::BEFORE THE DISTRICT CONSUMER DISPUTES  REDRESSAL FORUM, AT BIDAR::

                                                               C.C. No.30/2017.

                                                            Date of filing: 06.05.2017.

                                                                   Date of disposal: 13.03.2018.

P R E S E N T:-    

                              (1) Shri. Jagannath Prasad Udgata,                                                                                                                                    B.A., LL.B.,

                                                                                                President

                             (2) Shri. Shankrappa (Halipurgi),

                                                                                 B.A.LL.B.,

                                                                                           Member.

COMPLAINANT/S:    1.   Smt.Nirmala W/o Late Gopalreddy,

                                             Age: 43 years, Occ: House hold,

                                             R/o Village Hochaknalli, Tq & Dist: Bidar.

                                       (By Sri. P.M.Deshpande,  Adv.)                                            

                                                                 VERSUS

OPPONENT/S:        1)         The BranchManager,

                                             Life Insurance Corporation of India,

                                             Branch Bidar,

                                             Railway Station Road, Bidar.

                                    2)        The Divisional Manager,

                                                Life Insurance Corporation of India

                                             Division office, Raichur

                                             Jeevan  Beema, Court Road Raichur.

                                        (By Sri. Basavaraj Udgir, Adv.)

::   J UD G M E N T  ::

By Shri. Jagannath Prasad Udgata, President.

      The complainant has approached this forum by filling a complaint u/s 12 of the Consumer Protection Act, 1986.  Alleging deficiency of service in the part of the opponents.

The averments of complaint are as follows:

2.           That the husband of the complainant by name Gopal Reddy had purchased L.I.C. Policy No.665590350 (Jeevan Anand with profits with accident benefit) for a sum  of Rs.1,50,000/- on 08.02.2011.  At the threshold the due premium of Rs.9,101/- was paid by the proposer and was accepted by opponent corporation. The complainant was the nominee of the policy.  As per the complainant statement there was no health complications of the proposer.  The diseased proposer expired on 09.04.2012 for natural causes on the complainant lodged have claim before the opponents.  The later but have refused the claim stating that the proposer was suffering from health complications and he had to disclose the same at the time of obtaining the policy.  In the face of the denial of the opponents the complainant is before us for reliefs.

3.          The opponents putting of appearance after court notice have filed detailed versions trying to justify the rebuttal.  In the same the opponents had never disputed regarding the obtainment pf the policy or the death of proposer Gopal Reddy.

4.         Trying to justify the repudiation the opponents claim that the diseased policy holder was admitted into Vatsalya Hospital (Address of hospital not disclosed) from 29.03.2012 to 02.04.2012 for treatment of diabetes melitus and HTN and also diabetic Retinopathy.  The opponents claim that the proposer was suffering from such diseases for 12 years and that fact was not disclosed while filling of the proposal form. 

5.         The complainant and the opponent corporation have submitted documents detailed at the end of the order.  Even though the complainant has examined herself as PW-1 no evidence has been led by the opposite side.

6.         Basing on claims and counter claims of the parties the following points arise for our consideration.

1. Does the complainant prove that, there has been deficiency of service in the part of the opponents?
2. Do the opponents prove that, they were justified in rebutting the claim?
3. What order?

 7.        Our answers to the points stated above are as follows:-

            Point No.1.       In the affirmative.

            Point No.2.       In the Negative.

            Point No.3.        As per final orders, owing to the following.

:: REASONS ::

8.         The reasoning’s of Point No.1 & 2 of would proceed hand in hand and are  to be answered simultalously.  As discussed supra both the parties have submitted documents justifying their respective contentions.  The complainant had submitted the copy of the proposal form as well as the copy of the insurance Policy death certificate and repudiation letter.  The opponents L.I.C. has never disputed regarding the fact of purchase of Policy or death of the proposer.  The opposition of L.I.C. veers round a fact that the diseased proposer was suffering from diabetes mellitus and hypertension for a period of 12 years prior to his admission in Vatsalya hospital on 29.03.2012 To substantiate the contentions the opponent L.I.C. has submitted case sheet and discharge summary of Vatsalya Hospital as Ex.R2 and R3.  It is perplexing to note that though the above said two documents are written in  stationery of Vatsalya Hospital, the location, address, or any other information regarding the hospital is not printed on the stationery.  More-over the diagnosis in the discharge summary does not bear the signature of any doctor or any attestation of the documents are done by any medical practitioner.

9.         It is still more intriguing that this two certificate appear to be  attested by the learned counsel of the opponent.  We are at a loss  to understand as to how at all the learned counsel could attest the documents without ever seeing the originals.  Hence we conclude that the two certificate (copies issued by nonexistent Vatsalya Hospital) have no evidentiary value and the entire defence justifying the repudiation collapses like a pack of cards.  Our reasoning is more fortified from two decisions of the Honorable National Commission in which it has been held as follows:

2009 (3) CPR 150 (NC)

LIC of India v/s Kamala Devi.

The Insurance Company was required to prove that the life assured had suffered from liver cirrhosis before revival of policy and he had to he knowledge of the same.  It will not be out of place to mention here that no record has been produced to show that the life assured had ever taken the treatment of liver before the revival of policy.  Bed head ticket also does not indicate whether the life assured had any knowledge about the ailment, he was suffering form at the time of revival of policy.  The deceased could divulge the information only when he had the knowledge about the same.  Suppression of a fact means that the person had knowledge of a particular fact and he concealed that fact.  We feel that it cannot be inferred from the Bed Head Ticket that the life assured had the knowledge of the ailment and he internationally suppressed the same while filling the form regarding state of his health.  There is nothing on record to show that he had ever taken the treatment about the said ailment. The plea that the deceased was used to consume 1 to 2 litre of country liquor, since 10 to 15 years is also not acceptable.

2009 (3) CPR 161 (NC)

Smt. Rasheeda Khatoon V/s Life Insurance Corporation of India.

As far as the merit is concerned, there is no disputing the fact that the State Commission has dismissed the complaint based on the report dated 23.02.1995 of Dr. B.I. Singh, Sr. Consultant, which has been produced before us.  It is not in dispute, that no affidavit by the concerned Doctor was filed, whose report has been filed.  There is no other material to substantiate as to who is this Dr. B.I. Singh? As also, in what context did he go to him, as also where is the hospital record on which this report has been based? Had any affidavit been filed or original record of hospital/ consultant filed/produced, that would have given an opportunity to the petitioner to cress-examine him.

The legal position of the case is, that this report remains unsubstantiated, unproven and, in our view, the State Commission fell in error in relying upon an unproven document, hence the order passed by the State Commission cannot be sustained, which is set aside and the order passed by the District Forum is restored.

10.       Following the ratios of Honrable National Commission we  unhesitantly hold the point No.1-In affirmative point No.2- In negative.

                                                    ::ORDER:: 

1. The complaint is allowed in part.
2. The opponents are jointly and severally directed to pay the sum  assured of Rs.1,50,000/- to the complainant along with interest at the rate of 6% as per annum,  calculated from the date of raising the claim till date of realisation.
3. In the circumstances of the case we don’t it feel it proper to award any compensation in favour of the complainant but how ever litigation expenses of Rs.5,000/- would be payable by the opponents.
4. Four weeks time is granted to comply this order.   

(Typed to our dictation then corrected, signed by us and then pronounced in the open Forum on this 13^th  day of March 2018).

   Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

Member.                                                                President.                                                                                        

Documents produced by the complainant

1. Ex.P.1-  Copy of proposal from.
2. Ex.P.2– Copy of Insurance policy.
3. Ex.P.3– Copy of Death certificate.
4. Ex.P.4—Reply of opponents date 17.03.2014 to the RTI application of    
                  complainant.
5. Ex.P.5 – Reply notice to the legal notice.
6. Ex.P.6- Office copy of legal notice.
7. Ex.P.7-8- Courier receipt of above.
8. Ex.P.9- Photo copy of Aadhar card of the complainant.

 Document produced by the Opponents.

1. Ex.R.1- Copy of Repudiation letter.
2. Ex.R.2- Case sheet of Vatsalya Hospital.
3. Ex.R.3- Discharge Summery Vatsalya Hospital.

NIl

Witness examined.

Complainant.

1. P.W.1- Smt. Nirmala v/s Late Gopal Reddy (complainant).

Opponent No.1

     –Nil-

Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

       Member.                                                                      President.