BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
And
Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Friday the 21st day of October, 2011
C.C.No.48/2011
Between:
C.Venkataramudu,S/o C.Kottlaiah, R.M.P. Doctor,
R/o Pyalakurthy (V),Kodumur Mandal, Kurnool District,Now residing H.No.1-11-2-5-C, Kondapur Post, Serlingampalli Mandal, Ranga Reddy District, Hyderabad-500 048.
…Complainant
-Vs-
1. The Branch Manager, L.I.C of India, Branch Office,
H.No.12-17 Bus Stand Road Yemmiganur, Kurnool District-518 512.
2. The Senior Divisional Manager,L.I.C. of India, Divisional Office,
Post Box. No.10, Collage Road, Kadapa-516 004.
...Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri K.Sreedhar, Advocate for complainant and Sri L.Hari Hara Nath Reddy, Advocate for opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No.48/2011
1. This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying:-
- To direct the opposite parties to pay the claim under policy sum of Rs.1,00,000/- and benefits mentioned under policy;
- To pay compensation towards mental agony suffered in a sum of Rs.1,00,000/-;
- To pay costs of this complaint in a sum of Rs.5,000/-;
- To pay interest at 24% per annum from the date of claim petition;
- To pass such other relief as the Honourable Forum may deem fit and proper in the interests of justice.
2. The case of the complainant in brief is as under:- The complainant is working as R.M.P. Doctor and he took an “ASHA DEEP – II” Life Insurance Policy bearing No.65289915 from Yemmiganur Branch of LIC, Kurnool District. The period of the policy is 20 years. The annual premium payable is Rs.12,041/-. The assured amount under the policy is Rs.2,00,000/-. The policy covered Sickness benefits of 50% of assured amount of Rs.2,00,000/- for four major diseases like Cancer, Paralytic Stroke, Hear Diseases and Renal Failure. The complainant gave the proposal form for the policy on 10-05-2002. At the time of submitting the proposal form the Panel Doctor of LIC by name Dr. Mohan Prasad examined the complainant and found that the complainant was not suffering from above four diseases. The complainant paid first premium on 28-07-2002 and second premium on 04-08-2003. He paid third premium on 02-09-2004. The complainant suddenly fell sick and underwent bypass surgery on 25-09-2003 at Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore. Immediately the complainant informed opposite party No.1 and sent all relevant documents to opposite party No.1 claiming the benefits under the policy. Opposite party No.1 rejected the claim of the complainant stating that he suppressed material facts. Only in the month of September, 2003 the complainant suffered heart problem, but not earlier. The complainant was not suffering from any serious heart aliment prior to date of proposal form. Inspite of complainant’s continuous representation from 13-12-2004 to 09-12-2010 no action was taken by the corporation in favour of the complainant in settling the claim finally. The complainant sent legal notice to opposite parties 1 and 2. Opposite party No.2 gave reply notice on 10-03-2011. There is deficiency of service on the part of opposite parties. The complainant suffered mentally. Hence the complaint.
3. Opposite party No.2 filed written version and the same is adopted by opposite party No.1. It is stated in the written version that the complaint is not maintainable. The policy issued in favour of the complainant covers payment of Sickness benefits for four major diseases like Cancer, Paralytic Stroke, Hear Diseases and Renal Failure, where bypass surgery has been actual down. The complainant declared himself to be quite healthy in the proposal form. The complainant gave wrong information regarding his personal history. Basing on the statement and declaration given by the complainant the policy was issued. The complainant consulted Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthi Nagar, Anantapur District on 25-06-2002. The complainant paid the first premium on 31-07-2002. By that time the complainant was very well aware of his consultation at Hospital. The complainant himself mentioned in the claim form that the duration of line was illness was 1 ½ years. He was under treatment as on the date when he paid premium on 31-07-2002. The claim of the complainant was repudiated as he obtained the policy suppressing the real facts with regard to his health. The contract of insurance is a contract of utmost of good faith. The life assured was suffering from heart disease even prior to the submission of the proposal for the policy. The claim of the complainant was repudiated on 05-11-2004. The complainant also preferred an appeal against the repudiation. The complaint is barred by limitation. The claim of the complainant was repudiated on 05-11-2004 by the Senior Divisional Manager LIC of India, Kadapa. The complaint filed by the complainant before the insurance Ombudsman was dismissed on 18-11-2005. He ought to have filed the complaint with two years from the date of the original repudiation or with two years from the date of dismissal of the complaint by the insurance ombudsman on 18-11-2005. The present complaint is filed on 13-04-2011. The same is barred by time. The compliant is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to A17 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties 1 and 2 Ex.B1 to B7 are marked and sworn affidavit of M.Deva Prasad, Manager Divisional Office, Kadapa is filed.
5. Both sides filed written arguments.
6. The points that arise for consideration are:
- Whether the complaint is barred by time?
- Whether there is deficiency of service on the part of Opposite Parties?
- To what relief?
7. POINT No.1:- Admittedly the complainant had taken the policy bearing No.652899115 “ASHA DEEP – II” (Sickness benefits) from opposite party No.1 branch office on 31-07-2002. The sum assured under the policy is Rs.2,00,000/-. The period of policy is 20 years and yearly payable under the policy is 12,041/-. The policy covers Sickness benefits for four major diseases like Cancer, Paralytic Stroke, Hear Diseases and Renal Failure. It is the case of the complainant that on 25-09-2003 when the policy was in force he underwent bypass surgery at Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore and that he made a claim to the corporation for payment of Sickness benefits under the policy. Admittedly the complainant submitted his claim to the opposite parties. The said claim of the complainant was repudiated by the corporation on 05-11-2004. Ex.B3 is the repudiation letter dated 05-11-2004. It is the case of the opposite parties that the present complaint is not within time and that the complainant is not entitled to the reliefs claim. Under section 24(a) of the Consumer Protection Act of 1986 two years time period from the date of cause of action is provided for filing the complaint. Admittedly in the present case no petition was filed by the complainant to condone the delay in filing the complaint. The present complaint is filed on 13-04-2011. It is not the case of the complainant that he did not receive repudiation letter dated 05-11-2004 from the corporation. Admittedly the complainant issued Ex.A6 notice dated 13-12-2004 to the Zonal Manager LIC of India, Hyderabad. In Ex.A6 the complainant referred about the repudiation letter dated 05-11-2004 received by him on 29-11-2004. The complainant after receiving the repudiation letter preferred a complaint before the insurance ombudsman. Ex.B5 is the order of the insurance ombudsman da ted 18-11-2005. The period of limitation for filing the complaint starts from the date of the repudiation of the claim by the insurance company. As already stated the corporation repudiated the claim of the complainant through its letter dated 05-11-2004 and informed the same to the complainant. The complaint preferred by the complainant to the insurance ombudsman was also dismissed on 18-11-2005. The complainant ought to have preferred the complaint within two years from the date of repudiation of the claim i.e., 05-11-2004. It is argued by the learned counsel appearing for the complainant that the complainant issued several notices to the corporation under Ex.A6 to Ex.A12 and finally legal notice Ex.A13 dated 21-03-2011 was issued. Admittedly for the notice Ex.A14 got issued by the complainant the opposite parties gave a reply Ex.A16 dated 10-03-2011. It is the case of the complainant that limitation started on 10-03-2011 when the reply was given by the opposite parties. Mear exchange of notices by the parties does not extend the period of limitation. The learned counsel appearing for the complainant cited decisions reported in IV (2007) CPJ 492, IV (2007) CPJ 109 and IV (2007) CPJ 104 and argued that the present complaint is not barred by limitation. The facts of the present case are entirely different from the facts of the cases referred above. As already stated the claim of the complainant was repudiated on 05-11-2004. The complainant ought to have filed the complaint on or before 05-11-2006. The present complaint is filed on 13-04-2011 and it is barred by time.
8. Point No.2:- It is the case of the opposite parties that the claim of the complainant was repudiated as the complainant suppressed material particulars regarding his health condition. It is the case of the opposite parties that the complainant singed the proposal form on 10-05-2002 and paid the first premium on 31-07-2002. Ex.B1 is the proposal form. There is no mention in Ex.B1 that the complainant was suffering from any aliment. It is further case of the opposite parties that before the complainant paid first premium on 31-07-2002 he took treatment as outpatient at Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthi Nagar, Anantapur District. It is mentioned in Ex.B6 that the Diagnosis was AOE CL III. II/O REST PAIN. The complainant was advised to avoid heavy strain. The complainant did not inform the said fact to the corporation before he paid the first premium on 31-07-2002. The complainant underwent bypass surgery on 25-09-2003. The complainant suppressed the material fact that he took treatment at Sri Sathya Sai Hospital on 25-06-2002. The contract of insurance is based on good faith. The complainant having suppressed the material facts regarding his health condition, obtained the policyEx.B2 from the corporation. The corporation rightly repudiated the claim of the complainant as he did not disclose material particulars regarding his health condition. The claim of the complainant was rightly repudiated by the opposite parties. No deficiency of service is found on the part of opposite parties.
9. In the result, the complaint is dismissed without costs.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 21st day of October, 2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nill For the opposite parties : Nill
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Advertisement copy of “Asha Deep – II”.
Ex.A2. Photo copy of Policy No.652899115 dated 28-07-2002.
Ex.A3 Photo copy of Renewal Premium Receipts.
Ex.A4 Photo copy of Dr.Mohan Reddy issued medial report of complainant dated 03-08-2002.
Ex.A5 Photo copy of Out Patient report issue by Sri Sathya Sai
Institute of Higher Medical Sciences, Prasanthi Gram,
Anantapur District dated 25-06-2002.
Ex.A6 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad, dated 13-12-2004.
Ex.A7 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad, dated 10-12-2005.
Ex.A8 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad, dated 15-12-2006.
Ex.A9 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad dated 18-12-2007.
Ex.A10 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad dated 08-12-2008.
Ex.A11 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad dated 22-12-2009.
Ex.A12 Office copy of notice given by complainant to Zonal Manager, LIC of India, Hyderabad dated 09-12-2010.
Ex.A13 Office copy of legal notice dated 21-03-2011.
Ex.A14 Office copy of legal notice dated 05-03-2011.
Ex.A15 Postal Acknowledgement (No.3).
Ex.A16 Reply notice dated 10-03-2011.
Ex.A17 Photo copy of Patient Discharge Summary
dated 02-10-2003.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal for Insurance of the complainant.
Ex.B2 Policy No.652899115 dated 28-07-2002.
Ex.B3 Repudiation letter dated 05-11-2004.
Ex.B4 Photo copy of letter dated 15-07-2005 issued by Senior
Divisional Manager, LIC of India, Kadapa to complainant.
Ex.B5 Photo copy of letter Proceedings of the insurance ombudsman, Hyderabad dated 18-11-2005.
Ex.B6 Photo copy of Out Patient report issue by Sri Sathya Sai
Institute of Higher Medical Sciences, Prasanthi Gram,
Anantapur District dated 25-06-2002.
Ex.A7 Photo copy of Patient Discharge Summery
dated 02-10-2003.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
// Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties :
Copy was made ready on :
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