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
Thursday the 01st day of April , 2010
C.C.No. 28/09
Between:
N. Prakash, S/o. N. Ragavendra Rao,
H.No.4-149-32-11-33, Sreerama Nagar, Dhone - 518222.
…..Complainant
-Vs-
1.The Branch Manager, Life Insurance Corporation of India,
Yemmiganur Branch , D.No. 1/1295, Kurnool District 518360.
2. Life Insurance Corporation of India,Represented y its Divisional Manager,
D.No. 1-55, Jeevan Prakash Building, College Road, Kadapa - 516004.
. …Opposite Parties
This complaint is coming on this day for orders in the presence of Sri. A. Rama Subba Reddy , Advocate, for the complainant, and A.V. Subramanayam, Advocate for opposite parties and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C.No.28/09
1. This complaint is filed under section 12 of the C. P. Act,1986 praying to
a) direct the opposite parties No.1 and 2 to pay assured sum of Rs.50,000/- with bonus and compensation of Rs.10,000/-to the complainant.
b) Grant interest @ 24% p.a from the date of death.
c) Grant costs of the complaint.
d) Grant such other reliefs as the Hon’ble Forum may deem fit and proper.
2. The brief facts of the complaint is as follows : -
The complainant is the husband of Late. U.Kesamma @ N. Kesamma , who insured his life with the opposite parties under policy bearing No. 653701984 for Rs.50,000/- . The policy commenced on 28-10-2004 and the yearly premium payable by the insured was Rs.3,307/-. Kesamma who insured her life with the opposite parties and died due to Chest pain on 06-07-2006 in Aditya Nursing Home, Adoni . The complainant submitted claim forms to the opposite parties . The opposite parties repudiated the claim stating that the insured suppressed the material facts of her illness . The repudiation is not based on facts . The deceased did not suffer from Lung Fibrosis and Pulmonary Tuberculosis at any time . There is deficiency of service in repudiating the policy and the complainant is entitled for the assured sum of Rs.50,000/- with bonus and compensation of Rs. 10,000/- with interest at 24% p.a from the date of death of the deceased.
3. The opposite party No. 2 filed written version and the same was adopted by the opposite party No. 1 . The case of the opposite parties is that the complaint is not maintainable . It is admitted that the complainant’s wife Kesamma insured her life under the policy bearing No. 653701984. The deceased was a chronic patient and she was suffering from Lung decease before commencement of policy. The deceased during her life time consulted Dr. B Srinivasulu , Aditya Nursing Home , Adoni on 23-11-2004 with ailment systemic Hypertension and back pain . The deceased suppressed the said fact and obtained the policy fraudulently . The contract of insurance is utmost good faith and the deceased had not disclosed the material facts of hypertension , at the time of effecting the policy. There is no deficiency of service on the part of the opposite parties and the complaint is liable may be dismissed.
4. On behalf of the complainant Ex. A1 and A2 are marked and on behalf of the opposite parties Ex.B1 to B6 are marked .
5. On the basis of the above pleadings the points that arise for consideration are
(i) whether there is any deficiency of service on the part of the
respondents/ opposite parties ?
(ii) Whether the complainant is entitled to the relief as prayed
for?
(iii) To what relief?
6. Point No.1 & 2: Admittedly the complainant is the husband of Late U. Kesamma @ N. Kesamma who insured her life with the opposite parties under the policy bearing No. 653701984 for Rs.50,000/-. The Ex.B5 policy stands in the name of Kesamma . The said policy commenced on 28-10-2004. There is no dispute regarding issuance of life insurance policy by the opposite parties in the name of Kesamma wife of the complainant. Admittedly the insured Kesamma died on 06-07-2006 while the policy was in force . After the death of Kesamma her husband who is the complainant submitted claim forms to the opposite parties and the opposite parties repudiated the claim stating that the deceased suppressed the material facts obtained the policy fraudulently.
7. It is the case of the complainant that Kesamma died on 06-07-2006 due to chest pain and that the complainant is entitled for the benefits under the policy obtained by his wife Kesamma . It is the contention of the opposite parties that Kesamma was suffering from Lung decease before the commencement of the policy that she suppressed the said fact and obtained the policy fraudulently to obtain wrongful gain . During the course of enquiry the opposite parties caused interrogatories to complainant stating that the deceased was a patient and she was suffering from Lung decease before the commencement of the policy . The complainant denied the same . It is for the opposite parties to establish the deceased was suffering from lung decease by the date of the commencement of the policy. The opposite parties simply filed Ex. B1 O.P sheet dated 23-11-2004 said to have been issued by Dr. B.Srinivasulu , Adoni. ExB1 is subsequent to the date of commencement of the Ex.B5 policy. The policy commenced on 28-10-2004 and where as Ex.B1 policy was issued on 23-11-2004 . There is no satisfactory evidence to show that the assured was suffering from lung decease by the date of the commencement of the policy. No doubt in Ex.B2 medical attendance certificate issued by Dr.B.Srinivasulu it is mentioned that the deceased was suffering from the decease since long period . In Ex.B2 it is clearly mentioned that Kesamma died due to Cardiac arrest.
8. The complainant is disputing the genuineness Ex.B1 and Ex.B2. The opposite parties did not choose to examine the doctor who issued Ex.B1 and B2 to prove their contention . In the replies filed by the opposite parties for the interrogatories served by the complainant it is admitted that the Dr. B. Srinivasulu is the panel doctor . It is also admitted by the opposite parties that before issuing the policy the assured Kesamma was examined by the corporation doctor by name Dr. B. Subramanayam of Pattikonda. The opposite parties did not choose to produce medical report issued by Dr . B .Subramanyam who examined the assured before issuing the policy. As already stated the opposite parties did not establish that Kesamma the assured was suffering from Lung decease by the date of commencement of the policy and that she suppressed the said fact. I am of the firm view that the repudiation of the claim of the complainant by the opposite parties is not reasonable. The opposite parties instead of paying the amount to the complainant made him to file the complaint unnecessarily . There is deficiency of service on the part of the opposite parties .
9. Point No. 3 : In the result the complainant partly allowed directing the opposite parties jointly and severally to pay Rs.50,000/- with bonus to the complainant , Rs.1,000/- towards compensation and Rs.1,000/- towards costs with interest at 9% p.a on Rs.50,000/- from the date of the complaint i.e 27-01-2009 till the date of realization.
Dictated to the stenographer, transcribed by her , corrected and pronounced by us in the open bench on this the 01st day of April, 2010.
Sd/- Sd/-
MALE MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Repudiation letter dated 01-11-2007.
Ex.A2. Status report of policy bearing No. 653701984.
List of exhibits marked for the opposite parties:
Ex.B1. Prescription dated 23-11-2004 by Aditya Nursing Home, Adoni of Kesamma.
Ex.B2. Medical attendants certificate
Ex.B3. Form No. 5152 issued by Dr.B.Srinivasulu to the patient Kesamma.
Ex.B4. Proposal for insurance of Kesamma.
Ex.B5. Policy bond No. 653701984 infavour of Kesamma with
terms and conditions.
Ex.B6. Certificate of hospital treatment in claim form – B1
Sd/- Sd/-
MALE MEMBER PRESIDENT
// 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 :
