Before the District Forum:Kurnool
Present: Sri K.V.H. Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Tuesday the 30th day of November, 2004
C.D.No.183/2003
N.Parveen alias D.Parveen,
W/o. Late D.Suraj Basha,
Peravali (V),
Maddikera (M),
Kurnool Dist. . . . Complainant represented by his
Counsel Sri K.Yerukala Reddy
-Vs-
1. The Branch Manager,
LIC of India,Yemmiganur.
2. The Divisional manager,
LIC of India, College Road,
Cuddapah. . . . Opposite party 1&2 represented
By their counsel Sri A.S.U Javid Ali
O R D E R
(As per Smt C.Preethi, Member)
1. This compliant of the complainant is filed under section 12 of C.P. Act, 1986, seeking a direction on the opposite parties to pay Rs.50,000/- and Rs. 97,000/-with all benefits and interest at the rate of 18% per annum from 26.6.2002 under policy bearing Nos.651751292 and 651752487, Rs.10,000/- as compensation and any other reliefs which the complainant is entitled in the circumstance of the case.
2. The gist of the complaint of the complainant is that the complainants husband by name D.Suraj Basha took a policy bearing No.651751292 for Rs.50,000/- on 28.10.2000 and another policy bearing No.651752487 for Rs.97,000/- on 28.10.2001 from opposite party No.1. On 26.6.2002 the said Suraj Basha died in Gowri Gopal Hospital, Kurnool due to sudden ill health. Immediately, after the death the complainant submitted claim forms concerned to the above said two polices and other two policies which were taken by the deceased for Rs.25,000/- and Rs50,000/- from opposite party No.1 along with necessary relevant documents. But to the dismay of the complainant the opposite party No.2 repudiated the said two polices bearing No.s 651751292 and 651752487 while settling the other two policies. The reason for repudiating the two claims was that the insured did not disclosed material facts regarding his health condition that he suffered due to Chronic Hepatitis in 1999. But the complainant submits that the insured never suffered with any illness much less Hepatitis as alleged in the repudiation letter. Hence, the conduct of opposite parties in repudiating the claim is amounting to deficiency of service ensuing mental agony to the complainant.
3. The complainant in support of her case filed the following documents Viz (1) office copy of letter dt 23.1.2003 addressed by complainant to Zonal Manager LIC of India, Hyderabad (2) letter dt 24.8.2003 addressed by Senior Divisional Manager, LIC of India and (3) repudiation letter dt 27.3.2003 addreseed to the complainant by Senior Divisional Manager, LIC of India, besides to her sworn affidavit in reiteration of her complaint avernemnts and the above documents are marked as Ex A.1 to A.3 for its appreciation in this case.
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 contested the case and opposite party No.2 filed its denial written version and opposite party No.1 adopted the written version of opposite party No.2.
5. The written version opposite party No.2 admits the complainant’s husband late D.Suraj Basha as the policy holder of the polices bearing No.s 651751292 and 651752487 respectively and the complainant was the nominee under the above said two polices and the policy holder died on 26.2.2002, but allege the suppression of material facts as to his state of health and the treatment he has undergone prior to the proposing of the said two polices and answering negatively to the questionnaire in serial No. 11 of the proposal form and as per his declaration the untrue avenemnts found in the said proposal form makes the contract of the insurance null and void and forfeiture the corporation all amounts he paid to the corporation. As the claim for the policy assured amounts being within seven months 26 days from the date of first proposal i.e 28.10.2000 and within one year 7 months 28 days from the date of second proposal i.e 31.10.2001 for the above said policies, as they amount to early claims investigation was taken up and learnt that the said policy holder was unwell prior to the dates of proposal and has taken treatment for Chronic hepatitis from 1999 and initially he was started on interferon 3 MIU in Kurnool on 5.10.1999 for every three days for three months and stopped in December 1999. He was further treated with LAMIVUDINE 100mg OD in Jan, 2000 and used the said medicine for one year and stopped in March 2001.He later developed Jaundice with associated illness of ascites and UGI bleed in July 2001 and blood was transfused during the course of treatment. He was again admitted into Nizam’s Institute of Medical Sciences, Hyderabad, as per the case sheet vide I.P No.10901241/115638 dt 13.9.2001, the said policy holder was admitted for evaluation of Jaundice on 7.9.2001 and discharged on 13.9.2001. The deceased D.Suraj Basha was admitted in to Gowri Gopal Apollo Hospital, Kurnool on 22.6.2002 with complaint of Jaundice and Hyper tension and ascites and with history of treatment of the same decease at Hyderabad, and while under going treatment he expired in the same Hospital on 26.6.2002. Hence, the deceased was quite unwell prior to the above said two proposals for insurance on his life, dt 28.10.2000 and 31.10.2001. Condition No.5 of the policy also makes void the policy for with holding any material information and forfeiture all the amounts paid to the corporation in the consequence of the said two polices in favour of the corporation in view of the nature of the contract made on utmost good faith on the deceased statements and the declaration as the suppression of any material facts makes the policy null and vode under section 45 of insurance Act and attracting the forfeiture of the amounts and hence the said repudiation of the claim is proper and the action of opposite parties in the said repudiation of the claim suffers with no deficiency of service and hence, seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite parties filed the following documents Viz (1)proposal form for Rs.50,000/- (2) proposal from for Rs.97,000/- (3) policy bond for Rs.50,000/- bearing No.651751292 (4) policy bond for Rs.97,000/- bearing No. 651752487 (5) medical papers of deceased submitted by Gowri Gopal Hospital, Kurnool and (6) Medical papers of deceased given by NIMS Hospital, Hyderabad, besides to its sworn affidavit in reiteration of its written version as defence and the above documents are marked as Ex B.1 to B.6 for its appreciation in this case.
7. Hence the point for consideration is whether the complainant has made out the alleged deficiency of service in the conduct of the opposite parties in the repudiation of the claim, so as to enable her self to the reliefs claimed?:-
8. The Ex A.3 is the repudiation of the claims of the polices of the deceased bearing Nos. 651751292 and 651752487 for Rs.50,000/- and Rs.97,000/-. It says that the claim was repudiated as the said policy holder suffered from HBV related Chronic Hepataties since 1999 and also took treatment from Hospital prior to the date of proposal of the above said two policies and was suppressed by the said policy holder the facts relating to his personal statement.
9. The Ex B.6 is the Original Case Sheet pertaining to the patient Sri D.Suraj Basha IP No. 115638 of 2001 of NIMS Hospital, Hyderabad. The Ex B.5 discloses the history of patient D.Suraj Bahsa as diagnosed case of HBV related Chronic Hepatitis (biopsy not done) (1999), started interferon on 5.10.1999 every three days for three months and stopped in Dec 1999, in Jan 2000 started lamividine used for one year stopped in Mar 2001. The said patient developed Jaundice, ascites and VGI bleed two months back and blood transfusion was done on 5.7.2001. The Ex B.5 is the documents submitted by Gowri Gopal Hospital with reference to the patient D.Suraj Basha admitted as in patient vide IPNo. 1033/02 on 22.6.2002 at 8.39 P.M with case history of Jaundice and ascites suffering from three months and the said patient while under going treatment died at 4.30 A.M on 26.5.2002.
10. The Ex B.1 is the proposal form of the deceased for Rs.50,000/- dt 28.10.2000 and Ex B.2 is the proposal form of the deceased for Rs.97,000/- dt 31.10.2001 filed with Insurance Company for issual of Insurance Policies. The corresponding policies issued in pursuance of the said proposals is Ex B.3 showing the commencement of the policy from 20.8.2000 for 20 years with the policy bearing No.651751292 and B.4 showing the commencement of the policy from 28.10.2001 for 28 years with the policy bearing No.651752487. In the Ex B.1 and B.2 the proposals for the above said policies, the policy holder answered all the questions in serial No. 11 as to his Personal History negative besides stating as to usual state of health as good. The patient history in Ex B.6 shows the complainant suffering from Chronic Hepatitis from 1999 and the proposal in Ex B.1&B.2 being of 28.10.2000 and 31.10.2001 i.e the said suffering by the deceased is being prior to the said proposals in Ex B.1 &B.2. The deceased also signed in the Ex B.1 &B.2 a declaration agreeing to forfeite to the LIC all the money in case of any omission or error in the said material, he furnished in the said proposals for the issual of policies. The policy holder ought to have disclosed of the said facts within his knowledge in the answer to the question in 11 b, as he was suffering from HBV related Chronic Hepatitis as in Ex B.6. The non discloser of the said facts in answer to the question in 11 b of Ex B.1 and B.2 certainly amounts to an omission of its non discloser on the part of the said policy holder in the said proposals and the contract of insurance being made under the utmost good faith and belief and the declaration made by the complainant any such omission of non discloser of the material facts makes null and void the very contract of the insurance under section 45 of Insurance Act, besides forfeiting the amounts paid by the policy holder in favour of the corporation. In the light of the declaration signed by the policy holder in Ex B.1 &B.2 authenticating the correctness of the particulars stated in Ex B.1&B.2, the said omission in circumstances appears to be will full and intentional, as he has not disclosed the said facts within his knowledge. As the said declaration stipulates of a wiling ness on the part of the said policy holder to forfeite the amounts paid till then in favour of the LIC in case of error or omission in the material furnished in the said proposal and the said non discloser of the material facts as to the suffering from HBV related Chronic Hepatitis prior to obtaining of the said policies, as amounts to an intentional omission and the suppression of the material facts relating to his personal history within his personal knowledge, is attracting the penal provision mentioned in the said declaration in case of any such omission. Hence, in the circumstances discussed above there appears no error, defect or deficiency on the part the LIC ( opposite parties) in repudiating the claim of the complainant preferred on the policies bearing Nos. 651751292 and 651752487 of her deceased husband.
11. The complainant in support of her case relied on the following citation, LIC of India and others Vs Usha Agarwal and five others, where in, it was held that complainant’s husband died from Jaundice, a certificate of the doctor who had treated deceased before one year of his death he did not have present decease, hence, deceased was not suffering from Jaundice at the time of submitting proposal form, LIC is liable to pay insured amount to the complainant. In the present case there is no certificate of the doctor who treated the deceased D.Suraj Basha before submitting proposal form, hence the above decision has no relevancy to the present case.
12. Therefore, in conclusion of the above discussion as the case of the complainant is suffering for want of proper cause of action the complainant cannot have any remedy she sought for from the opposite parties.
13. Consequently, there being no merit and force in the case of the complainant it is dismissed.
Dictated to the Stenographer, Typed to the dictation corrected by us, Pronounced in the Open Court this the 30th day of November, 2004
PRESIDENT
MEMBER MEMBER
