BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, President
And
Smt.C.Preethi, Member
Friday the 16th day of March, 2007
C.C. No.89/2006
G. VENKATESWARLU, S/o. Late Polaiah, Retired lecturer, aged about 60 years,
H.No.18-115-B-3, Madhava Nagar, KURNOOL, Kurnool District.
…Complainant
-Vs-
1. The Branch Manager,
Life Insurance Corporation of India Ltd., Kurnool, Kurnool District.
2. The Divisional Manager, Life Insurance Corporation of India Ltd.,
P.B.No.10, College Road, KADAPA - 516 004. …Opposite parties
This complaint coming on this day for orders in the presence of Sri. P.Siva Sudarshan, Advocate, Kurnool for complainant, and Sri.B. Rama Subba Reddy, for opposite parties and stood over for consideration till this day, the Forum made the following:-
ORDER
(As per Smt. C. Preethi, Member)
- This consumer complaint of the complainant is filed U/S 11 and 12 of
C.P. Act., seeking a direction on opposite parties to pay policy amount of
Rs.5,00,000/- to the complainant with 24% interest from the date of death
till realization, Rs.20,000/- towards mental agony, Rs.2,000/- towards cost
and any other relief or reliefs which the complainant is entitled in the
circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s son G.Sreedhar insured his life with opposite parties under policy bearing No.652671305 for Rs.5,00,000/- in the year 2000 and paid installments regularly. The policy holder died on 17-8-03 due to Bronchitis and on the claim preferred by the nominee the opposite parties repudiated on 03-02-05 stating that the complainant’s son withheld correct information regarding his health at the time of contract of insurance and they are not considering the claim of the complainant. But the complainant submits that his son never suffered from any decease such as Tuberculosis and he had not taken treatment from any hospital prior to the date of proposal and his death is due to Bronchitis and alleges deficiency of service on part of opposite parties in falsely repudiating his valid claim and seeks for redressal in this forum.
3. In substantiation of his case the complainant relied on the following documents viz: (1) Repudiation letter dated:03-02-05 of opposite party No.1 addressed to the complainant (2) Death certificate issued by Kurnool Municipal Corporation and (3) Letter dated:6-8-05 of opposite party No.1 to the addressed to the complainant, besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A3 for its appreciation in this case. The complainant relied on Ex.X1 case sheet issued by Government General Hospital, Kurnool and Ex.X2 discharge summary card issued by Christian Medical College, Vellore and caused interrogatories to opposite party No.1 and suitablely replied to the interrogatories caused by opposite party No.1.
3. 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.1 filed written version and opposite party No.2 adopted the written version of opposite party No.1.
4. The written version of opposite parties denies the complaint as not maintainable either in law or on facts and admits late G.Sreedhar took a policy for assured sum of Rs.5,00,000/- on 28-12-00 and paid 3 premiums up to December, 2002 and the complainant is nominee under the said policy. But alleges Sreedhar death is not due to Bronchitis but due to Bone T.B. for which he was suffered since 4 years prior to his death and he was admitted in Christian Medical College and Hospital, Vellore for a period of 72 days from 23-9-02 to 03-12-02 and was diagnosed as Dissiminated tuberculosis after investigation. And he was suffering for fever for 2 ½ years and he received two courses and A.T.T. six month each over a precedings 2½ years and had multiple episodes of seizures which clearly establishes that the policy holder Sreedhar was a tuberculosis patient prior to taking the policy and he suppressed this material facts from the opposite parties at the time of taking policy. Hence, the policy itself is Vitiated on account of fraudulent suppression of material facts as he had been treated for serious ailments few months before taking the policy. The holder fraudulent suppressed information at the time he made his statements and hence relying on those statements the policy is Vitiated. Hence, the opposite parties are not liable to pay any amount to the complainant as the policy holder knowing fully that he was suffering from T.B has taken this policy. Hence, lastly seeks for the dismissal of complaint with exemplary cost.
5. In substantiation of their case the opposite parties relied on the following documents viz:(1) Proposal form for insurance of G.Sreedhar (2)Original policy bond number 625671305 along with conditions (3) office copy of letter dated:20-8-04 addressed to Christian Medical College and Hospital Vellore by opposite party No.2 (4) Office copy of letter dated:31-12-04 addressed to Medical Superintendent Christian Medical College and Hospital, Vellore (5) Medical Attendance certificate – claim form-B and (6) certificate of hospital treatment – claim form – B1, besides to the sworn affidavit of opposite party No.1 in reiteration of his written version and the above documents are marked as Ex.B1 to B6 for its appreciation in this case. The opposite parties also relied on the deposition of RW1 Dr.B.V.Subba Reddy and caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
6. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:?
7. It is not in dispute that the deceased G.Sreedhar obtained aL.I.C. policy bearing No.652671305 vide Ex.B2 and nominated his father G.Venkateswarlu as his nominee and the policy holder died on 17-8-03 due to Bronchitis. On the claim preferred by the nominee it was repudiated by opposite parties vide Ex.A1 dated:03-02-05 stating that the policy holder was suffering from T.B. and has taken treatment from a hospital prior to date of proposal and hence they repudiated the claim of the complainant.
8. Therefore, the main contentions of the opposite parties is that the deceased G.Sreedhar suppressed material information regarding his health at the time of taking the policy. The counsel for opposite parties had forcefully contended that while submitting the personal statement regarding his health in the proposal form, the deceased concealed that he was suffering from T.B. and he had taken treatment at a hospital. Therefore, the opposite parties are justified in repudiating the claim.
9. The opposite parties in support of their case relied on Ex.B1 to B6, the Ex.B1 is the proposal form of the deceased policy holder for taking Ex.B2 policy bond bearing No.652671305, for covering the life risk of the deceased policy holder for Rs.5,00,000/- and the dated commencement of the policy was from 28-12-2000, the Ex.B3 and B4 are the office copies of letters dated:20-8-04 and 31-12-04 addressed to medical superintendent, Christian Medical College and hospital vellore, requesting to furnish copies of case sheet of G.Sreedhar. The Ex.B5 is the medical attendance certificate issued by Dr.B.V.Subba Reddy it says that the name of the patient as G.Sreenivasulu in the present case the policy holders name of G.Sreedhar, hence the said exhibit cannot be looked into, the Ex.B6 is a certificate of hospital treatment, it says that G.Sreedhar admitted in their hospital on 04-8-03 and he had previously taken treatment at Christian Medical College, Vellore and the said patient expired on 17-8-03. The main reason for repudiated the claim of the complainant as per Ex.A1 is that the policy holder had taken treatment from a hospital for T.B. prior to taking the policy. The opposite party in support of their case merely relied on Ex.B1 to B6 and Ex.X1 and X2, the Ex.X1 is the case sheet pertaining to G.Sreedhar of Govt., General Hospital, it says that patient by name G.Sreedhar was admitted in their hospital on 04-8-03 as in patient and died on 17-8-03. The Ex.X2 is the discharge summary card pertaining to G.Sreedhar of Christian Medical College, Vellore, it says that a 25 years old G.Sreedhar was admitted on 04-12-02, and discharged and 23-4-03 and he had taken treatment as in patient for the said period. The policy in Ex.B2 commenced from 28-12-2000 and the exhibits B1 to B6 relied by the opposite parties, and the Ex.X1 and X2 says that the policy holder had taken treatment after the commencement of the policy i.e., from 04-8-03 to 17-8-03 and 04-12-02 to 23-4-03, both, hospitalizations are after the commencement of the said policy, hence the opposite parties cannot rely upon the said exhibits. Mere assertion or oral testimony in respect of treatment prior to taking the policy neither inspires any confidence nor can be acted upon. Onus is on the opposite parties to substantiative their plea that policy holder concealed material facts of his treatment before taking the policy or at the time of submitting praposal form which was not done in this case. The evidence of Rw1 Dr.B.V.Subba Reddy also says that the patient by name G.Sreedhar had taken treatment from 4-8-03 and died on 17-8-03 during treatment, this evidence also doesn’t support the case of the opposite parties as the treatment is after to taking the policy.
10. Hence, the Exhibits filed by the opposite parties does not substantiative that the policy holder G.Sreedhar had taken treatment prior to taking the policy. The decision of national commission reported in I-2007 C.P.J page 226 between L.I.C. of India V/s. Kamaladevi Gupta it was held that no evidence was placed on record that the life assured ever remained admitted in any hospital or treated for any cancer prior to obtaining the policy, insurance company was made liable to pay assured amount to the nominee. In the present case on hand the opposite parties did not placed any peace of record to show that the policy holder was hospitalised or taken treatment for T.B. prior to taking the policy.
11. Having regard to over all consideration and relying on the decision of nation commission, there is no hesitation to hold that the opposite parties have miserably failed to substantiate that the policy holder before to taking the policy or at the time of submitting praposal form suppressed material information of taking that must for T.B. Therefore, in these circumstances the repudiation of claim by the opposite party is wholly arbitrary unreasonable and unjust.
12. In the result, the complaint is allowed directing the opposite parties to pay to the complainant the assured amount as per the policy of the deceased G.Sreedhar bearing No.652671305 with interest at the rate of 9% interest per annum from the date of filling of this case i.e., 25-5-06 till realization along with costs of Rs.5,000/- with in a month from the date of receipt of this order.
Dictated to the Stenographer transcribed by him, corrected and pronounced in the Open bench on this the 16th day of March, 2007.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant:Nil For the opposite parties :
Rw1: Deposition of RW1, Dt:20-2-07
(Dr.B.V.Subba Reddy).
List of exhibits marked for the complainant:-
Ex.A1 Repudiation letter, Dt:03-02-2005.
Ex.A2 Death certificate issued by Kurnool Municipal Corporation.
Ex.A3 Letter, Dt:06-8-2005 of opposite party No.1 to the complainant.
Ex.X1 Case sheet of G.Sreedar I.P.No.24603.
Ex.X2 Discharge summary card Christian Medical College, Vellore-4.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal form for Insurance (No.in 3 pages).
Ex.B2 Original Policy Bond along with condition.
Ex.B3 Office copy of letter, Dt:20-8-04 addressed to Christian Medical College
& Hospital, Vellore.
Ex.B4 Office copy of letter, Dt:31-12-2004 addressed to Medical
Superintendent, Christian Medical College & Hospital, Vellore.
Ex.B5 Medical Attendant’s certificate claim form “B”.
Ex.B6 Certificate of Hospital treatment claim form B1.
MEMBER PRESIDENT
Copy to:-
1. G. VENKATESWARLU,S/o. Late Polaiah, Retired lecturer, aged about 60
years,H.No.18-115-B-3, Madhava Nagar, KURNOOL, Kurnool District.
2. Sri. P.Siva Sudarshan, Advocate, Kurnool.
3. The Branch Manager, Life Insurance Corporation of India Ltd., Kurnool,
Kurnool District.
4. The Divisional Manager, Life Insurance Corporation of India Ltd.,
P.B.No.10, College Road, KADAPA – 516 004.
5. Sri. B.Rama Subba Reddy, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
