IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Thursday the 30th day of December, 2010
Filed on 15.10.08
Present
- Sri. Jimmy Korah (President)
- Sri. K. Anirudhan (Member)
- Smt. Shajitha Beevi (Member)
in
C.C.No.234/08
between
Complainant:- Opposite Party:-
Smt.P.N.Beena, Alias Beena Ravikumar, The Life Insurance Corporation of India,
Wife of late K.Ravikumar, Represented by its Senior Divisional Manager,
Keeruveli, Uthradom House, L.I.C. Division Office, Jeevan Prakash,
Sanathanapuram.P.O., Pattom, P.B. No.1001,
Kalarkode, Alappuzha-688 003. Thiruvananthapuram-695 004.
(By Adv.K.V.Subhakumar) (By Adv. Jayan C Das)
O R D E R
SRI.JIMMY KORAH (PRESIDENT)
The case of the complainant is that the complainant is the wife of the deceased Ravikumar. Complainant’s husband Mr.Ravikumar had availed two policies bearing No.771743211 for Rs.2,00,000/- (Rupees two lacs only) and bearing No.391946672 for Rs.51,000/-(Rupees fifty one thousand only) respectively. Thereafter on 30th September 2004 the insured succumbed to death at his residence. After the death of her husband, the complainant, the nominee of the deceased submitted a claim with the opposite party for the amount due under the aforesaid policy. The opposite party on 11th January 2007 repudiated the complainant's claim on the ground that the deceased had withheld correct information with regard to his health at the time of availing the said policies. At the time of availing the policies, the deceased was not suffering from any sort of deceases. The proposal form was duly filled up and approved by the agent of the opposite party. The doctor of the opposite party acknowledged the correctness of the disclosures of the deceased regarding his health in the proposal form. In any event the repudiation of the claim of the complainant is unlawful. Got aggrieved on this the complainant approached this Forum for compensation and other relief.
1. On notice being sent the opposite party turned up and filed version. The contention of the opposite party is that the insured was suffering from pre-proposal illness. The deceased willfully suppressed the same in the proposal form. The insured did not answer the proposal form properly. The proposal form was not filled up by the authorized agent of the opposite party as alleged by the complainant. That apart, no doctor on behalf of the opposite party verified the correctness of the entries with regard to the health of the insured. The repudiation of the claim was the inevitable consequence of the prompt and proper enquiry by the opposite party. The complainant was allowed to produce all relevant documents pertaining to the policy claim. The conclusion arrived by the opposite party is not behind the complainant's back. There is absolutely no deficiency of service. The complainant is not entitled to any relief sought for. The complainant is only to be dismissed with cost to the opposite party, the opposite party vociferously argues.
2. The complainant's evidence consists of the testimony of the complainant as PWl, and the documents Exbt Al was marked. Ext. A1 is the letter of repudiation issued by the opposite party. On the side of the opposite party, the manager of the opposite party filed proof affidavit and the documents B1 to B7 were marked. Exbt B1 is the letter by the complainant to the opposite party, B2 is the copy of the discharge summary, B3 is the echo report, B4 is the copy of the claim fom1, B5 is the copy of leave certificate and B6 & B7 are the proposal form of the insured.
3. Taking into account the contentions raised by both the parties the issues arise for consideration are:-
(1) Whether the complainant suppressed any material facts the disclosure of which would have disqualified him from availing the policy?
(2) Whether the complainant is entitled to the policy amount and other relief?
4. The deceased was holding insurance at the time of his death from the opposite party. The complainant is the wife and the nominee of the deceased. All these aspects have not been disputed or denied by the opposite party. The key contention of the opposite party is the insured at the time of availing the policy suppressed material facts and tendered false information as to his health. On the other hand, the complainant affirms that the proposal form was filled up by the authorized agent of the opposite party, and the doctor on behalf of the opposite party acknowledged the health condition of the insured. We thoroughly analyzed the facts and circumstances of the case. We perused the materials put on record by the parties with mathematical exactitude. At the out set, we are of the impression that the opposite party has not adopted any positive steps to disprove the case of the complainant. That apart, even on a closer scrutiny of the version and the affidavit placed on record by the opposite party, it does not come out categorically that what facts or factors material to the policy were suppressed by the insured. To put it differently the opposite party appears to be not keen on bringing home, in what manner the facts allegedly suppressed or misrepresented by the insured fall material to the policy. More over it is worthier to note that the opposite party does not make it a point to plead or prove what could have been consequence thereof, had the insurer not suppressed or misrepresented facts allegedly material to the proposal form of the policy. In other words, no prejudice is proved to have caused to the opposite party by the aforesaid alleged acts of the insured.
5. It appears that the opposite party has produced some documents with regard to the treatment of the insured. The photocopies of certain documents filed by the opposite party are short of evidentiary value. We are of the considered view that at least, the affidavit of these persons should have been got filed by the opposite party. As such there is no evidence worth the same to rebut the case advanced by the complainant. Thus when the complainant case has not been rebutted by the opposite party, this Forum has no other course open but to accept the version put forth by the complainant.
6. In the light of the facts and circumstance discussed herein above the opposite party is directed to pay to the complainant an amount of Rs.2,51,000/- (Rupees two lacs fifty one thousand only) with 9% interest from the date of her application for claim till the recovery of the said amount. The opposite party is further directed to pay a compensation of Rs.5,000/-(Rupees five thousand only) to the complainant. The opposite party shall comply with the order within 45 days of receipt of this order.
In the result the complainant is allowed accordingly. No order as to cost.
Pronounced in open Forum on this the 30th day of December, 2010.
Sd/-Sri. Jimmy Korah
Sd/-Sri. K. Anirudhan
Sd/-Smt. N. Shajitha Beevi
Appendix:-
Evidence of the complainant:-
PW1 - P.N.Beena (Witness)
Ext. A1 - The letter of repudiation dated, 11.01.2007
Evidence of the opposite party:-
Proof affidavit in lieu of position
Ext. B1 - The letter by the complainant to the opposite party dated, 30.11.2006
Ext. B2 - The copy of the discharge summary dated, 26.07.2003
Ext. B3 - The copy of the Echo report dated, 22.07.2003
Ext. B4 - The copy of the claim form
Ext. B5 - The copy of the leave certificate
Ext. B6 - The proposal form dated, 25.03.2004
Ext. B7 - The proposal form dated, 19.09.2003
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite Parties/S.F.
Typed by:- k.x/-
Compared by:-
