DISTRICT FORUM :: KADAPA Y.S.R DISTRICT
PRESENT SMT. K. SIREESHA, B.L., PRESIDENT FAC
SRI M.V.R. SHARMA, MEMBER.
Saturday, 22nd March 2014
CONSUMER COMPLAINT No. 30/ 2013
A. Sudharshan Reddy, S/o Late A. Sudhakar Reddy,
Indian, Hindu, age 30 years, Pvt. Employee,
Resident of D.No. 5/238, Yerramukkapalli,
Kadapa Town. ….. Complainant.
Vs.
The Branch Manager, LIC of India,
Branch Office, R.S. Road, Kadapa town. ….. Respondent.
This complaint coming on this day for final hearing on 21-3-2014 in the presence of Sri S. Tirupathaiah, Advocate for complainant and Sri D. Lakshminarayana, Advocate for Respondent and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, President FAC),
1. Complaint filed under section 12 of the C.P. Act 1986.
2. The brief facts of the complaint are as follows:- The complainant respectfully and humbly submitted that the complainant’s father one A. Sudhakar Reddy took policy by name New Bima Gold bearing No. 655300737 on 24-12-2008 on his life for Rs. 2,00,000/- on payment of Rs. 9,694/- as yearly premium from the respondent branch and nominated the complainant as nominee for the same.
3. Further submits that unfortunately said A. Sudhakar Reddy died on 15-5-2010 at RIMS, Kadapa, immediately complainant approached the respondent and submitted death certificate, original policy bond and premium payment receipts and requested to settle the death claim.
4. Further submits that a letter dt. 19-11-2011 issued by the Senior Divisional Manager, Kadapa was received by the complainant that zonal Office also repudiated the claim of the complainant.
5. The acts of the respondent clearly amounts to deficiency of service and due to their acts complainant suffered mental agony and financial loss to the tune of Rs. 30,000/- and that the respondent is liable to be punished under the provisions of the Consumer Protection Act.
6. Both the complainant respondent all transactions taken place at Kadapa are within the jurisdiction of this Hon’ble forum. A court fee of Rs. 200/- paid through I.P.O, Kadapa dt. 01-4-2013.
7. It is therefore, prayed that the Hon’ble forum may be pleased to pass an order directing the respondent to pay the complainant (a) a sum of Rs. 2,00,000/- together with respective bonus and interest assured under the policy from the date of the bond and till the date of realization, (b) a sum of Rs. 30,000/- towards compensation, (c) a sum of Rs. 5,000/- towards the cost of the complaint and (d) pass such other orders as the Hon’ble forum deem fit and proper in the interest of justice.
8. Counter filed by the respondent. The complaint filed by the complainant is unjust and not maintainable either in law or on facts.
9. The complainant is put to strict proof of all the allegations made in this complaint except those which are specifically admitted herein by this respondent.
10. It is submitted that the issuance of the subject policy in favour of the deceased A. Sudhakar Reddy is admitted but the allegation that the repudiation of the petitioners claim suffers from deficiency in service, is utter false. The respondent submits that the repudiation of the petitioner’s claim is due to deliberate suppression of health conditions of the deceased policy holder while submitting the proposal form.
11. As seen from the proposal form, the deceased policy holder has given information under column No. 11 of ‘Personal History’ as “NO” for all the questions relating to his history of health and for the question of usual state of health, he has answered as “GOOD”. Curiously, for the questions 11 (a), (b), (d), € the deceased policy holder has answered as “NO”. Further curiously, for the question in column 11 (h) – Do you use or have you ever used (i) alcoholic drinks, the deceased policy holder has categorically answered as “NO”.
12. The deceased policy holder is a chronic alcoholic patient and on 11-3-2008 he was got admitted in NIMS Hospital, Hyderabad vide I.P.No. 806168 with a diagnosis of “ALCOHOLIC LIVER DISEASAE WITH PORTAL HTN BLEEDER – POST EVL STATUS” and after treatment of Grade II Hapatic Encephalopathy treatment, he was discharged on 13-3-2008. The subject policy was dated 24-12-2008. Further the deceased policy holder was again got admitted in same hospital on 24-2-2009 vide I.P.No. 902378 with a diagnosis of “Cirrhosis of liver – Decompensated – Alcohol Related” and after treatment of Hapatic Encephalopathy – Grade III, he was discharged on 26-2-2009. It may be observed by the Hon’ble Forum that in the discharge summary dt. 26-2-2009 under the column of “Clinical Summary” it is clearly stated as “known case of Alcoholic Cirrhosis diagnosed 6 years back”. Later, again he was got admitted in same hospital on 10-5-2010 at 10-15 p.m and expired on 15-5-2010 at 8.00p.m.
13. Thus, in view of the above medical history of the deceased policy holder, it has become crystal clear that since 6 years prior to obtaining of the subject policy he was suffering from chronic liver decease and that he was a chronic alcoholic patient. Therefore, it is clear that the deceased policy holder has deliberately suppressed the material facts relating to his health condition while obtaining the policy.
14. In the proposal form the deceased policy holder has made a clear and voluntary declaration which is mandatory for issuance of the policy as hereunder “I, A. Sudhakar Reddy the person whose life is herein being proposed to be assured, do hereby declare that the foregoing statements and answers have been given by me after fully understanding the questions and the same are true and complete in every particular and that I have not withheld any information and I do hereby agree and declare that these statements and this declaration shall be the basis of the contact of assurance between me and the life Insurance Corporation of India and that if any untrue averment be contained therein the said contract shall be absolutely null and void and all moneys which shall have been paid in respect thereof shall stand forfeited to the corporation”.
15. It is submitted that while Respondent Corporation has made specific question vide questionnaire No. 11 in the proposal form with regard to the health and habits of the life assured, against which the policy holder has given the answer in negative as “NO”. Had Respondent Corporation been informed about her pre health condition and deformity in particular before taking the above policy, they would not have issued the above policy. Hence, for non- disclosure of the material facts through their letter, the respondent corporation have intimated the complainant that the policy claim has been repudiated and treated the matter as closed.
16. The deceased policy holder, with a fraudulent intention and to have undue advantage of the policy benefits, had suppressed the above material facts. Hence, the repudiation is justifiable and based on sound principles of law.
17. It is submitted that the primary duty of the proposer while taking the life insurance policy is to disclose about his health conditions pre-deceased and habits of life proposed for insurance. As late A. Sudhakar Reddy has deliberately suppressed the material facts which were suppressed to have been disclosed at the time of taking the policy and violated the terms and conditions of the policy, the contract has now become void, unenforceable and not legally binding on the respondent corporation. Therefore, the respondent corporation is not liable to pay any amount towards the policy claim as alleged by the complainant. Hence, no amount is payable under the subject policy.
18. There are no bonafides in filing the present complainant by the complainant and there is no deficiency on the part of the respondent corporation at any point of time much less in repudiating the claim in the present case.
19. The respondent corporation reserves right to file additional counter, if any, if new facts come to its notice or advised so at a later stage. Therefore, prayed that the Hon’ble forum may be pleased to dismiss the complaint with exemplary costs in the interest of justice.
20. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is entitled to the relief as prayed for?
- Whether there is negligence or deficiency of service on the part of the Respondent?
- To what relief?
21. On behalf of the complainant Ex. A1 and A2 were marked and on behalf of the respondent Ex. B1 to B6 were marked.
22. Point Nos. 1 & 2. It is true that the complainant’s father deceased A. Sudhakar Reddy had obtained a policy from the respondent corporation and paid premium of Rs. 9,694/- under Ex. A1. The policy bearing No. 655300737 by name New Bima Gold dt. 24-12-2008 on his life. It is very clear under Ex. B1 that the deceased life assured A. Sudhakar Reddy had suppressed material facts, regarding his health. Ex. B2, B3, B4, B5 and Ex. B6 clearly proves that the deceased life assured A. Sudhakar Reddy was suffering with “ALCOHOLIC LIVER DISEASAE WITH PORTAL HTN BLEEDER – POST EVL STATUS.” Ex. B2 clearly shows that the deceased life assured A. Sudhakar Reddy was admitted at NIMS Hospital on 11-3-2008 with ALCOHOLIC LIVER DISEASAE WITH PORTAL HTN BLEEDER – POST EVL STATUS”. So it is crystal clear that the deceased A Sudhakar Reddy was admitted at NIMS Hospital as per Ex. A2 prior to taking of the above said policy i.e. he was admitted at NIMS Hospital on 11-3-2008 with preexisting disease. Ex. B2, B4 and B5 supports the case of respondent. As per rules and regulations of Life Insurance Corporation of India suppression of material facts leads to repudiation of the claim. It is very clear that the complainant’s father deceased A. Sudhakar Reddy had suppressed the ill health of his health history, While taking above subject mentioned policy. As seen from the evidence field by the respondent and Ex. A2 Corporation had repudiated the claim due to suppression of material facts while taking the policy. As the deceased A Sudhakar Reddy had deliberately suppressed the material facts, which were suppressed have been discussed at the time of taking policy and violated the terms and conditions of the policy as per rules and regulations of the Life Insurance Corporation of India. The contract between the deceased and the respondent became void and enforceable. So the complainant is not eligible for compensation as prayed by him. At the same time there is no deficiency of service or negligence on the part of respondent.
23. Point No. 3 In the result, the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 22nd March 014
MEMBER PRESIDENT FAC
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Respondents : NIL
Exhibits marked for Complainant : -
Ex. A1 P/c of premium receipt.
Ex. A2 P/c of repudiation letter dt. 19-12-2011.
Exhibits marked for Respondents: -
Ex. B1 Proposal form submitted by the deceased policy holder dt.21-12-08.
Ex. B2 Discharge record dt. 13-3-2008 issued by NIMS Hospital,
Hyderabad.
Ex. B3 Discharge record dt. 26-2-2009 issued by NIMS Hospital,
Hyderabad.
Ex. B4 Case sheet of the deceased policy holder.
Ex. B5 Case record dt. 15-5-2010 issued by the NIMS Hospital, Hyderabad.
Ex. B6 Death memo issued by NIMS Hospital, Hyderabad relating to the deceased policy holder.
MEMBER PRESIDENT FAC
Copy to :-
- Sri S. Tirupataiah, Advocate for complainant.
- Sri D. Lakshminarayana, Advocate for respondent.
B.V.P. - - -
