Before the District CONSUMERS Forum:Kurnool
Present: Sri K.V.H. Prasad, B.A., LL.B., President And
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Wednesday the 15th day of October, 2002
C.D.No.11/2002
K.Rama Devi,
W/o Late Bala Sliddaiah,
Presently resident
D.No.65A/R2, Forest Compound, Kurnool District. ...Complainant represented by her
counsel Sri.G.Madhusudhana Reddy.
-Vs-
- The Branch Manager,
L.I.C of India,
- The Sr.Divisional Manager,
L.I.C of India,
- The Zonal Manager,
South Central Zonal Officer,Hyderabad. …Opposite parties 1 to 3 represented by their counsel Sri. A.S.Ummer Javid.
ORDER
C.C.No.11/2002
1. This consumer dispute case of the complainant is filed under section 12 of the C.P. Act seeking a direction to the opposite parties to award an amount of Rs.1,60,000/- under the policy No.651598587 with interest at 24% per annum and costs of the case.
2. The brief fact of the complainant’s case are that the husband of the Complainant K.BalaSiddaiah became policy holder under the scheme Jeevana Mithra (double cover endowment plan) on 28.11.1994 for Rs.80,000/- and the installments premium fixed at Rs.2,779/- half yearly. As per the terms and conditions of the policy “ on the stipulated date of maturity, if the life assured is then alive or his death if earlier” the benefits under the scheme double of the sum assured. As the assured died on 02.08.1999 when he was working as Agricultural officer the deceased’s wife i.e., complainant being nominee is entitle to the assured amount of Rs.1,60.000/-. In this regard the complainant under an application on 02.04.1999to the opposite party No.1 submitted all the original records under Registered post, and the opposite party No.1 having received the necessary information not settle the claim, but on 28.09.2001 sent a letter to the complainant stating that the matter is being attended to by the opposite party No.2. The complainant also being attended to by the opposite party No.3 and in acknowledgement of it the opposite party No.3 informed on 08.11.2001 that the matter is referred to the opposite party No.2. Further the complainant submits that during the life time of her husband the opposite party No.1 settled small amount under the policy No.71763614, but this C.D. amount is not settled for the last two years without any convincing reasons.
3. The complainant besides filling a sworn affidavit in re-iteration of the complainant averments relies upon the documentary record which is marked as Ex.A1 to Ex.A6 for their appreciation.
4. In pursuance of the receipt of the notice of this case the opposite party No.2 made his appearance and filed his written version while the opposite party No.1 and opposite party No.3 adopted the written version of the opposite party No.2. the sworn affidavit/ counter (written version) filed by the opposite party No2 besides denying the justness and maintainability of the complainant’s case requires the strict proof of the complainant averments. It admits the husband of the complainant as policy holder and the complainant is being the wife of the life assured was nominated to receive the policy amount and the lapse of policy due to nonpayment of the premium from November, 1997 and the same was its revival by the life assured on 15.12.1997 after submitting declaration of the good health and the Medical report and payment of the premiums of Rs.8,337/- along with the interest of Rs.396.10 P.S.
5. The compliant made her claim on 31.08.1999 and it was received by the opposite party No.1 on 17.09.1999 on the said claim the complainant informed that the Life assured died on 02.08.1999. The complainant submitted the claim forms on 02.12.1999 which was received by the opposite party No.1 on 04.12.1999. The death certificate enclosed to it obtained from the Satya Kidney Centre Hyderabad shows that the deceased life assureds case is a known case of post Renal transplant and undergone Kidney transplantation on 07.10.1997. Hence it falls prior to the date of revival i.e. on 15.12.1997 ( and found that the life assured was un-well). In claim form-A (caliment’s statement) under column 6(i)the complainant informed that the life assured undergone kindly transplantation in “Satya Kidney Centre” Hyderabad on 06.10.1997 and the claim form ‘B’ Medical Attendance certificate and the claim form B (i) certificate of Hospital treatment shows that primary cause of the death of the life assured was post transplant case. Which was done on 06.101997 further the claim form ‘E’ certificate by the Employer shows that the life assured had availed sick leave on Medical grounds form 06.06.1997 to 16.11.1997 and 01.01.1999 to 20.01.1999 for to treatment of renal (Kindly) failure. Hence the opposite party submit that the deceased/life assured was continuously on Medical Leave from 06.06.1997 to 16.11.1997 for having treatment for renal failure and wantonly and purposely suppressing his ill health, the deceased life assured, got his lapsed policy revived and official leave record of the insured showing his leave on Medical grounds cannot be disputed.
6. Further the opposite party No.2 submits that the life assured suppressed his ill health, and his undergoing kidney transplantation operation on 07.10.1997 prior to revival and as this comes under mis-representation of suppression the material facts the ill health prior to revival as per sec.45 of the Insurance Act, 1938 the claim is liable for repudiation and hence the corporation has repudiated the claim on 25.01.2002.
7. The opposite party No.2 relies besides to his sworn affidavit on the following documentary record for their appreciation. Ex.B1 original policy bond bearing No.651598587 of the deceased life assured, Ex.B2 original letter of the petitioner addressed to the Respondent No.1 dated. 02.12.1999 Ex.B3 attested copy of the certificate or death issued by the Satya Kidney Centre, Hyderabad dated 02.08.1999, Ex.B4 Original claim form ‘A’ by the petitioner Ex.B5 claim form ‘B’ Medical Attendance certificate, Ex.B6 claim form B (i) Hospital treatment, Ex.B7 claim form ‘E’ certificate of the Employer and Ex.B8 copy of the original letter speaking order of the respondent dated 25.01.2002 addressed to the petitioner and they are marked as Ex.B1 to Ex.B8 for their appreciation.
8. Hence, the point for consideration is whether the complainant has made out any case of the deficiency of service on the part of the opposite parties in settlement of the claim preferred on the policy of her husband consequent to his demise and of her entitlenese to the reliefs clamed.
9. The Ex.B1 filed by the opposite party No.1 is the Insurance policy (651598587) issued by him to the complainant’s husband on 28.11.1994, the sum assured is Rs.80,000/- (double cover) with the half yearly premium of Rs.2,779/- showing the complainant is nominee. The said fact is not denied by the opposite party’s side. As on 02.08.1999 the complainant’s husband died the opposite party No.1 wrote a letter to the complainant on 29.09.1999, which is marked as Ex.A1 requesting the complainant to send the original policy, and the original death extract. In response to this letter the complainant sent the required particulars to the opposite party No.1 by a registered letter which is marked as Ex.A2, which was also admitted by the opposite party No.2 by marked the same as Ex.B2. As the claim delayed by the opposite party No.1 again the complainant wrote another registered letter dated. 20.11.2000 to the Accounts officer, Regional office Cuddapah requesting the opposite parties to settle the matter as early as possible as it was badly delayed. This letter was marked as Ex.A3, Ex.A4 letter dated 28.09.2001 of opposite party No.1 envisages that the matter is being attended to through its Divisional office, Cuddapah and the Ex.A5 which was addressed by the opposite party No.2 admits the delay of the settlement of the claim and the Ex.6 letter dated 08.11.2001 of the zonal office, Hyderabad (i.e., Opposite party No.3) in form receipt of letter 28.10.2001 of complainant and the delay by stating that its reference to its Divisional office Cuddapah. All these matter reveals that the complainant’s matter badly delayed and left her awaits.
10. Opposite party No.3 relied on Ex.B1 to Ex.lBl8 the policy taken by the complainant’s husband is not in dispute. But what they allege is the concealment of policy holder undergoing Kindly transplantation and treatment he has undergone in that regard at the time of revival of policy as the claim form dated02.12.1999 shows that the deceased life assureds’ was case of known case of post renal transplant (date of KTP 7 Oct, 1997) and treated for one week for fever and cough and died on 02.08.1999 due to cardio respiratory failure. The Ex.B4 is the claim settlement pertaining of policy No.71763614 for Rs.5,000/- in which also the complainant’s husband informed on 26.07.1999 he was suffered with fever and cough. This claim settled by the opposite parties without raising any objection. The Ex.B5 Medical Attendance certificate of Satya Kidney Centre, Hyderabad shows that the complainant’s husband was treated on 02.08.1999 at 7.15 A.M died on the same day i.e.02.08.31999 at 5.P.M due to cardio Respiratory failure. In the same certificate if was noted that Kidney transplantation was done on 06.10.1997 in their Hospital and it was a post transplant case due to preceded illness. Ex.B6 is the certificate of the Hospital treatment which shows that the complainant’s husband admitted on 06.10.1997 for kidney transplantation and on 02.08.1999 on the date of the death and further it reveals that the patient was treated for fever and cough for 10 days (particulars of the dates not noted). The Ex.B7 is the certificate by the Employer it shows that he was ill from 06.06.1997 to 16.11.1997 and 01.01.1999 to 20.01.1999 and applied leave on medical grounds, but copies of such letters are not furnished to ascertain the cause alleged for obtaining said leave. The Ex.B8 is the Registered letter dated 25.01.2002 by the opposite party No.2 to the complainant alleging the deliberate as stated in the withheld by complainants husband as to treatment for kidney failure and its transplantation at the time of revival of lapsed policy on 15.012.1997 and the said withheld is deliberate the policy is void and hence all moneys paid towards revival of the policy and subsequent there to as of L.I.C. The said letter was sent to the claimant after filing the C.D. on 08.01.2002. Hence the said reveals repudiation does not appear to be proper.
11. In this case the crux of the material is that whether the lapsed the policy holder was faulty of reviving policy concealment of any material fact as to this health and the O.P accepting the revival of policy on the medical report of it to policy holder by its doctor and on the report of competent medical officer as to policy holder health and on receipt of due premium and interns as per records has now properly repudiates the claim in the alleged cause of death of the policy holder is having no direct or indirect axis and nexus to the treatment and kidney transplantation which the policy holder said to have concerned at the time of revival of policy. But the Ex.B3 reveals that the claimants husband died due to Cardio Respiratory failure. The opposite parties has not filed any co-gent material to establish that the kidney transplantation on 07.10.1997 lead to Cardio Respiratory failure which was the cause of the death. Hence there being no nexus between the actual cause of demise and concealed cause of a past ill-health, the repudiation by O.Ps of the complainant claim does not appear to be one drawn on said lines.
12. The State Consumer Disputes Redressal Commission, Madhya Pradesh in Ashok Kumar Shatia -Vs- Mandal Prabandhak Life Insurance Corporation of India reported in I(2000) CPJ says the seriousness of ailment and its nexus with the cause of the death has to be established when it could not the basis of the repudiation is wrong and un-justified and it amounts to deficiency of service making the LIC liable to make the payment along with interest.
13. The State Consumer Disputes Redressal Commission, Punjab in the Life Insurance Corporation of India -Vs- Charan with Kowl reported in 2001 CTJ 135 CPSCDO holds the policy holder cannot be held as suppressed the material information as to the state of his health in the answer of the proposal forms when there is no direct evidence to prove that the deceased suppressed his previous ill health.
14. The National Consumer Disputes Reddressal commission, New Delhi in the LIC of India -Vs- JASBHEER Singh reported in 2003 (I) CPR 277 (NC) holds the knowledge of the insured of the deceased with which he was suffering that at the time of taking the policy to hold him liable for the forfeiture for not revealing the said facts in the proposal form if the said deceased has direct nexus to the death.
15. In the light of the above decisions and in the absence of the any co-gent material on the record to the effect that the non-revilement of the above said facts at the time of the revival of the said policy to his sate of health does not amounts to any material suppression entitling the forfeiture of her right/especially when the said alleged concealment has no bearing or contribute to actual cause of demise. Hence the findings in Ex.B8 that the revival of the said policy declaring it as void and all the moneys paid towards the revival of the policy and the subsequent there too belong to the LIC holds no merit and force worthy of considerate. Hence he claim arising on the said policy on the complainant’s husband is justifiable.
16. Therefore in the result of the above discussion as the complainant is entitled to the policy amount of the deceased, K.Balasiddaiah on the contingency of his death and the opposite parties by their avoiding conduct put the complainant to the mental agony and also driven her to seek the redressal in this Forum, the complainant is not only remaining entitled to the said policy amount of Rs.1,60,000/- as the nominee of the deceased policy holder with interest at 12% per annum from the date of the demise of the policy holder, but also to Rs.10,000/- as compensation and Rs.5,000/- as costs.
17. Therefore, the opposite parties are directed to pay the awarded amount to the complainant within a month of the receipt of this order. In default the opposite parties are liable to pay the awarded amount with 18% interest from the date of the said default till realization.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the open bench on this the 15th day of October, 2003.
MEMBER PRESIDENT MEMBER
APENDIX OF EVIDENCE
Witnesses Examined
For the complainant:Nill For the opposite parties:Nill
List of Exhibits marked for the complainant:-
Ex.A1 Letter dated 29.09.1999 from opposite party No.1 to the complainant.
Ex.A2 Office copy of letter dated02.12.1999 from the complainant to opposite party No.1 along with postal receipt.
Ex.A3 Letter dated 20.11.2000 addressed by the complainant to the Account Office claims department LIC of India, Divisional office, Cuddapah( office copy).
Ex.A4 Letter dated 28.09.2001 addressed by opposite party No.1 to the complainant.
Ex.A5 Letter dated 18.09.2001 addressed by opposite party No.2 to the complainant.
Ex.A6 Letter dated 08.11.2001 addressed by opposite party No.3 to the complainant.
List of Exhibits marked for the opposite parties:-
Ex.B1 Policy bond bearing No.651598587 of the deceased showing the complainant as nominee.
Ex.B2 Letter dated 02.12.1999 addressed by the complainant to opposite party No.1
Ex.B3 Attested copy of death certificate issued by Satya Kidney Centre, Hyderabad dated 02.08.1999 (date not visable)
Ex.B4 Claiment statement form A of the complainant.
Ex.B5 Medical Attendance certificate Form B of the deceased.
Ex.B6 Certificate of Hospital treatment claim Form B1 of the deceased.
Ex.B7 Certificate by employees Claim Form E.
Ex.B8 Letter dated 25.01.2002 addressed by Senior Divisional Manager, Cuddapah to the complainant.
MEMBER PRESIDENT 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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