Before the District 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
Tuesday the 22nd day of February, 2005
C.D.No. 135/2004
Smt S.Lakshmi Devi,
W/o. Late S.Venkatachalam,
Door No. 17/120/21,
Opp to Venkateswara Talkies,
Pathikonda (Post),
Kurnool Dist. . . . Complainant represented by
his counsel Sri K.Onkar Advocate
-Vs-
1. The Branch Manager,
LIC of India,Branch Office,
M.G.Colony, Yemmiganur,
Kurnool Dist.
2. Senior Divisional Manager,
LIC of India,
Divisional Office,
Jeevan Prakash
College Road,
Cuddapah.
3. The Zonal Manager,
LIC of India,
South Centeral Zonal Office,
Hyderabad. . . . opposite parties No1 and 3
represented by their counsel
Sri G.MD.Habeebur Rahiman.
O R D E R
(As per Smt C.Preethi, Hon’ble Lady Member)
1. This CD complaint of the complainant is field under section 12 of C.P.Act, 1986, seeking a direction on the opposite parties to pay the policy amount to the complainant with interest, cost of the case and any such other relief or reliefs which the complaint is entitled in the circumstance of the case.
2. The brief facts of the complainant’s case is that the complainant’s husband S.Venkatachalam has taken a policy bearing No. 652899277 from the opposite party No.1 for assured sum of Rs.25,000/- and nominated his wife/complainant as his nominee. The policy holder died on 21.5.2003, the complainant sent all particulars of late S.Venkatachalam to opposite party No.2 and there was neither any suitable reply or paid the policy amount to the complainant. Hence, constrained the complainant to seek redressal in this Forum.
3. The complainant in support of her case filed the following attested Xerox documents Viz (1) policy bond of the deceased S.Venkatachalam (2) death certificate issued by Panchayat Secretary, Pattikonda (3) repudiation letter dt 23.3.2004 and (4) first premium receipt dt 28.8.2002, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex A.1 to A.4 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 contested the case by filing denial written version by opposite party No.2 and opposite party 1&3 adopted the written version of opposite party No.2.
5. The written version of opposite parties admits the deceased policy holder has taken a policy bearing No. 652899277 and the date of commencement of said policy was from 28.8.2002 for the assured sum of Rs.25,000/- and yearly mode of payment with premium of Rs.1,794/-. The complainant informed the demise of the policy holder on 21.5.2003 due to Heart attack and preferred a claim, as a claim aroused consequent to the demise of the policy holder within 8 months 23 days from the date of commencement of policy, the claim was treated early claim and investigation was taken up. The investigation revealed that the deceased S. Venkatachalam was unwell and has taken treatment at Gowri Gopal Hospital on 20.8.2002 vide IP No. 1735 for (1) Acute Gastritis Dysentery (2) IHD (Ischemic Heart Decease) and (3) Old Infection of M.1. The deceased also suppressed the statement of age by 9 years, he furnished his age as 47 years at the time of admission into the hospital where as he furnished his age as 38 years in the proposal form. Condition 6 of the policy also makes void the policy for with holding any material information and forfeiture all the amounts paid to the corporation in the consequent of the said policy infavour of the corporation in view of the nature of the contract made on the utmost good faith on the deceased statements and the declaration as the suppression of material facts makes the policy null and void under section 45 of Insurance Act 1938, and attracting the forfeiture of amounts, hence, the repudiation of claim by their speaking Order dt 23.3.2004 suffers with no deficiency of service and hence seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite parties filed the following documents Viz (1) proposal form of New Janarakasha policy of the late S.Venkatachalam (2) policy bond bearing No. 652899277 of the deceased S.Venkatachalama (3) attested Xerox copies of Hospital Reports of deceased Venktachalam and (4) repudiation letter dt 23.3.2004 of opposite parties to the complainant, besides to the sworn affidavit of the opposite party No.2 in reiteration of its written version as defence and the above documents are marked as Ex B.1 to B.4 is appreciation in this case.
7. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of service of opposite parties to have the claim from the opposite parties ?:-
8. The Ex A.3 /B.4 is the repudiation of the policy bearing No. 652899277 of the deceased S.Venkatachalam for assured of Rs.25,000/-. Its says that the claim of the complainant was repudiated as the policy holder with held correct information regarding his health at the time of effecting the assurance, and has suffered from acute Gastritis, IHD and Old Infection MI and had consulted a Medical man and had taken treatment from a Hospital earlier to date of proposal and answered all questions in Ex B.1 negatively.
9. The Ex A.1 / Ex B.2 is the policy bond issued to S.Venkatachalam on 28.8.2002 on payment of premium amount of Rs.1,794/- and the deceased nominated his wife S.Lakshmi Devi as his nominee. The Ex A.2 is the Xerox copy of death certificate issued by Panchayat Secretary, Pattikonda, Kurnool Dist, which envisages the death of policy holder S. Venkatachalam S/o S.Ramalingappa on 21.5.2003, aged about 38 years. The Ex A.4 is the first premium receipt dt 28.8.2002 issued by LIC, Yemmiganur Branch on payment of RS.1, 794/- by the complainant. The Ex B.1 is the proposal form of the deceased S.Venkatachalam S/o S.Ramalingappa R/o Pattikonda dt 28.8.2002 for obtaining the said policy.
10. The Ex B.3 is the Attested Xerox copy of Hospital Records of Venkatachalam issued by Gowri Gopal Apollo Hospital, Kurnool, dt 20.8.2002, it envisages a male person by name Venkatachamalam aged 47 years was admitted into Gowri Gopal Apollo Hospital vide IP No. 1735 on 20.8.2002, under the care of Doctor Gajjela Ramakrishna Reddy for final Diagnosis of Acute Gastritis, Dysentery, IHD and old infection of MI. The opposite parties strongly argued that the policy holder with held correct information regarding his health in Ex B.1 prior to taking of the policy, but the opposite parties failed to establish the identity of the person who has taken treatment in Gowri Gopal Apollo Hospital, Kurnool is the deceased policy holder S.Venkatachalam only. In the absence of any cogent relevant supporting material placed by the opposite parties on record to establish the identity the deceased policy holder and the person who has taken treatment in the hospital are one and the same, the said statement of the opposite parties on this aspects not only remains highly inconsistence but also thereby un-trust worthy and as consisting of any bonafides of the opposite parties in that regard. The deceased policy holder’s name is S.Venkatachalam S/o. S Ramalingappa R/o Pattikonda and the hospital records show the patient’s name as Venkatachalam C/o Babu of Kurnool. Hence, the hospital records in Ex B.3 relied by the opposite parties doesn’t inspire any confidence about the contents of the documents which can be acted upon, as the identity of the patient is not established as that of the deceased policy holder. Therefore, there is absolutely no material placed by the opposite parties in justification of their repudiation of claim of the complainant. Hence, the opposite parties miserablely failed to prove their case by placing any supporting material for rejecting the claim of the complainant. Hence, the contents of the Ex B.3 cannot be looked into nor has any confidence to act upon.
11. Having regarding to over all consideration and the discussion made above there is no hesitation to hold the opposite parties have miserable failed to substantiate that the deceased suppressed material facts about his health condition prior to taking the policy. Therefore, in the said circumstances the repudiation of claim by the opposite parties is wholly arbitrary, unreasonable and unjust and amounts to deficiency of service on their part .In the light of above discussion and the material placed on record not substantiating any suppression of health condition by the deceased while taking the said policy and further there appears any substance in the allegation made by the opposite parties and the complainant is remaining entitled to the insured amount.
- In the result, the complaint is allowed directing the opposite parties to pay to the complainant assured amount under the policy of the deceased S.Venkatachalam with 12% interest from the date of filing of this complaint till realization along with Rs.500/- as costs of the complaint within a month of receipt of this order.
Dictated to the Stenographer, Typed to the dictation corrected by us, pronounced in the Open Court this the 22nd day of February, 2005
Sd/-
Sd/- PRESIDENT sd/-
MEMBER MEMBER
