BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
And
Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Wednesday the 5thday of October, 2011
C.C.No.22/2011
Between:
A.Subbamma, W/o Late Allannagari Boya Venkata Maddaiah, @ A.Boya Venkata Maddaiah,
R/o H.No.9/89, Narnoor Village-518002, Orvakal Mandal, Kurnool District.
…Complainant
-Vs-
- The Branch Manager, LIC of India,
H.NO.40-36-3, River View Colony,Kurnool-518001.
2. The Senior Divisional Manager, LIC of India, Divisional Office,
Post Box No.10, College Road, Kadapa-516004
....Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri M.Sivaji Rao, Advocate for complainant and Sri G.Md.Habeebur Rahiman, Advocate for opposite parties 1 and2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No.22/2011
1. This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying:-
- To direct the opposite partiesjointly and severally to pay the assured amount in the policy along with other benefits and bonus with interest @ 24% per annum to pay a sum of Rs.10,000/- towards the compensation for causing mental agony and hardship;
- To pay the costs of this complaint;
- To passany other reliefor reliefs that are deem to be fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as under:- The deceased A.Boya Venkata Maddaiah took L.I.C. Policy bearing No.654628042 from opposite party No.1, on 31-03-2007. The complainant who is the wife of the insured is the nominee under the policy. The sum assured under the policy is Rs.1,00,000/-. The insured died on 11-10-2008 due to Heart-attach. After the death of the insured the complainant who is the nominee under the policy submitted claim along with relevant documents to the opposite parties. The opposite party no.2 by its letter dated 17-07-2009 illegally repudiated the claim of the complainant on the ground that the deceased suppressed material facts regarding to his health condition prior to the taking of the policy. Hence the complaint.
3. Opposite party No.2 filed written version and the same is adopted by opposite party No.1. It is stated in the written version of opposite party No.2 that the complaint is not maintainable. The deceased submitted the proposal dated 29-03-2007 stating that he was keeping good health. In fact the deceased was suffering from Asthma and took treatment in the Hospital. He did not inform the said fact to insurance company. The claim of the complainant was dismissed as the insured obtained the policy by suppressing material facts regarding his health. The deceased was suffering from Asthma since 20 years. He died due to COPD (Cardiac Pulmonary Disease) at Government General Hospital, Kurnool. As the policy is unit linked insurance policy the complainant was paid bid value of units through cheque. The complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to A4 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to B4 are marked and sworn affidavit of the opposite party No.2 is filed. RW1 is examined and Ex.X1 is marked through him.
5. Both sides filed written arguments.
6. The points that arise for consideration are:
- Whether there is deficiency of service on the part of Opposite Parties?
- Whether the complainant is entitled to the reliefs as prayed for?
- To what relief?
7. POINTS 1 and 2:- AdmittedlyA.Boya Venkata Maddaiah husband of the complainant obtained Ex.B1 policy bearing No.654628042 from the opposite party No.1. The complainant is the nominee under the policy. The sum assured under the policy is Rs.1,00,000/-. It is the case of the complainant who is the wife of the insured that her husband A.Boya Venkata Maddaiah died on 11-01-2008 due to Heart-attach. The complainant filed Ex.A4 death certificate of her husband issued by Village Revenue Officer, Narnoor Cluster. In Ex.A4 it is mentioned that A.Boya Venkata Maddaiah died on 11-10-2008. The medical officer attached to Government General Hospital Kurnool also in his evidence stated that A.Boya Venkata Maddaiah was admitted in the Hospital on 08-10-2008 and he died on 11-10-2008. There is no dispute about the death of the insured on 11-10-2008.
8. Admittedly after the death of A.Boya Venkata Maddaiah, his wife submitted claim to the opposite parties. The claim of the complainant was repudiated by the opposite parties on 17-07-2009 alleging that the deceased was suffering from Asthma by 31-03-2007 and that he obtained the policy by suppressing the material facts regarding his health. As already stated the opposite parties issued Ex.B1 policy in favour of the deceased basing on the information furnished by the assured (deceased). The opposite parties field Ex.B2 proposal of the insured to issue the policy. In the said proposal it is mentioned “under the head of personal statement regarding health of life to be assured”, that the assured was keeping good health. It is the case of the opposite parties that the insured was suffering from asthma at the time of taking policy on 31-03-2007and that he did not reveal the same in the proposal submitted by him. The burdened is on the opposite parties to establish that the insured obtained the policy by suppressing material facts regarding his health. The opposite parties mainly relied on the evidence of RW1 who is working as a principal in Government Medical College, Kurnool. RW1 in his evidence stated that A.Boya Venkata Maddaiah (assured) was admitted in Government General Hospital, Kurnool on 08-10-2008 and he was suffering from breathlessness since 20 years and he died on 11-10-2008. RW1 also produced Ex.X1 Case Sheet of A.Boya Venkata Maddaiah. In the said Case Sheet at page No.14 it is mentioned that the patient was suffering from breathlessness since 20 years. RW1 in his evidence stated that post graduates wrote the particulars in page No.14 of Ex.X1. He stated that the name of the doctor who wrote the particulars in page No.14 of Ex.X1 is not there. No doubt in Ex.X1 there is a mention that the insured was suffering from breathlessness since 20 years. The doctor who made the said endorsement at page No.14 Ex.X1 is not examined by the opposite parties. It is argued by the learned counsel appearing for the complainant that the opposite parties failed to establish that the insured was suffering from Asthma since 20 years. He relied on the decision reported in IV (2008) CPJ 89 (NC) where in the Honourable National Commission held that “History recorded in hospital bed ticket, not to be treated as evidence as doctor recording that history was not examined as a witness or his affidavit filed”. In theinstant case also the opposite parties could not examine the doctor who made endorsement that the insured was suffering from breathlessness since 20 years. As already stated RW1 is not in a position tosay the name of the doctor who wrote the particulars in page No.14 of Ex.X1. Merely because there is endorsement in Ex.X1 that the deceased was suffering from asthma since 20 years, it cannot be said that the deceased suppressed material particulars regarding his health condition. RW1 also in his evidence stated that he cannot say who furnished the information mentioned in page No.14 of Ex.X1. The opposite parties failed to establish that the insured was suffering from asthma by the date of the proposal Ex.B2. The repudiation of the claim of the complainant by the opposite parties is not just and reasonable. The opposite parties are liable to pay the assured amount to the complainant who is a nominee under the policy. There is deficiency of service on the part of the opposite parties.
9. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay assured amount of Rs.1,00,000/- along with other benefits to the complainant with interest at 9% per annum from the date of the repudiation of the claim i.e., 17-07-2009 till the date of payment along with cost of Rs.500/-.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 5thday of October, 2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties:RW1
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of letter submitted by the complainant
to the Zonal Manager L.I.C of India Hyderabad
dated 11-08-2009.
Ex.A2. Photo copy of repudiation letter dated 17-07-2009.
Ex.A3 Photo copy of letter of Zonal Manager to
complainant dated 14-08-2009.
Ex.A4 Photo copy of death certificate issued by Village
Revenue Officer Narnoor (V) Orvakal (M)
Kurnool District.
Ex.X1 Case sheet of A.Maddaiah issued by Government
General Hospital, Kurnool dated 11-10-2008.
List of exhibits marked for the opposite parties:-
Ex.B1 L.I.C. Policy No.654628042.
Ex.B2 Proposal for L.I.C. Money plus Plan,dated 29-03-2007.
Ex.B3 Office copy of repudiation letter dated 17-07-2009.
Ex.B4 Photo copy of case sheet of A.Maddaiah issued by
Government General Hospital, Kurnool
dated 11-10-2008.
RW1 Deposition of Dr.Bhavani Prasad dated 08-08-2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
// Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties :
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