| Complaint Case No. CC/10/30 |
| | | | 1. Nunavath Bujii ,W/o. late Roopla ,R/o. Teegala Banjara Village ,Konijerla Mandal,Khammam dist. | | Nunavath Bujii ,W/o. late Roopla ,R/o. Teegala Banjara Village ,Konijerla Mandal,Khammam dist. | | Khammam | | Andhra Pradesh |
| ...........Complainant(s) | | Versus | | 1. The Branch manager ,LIC of India ,Khammam Branch. | | The Branch manager ,LIC of India ,Khammam Branch. | | Khammam | | Andhra Pradesh | | 2. The Divisional Manager ,LIC of India ,Jeevan Prakash,Balasamudram,Hanmakonda ,Warangal Dist. | | The Divisional Manager ,LIC of India ,Jeevan Prakash,Balasamudram,Hanmakonda ,Warangal Dist. | | Warangal | | Andhra Pradesh |
| ............Opp.Party(s) |
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| ORDER | | BEFORETHE DISTIRCT CONSUMERS FORUM AT KHAMMAM Dated this, the 7th day of December, 2010. CORAM: 1. Sri Vijay Kumar, B.Com, L.L.B., President 2. Smt. V. Vijaya Rekha, B.Sc. B.L., Member 3. Sri R. Kiran Kumar, B.Sc., L.L.B., Member C.C.No.30/2010 Between: Nunavath Bujji, w/o. late Roopla, age: 30 years, occu: Household r/o. Teegala Banjara village,Konijerla (M), Khammam District. …Complainant and 1. The Branch Manager, LIC of India, Khammam Branch. 2. The Divisional Manager, LIC of India, Jeevan Prakash, Balasamudram, Hanamkonda, Warangal District. Opposite parties. This C.C. is coming on before us for final hearing in the presence of Sri M.Srinivasa Rao, Advocate for the complainant and of Sri.K.Jagan Mohan Rao, Advocate for opposite parties; upon perusing the material papers on record; upon hearing the arguments and having stood over for consideration this forum passed the following: ORDER (Per Sri R. Kiran Kumar, Member) This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the husband of the complainant during his lifetime had taken Jeevan Anand Policy bearing No.688187811 on 11-3-2008 from the opposite party No.1 for the sum assured Rs.1,00,000/-, in the said policy the complainant was shown as nominee for the said policy. Subsequently, the husband of the complainant died on 29-9-2008 at Teegala Banjara due to suffering from Jaundice. For that the complainant has submitted claim form along with all necessary documents to the opposite party Corporation for settlement and release of death claim, but the opposite parties did not come forward to pay the death claim to the complainant and repudiated the claim. On 10-2-2010 the complainant received a letter, dt.30-1-2010 from the opposite party No.2 through speed post, in that the opposite party No.2 stated that they have decided to repudiate all liabilities under the above policy, the complainant was advised to approach the zonal office. In the above circumstances, the complainant is compelled to approach the forum for redressal. 2. On behalf of the complainant the following documents were filed and marked as Exhibits A1 to A3. Ex.A1:- Photocopy of policy, dt.11-3-2008 Ex.A2:- Photocopy of Repudiation letter dated 30-01-2010. Ex.A3:- Photocopy of death certificate, dt.8-10-2008 3. On receipt of the notice, the opposite party Corporation appeared through their counsel and filed counter. In the counter the opposite party submitted that as per the claim submitted by the complainant, the life assured died on 29-9-2008, i.e. within 6 months of commencement of policy, since the death occurred within 6 months, the opposite party treating the claim under the policy as very early, the investigation has been caused into the bonafides of the said claim, so as to decide its admissibility. It is further submitted that during the investigation it came to light that the deceased/life assured had a personal history of alcoholism and was taking treatment for jaundice, for a period of two years and two months prior to his death, which fact is corroborated by the declaration, dt.24-1-2010 given by the deceased/ life assured attending doctor, Dr.Sk.Yakub Ali, R.M.P. of Teegala Banjara, Konijerla Mandal, Khammam District and also came to light that the deceased/ life assured had taken treatment for acute on chronic pancreatitis, sepsis, renal failure and right lower lobe pneumonia from 11-7-2008 to 14-7-2008 in the Narayana Super Specialty Hospital under the care of Dr.S.Nageswara Rao, M.D., D.M., Khammam. And also submitted that the deceased/ life assured had replied to the questions under Q.No.11 (a) to (j) in his proposal for insurance, signed by him, in that he is in good health and that he did not receive any treatment for any disease/ symptoms of illness which are false and he intentionally suppressed the fact, which is fully attracting the provisions of Sec.45 of Insurance Act, 1938. 4. And further submitted that the deceased/life assured contravened the doctrine of Uberrimae Fides (i.e. doctrine of utmost good faith), which is the basis of insurance, to support their contention submitted citation of the Hon’ble Supreme Court of India in Civil Appeal No.5322 of 2007 in SLP(C) No.23951 of 2005 in PC CHACKO and Another Vs. LIC of India and others, in which observed that “an insurer can repudiate the contract of life insurance under Sec.45 of Insurance Act for suppression of Material facts by the proposer”, that there is no deficiency of service at all in the instant complaint, on the part of opposite party Corporation to repudiate the claim under the above said policy, pleased to dismiss the complaint. 5. On behalf of the opposite parties the following documents were filed and marked as Ex.B1 to B3. Ex.B1:- Proposal form for insurance dated 10-03-2008 signed by the deceased/ life assured Ex.B2:- Declaration, dt.24-1-2010 issued by Dr.Sk.Yakub Ali, R.M.P., Teegala Banjara Ex.B3:- Photocopy of Discharge summary, Narayana Super Specialty Hospital, Khammam. 6. On behalf of the complainant counsel for complainant filed written arguments. Counsel for opposite party filed a memo treating their written version, as their written arguments. 7. Upon perusing the material papers on record, now the points that arose for consideration are, 1. Whether the complainant is entitled for the claim? 2. To what relief? Point No.1:- 8. In this case the husband of the complainant by name Nunavath Rupla during his lifetime had taken Jeevan Anand Life Insurance Policy bearing No.688187811 on 11-3-2008 from the opposite party corporation and in which the name of the complainant was shown as nominee, subsequently the husband of the complainant died on 29-9-2008 at Teegala banjara due to suffering from Jaundice. As per the terms and conditions of the policy the complainant submitted claim form along with all the relevant documents, but the opposite party made investigation on the death of the insured, as the claim is very early. On investigation the opposite party came to know that the deceased/ life assured has intentionally suppressed the material facts about assured had a personal history of alcoholism which directly affect the issuance of policy on his life as such the opposite party repudiate the claim of the complainant, for that complainant approached the Forum. 9. It is an undisputed fact that the husband of the complainant died on 29-9-2008, when the policy was in force. The assured died due to suffering from Jaundice. The claim put forward by the complainant was repudiated by the opposite party corporation on the ground that the deceased was having personal history of alcoholism and also deceased was suffering from Jaundice for a period of 2 years 2 months prior to his death. In order to prove their contention the opposite parties filed a declaration, dt.24-1-2010 given by Dr.Sk.Yakub Ali, RMP. In the said questioner (Ex.B.2), Dr.Sk.Yakub answered for question No.1 - on 5-7-2008 he first consulted by the deceased and the duration of the treatment given by him for 10 days, for question No.3 – the deceased had been suffering from the disease since two years two months, for question No.6 – the diagnosis arrived by him through x-ray. The doctor, Sk.Yakub, who gave the answers to the questioner (Ex.B.2) is not a qualified doctor and no affidavit of Dr.Sk.Yakub was filed. The opposite party corporation failed to produce any documentary evidence to show that the deceased suffered from the said disease prior to issuance of the policy. The opposite party corporation filed the medical record, Ex.B.3 is after the policy i.e. from 11-7-2008 to 14-7-2008. 10. From the above we observed that the deceased never suppressed any material facts, which are not attracting the provisions of section 45 of Insurance Act and also the opposite party did not file any evidence to show that the assured had taken any treatment for jaundice prior to issuance of the policy. In the absence of material evidence, the fact remains that the deceased never suppressed any material facts regarding his health. The same was observed by the Hon’ble National Commission in LIC of India Vs. Pariapally Sujatha and others I (2010) CPJ 106 (NC) wherein the Hon’ble National Commission observed that – suppression of material facts – no evidence adduced in support – exgratia payment made by insurer – complaint dismissed by forum – allowed by State Commission – no interference required in Revision. The counsel for opposite party relied on PC Chacko and another Vs. LIC of India wherein the Hon’ble Apex Court observed that an insurer can repudiate the contract of life insurance under section 45 of Insurance Act for suppression of material facts by the proposer. But the facts of the present case do not attract the facts observed by the Hon’ble Apex court. In these circumstances, this point is answered accordingly in favour of the complainant. Point No.2: 11. In the result, the complaint is allowed, directing the opposite parties to pay the claim amount of Rs.1,00,000/- along with other benefits entitled by the complainant under the Jeevan Anand Policy along with interest @ 9% P.A. from the date of repudiation (i.e. from 30-1-2010) till the date of deposit and also directed to pay Rs.2,000/- towards costs of the litigation to the complainant. Dictated to steno, transcribed by her, corrected and pronounced by us in the open forum, on this 7th day of December, 2010 PRESIDENT MEMBER MEMBER DISTRIC CONSUEMRS FORUM, KHAMMAM APPENDIX OF EVIDENCE Witnesses examined for complainant: None Witnesses examined for opposite parties: None Exhibits marked for Complainant: Ex.A1:- Photocopy of policy, dt.11-3-2008 Ex.A2:- Photocopy of Repudiation letter dated 30-01-2010. Ex.A3:- Photocopy of death certificate, dt.8-10-2008 Exhibits marked for opposite parties: Ex.B1:- Proposal form for insurance dated 10-03-2008 signed by the deceased/ life assured Ex.B2:- Declaration, dt.24-1-2010 issued by Dr.Sk.Yakub Ali, R.M.P., Teegala Banjara Ex.B3:- Photocopy of Discharge summary, Narayana Super Specialty Hospital, Khammam. PRESIDENT MEMBER MEMBER DISTRIC CONSUEMRS FORUM, KHAMMAM | |
