BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri. S. Chinnaiah, B.A. B.L., I/C President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Friday the 14th day of December, 2007
C.C.No.97/07
Between:
Smt. Boya Lakshmi, alias Lakshmi, W/o. Late Sri. Boya Narasanna,
Jaggapuram Village, Nandavaram Mandal, Kurnool District.
… Complainant
Versus
1. The Branch Manager, LIC of India,
Yemmiganur, Kurnool District.
2. The Senior Divisional Manger, LIC of India,Divsional Office,
College Road, Kadapa.
… Opposite Parties
This complaint is coming on this day for orders in the presence of Sri..M.Sivaji Rao, Advocate, Kurnool, for the complainant, and Sri.L. Hari Hara Natha Reddy, Advocate, Kurnool for the opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following:-
ORDER
(As per Smt.C.Preethi, Member)
C.C.No.97-07
1. This consumer complaint of the complainant is filed U/S 12 of C.P.Act 1986, seeking a direction on the opposite parties to pay assured amount of Rs.50,000/- with 12% interest from the date of death, Rs.10,000/-towards compensation, cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant’s husband Late. Boya Narasanna insured his life with opposite party for Rs.50,000/- vide policy bearing No.652893293 by nominating the complainant as his nominee. The policy holder paid premiums regularly from 2002 to 2005, but in the year 2005 the policy holder could not get his crop due to drought, could not pay the due premium dated 28.2.2005, which resulted in lapse of the policy. Thereafter, on 25.2.2006 the policy holder revied his policy by paying due amount with fine and by giving his personal statement. On 4.5.2006 the policy holder fell sick and died in the house. As nominee the complainant submitted her claim to opposite party No.1 for assured amount, but to the surprise of the complainant, the opposite party repudiated the claim vide letter dated 26.2.2007 without any basis and paid Rs.15,025/- only. The opposite parties wrongly and illegally repudiated the complainants claim, hence the complainant resorted to the forum for reliefs.
3. The complainant in support of her case relied on the following documents viz., (1) death certificate and (2) repudiation letter dated 26.2.2007, besides to the sworn affidavit of the complainant in reiteration of her complaint avernments and the above documents are marked as Ex.A1 and A2 for its appreciation in this case.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties appeared through their standing counsel and opposite party No.1 filed written version and opposite party No.2 adopted the written version of opposite party No.1.
5. The written version of opposite parties submits that the deceased policy holder Boya Narsanna has taken a policy for Rs.50,000/- vide policy bearing No.652893293 and nominated the complainant as his nominee. He declared himself quite healthy as per the personal statement of good health and replied to the question No.11 (A to I) and signed the declaration stating that all the particulars given above are true and if found untrue, the contract shall be null and void. It further submits that the policy of the deceased was lapsed due to non payment of premium from 27.2.2005 and later it was revived by paying premium amount due with interest and by submitting a personal statement regarding health on 25.2.2006 and the policy holder affirmed that he never under went any operation or suffered any illness, the revival of the policy is a fresh contract and the said revival was made on declaration of good health. As the death of the policy holder arisen within three months from the date of revival, investigation was conducted, which revealed that the policy holder was suffering from coronary artery decease, chest pain and shorten of breath and the cause of death is due to pain and sudden. It is also further submitted that the policy holder has taken treatment under the care of doctor
B. Sreenivasulu, M.D., Aditya Nursing Home, Adoni and the certificate given by the said doctor under form No.5152 dated 17.1.2007 confirms that the policy holder had taken treatment for coronary artery decease prior to revival of policy and the said illness was not disclosed in the personal statement regarding health. Hence, the policy holder suppressed material information about his health before to revival. Hence, the revival of policy is declared void and all moneys paid towards revival of policy stands forfeited. The opposite parties paid up of value of Rs.15,025/- to the complainant after deducting the loan amount of Rs.3,000/- + interest of Rs.50/-. Hence, the repudiation was made on justifiable grounds and seeks for the dismissal of complaint with costs.
6. In substantiation of their case the opposite parties relied on the following documents viz., (1) original policy bond issued Boya Narasanna, (2) original proposal form, dated 15.3.2002, (3) medical examiners report, (4) personal statement of deceased dated 22.5.2006, (5) loan application submitted by the deceased, dated 29.9.2004, (6) claimant’s statement submit by the complainant, (7) questionnaire completed by Doctor B.Sreenivasulu, dated 17.1.07 in form No.5152 ,(8) out patient card of the policy holder, (9) repudiation letter dated 26.2.2007 and (10) Xerox copy of discharge voucher besides to the sworn affidavit of opposite party No.2 in reiteration of his written version avernments and the above documents are marked as Ex.B1 to B.10 for its appreciation in this case.
7. It is not in dispute that the deceased by name Boya Narsanna has taken a policy bearing No.652893293 and nominated the complainant as his nominee. The said policy lapsed on 27.2.2005 for non payment of premium and the said policy was revived on 25.2.2006 by the deceased by paying premium due with fine and submitting a personal statement regarding his health. On 4.5.2006 the policy holder died and a claim was put forth by the complainant for assured amount which was repudiated by the opposite parties vide Ex.A2 dated 26.2.2007 stating that the policy holder withheld material information as to the suffering from coronary artery decease at the time of getting the policy revived and has taken treatment in hospital prior to the revival.
8. In support of their contention the opposite parties relied on Ex.B1 to B10. The Ex.B1 is the policy bond issued to the deceased Boya Narasanna , the Ex.,B2 is the proposal form of the deceased for issuing Ex.B1, the Ex.B3 is a medical examiner’s confidential report dated 15.3.2002 issued by Dr.Rajappa, the Ex.B4 is a personal statement regarding health submitted by the deceased Narasanna at the time of revival of the policy, the Ex.B5 is the application for loan dated 29.9.2004 submitted by the deceased to the opposite parties as to the payment of advance of Rs. 3,000/-, the Ex.B6 is the claimant’s statement in claim form-A submitted by the complainant to the opposite parties, the Ex.B7 is a questionnaire completed by Dr. B. Sreenivasulu, the counsel for opposite parties forcefully contended that the deceased Boya Narasanna has taken treatment from said Dr.B. Sreenivasulu on 9.11.2002 for coronary artery decease. The said contention of the opposite parties does not inspire any confidence about the contention and the contents of Ex.B7 which can be acted upon. The opposite parties in support of the Ex.B7 did neither filed the affidavit of the doctor who is alleged to have issued Ex.B7 nor said doctor has been examined. Unless an expert evidence of the doctor who has treated the complainant is produced, such evidence can not be relied upon and form the basis of finding that the deceased Narasanna has taken treatment for coronary artery decease prior to the revival, merely filling Ex.B7 does not mean that the contents there of are necessarily true, no documents or direct evidence is produced by the opposite parties about the prior existing of coronary artery decease by the policy holder , mere assertion or oral testimony in respect of treatment prior to the revival neither inspires any confidence nor can be acted upon. Onus is on the opposite parties to substantiate their plea that the complainant has concealed material facts of his treatment before to the revival of the policy. Hence the Ex.B7 relied by the opposite parties can not looked into nor it can inspire any confidence.
9. The Ex.B8 is the out patient card issued by Aditya Nursing Home, Adoni to the deceased, the counsel for complainant submitted that the said Ex.B8 is the original out patient card which is supposed to be in the custody of the deceased, but the opposite parties did not rebut the said contention of the complainant by placing any material nor there is any avernment in the written version of the opposite parties as to how they received the original out patient card, therefore the opposite parties failed to prove the said Ex.B8 as to its possession. Hence the said Ex.B8 cannot be looked into. The Ex.B9 is the repudiation letter dated 26.2.2007 of opposite parties addressed to the complainant, the Ex.B 10 is the Xerox copy of discharge voucher as to the payment of Rs.15,025/- to the complainant as to full and final statement of the claim.
10. The main contention of the opposite parties in their repudiation letter is that the policy holder with held correct information as to his health at the time of revival of the policy, and relied on Ex.B7 questionnaire completed by Dr.
B.Sreenivasulu, where in it was disclosed by the said doctor that the deceased was first consulted him on 9.11.2002, the policy in question was issued to the deceased on 27.2.2002 and it was lapsed on 27.2.2005, hence from the above what appears is that the policy holder consulted Dr.B Sreenivasulu for one day during the life time of the policy and not during the time when the policy was in lapsed condition, hence the contention of opposite parties that the policy holder with held the correct material information before to the revival can not be acted upon nor relied upon. Having regard to the over all consideration, there is no hesitation to hold that the opposite parties miserably failed to substantiate that the policy holder before to the revival suppressed material information about taking treatment for coronary artery decease from Dr.B. Sreenivasulu. Therefore in these circumstances the documents relied by the opposite parties does not support their contention, hence, the repudiation of claim by the opposite parties is wholly arbitrary and unreasonable and unjust and amounts to deficiency of service on their part.
11. To sum up and in conclusion of the above discussion and having record to such circumstances, the complainant is certainly remaining entitled to the assured amount with interest and as the opposite parties driven the complainant to the forum for reliefs, the complainant is also entitled to costs. As interest is awarded t the assured amount, compensation is not awarded.
12. In the result, the complaint is allowed directing the opposite parties to pay to the complainant the assured amount as per the policy of deceased
Boya Narasanna bearing No.652893293 with interest at the rate of 9% P.A from the date of repudiation i.e 26.2.2007 till realization, along with costs of Rs.1,000/- 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 14th day of December, 2007.
Sd/- Sd/-
LADY MEMBER I/C PRESIDENT
Appendix of evidence
Witness examined
For Complainant: For Opposite parties:
-Nil- -Nil
Documents marked
For the Complainant:
Ex.A-1. Death Certificate dated. 14-06-2007.
Ex.A-2. Repudiation letter dated 26-02-2007.
For the opposite parties:
Ex.B1. Original policy bond issued Boya Narasanna.
Ex.B2. Original proposal form, dated 15-03-2002.
Ex.B3. Medical examiners Report.
Ex.B4. Personal statement of deceased dated 25-02-2006
Ex.B5. Loan application submitted by the deceased, dated 29-9-2004.
Ex.B6. Claimant’s statement submit by the complainant.
Ex.B7. Questionnaire completed by Doctor B.Sreenivasulu, dated
17.1.07 in form No.5152.
Ex.B8. Out patient card of the policy holder.
Ex.B9. Repudiation letter dated 26.2.2007.
Ex.B.10. Xerox copy of discharge voucher
By the Forum:
- Nil- Sd/-
I/C PRESIDENT
Copy to :-
1. Sri.M. Sivaji Rao Advocate,Kurnool for the complainant.
2. Sri.L. Hari Hara Natha Reddy, Advocate, Kurnool for the opposite
Parties 1 & 2.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
