Per Smt T. Suneetha, Member:-

This complaint is filed U/s 12 of Consumer Protection Act, Seeking directions on opposite parties to pay the insurance amount of Rs.1,50,000/- with 12% interest i.e., Rs.78,707/- from the date of death of the deceased till the date of filing and interest thereon and further to pay Rs.30,000/-towards compensation and costs. 

2.   In brief the averments of the complaint are here under:

          Complainant’s husband late Boyanapalli Lakshmana Rao S/o.Rama Rao has obtained L.I.C. policy on 28-01-06 and policy bearing No.842673848 for Rs.1,50,000/- from the opposite parties.  The deceased paid the premiums regularly till his death.  The insured/deceased Boyanapalli Lakshmina Rao expired on 13-11-07 due to cardiac arrest while he was undergoing treatment for Kidneys  from 04-11-07 to 13-11-07 in Aswini Hospitals, Guntur.   Prior to that red the insured consulted Dr.A.Srinivasa Rao, Aswini Hospitals, Guntur for his illness in March, 2007. 

3.     The complainant lodged claim with opposite parties and submitted all required papers.  But the opposite parties have not settled the claim of the complainant. The complainant sent registered letters to the opposite parties and also Divisional Office, L.I.C., Nellore on 05-08-11.  The 1^st opposite party sent a letter dated 09-08-11 to the complainant stating that complainant’s claim was being repudiated and the same was informed through a letter dated 31-03-2009.  Complainant astonished seeing the said letter and wrote a letter to the 1^st opposite party on 13-02-2012 asking clarification evidence copy that her husband had suffered from chronic kidney decease and got treatment from Aswini Hospitals, Guntur prior to the date of proposal. But in vain.  The complainant suffered inconvenience and lot of mental agony due to the negligence of the opposite parties.  Therefore there is deficiency of service on the part of the opposite parties.  Thus the complaint.          

4.      2^nd Opposite party filed its version which is in brief as follows. 

          It is true that the deceased Boyanapalli Lakshmana Rao, S/o.Rama Rao obtained a L.I.C policy during his life time on his life on 28-01-06 under No.842673848 for Rs.1,50,000/- from the opposite parties.  The deceased died on 13-11-07 due to cardiac arrest. 

        As per the admission form of Aswini Hospitals, Guntur the    deceased was a known case of chronic kidney decease and was on dialysis since 3 years.  The deceased was suffering with the said decease even prior to the date of proposal of the policy i.e., 28-01-06 and did not disclose these facts in his proposal.  Due to the suppression of facts the claim application of the complainant was repudiated by the opposite parties.  Hence there is no liability under the said policy.  The Divisional Office, Claims Department, Nellore, has sent a letter dated 31-03-09 with regard to the said claim repudiation.  Therefore there is no deficiency of service on the part of the opposite parties and Hon’ble Forum may kindly be pleased to dismiss the complaint with costs.     

5.      The complainant and opposite parties filed their respective affidavits. Exs.A-1 to A-16 were marked on behalf of the complainant.  Ex. B-1 is marked on behalf of the opposite parties.    

6.      Now the points that arose for consideration in this          complaint are:      

1.  Whether the opposite parties committed deficiency of      

     service?

2.  To what relief the complainant is entitled to?

7.      POINT NO. 1:-   The complainant’s claim was repudiated by the opposite parties on the ground that the deceased suppressed the material fact that he is having chronic kidney decease prior to the policy.  In support of their contention the opposite parties filed Ex.B-1 Hospital record of the deceased in which it was written “known case of CKD on dialysis since 3 years & HCV……..”    

        The material from Medical Attendance certificate Ex.A-5 obtained from the treatment doctor of deceased, Dr.A.Srinivasa Rao, Aswini Hospitals, Guntur, is extracted below:

a).  What was the exact cause of death?             a).Primary cause :  HTN

(Beside defining the desease or other cause                  Secondary cause : Chr.renel

                                                                                   failure. 

of death in such terms as you consider

appropriate kindly add the distinctive technical name)

b).Was it ascertained by examination

     after death or inferred from symptoms

     and appearance during life?                   b).              NO.

c). How long he had been suffering

     from this diseased before his death?       c). 8 months

d). What were the symptoms of the illness?   d). Anoroxea / decrease

                                                                      UOP.

e). When were they 1^st observed by

     the deceased?                                             e).  10-03-07. 

f).  What was the date on which you

      were first consulted during the illness?     f).  10-03-07.

9.  When and for what elements did you treat

      the deceased during the three

      years preceding his last illness?            9). Since 8 months HTN

                                                                        & CRF         

The above material revealed that the complainant was suffering from HTN & CRF just before 8 months of his death ie;10-03-07 . 

        The deceased took the policy on 28-01-06 i.e., one year ten months before his death. The contention of the opposite parties that the deceased was having the said decease prior to the policy cannot be placed reliance.    

        The evidence adduced by the opposite parties Ex.B-1 is not supported by any of the documents or statements given by the deceased’s doctor Dr.A.Srinivas Rao.  The opposite parties ought to have produced affidavit of the doctor in support of their contention. 

        In these circumstances the Forum opines that reliance should be placed on the medical attendance certificate to decide the case.  The Forum comes to a considered opinion that the deceased is having CKD & HTN 8 months before his death and not before 3 years  and thereby inferred  that the deceased was not having the said deceases prior to the policy.  Therefore, the repudiation made by the opposite parties is not justified.  The point is answered accordingly in favour of the complainant. 

8.      POINT NO.2:-   Since the opposite parties repudiation of the complainant’s claim was not justifiable they need to compensate the complainant by giving away the policy amount along with interest, compensation for mental agony and costs to the complainant.

The complainant sought interest on the policy amount from the date of death of the deceased. The complainant during arguments told that after her husband’s demise she was residing at her maternal house (noted on the docket of IAno.142/12 by the forum) and had no knowledge of repudiation. Under these circumstances, allowing interest from the date of death, or repudiation is not justifiable.

9.     In the result, the complaint is allowed in part, as indicated below:

1. The opposite parties 1&2 are directed to pay policy amount of Rs.1,50,000/-(one lakh fifty thousand rupees) along with an interest @ 9% p.a. from the date of complaint till realisation, to the complainant. 
2. The opposite parties 1&2 are directed to pay compensation of Rs.5,000/- (five thousand rupees) towards mental agony and pain, to the complainant.   
3. The opposite parties 1&2 are directed to pay Rs.1,000/- (one thousand rupees only) towards costs of the complaint, to the complainant. 
4. The above order shall be complied within a period of six weeks from the date of receipt of copy of the order, failing which the amounts ordered in item No.2&3 shall carry interest @9% p.a. till realisation.    

Typed to my dictation by Junior Stenographer, corrected by us and pronounced in the open Forum dated this the 18^th day of February, 2013.

MEMBER                                    MEMBER                                PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties: -

PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.