BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
And
Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Wednesday the 21st day of March, 2012
C.C.No.118/2011
Between:
G.Ramakka,W/o Ganamaddela Gurrappa,
1-91, SC Colony,Pedda Kopperla Village, Koilakuntla Mandal - 518134,
Kurnool District.
…Complainant
-Vs-
1. The Branch Manager, Life Insurance Corporation of India,
3-48, Opposite Mahaboob Talkies, Banaganapalli - 518 124.
2. The Senior Divisional Manager, Life Insurance Corporation of India, Divisional Office,
Post Box No.10, College Road, Kadapa - 516 004.
...Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri M.Sivaji Rao, Advocate for complainant and Sri L.Hari Hara Natha Reddy, Advocate for opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. M.Krishna Reddy, Male Member)
C.C. No.118/2011
1. The complainant is filed this complaint under section 11 and 12 of C. P. Act, 1986 praying an order on opposite parties for the payment of :-
- The assured amount with profits and accident benefits with interest at the rate of 24% per annum from the date of death;
- Rs.25,000/- towards the compensation for mental agony;
- The cost of the case;
2. Briefly the complainant’s case is that she is the widow and nominee of deceased Ganamaddela Gurrappa. Her husband insured his life for Rs.40,000/- on 28-03-2006 under the Bima Gold LIC Policy bearing No.654187277. The mode of premium payment was yearly. The policy was lapsed and revived on 30-10-2007. The insured died suddenly on 01-06-2008. At the time of taking the policy and its revival, the insured was hale and healthy. After the death of the insured the widow of the insured submitted the claim to opposite party No.1. But opposite party No.2 repudiated the claim on the ground that the information regarding the health of insured was suppressed at the time of revival. Inspite of several requests the opposite parties did not take any steps to settle the claim. Hence this case is filed before the Forum for redressal.
3. The complainant filed sworn affidavit and Ex.A1 to Ex.A3 to support his claim.
4. Persuent to the notice of this Forum opposite party No.2 filed a written version denying his liability to the complainant’s claim. Opposite party No.1 adopted the written version of opposite party No.2. The opposite parties admitted the issuance of the policy to the insured for Rs.40,000/- under the plan and term of 174 – 20 to pay the premium under yearly made, covering the risk from 28-03-2006. The insured declared his wife G.Ramakka as his nominee. He signed the declaration of the proposal stating that he is healthy. He allowed the policy to lapse due to non payment of yearly premium due from 28-03-2007. The life assured sought for the revival of the policy on 30-10-2007 by paying the premium and submitting a personal statement regarding the health condition, affirming that he never under went any operation or suffered from any illness or he was advised to go any treatment or taken X-ray, screening blood, urine etc. Basing on the declaration of good health, the policy was revived on 30-10-2007 under non medical general scheme. The claim under this policy with in 8 months from the date of revival of the policy was treated as an early claim and investigation was conducted. During investigation it was found that the insured was suffering from Bilateral Pulmonary Tuberculosis and took treatment in Government General Hospital, Kurnool for breathlessness and cough as inpatient from 07-05-2008 till his death on 01-06-2008. Had the insured disclosed the true and correct information with regard to his health at the time of revival of the policy, the decision of opposite parties would have been different. The revival was taken with a malafied intention to defraud the opposite party corporation. Hence opposite parties are not at fault in rejecting the paid up value for which at least three premiums of three years need to be paid. The approach of the complainant for redressal before this Forum is untenable as there is no deficiency on the part of opposite parties. Hence the complaint is liable for dismissal with costs.
5. Sworn affidavit and Ex.B1 to Ex.B7 are filed by opposite party No.2 to prove his case.
6. Both sides filed written arguments.
7. Hence the points that arise for consideration are:
- Whether the complainant proved deficiency on the part of opposite parties?
- Whether the complainant is entitled for the reliefs?
- To what relief?
8. POINTS i and ii:- Insurance is a contract entered between the parties in utmost good faith. The husband of the complainant had taken insurance policy from opposite parties for Rs.40,000/- under the plan 174 – 20 commencing w.e.f. 28-03-2006 at a yearly premium, submitting a declaration form stating that he is in good health. The policy had lapsed due to non payment of premium and was revived at the request of insured on 30-10-2007. At that time the insuree submitted a personal statement affirming that he never under went any operation or suffered from any illness or he was advised to go for any treatment etc. Ex.A1 / Ex.B2 the policy bearing No.654187277. Ex.B3 the personal statement regarding health dated 30-10- 2007. The insured was admitted in Government General Hospital, Kurnool on 07-05-2008 with the problem of Breathlessness and cough. Ex.B4 the case sheet of the insured, issued by Government General Hospital confirming that he took treatment for Bilateral Pulmonary Tuberculosis and died on 01-06-2008 due to cardio respiratory arrest. Ex.A2 the death certificate of insured, Ex.B6 is Form 3784 claim Form B, medical attendants certificate dated 11-11-2008. Ex.B7 is Form 3816 claim Form B1, the certificate of hospital treatment dated 11-11-2008. The contention of opposite parties is that the insured being fully aware of his illness deliberately had given declaration that he was in good health at the time of revival, though he was suffering from Bilateral Pulmonary Tuberculosis. The deceased life assured, intentionally suppressed the facts and got revival of the policy. The revival of the policy is null and void and nothing is payable under the policy, in view of the discussions made above Ex.A3/ Ex.B5 the repudiation letter by opposite party No.2 dated 13-08-2009. The opposite parties relaying on the decision in CPJ – 2011, Vol – 4 Pages 645 to 647 in the support of his case prayed the Forum for the dismissal of the case with cost as the insured suppressed the health condition at the time of policy revival. In Ex.B6 under 5 (f) the doctor who treated the insured admitted that the deceased consulted him for the first time on 08-05-2008. He did not treat the insured prior to the admission in Government General Hospital. As per Ex.B7 the insured had, the reported history, at the time of admission in the hospital and was suffering from Breathlessness since one week. In 5 (c) of Ex.B7, post graduate recorded that the insured was suffering PT since one year. Except this entry, there is nothing on the record to prove that the insured had suffered from Pulmonary Tuberculosis prior to the revival of the policy. The complainant filed a citation IV (2008) CPJ 163 (AP) relied on the judgment of the National Commission reported in I (2004) CPJ 91 in which it was held that the repudiation was unjustified since no doctor was examined nor any affidavit of medical expert filed to show that the deceased suffered PT prior to the date of revival of the policy. Another citation IV (2008) CPJ 98 (NC) filed by the complainant to support his claim. The synopsis of the order is that, “Insurance - Repudiation of claim suppression of disease at time of revival of policy alleged no document produced in support of allegation history recorded in hospital’s bed ticket, not to be treated a evidence as doctor, recording history not examined, suppression of disease not proved insurer liable under policy”. In this case also except the history recorded by a post graduate no other evidence is available on record to prove that the insured the suppressed about his disease. Taking in to consideration these facts and circumstances and evidence on record this forum holds that the opposite parties erred in repudiating the claim of the complainant. Therefore the deficiency on the part of opposite parties is proved entitling the complainant the benefits of the policy.
9. Point No.iii:- The complainant claimed the assured amount along with all other benefits with 24% per annum interest. The claim of 24% per annum interest is excessive. The Forum sanction only 9% per annum interest from the date of repudiation of the claim. So the complainant is entitled to receive the assured amount of Rs.40,000/- and all other benefits of the policy with 9% per annum interest. For causing mental agony the opposite parties have to pay Rs.2,000/- as compensation.
10. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay the assured amount of Rs.40,000/- along with all other benefits of the policy with 9% per annum interest from the date of repudiation. Rs.2,000/- for causing mental agony and Rs.500/- as cost of the case. The time for compliance is one month form the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 21st day of March, 2012.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties : Nill
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Policy bearing No.654187277.
Ex.A2. Photo copy of Death Certificate dated 22-09-2008.
Ex.A3 Photo copy of Repudiation Letter by opposite party
No.2 to complainant dated 13-08-2009.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal for Insurance on own life No.11391.
Ex.B2 Policy bearing No.654187277 of Ganamaddela
Gurrappa (Deceased Life Assured).
Ex.B3 Personal statement regarding health dated 30-10-2007.
Ex.B4 Photo copy of Case Sheet of G.Gurrappa issued by
Government General Hospital, Kurnool.
Ex.B5 Office copy of Letter by Zonal Manager LIC of India
Hyderabad to complainant dated 13-08-2009.
Ex.B6 Form No.3784 Claim Form – B Medical Attendant’s
Certificate dated 11-11-2008.
Ex.B7 Form No.3816 Claim Form – B1 Certificate of Hospital
Treatment dated 11-11-2008.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY 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 :
Copy was made ready on :
Copy was dispatched on :
