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
Friday the 28th day of January, 2005
C.D. No. 62/2004
V.Sivakesamma,
W/o. Late V.Veera Brahmam,
R/o. Pagadirai (V),
Tuggali (M), Kurnool Dist. . . . Complainant represented by his counsel
Sri K.Yerukala Reddy.
-Vs-
1. The Branch Manager,
L.I.C of India, Yemmiganur.
2. The Divisional Manager,
L.I.C of India, Divisional Office,
College Road, Kadapa. . . . Opposite party No.1 &2 represented by
their Counsel Sri G.MD. Habeebur-
Rahiman
O R D E R
(As per Smt C.Preethi, Member)
1. This CD complaint of the complainant is filed under section 12 of C.P. Act, 1986, seeking a direction on the opposite party to pay assured amount of Rs.25, 000/- with all benefits and interest @ 18% per annum from the date of death of insured, Rs.10, 000/- as compensation for mental agony and any such other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The gist of the complaint of the complainant is that the complainant’s husband late V. Veera Brahmam has insured his life with opposite parties under policy bearing No. 650587400 dt 27.12.1991 and nominated the complainant as his nominee. The said policy was lapsed on 27.12.1996 for non payment of due amount and the said policy was revived on 13.1.2003 by paying due premiums with penalty and the opposite party accepted the same. The said V.Veera Brahmam died on 29.3.2003 due to heart pain at Payadirai Village and the complainant later submitted claim form along with necessary forms for insured amount, but the opposite parties through its communication dt 28.2.2004 repudiated the claim of the complainant and paid only paidup value of Rs.8,375/- stating that the insured has suppressed his health conditions at the time of getting the policy revived. The complainant further submits that the insured never underwent knee operation and never suppressed his health condition. Even assuming that there is no nexus to the cause of death of the deceased and the alleged knee
operation, hence the repudiation of claim by opposite parties is untenable and amounts to deficiency of service, therefore, the opposite parties are liable to pay insured amount to the complainant.
3. The complainant in support of her case filed the following document Viz (1) repudiation letter of opposite party dt 28.2.2004 addressed by the opposite party to the complainant, besides to her sworn affidavit in reiteration of her complaint avernments and the above document is marked as Ex A.1 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. The 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 questions the maintainability of the complainant’s case either in Law or on facts. It admits the deceased V.Veera Brahmam has insured his life for Rs.25,000/- and nominated his wife Smt Sivakesamma (complainant) as his nominee. The insured allowed the said policy to lapse due to non payment of premium from 27.12.1996 and sought the revival of said policy by submitting a declaration of good health on 31.12.2002 and the said policy was revived on 12.1.2003. The complainant on 29.3.2002 informed the opposite parties about the demise of insured and preferred a claim for insured amount, as the claim has arisen within two months and sixteen days from the date of revival and the said claim was treated as early claim investigation was conducted which revealed that the deceased has taken treatment in Govt General Hospital Kurnool, with IP No. 43523, in Ortho Ward III from 10.8.2002 to 29.1.2002 for knee and other problems and also underwent knee operation on 16.8.2002, the above treatment was not disclosed by the insured in his declaration of good health dt 31.12.2002, which he was suffering prior to the date of revival of policy and answered all questions negatively in the personal statement of health and gave declaration that he is hale and healthy on the date of revival, so the untrue statements made by the deceased in the personal statement of health regarding his health, the contract was declared null and void by the opposite parties in their repudiation letter dt 28.2.2004. Therefore, the repudiation of the claim by the opposite parties was made on justifiable grounds and after application of mind basing on evidence, so the complainant is not entitled to the insured amount of the deceased V.Veera Barhmam and seeks for the dismissal of complaint with costs.
6. The opposite parties in substantiation of his case filed the following documents Viz (1) Proposal form dt 20.12.1991 of the insured (2) Policy bond bearing No. 650587400 of the insured issued by LIC of India, Yemmiganur Branch (3) personal statement of the insured (4) Xerox copy of Ultra Sound Report issued by Govt. General Hospital, Kurnool (5) Case Sheet of Mr Brahmachari of Govt. General Hospital, Kunool, vide IP No. 43523 dt 10.8.2002 (consists of 1 to 34 papers) and
(6) letter dt 28.2.2004 of opposite party to the complainant, besides to the sworn affidavit opposite party No.2 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 to what relief the complainant is remaining entitled alleging deficiency of service and deficient conduct on part of opposite parties?:-
8. It is not in dispute that the deceased V.Veera Brahamam has obtained a LIC policy bearing No. 650587400 for Rs.25,000/-, on lapsation of said policy the deceased revived it on 13.1.2003 and nominated his wife Sivakesamma as his nominee. It also not in dispute that the deceased V.Veera Brahmam died on 29.3.2003 at his village due to heart pain.
9. The main contention of opposite parties is that the deceased suppressed material information regarding his health and has taken treatment for knee problem and underwent knee operation, the counsel for opposite parties had force fully contended that while submitting the personal statement regarding his health at time revival of the said policy, the deceased had concealed the above said material facts from the opposite parties about his knee problem and underwent knee operation at Govt. General Hospital Kurnool 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 B.1 to B.6, the Ex B.1 is proposal form of the deceased policy holder dt 20.12.1991, the Ex B.2 is the policy bond bearing No. 650587400 for covering the risk of deceased policy holder for Rs.25,000/- and the date of commencement of the said policy was from 27.12.1991 and nominated his wife Sivakesamma as his nominee, the Ex B.3 is the personal statement regarding health for getting revival of lapsed policy of the deceased dt 31.12.2002, where in the deceased policy holder answered negatively to all the questions. The opposite parties strongly alleged that the deceased policy holder withheld correct information regarding his health condition in the Ex B.3 and further alleges that they have indisputable proof to show that the deceased policy holder underwent knee operation prior to revival of said policy and brought on record Ex B.4 & B.5, Ex B.4 is the Xerox copy of ultra sound report form of Y.Bramaiah Chari, dt 10.8.2002 and B.5 is the Case Sheet of Y.Bramhaiah Achari who was admitted in Govt. General Hospital, Kunrool, vide IP No. 43523 on 10/8/2002 (consists of pages 1 to 34). The deceased policy holders name is V.Veera Brahmam and the case sheet in Ex B.5 and Ultra Sound Report form in Ex B.4 is that of Y.Bramaiah Chari and the opposite parties did not place any material to show that both the persons are one and the same. Even other wise the case sheet in Ex B.5 relied by the opposite parties doesn’t inspire any confidence about the contents of the said documents which can be acted upon, neither the contends are legible enough to read about the practice followed nor any affidavit of the doctor is filed under whose care the said Bramaiah Chari has taken treatment. In support of the said Ex B.5 no doctor has been examined nor any affidavit of any medical expert has been produced to show that the deceased was suffering from knee problem and later underwent knee operation to substantiate their allegations made in the written version. No doubt it has been stated in the Ex B.5 that Y.Bramaiah Chari was admitted in Govt. General Hospital for treatment, but no substantiating material in placed on record to support the said Ex B.5. In the absence of any supporting material to substantiate the contents of Ex B.5, it cannot be said that opposite party have proved the said Ex B.5, neither the affidavit of the doctor under whose care deceased policy holder has taken treatment is filed, nor the affidavit of the person who has written the case sheet is filed. Therefore the opposite parties miserably failed to prove their case by placing any supporting material in support of their allegations, which was not done. Hence, the contents of Ex B.5 cannot be looked into nor it can inspire any confidence to act upon.
10. There is no dispute between the parties that no affidavit of the doctor who is alleged to have treated the deceased in Govt. General Hospital is filed, the doctor was neither examined nor his affidavit has been brought on record, unless expert evidence of the doctor, who has treated the deceased is produced such evidence cannot be relied upon and form the basis of a finding that the deceased was suffering from any ailment before revival of the said policy. Merely by filing Ex B.5 does’ not mean that the contents there of are necessarily true, mere assertion or oral testimony in respect knee problem prior to revival of the said policy neither inspire any confidence nor can be acted upon and relied upon, it is needless to observe that the burden is on the opposite parties to establish that there was suppression of material facts and the deceased policy holder concealed the said material facts before revival of the said policy. The opposite parties did not aduced any evidence to discharge this burden.
11. The Ex A.1 and B.6 is repudiation letter dt 28.2.2004 of opposite party to the claim made by the complainant. Where in the opposite parties alleged that the deceased suffered from knee problem and took treatment in a hospital prior to the revival of the said policy but did not disclose this fact in the personal statement of his health. But the deceased policy holder died due to heart pain. There is no nexus between the alleged suppression of knee problem and the actual cause of death which is admitted due to heart pain. It is held in Smt B.Chinnamma Vs Divisional Officer, LIC of India, reported in 1996 (3) CPR Pg 229 (National Commission) that “ when the assured underwent treatment for peptic ulcer and died of heart attack which has no nexus with the peptic ulcer, repudiation made by the insurer is arbitrary. It is also stated that so-called ailment for which the deceased was treated in the hospital during the said period had no nexus whatsoever with the cause of death. It is stated in the death certificate that he died of ‘heart stroke’ “.It is also held in Life Insurance Corporation of India and Oths Vs Rahana Begum, A.P. State Commission Disputes Redressal Commission Hyderabad reported in 2004(3) CPR Pg 503, where in, it was held that when insured underwent treatment for typhoid fever but did not discloses it and later died due to heart attack, he cannot be alleged to have concealed such material facts as to enable Insurance Company to avoid the policy on ground of fraud.
12. In Divisional Manager, LIC of India & Ors Vs T.Venkateshwarlu, A.P. State Consumer Disputes Redressal Commission, Hyderabad, reported in III (1997) CPJ Pg 332, where in it was held that when the insured underwent treatment for abdominal T.B and did not disclose it and died within 6 months due to heart attack, as there is no nexus between the suppressed ailment and cause of death, the LIC is liable to pay insured amount.
13. In Life Insurance Corporation of India Vs Jayat Kumar, Madhya Pradesh State Consumer Dispute Redressal Commission, Bhopal, reported in 2004 (1) CPR Pg 207, where in it was held that when the fact regarding ailment which insured suffered had no relation or nexus to the cause of death of insured, claim under insurance policy could not be repudiated on ground of suppression of material facts.
14. Having regard to over all consideration and following the aforementioned judgments, there is no hesitation to hold that the opposite parties have miserablely failed to substantiate that the deceased suppressed material facts about his health condition before revival of the said policy from the opposite parties. Therefore, in the said circumstances the repudiation of claim by the opposite parties is wholly arbitrary, unreasonable and unjust and amounts to deficiency of service on their part.
15. In the light of the above discussion and material on record not substantiating any suppression of health condition by the deceased, while reviving the said policy and further there appears any substance in the allegations made by the opposite parties and the complainant is remaining entitled to the insured amount.
16. In the result, the complaint is allowed, directing the opposite parties to pay to the complainant assured amount of RS.25, 000/- with 12% interest per annum from the date of demise of the deceased till realization along with Rs.1,000/- as costs of this case, within a month of the receipt of this order.
Dictated to the Stenographer Typed to the dictation corrected by us, pronounced in the Open Court this the 28th day of January, 2005.
PRESIDENT
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex A.1 Letter dt 28.2.04 of opposite party to the complainant.
List of exhibits marked for the opposite parties:-
Ex B.1 Proposal form dt 20.12.1991 of the policy holder.
Ex B.2 Policy No. 650587400 of the policy holder issued by LIC of India
Yemmiganur Branch.
Ex B.3 Personal statement of the policy holder regarding to the health of the policy
holder.
Ex B.4 Xerox copy of Ultra Sound Report Form issued by Govt. General Hospital,
Kurnool.
Ex B.5 Case Sheet of Mr. Brahmachary who admitted in Govt. General Hospital,
Kurnool vide IP No. 43523 on 10.8.2002.
Ex B.6 Letter dt 28.2.2004 of opposite party to the complainant’s
PRESIDENT
MEMBER MEMBER
