. 11-3-2005 addressed by the complainant counsel to OP2
A2 Reply notice of OP2, Dt. 16-3-2005
List of Exhibits Marked for the Opposite parties
B1 Affidavit of complainant (Policy of Assurance bearing No.653022676)
B2 Claimant’s requisition for claim forms for consideration of Death Claim
B3 Medical Attendant’s Certificate
B4 Certificate of Hospital Treatment
B5 Claim Enquiry Report
PRESIDENT
MEMBER MEMBER
Copy to
1. Sri. A. Rama Subba Reddy, Advocate, Kurnool.
2. Sri. I. Anantha Rama Sastry, Advocate, Kurnool.
Copy was made ready on :
Copy was dispatched on :
Copy was delivered to parties:
