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
Friday the 28th day of October, 2005
CD No. 114/2005
D. Suresh Babu,
S/o. Late D. Ranga Swamy,
D.No. 28-1052-758,
Deva Nagar, Nandyal,
Kurnool, Dist. . . . Complainant
-Vs-
1. The Branch Manager,
LIC of India, Nandyal,
Kurnool Dist.
2. The Divisional Manager,
LIC of India, College Road,
Kadapa, Kadapa Dist. . . . Opposite parties
This complaint coming on 27.10.2005 for arguments in the presence of Sri C. Ramana Reddy, Advocate, Kurnool for complainant and Sri L. Hari Hara Natha Reddy, Advocate Kurnool for opposite party No.1 and No.2 and stood over for consideration till this day the Forum made the following.
O R D E R
(As per Smt C.Preethi, Hon’ble Lady 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 Rs.2,00,000/- under policy bearing No. 653114674, Rs.1,00,000/- under policy bearing No. 651694995 and Rs.1,00,000/- under policy bearing No. 653285044 with all benefits and interest at the rate of 18% per annum from the date of death, Rs.25,000/- as compensation for mental agony, and costs 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 the complainant is the nominee of Late D.Krishna Veni, who has taken policies bearing Nos. 653114674 for Rs.2,00,000/- on 15.7.2003, 651694995 for Rs.1,00,000/- on 20.6.2003 and 653285044 for Rs.1,00,000/- on 21.6.2003 from opposite party No.1 and all the three policies are medical policies. The said policy holder D.Krishna Veni died on 7.10.2003 by full due to sudden fits. On the claim preferred by the complainant for assured amounts the opposite party No.2 repudiated through their letter dt 12.4.2005 on the ground that the policy holder suffered from Epilepsy and Broncharil Asthama and consulted a medical man and had taken treatment from a hospital. But the complainant submits that the policy holder never took any treatment for the said alleged disease. Hence, the said allegations of opposite parties is false and baseless, so the repudiation is on untenable ground. The above said lapsive conduct of opposite parties in repudiating the policies is amounting to deficiency of service to the complainant.
3. The complainant in support of his complaint filed his sworn affidavit in reiteration of his complaint averments and caused interrogatories to the opposite party No.2.
4. In pursuance of the service of the notice of this Forum as to this case of the complainant, the opposite parties appeared through their standing counsel and contested the case, the opposite party No.2 filed written version denying any of its liability and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version of opposite parties even though admits the deceased D. Krishna Vani, mother of the complainant as holder of the policies as stated in the complaint for the assured sum of Rs.2,00,000/- Rs.1,00,000/- and Rs.1,00,000/- and nominated her son D.Suresh Babu as nominee but alleges suppression of material facts as to her state of health and the treatment she has undergone prior to the proposing of the above said policies and answering negatively to the question No.11 in all the proposal forms and as per her declaration the untrust averments found in the said proposal forms makes the contract of insurance Null and Void and for feiture the corporation all the amounts she paid to the corporation. As the claim of policies for assured amounts, consequent to the demise of the policy holder on 7.10.2003 being with in 2 years from the date of commencement of three policies, as they amount to early claim, investigation was taken up and learnt that the policy holder was suffering from fits and Broncharil Asthama prior to the date of commencement of policies and has consulted Dr N.Abdul Malik of Nandyal. It is also further submitted that the policy holder three years prior to her death has consulted the said doctor for the disease Epilepsy and Broncharil Asthama. The policy holder in order to defraud the opposite parties suppressed material facts of her ill-health knowingly and intentionally, therefore, all the amounts paid stand forfeited and no amount is payable towards policy contract and seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite parties filed the following documents Viz (1) repudiation letter dt 12.4.2005 addressed to the complainant by opposite party No.2 (2) Original proposal form of the deceased dt 13.6.2003 for Rs.1,00,000/- (3) Original proposal form of the deceased dt 22.6.2003 for Rs.1,00,000/- (4) Original proposal for the deceased dt 14.8.2003 for Rs.2,00,000/- (5) questionnaire completed by medical practioner Dr N.Abdul Malik dt 30.3.2005 (6) claimant’s statement of submitted by complainant to opposite parties, besides to the sworn affidavit opposite party No.2 in reiteration of its written version and the above documents are marked as Ex B.1 to B.6 for its appreciation in this case and suitablely replied to the interrogatories caused by the complainant.
7. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of service in the conduct of opposite parties in repudiating the claim so as to enable himself to the reliefs claimed:-
8. It is not in dispute that the deceased D.Krishna Vani has taken three policies on different dates by submitting proposals vide Ex B.2, B.3 and B.4 and the claim put forth by the complainant vide Ex B.6 for insured amount under the said policies the opposite parties repudiated vide Ex B.1. The Ex B.1 envisages the repudiation of the claim of the complainant for the policies bearing No.s 653114676, 651694995 and 653285044 of the deceased D.Krishna Veni. It says that the claim was repudiated as the policy holder was suffering from Epilepsy and Brancharil Asthama and also consulted a medical man and had taken treatment and the above said facts are suppressed by the policy holder in the facts relating in her proposal form.
9. The Ex B.5 is the questionnaire completed by Dr N. Abdul Malik, dt 30.3.2005, from the contends of the Ex B.5 which does not inspire any confidence which can be acted upon, the said Ex B.5 is dt 30.3.2005 and the repudiation letter in Ex B.1 is dt 12.4.2005, so what appears is that the said Ex B.5 is obtained only to repudiate the claim of the complainant. There is nothing on record to show that when the policy holder died on 7.10.2003, and what made the opposite parties to obtain the said Ex B.5 on 30.3.2005. Hence the said Ex B.5 cannot be looked into.
10. The opposite parties in support the above exhibit B.5 did neither filed the affidavit of said doctor who is alleged to have issued the above said Ex B.5 nor the said doctor has been examined. Unless the expert evidence of the doctor who treated the deceased is produced, such evidence cannot be relied upon and form the basis of a finding, that the deceased has taken treatment for Epilepsy and Broncharil Asthama Prior to submitting the three proposal forms, merely filling Ex B.5 by opposite parties, doesn’t mean that the contends there of are necessarily true, no documents or direct evidence is produced by opposite parties about the prior existence of Epilepsy and Broncharil Asthama, mere assertion or oral testimony in respect of treatment prior to taking of above said three policies neither inspire any confidence nor can be acted upon. Onus is on the opposite parties to substantiate their plea that the policy holder concealed material facts of her treatment before taking policies or at the time of submitting proposal forms. Hence, the Ex B.5 filed by the opposite parties cannot be looked into on this aspect also and does not inspire any confidence.
11. Having regard to over all consideration, there is no hesitation to hold the opposite parties has miserably failed to substantiate that the policy holder before taking the policy or at the time of submitting proposal forms suppressed material information about taking treatment for Epilepsy and Broncharil Aathama from Dr. N Abdul Malik. Therefore, in these circumstances the repudiation of claim by opposite parties in wholly arbitrary, unreasonable and unjust and amounts to deficiency of service on their part.
12. The written version of opposite parties contends that the policy holder negatively answered to the questionnaire in serial No.11 of the proposal form makes the contract of insurance null and void and condition No.5 of the policy also makes the policies void for with holding material information, hence the repudiation of the claim was made in good faith having regard to the facts and circumstances of the case and after proper investigation. This contention is equally devoid of merit and force as it has been already held that repudiation is arbitrary and untenable and the claim of the complainant should not have been rejected as per the decision of Himachal Pradesh State Consumer Disputes Redressal Commission, reported in 1999 Consumer cases reported Pg 416. Hence, there appears every justification to the claim made by the complainant. As the opposite parties by their deficient conduct driven the complainant to Forum for redressal the complainant is entitled is entitled to interest on the assured amount.
13. The other decision relied by the complainant is that of Andhra Pradesh High Court reported in 2003 (5) ALD 162 pg, wherein it was held that medical certificates and medical bills produced by claimants required to be proved in manner provided under Evidence Act, mere marking of documents through claimants does not amount to proof of said documents.
14. Therefore, in conclusion of the above discussion and following the afore mentioned decisions and having regard to such circumstances, there appears every justification to the claim made by the complainant as the opposite parties by their deficient conduct driven the complainant to Forum for redressal.
15. In the result, the complaint is allowed directing the opposite parties jointly and severally to pay to the complainant the insured amounts under the three policies of the deceased D. Krishnavani bearing No.s 653114674, 651694995 and 693785044 with all benefits and interest at the rate of 12% per annum from the date of demise of the deceased till realization along with Rs.5,000/- as costs of the case within a month of receipt of this order.
Dictated to the Stenographer, Transcribed by her, corrected and pronounced by us, in the open Forum, on this the 28th day of October, 2005
Sd/-
PRESIDENT
Sd/- Sd/-
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of Exhibits Marked for the complainant: Nil
List of Exhibits Marked for the opposite parties:-
Ex B.1Repudiation letter dt 12.4.2005 addressed to the complainant by OP
No.2.
Ex B.2 Original proposal form of the deceased dt 13.6.03 for Rs.1,00,000/-.
Ex B.3 Original proposal form of the deceased dt 22.6.03 for Rs.1,00,000/-.
Ex B.4 Original Proposal form of the deceased dt 14.8.03 for Rs.2,00,000/-.
Ex B.5 questionnaire completed by medical practioner Dr N. Abdul Malik.
Ex B.6 Claimant’s statement submitted by complainant to opposite parties.
Sd/-
PRESIDENT
Sd/- Sd/-
MEMBER MEMBER
Copy to:-
- Sri C.Ramana Reddy, Advocate, Kurnool.
- Sri L. Hariharanatha Reddy, Advocate, Kurnool
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
