Andhra Pradesh

Chittoor-II at triputi

CC/61/2014

T.Murali, S/o. Late T.Anjalamma - Complainant(s)

Versus

The Branch Manager, LIC of India - Opp.Party(s)

S.Naveen Kumar

18 Sep 2015

ORDER

Filing Date:07.11.2014

Order Date: 18.09.2015

 

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II,

CHITTOOR AT TIRUPATI

 

 

      PRESENT: Sri.M.Ramakrishnaiah, President ,

        Smt. T.Anitha, Member

 

 

FRIDAY THE EIGHTEENTH DAY OF SEPTEMBER, TWO THOUSAND AND FIFTEEN

 

 

C.C.No.61/2014

 

Between

 

T.Murali,

S/o. late. T.Anjalamma,

Hindu, aged 40 years,

D.No.1-139, Cherlopalle,

Pudipatla post,

Tirupati Rural Mandal,

Chittoor District.                                                                                          … Complainant

 

 

And

 

1.         The Branch Manager,

            LIC of India,

            Branch office at TUDA Office Road,

            Tirupati.

 

2.         The LIC of India,

            Rep. by its Divisional Manager,

            Office at Jeevan Prakash,

            Dargah Mitta,

            Near TTD Kalyana Mandapam,

            Nellore – 524 003.

 

3.         The Zonal Manager,

            LIC of India,

            South Central Zone,

            Zonal Office,

            Jeevan Bhagya,

            Secretariat Road,

            Saifabad,

            Hyderabad – 500 463.                                                         …  Opposite parties..

 

 

            This complaint coming on before us for final hearing on 03.09.15 and upon perusing the complaint, written version and other relevant material papers on record and on hearing Sri.S.Naveen Kumar, counsel for the complainant, and Sri.A.Sudarsana Babu, counsel for the opposite parties, and having stood over till this day for consideration, this Forum makes the following:-

 

ORDER

DELIVERYED BY SRI. M.RAMAKRISHNAIAH, PRESIDENT

ON BEHALF OF THE BENCH

           

            This complaint is filed under Section-12 of C.P.Act 1986 by the complainant (nominee) against the opposite parties for the following reliefs 1) to direct the opposite parties to pay the policy amount of Rs.1,00,000/- with interest at 18% p.a. from the date of death of insured T.Anjalamma, till realization, 2) to direct the opposite parties to pay a sum of Rs.50,000/- towards damages for causing mental agony and for the deficiency in service and 3) to direct the opposite parties to pay costs of the litigation.

            2.  The averments of the complaint in brief are:-   that the mother of the complainant Smt.T.Anjalamma (died) during her life time purchased a policy on 31.03.2011 under policy No.842159717 from opposite party No.1, for Rs.1,00,000/- with monthly installment of Rs.635/-, term of policy is 14-16, with life risk as well as accidental risk. Premium amount was collected by opposite party No.1 on 31.03.2011, by that date the age of his mother was 50. The complainant is shown as nominee of the insured Anjalamma. That the insured suffered from heart attack on 19.09.2013, immediately she was taken to SVIMS hospital, Tirupati. Insured died on 20.09.2013 at 5.30 p.m. in SVIMS hospital due to cardiac arrest.

            3. After the death of Anjalamma (insured), the complainant being her nominee, approached opposite party No.1, claiming insured amount of Rs.1,00,000/-. Opposite party No.1 assured that the claim will be settled as early as possible and received the original policy and claim form, but to the surprise of complainant, he received a notice from opposite party No.2, repudiating the claim on 15.04.2014, on the ground that the insured died due to pre-existing disease. Thus, the opposite parties caused mental agony to the complainant. On 23.07.2014 complainant got issued notice to the opposite parties and the same was acknowledged by opposite parties 1 to 3. Opposite party No.2 gave reply informing that the repudiation was confirmed by Zonal Office. Hence the complaint.

            4.  Opposite party No.1 filed its written version and the same was adopted by opposite parties 2 and 3. In the written version though formally denied the contents of  complaint parawise, they have admitted that late Anjalamma had taken life insurance policy bearing No.842159717 for a sum assured of Rs.1,00,000/- from the opposite party on 28.03.2011 and the life assured died on 20.09.2013, and the nominee in the said policy, claimed the amount insured. The 2^nd opposite party has repudiated the claim on 15.04.2014 on the ground of suppression of material facts regarding her ill-health at the time of taking insure policy. The deceased life assured had been taking treatment since 2002 at SVIMS and also she had been an inpatient on five occasions at SVIMS hospital, Tirupati, prior to the date of proposal and these details were not revealed while submitting the proposal and hence the claim is repudiated on the said facts. They further contended that, it was revealed that the insured was suffering from  diabetic mellitus before the date of proposal and if she disclosed her ill-health at the time of effecting insurance, the opposite party could not have accepted the insurance of the policy. The action of repudiation has been informed to the complainant. As such there is no liability under the policy and no deficiency of service on the part of opposite parties. In the proposal form, the relevant columns were answered that the insured was not suffering from any sort of illness. In view of the suppression of material facts with regard to health of the insured, the claim of the complainant was repudiated and prays the Forum to dismiss the complaint with costs.

            5.  The complainant as P.W.1 filed his evidence affidavit and chief affidavit of R.W.1 filed. Dr.A.Vidya Sagar, examined as R.W.2, on behalf of opposite parties. Exs.A1 to A7 were marked for the complainant and Exs.B1 to B5 were marked for the opposite parties. Both parties have filed their respective written arguments.

            6.  Now the point for consideration is whether the repudiation order passed by the opposite parties is justified?

            7.  Point:-  in the complaint as well as chief affidavit, the complainant categorically stated that his mother late.T.Anjalamma, insured her life during her life time on 31.03.2011 under insurance policy No.842159717 from the agent of opposite party No.1. Subsequently, Anjalamma got admitted in SVIMS hospital, Tirupati, due to heart attack on 19.09.2013 and she died on 20.09.2013 at about 5.30 p.m. That the   complainant is son of Anjalamma and he was shown as nominee in the policy. The life assured is for Rs.1,00,000/-. All these facts are admitted. No dispute with regard to payment of installments, death of Anjalamma, the status of complainant as nominee. Immediately after the death of Anjalamma, the complainant filed claim form, claiming the insurance amount, that it was repudiated by the opposite parties on the ground that Anjalamma suppressed the material facts i.e. regarding her health. That Anjalamma was suffering from ailments since 2002 and taking treatment in SVIMS hospital, Tirupati, and that she has suppressed pre-existing disease on the date of filling of the proposal form at the time of taking policy. Except this ground alone, no other objections or no other faults were raised by the opposite parties. So, the burden lies on the opposite parties to prove that she was suffered from pre-existing ailments as on the date of proposal form. The opposite parties relied on Exs.B1 to B5. Ex.B1 is the copy of insurance policy, which is totally invisible. Ex.B2 is filled in proposal form that was in the hand-writing of the agent of opposite party No.1 and another important document is Exs.B5 medical history of deceased Anjalamma. In Ex.B2 at column No.11(b) i.e. have you ever been admitted to any hospital or nursing home for general check-up, observation, treatment or operation? the answer was shown as “Yes”, other columns were filled as “No”, column No.11(i) with regard to state of health was recorded as “Good”. So, the ground that Anjalamma suppressed the material facts cannot be accepted as column 11(b) itself shown as she was admitted in hospital / nursing home for general check-up, observation etc.

            8.  When the opposite parties contravening the above said facts and filed Ex.B5 showing that Anjalamma was suffered from diabetic and hyper tension prior to submitting the proposal form, they have examined Dr.A.Vidya Sagar, as R.W.2, who deposed that he was not summoned to give evidence, that he is not the Medical Superintendent as mentioned in the summons, that he has not obtained any authorization from the Medical Superintendent, SVIMS, to give evidence in this case. He further deposed that the summons was addressed to the Department of Cardiology. The Head of Department of Cardiology, directed him to attend the Forum and give evidence on producing record, but no such authorization is filed in the Forum and he has not taken authorization admittedly. He further deposed that the Head of Department has not given any letter to that extent. He further admitted as on the date of admission of patient on 19.09.2013 he was not working as Assistant Professor of Cardiology, that he is giving evidence as per record. During chief examination, he stated that the patient Anjalamma was a known patient of diabetes. It shows that the opposite parties failed to examine the doctor, who treated Anjalamma on 19^th and 20^th September 2013. Dr.Krishna Chaitanya is the Resident Doctor, Duty Doctor and Head of Department of Cardiology, who treated Anjalamma on 19.09.2013 and 20.09.2013, but he was not examined by opposite parties. R.W-2, Dr.A Vidya Sagar, therefore, is not the competent Doctor to give evidence in this regard. Ex.B5 therefore was not proved. They have also filed another document under Ex.B3 Certificate of Hospital Treatment. The name of the doctor, who issued Ex.B3 was not clearly mentioned in the certificate but designation seal was put on the certificate as Head of Department of Cardiology. The said doctor, who issued Ex.B3 was not examined. In this regard, I am to state that mere production of certificate is not sufficient to prove pre-existing disease. In this regard I am relying on a decision reported in I (2015) CPJ 7 Chhattisgarh SCDRC – L.I.C. of India Vs. Kanchan Thawait.

            9.  It is not out of place to mention that the agent who filled up the proposal form in his own handwriting specifically recorded the answer for the question under 11(b) as ‘Yes’. But so far as other questions are concerned answer is recorded as ‘No’. Under those circumstances, opposite parties ought to have examined the agent through whom the policy was received by opposite parties. For the mistakes of agent, the policy holders or their nominees cannot be deprived of their right of getting the sum assured. At the time of taking or registering the policies, simply the agents will obtain the signatures of policy holders, assuring huge benefits through such policies, whereas, while releasing the policy amounts, the Insurance Companies will raise number of queries / doubts and objections for releasing the amounts. It became common precedent, which is unsustainable and unjust, certainly it amounts to deficiency in service.

10.  According to Ex.B5, which contains number of receipts and detailed death summary of Anjalamma, reveals that she has taken treatment as O.P.No.226275. There is no specific certificate that she was suffered from any serious ailments prior to submitting the proposal form, opposite parties ought to have produce such certificates from competent authority and prove such ailments but failed to do so. Opposite parties having collected the premium amount of Rs.635/- p.m. from 31.03.2011 till the date of death of insured, simply repudiated the claim after the death of the policy holder / life insured, this is not proper on the part of opposite parties. In this regard,     I am relying on a decision reported in I (2015) CPJ 473 (NC) – Birla Sun Life Insurance Co. Ltd. Vs. Kiran Prafull Bahadure, in which their Lordships held at para.9 that “Even otherwise, the petitioner has no case on merits as well. Perusal of the record placed before us indicates that the main ground on which the claim of the complainant has been repudiated is that the husband of the complainant failed to make a disclosure about his alleged existing Ischemic Heart Disease. The District Forum while non-suiting the defence of the petitioner has passed a well reasoned order in which it has considered the submissions of the petitioner Insurance Company at length in the light of the evidence adduced before it. Regarding the investigation carried out by the petitioner Insurance Company which led to the repudiation of the claim of the complainant by the Insurance Company, the District Forum has recorded as: the applicant says that her husband died due to Cardiogenic Shock and therefore it was a natural death and the opposite party has given a false reason so as not to pay the benefits under the policy. The opposite party Insurance Company has submitted an investigation report also with their written statement. While perusing the investigation report, the opinion of the late policy holder’s family doctor has been recorded in the investigation report and it was against the contention of the opposite party”. In the case on hand, the opposite parties have not filed any such investigation report, in particular except the Case Sheet of Anjalamma under Ex.B5 and the Medical Attendance Certificate under Ex.B4 as well as Certificate of Medical Treatment under Ex.B3. So, in the absence of investigation report and in the absence of evidence of the doctor who treated Anjalamma on 19.09.2013 and 20.09.2013, the repudiation order passed by the opposite parties can be held as unjustified and the complainant is entitled to the policy amount of Rs.1,00,000/- with interest. Accordingly, the complaint is to be allowed.

            11.  In the result, the complaint is allowed holding that the repudiation order passed by opposite party No.2 dt:15.04.2014 under Ex.A3 is unjust and opposite parties 1 to 3 jointly and severally liable to pay the sum assured of Rs.1,00,000/- (Rupees one lakh only) with interest at 9% p.a. from the date of repudiation, till realization. Opposite parties 1 to 3 are further directed to pay a sum of Rs.10,000/- (Rupees ten thousand only) towards mentally agony caused to the complainant and also towards deficiency in service on the part of opposite parties, and the opposite parties 1 to 3 further directed to pay a sum of Rs.2,000/- (Rupees two thousand only) towards costs of the litigation. Opposite parties 1 to 3 further directed to comply with the orders within six (6) weeks from the date of receipt of copy of this order, else the compensation amount of Rs.10,000/- shall also carry interest at 9% p.a. from the date of order, till realization.    

Dictated to the stenographer, transcribed and typed by him, corrected and pronounced by me in the Open Forum this the 18^th day of September, 2015.

        Sd/-                                                                                                                     Sd/-                                                                                   

Lady Member                                                                                                      President

 

 

APPENDIX OF EVIDENCE

 

Witnesses Examined on behalf of Complainant.

 

PW-1: T. Murali (Chief Affidavit filed).

 

Witnesses Examined on behalf of Opposite Party.

 

RW-1: Chilumula Sridhar (Evidence Affidavit filed).

RW-2: Dr. A. Vidya Sagar

 

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT

 

Exhibits (Ex.A)	Description of Documents
	Photo copy of Death Certificate of T.Anjalamma. Dt: 09.10.2013.
	Photo copy of Death commentary of T.Anjalamma issued by SVIMS, Tirupati.
	Repudiation of claim of T.Anjalamma by O.P.2. 15.04.2014.
	Office copy of Legal notice Opposite Party No’s from 1 to 3 with postal receipts. Dt: 23.07.2014.
	Acknowledgements from Opposite Parties 1 to 3.  Dt: 24.07.2014.
	Letter of Opposite Party No.2. Dt: 28.07.2014.
	Letter of Opposite Party No.2. Dt: 14.10.2014.

 

EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTYs

 

Exhibits   (Ex.B)	Description of Documents
1.	Attested copy of LIC Policy vide No.842159717 Dt: 28.03.2011 filed for Opposite Parties.
2.	Attested copy of Filled in Proposal Form of 31.03.2011 filed for Opposite Parties.
3.	Certificate of Hospital treatment Dt: 15.10.2013 issued by SVIMS, Tirupati.
4.	Medical Attendance Certificate Dt: 15.10.2013 issued by SVIMS, Tirupati.
5.	Case sheet of T.Anjalamma with IP Admission MRD No.226275. Dt: 13.12.2002.

 

 

                                                                                                                                    Sd/-

                                                                                                                President

            // TRUE COPY //

// BY ORDER //

 

 

Head Clerk/Sheristadar,

            Dist. Consumer Forum-II, Tirupati.

            

 

  Copies to:-   1. The Complainant.

                       2. The opposite parties 1 to 3.