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
Friday the 10th day of August, 2007
C.C. No.47/2007
B. Bhaskar Reddy,
S/o B.C. Rami Reddy,
Agriculturist,
R/o Chandra palli Village,
Peapully Mandal,
Kurnool District. … COMPLAINANT
Verses
1) The Branch Manager,
Life Insurance Corporation of India,
Dhone.
2) The Divisional Manager,
Life Insurance Corporation of India,
College Road,
Kadapa.
. … OPPOSITE PARTIES
This complaint coming on this his day for orders in the presence of Sri C. Ramana Reddy, Advocate, kurnool for complainant, Sri. A.V.Subramanyam, Advocate, Kurnool for Opposite Party No.1 and opposite party No.2 and upon the perusing the material papers on record, the Forum made the following:-
ORDER
(As per Smt. C.Preethi, Member)
C.C.No. 47-2007
1. This consumer complaint of the complainant is filed Under Section 12 of C.P. Act., 1986, seeking a direction on opposite parties to pay the assured amount of Rs.50,000/- to the complainant with all benefits and interest at 12% per annum, Rs.50,000 as compensation and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant’s brother B.Chinna Rami Reddy has take an endowment insurance policy for Rs.50,000/- vide policy bearing No.653017684 on 23.4.2002 and nominated the complainant as his nominee. The said policy was lapsed after paying 2 installments and the deceased reviewed the policy on 17.1.2004 by paying due premiums with interests. The policy holder died on 28.4.2004 due to stomach pain at his village. On the claim preffered by the complainant the opposite parties repudiated the claim on 10.1.2007 stating that the deceased policy holder was suffering from Kidney problem prior to the date revival of the policy. But, the complainant submits that the policy holder never suffered and took treatment for the alleged decease. Hence, the repudiation of his claim by the opposite party is amounting to deficiency of service. Therefore, resorted to the forum for redressal.
3.. In substantiation of his case the complainant relied on the following documents viz., (1) Repudiation letter dated 10.01.2007 of opposite party No.2 addressed to the complainant and (2) attested Xerox copy of the policy Bond issued to the policy holder B. Chinna Rami Reddy, besides to the sworn affidavit of the complainant in reiteration of his complaint avernments and the above documents are marked as Ex.A1 and A2 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitably replied to the interrogatories of opposite parties.
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 opposite party No.2 filed written version and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version of opposite parties denies the complaint as not maintainable either in Law or on facts. But admits the deceased policy holder B.Chinna Rami Reddy has taken an endowment policy No.653017684 on 23.4.2002 and nominated the complainant as his nominee. The nominee informed the death of the policy holder on 28.4.2004 and preferred a claim. As the claim aroused with a gap of 3 months and 12 days from the date of revival of the policy investigation was conducted, which revealed that the policy holder was suffering from kidney problem and has taken treatment from Dr. R. Siva Reddy, M.B.B.S., Koilakuntla in November 2003 i.e., prior to the date of revival of the policy. Dr. R. Siva Reddy submitted a notarized form in Form-No.5152 stating the deceased was first consulted in November 2003 for abdomen pain (kidney stone Diagnoised by scan). The policy holder in the declaration of good health dated 17.1.2004 submitted at the time of revival of the policy gave negative answers to all the questions and violated condition No.5 of the policy and hence the contract was declared null and void. Therefore, the repudiation by opposite parties as to the claim of the complainant was made on justifiable ground and seeks for the dismissal of complainant with costs.
6. In substantiation of his case the opposite parties relied on the following documents viz., (1) Policy Bond with its terms and conditions (2) personal statement regarding health dated 17.1.2004 (3) Renewal premium receipt dated 21.1.2004 (4) ordinary revival quotation dated 17.1.2004 (5) Medical Examiner’s confidential Report, dated 15.1.2004, (6) Form No.5152 filled by Dr. R. Siva Reddy, (7) notarized affidavit of the complainant, dated 14.11.2006 and (8) claim form-A (claimants statement ) dated 14.3.2006 , besides to the sworn affidavit of opposite party No.2 in reiteration of his written version avernments and the above documents are marked as Ex.B.1 to B.8 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and replied to the interrogatories of complainant.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties ?.
8. It is not in dispute that the deceased B. Chinna Rami Reddy, has obtained a LIC policy bearing No.653017684 for Rs.50,000/-and on lapsation of said policy the deceased revived it on 17.1.2004 and nominated the complainant as his nominee.
9. The main contention of the opposite parties is that the deceased suppressed material information regarding his health and had taken treatment from Dr. R. Siva Reddy, for kidney problem. The counsel for opposite parties forcefully contended that while submitting the personal statement regarding his health at the time of revival of said policy, the deceased had concealed the above material facts from the opposite parties. Therefore, the opposite parties are absolutely justified in repudiating the claim of the complainant. The opposite parties in support of their case relied on Ex.B1 to B6, the Ex.B1 is the policy Bond with its terms and conditions, the Ex.B2 is the personal statement regarding health executed by the policy holder at the time of revival of the policy dated 17.1.2004 , the Ex.B3 is the renewal premium receipt dated 20.1.2004 as to the payment of premium quotation of Rs.3,296/- , the Ex.B4 is the ordinary revival quotation dated 17.1.2004, the Ex.B5 is the Medical Examiner’s confidential Report dated 15.1.2004., the Ex.B6 is the form 5152 questionnaire filled by Dr. R. Siva Reddy, M.B.B.S., Koilakuntla. The opposite parties mainly relied on Ex.B6, where in Dr .R. Siva Reddy, who said to have treated the deceased in the beginning of the last illness filled the questionnaire given by the opposite parties stating that he has seen the deceased on November 2003 for abdomen pain (kidney stone diagnoised by scan) suffering from past 7 days before coming to the Hospital and later visited the said doctor twice or thrice for minor complaints like fever and cold. From the contends of Ex.B6 relied by the opposite parties does not inspire any confidence to presume that the insured had taken treatment for kidney problem prior to revival of policy. The doctor in Ex.B6 stated that he had seen the deceased, but no where stated that he had given treatment to the deceased for kidney problem, no document or any direct evidence showing the deceased actually taken treatment for kidney problem have been put forth on record by the opposite parties. In the absence of any evidence produced on record, primary or secondary regarding treatment taken before the revival of the policy it cannot be said that opposite parties have proved on record that the deceased has taken treatment for kidney problem before to the revival from Dr. R. Siva Reddy. The opposite parties have to prove the fact of actual illness, mere filling and relying on Ex.B6 doesn’t mean that the contends are necessarily true. Mere asertion or oral testimony as to the treatment before to the revival cannot be acted upon and relied upon. Onus is on the opposite parties to substantiate their plea, no substantiative affidavit is filed by the opposite parties in support of Ex.B6, nor any doctor is examined to show that the deceased had taken treatment for kidney problem. Therefore, the Ex.B6 cannot be looked into.
10. The Ex.B7 is the notarized affidavit of the complainant dated 4.11.2006 issued to the opposite parties . The complainant in his sworn affidavit avernments denies the issual of said affidavit , but submits that he has put his thumb impression on a plain paper, as the opposite parties promised to settle the claim of his brother and pay the assured amount. Therefore, the Ex.B7 also cannot be looked into. Hence, absolutely there is no material on record in support of the contentions of opposite parties in repudiating the claim of the complainant. Hence, for want of substantiating material in support of opposite parties contentions, the act of repudiating the claim of the complainant by the opposite parties as is remaining without any justifiable excuse.
11. To sum up the above discussion , there is no hesitation to hold the opposite parties have miserablely failed to substantiate that policy holder before revival of the policy has suppressed the fact of kidney problem he was suffering. Therefore, in these circumstances the said conduct of opposite parties in repudiating the claim of the complainant is certainly amounting to deficiency of service on the part of opposite parties and the complainant thereby remaining entitled to the reliefs.
12. In the result, the complaint is allowed directing the opposite parties to pay to the complainant the assured amount Under the policy bearing No.653017684 of B. Chinna Rami Reddy along with costs of Rs.1,000 within a month of receipt of this order. In default the opposite parties are liable to pay the supra award amount with 12% interest from the date of default till realization.
Dictated to the stenographer , transcribed by her, corrected and pronounced in the open bench this is the 10th August, 2007.
Sd/- Sd/-
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 10.1.2007 (No in 2 papers)
Ex.A2 .Attested Xerox of policy bond No.653017684.
List of exhibits marked for the opposite parties:
Ex.B1. Original policy bond with terms and conditions.
Ex.B2. Personal statement regarding health executed by policy holder on dated 17.1.2004.
Ex.B3. Renewal Premium receipt dated 20.1.2004.
Ex.B4. Ordinary Revival Quotation dated 17.1.2004.
Ex.B5. Medical Examiner’s confidential Report, dated 15.1.2004.
Ex.B6. Form No.5152 filed by Dr. R. Siva Reddy, M.B.B.S., Koilakuntla.
Ex.B7. Notarized affidavit of the complainant , dated 4.11.2006.
Ex. B8. Claim Form ‘A’ (claimant’s statement) dated 14.3.206.
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
1. Sri.C. Ramana Reddy, Advocate, Kurnool.
2. Sri.A.V. Subramanyam, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
