F.A.No. 357  OF 2008 AGAINST C.D.NO.37 OF 2006 DISTRICT CONSUMER FORUM VIZIANAGARAM

Between

1.   Kalisetti Devi W/o late Ramakrishna
30 yrs, R/o Pinathadivada Village
Denkada Mandal, Vizianagaram Dist.

2.   Kalisetti Rupa D/o late Ramakrishna, 13 yrs

3.   Kaliseti Maduri D/o late Ramakrishna 12 yrs

4.   Kalisetti Sai Latha D/o late Ramakrishna 10 yrs

5.   Kalisetti Ademma W/o late Seethanna
57 yrs, R/o P.Inathadivada – Rest do
(Complainants no.2 to 4 being minors rep. by their
mother & guardian i.e., 1^st complainant Kalisetti Devi)

                                                                                                        Appellants/complainants              

        A N D

1. The Zonal Manager
   South Central Zonal Office
   Life Insurance Corporation of India
   Saifabad, Hyderabad
2. The Divisional Manager
   Life Insurance Corporation of India
   Visakhapatnam
3. The Branch Manager,
   Life Insurance Corporation of India
   Lower Tank Bund Road, Vizianagarm

                                                                                                Respondents/opposite parties

Counsel for the Appellants             Sri MSR.Subrahmanyam

Counsel for the Respondents         Sri B.Rajendra

 QUORUM:                 SRI SYED ABDULLAH, HON’BLE MEMBER

&

                            SRI R.LAKSHMINARSIMHA RAO, HON’BLE MEMBER

                          THURSDAY THE TWENTY NINETH DAY OF JULY

                                            TWO THOUSAND TEN

Oral Order ( As per R.Lakshminarsimha Rao, Member)
                                     ***

The complainants are the appellants. The appeal is directed against the order dated 6.8.2007 in C.D.No.37 of 2006 by the District Forum Vizianagaram whereby their complaint was dismissed.

.

The facts of the case as stated in the complaint are that the complainant no.1 is the wife, complainants no.2 to 4 are the minor daughters and complainant no.4 is the mother of deceased late Ramakrishna.  The deceased RamakKrishna was in service under Government as attender.  The deceased Rama Krishna insured his life under policy bearing No.692681930 and 692680060 since 24.6.2004 by collecting premium of Rs.390/-.  The insured died on 25.8.2004 due to jaundice.  The complainants being the legal representatives of the deceased submitted a claim application to the opposite parties for  payment of the insurance amount of `1,00,000/-.  The opposite parties by letter dated 31.3.2005 repudiated the claim of the complainants on the ground that the deceased Rama Krishna availed leave on sick grounds from 2.5.2004 to 13.7.2004 for Hepatitis and it was not disclosed in the proposal form.  Hence the complainants filed the complaint before the District Forum seeking direction to the opposite party to pay `1,00,000/- to the complainants with interest and costs.

        The opposite party resisted the case contending that the life assured was on sick leave for treatment of Hepatitis as on the date of proposal i.e., 24.6.2004. All the polices were in force as on the date of death of the life assured.  The life assured died on 25.8.2004 with a duration of 2m-1d, 1y-7m-27d and 3y-5m-27d respectively from the date of commencement of the polices.  Since the first two policies come under early category  an inquiry was conducted and opposite parties found that the life assured was sick on the date of proposal.  Basing on the evidence opposite parties repudiated the claim on the policy No.6926814930 which was procured during the period of the life assured’s sick leave and admitted the other two policies and paid the amounts accordingly.  Hence, the opposite parties prayed for dismissal of the complaint. 

        The complainant no.1 filed his affidavit and got marked exhibits A1 to A4. On behalf of the opposite parties, Sri B.Narayana Murthy, Divisional Manager of opposite party no.2 filed affidavit and Ex.B1 was marked.

        The point for consideration is whether the opposite parties have rendered deficient service in repudiating the claim of the complainant?

        The learned counsel for the complainants has contended that the panel doctor of the opposite parties has conducted medical examination of the husband of the complainant no.1 and thereafter having satisfied with the health condition,  the opposite party had issued the insurance policies in his favour.  The deceased insured opting for earned leave on medical grounds does not by itself be made a ground for repudiation of the claim. 

        The opposite parties had issued insurance policies in favour of the husband of the complainant no.1 on 24.6.2004.  The husband of the complainant no.1 died on 25.8.2004.  The complainants, after the death of the insured, lodged claim with the opposite parties and their claim was repudiated by the opposite parties on the ground that the deceased insured availed earned leave on medical grounds from 2.5.2004 to 13.7.2004 and as such at the time of filing the proposal i.e., on 24.6.2004 he was on leave and not doing well at the time of obtaining the insurance policy.  An enquiry stated to have been conducted by the opposite parties said to have revealed that the deceased suppressed material facts at the time of submitting the proposal.

        There is no dispute of the fact the deceased availed of leave on medical grounds.  The copy of the certificate issued by the employer of the deceased is marked as Ex.B1 and it shows that the deceased was on leave from 17.12.2003 to 23.12.2003 and from 2.5.2004 to 13.7.2004, on both the occasions medical grounds was shown as the ground on which leave was sought for. However, the columns relating to the nature of leave and medical benefit scheme was kept blank and answered in negative.  Therefore, this document provides for two inferences, the deceased has not availed of sick leave which necessarily requires a medical certificate.  It is also a fact to be considered here that the deceased has not claimed any reimbursement from his employer and in the circumstances it cannot be said that the certificate issued by the employer can be made the sole criterion for arriving at the conclusion that the deceased was on sick leave at the time of submitting theproposal and obtaining the insurance policy. 

        During pendency of the opposite parties have filed copy of certificate issued by the employer of the deceased and the copy of certificate issued by doctor.  At this stage, if this document is considered; the complainants would be deprived of the opportunity to question the proof and relevancy of such document.  The circumstances where the opposite parties have filed a copy of document without any supporting affidavit or petition  would in essence deprive the other party of the opportunity to question the authenticity and genuineness of such document.  Hence we are inclined to deem it a fit case to remand to the District Forum for denova enquiry.

        In the result the appeal is allowed.  The order dated 6.8.2007 passed by the District Forum is set aside. The matter is remanded to the District Forum for denova enquiry and disposal of within a period of two months. 

                                                                                MEMBER

                                                                                MEMBER

                                                                            Dt.29.07.2010
KMK*