BEFORE THE DISTRICT CONSUMER’S 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 1st day of June, 2012
C.C.No.47/2011
Between:
G.Eswaraiah,
S/o Late G.Naganna,
Ambether Nagar,
Dinnedevarapadu Village,
Kurnool District-518 004. …Complainant
-Vs-
1. The Branch Manager,
L.I.C of India, H.No.34/572,
Handri river view colony,
Kurnool-518 001.
2. The Senior Divisional Manager,
L.I.C. of India, Divisional Office,
Post Box. No.10, Collage Road,
Kadapa-516 002. ...Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri K.Sreedhar, Advocate for complainants and Sri A.V.Subramanyam, Advocate for opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member)
C.C. No.47/2011
1. This complaint is filed under section 11 and 12 of C.P. Act, 1986 praying:-
- To direct the opposite parties to pay the assured sum (Jeevan Anand) of Rs.1,00,000/- and Rs.2,00,000/- (LIC’s Money Plus) and benefits mentioned under policy;
- To pay Rs.50,000/- for mental agony suffered;
- To pay costs of Rs.5,000/-;
- To pay interest at 24% per annum from the date of claim petition;
- To pass any other relief as the Honourable Forum may deems fit and proper in the interests of justice.
2. The case of the complainant in brief is as under:- The complainant is the son of the Late G.Naganna. Late G.Naganna insured his life with the opposite parties under the “JEEVAN ANAND” policy bearing No.654236783 for Rs.1,00,000/- in the year, 2006. The yearly premium payable under the policy is Rs.8,715/-. The period of the policy is 16 years. The Late G.Naganna again took LIC Money Plus life insurance policy bearing No.654629254 from opposite parties in the year, 2007 for Rs.2,00,000/-, on the payment of premium Rs.20,000/- per year. The period of the policy is 10 years. The complainant is the nominee under the two policies. On 14-02-2010 the insured died due to Chemotherapy. The complainant who is the nominee under the two policies submitted the claim to the opposite parties. Though the complainant got issued legal notice to opposite parties on 23-03-2011, the opposite parties not settled the claim on the ground that the life assured suppressed the material fact regarding his health condition by the time of revival of the two policies. There is deficiency of service on the part of opposite parties in not honouring the claim of the complainant. The opposite parties caused mental agony by falsely repudiating the claim of the complainant. 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 of opposite party No.2 that the complaint is not maintainable. The opposite parties admitted that the life assured insured his life with opposite parties corporation under two policies bearing Nos.654236783 and 654629254. The premium under the first policy is Rs.8,715/- per year and Rs.20,000/- for second policy per year. At the time of taking second policy, the life assured mentioned his age as below 50 years, though he crossed 50 years and also suppressed about his existing policy on his life policy No.654236783. The life assured failed to pay the premiums amount regularly. Hence two policies were lapsed. Subsequently, the policies were revived on 08-12-2009 by paying the arrears of premium with interest along with submitted declaration of good health. After submiting the claim form by the complainant, the opposite parties corporation got investigated the claim, and during the investigation, it was disclosed that the life assured was not in good health, by the date of revival of two policies, that he had taken Chemotherapy treatment for Carcinoma Lungs from 27-10-2009 to 28-10-2009. As both the policies were revived basing on the false declaration of the life assured, both of them stand cancelled. There is no deficiency of service on the part of the opposite parties. Hence the complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to A10 are marked and sworn affidavit of complainant is filed. On behalf of the opposite parties Ex.B1 to B11 are marked and sworn affidavit of opposite party No.2 is filed. RW1 is examined.
5. Both sides filed written arguments.
6. Now the points that arise for consideration are:
- Whether there is deficiency of service on the part of opposite parties?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINTS i & ii:- Admittedly Late G.Naganna who is the father of the complainant obtained insurance policies bearing Nos. 654236783 (Ex.A1 = Ex.B1) and 654629254 (Ex.A2 = Ex.B2) in his name. The sum assured under the first policy is Rs.1,00,000/- and Rs.2,00,000/- under the second policy. Yearly premium payable under the first policy is Rs.8,715/- (Ex.A3) and Rs.20,000/- (Ex.A4) under the second policy. The complainant is the nominee under both policies is not under dispute. The Medical Attendance Certificate is marked as Ex.A5 and Ex.B3. The certificate of hospital treatment is marked as (Ex.A6 = Ex.B4). It is the case of the complainant that his father died on 14-02-2010 due to Chemotherapy. The complainant in his affidavit clearly stated that his father died on 14-02-2010 due to Chemotherapy. Admittedly after the death of the insured the complainant submitted claims to opposite parties. The said claims of the complainant was repudiated by opposite party No.2 under Ex.A5 and Ex.B6 dated 04-06-2011 stating that the insured was suffering from Lungs Cancer at the time of revival of both policies on 08-12-2009, that he suppressed the said fact in the personal statement regarding his health, and that the complainant is not entitled to the benefits under the policies. The learned counsel appearing for the complainant contended that the life assured was hale and healthy, the Panel doctor examined him at the time of taking both policies, and he paid the premiums regularly, that he suddenly fell sick and admitted in Vishwa Bharathi Hospital, Kurnool on 24-01-2010, that while taking treatment he died in the said hospital on 14-02-2010 due to Chemotherapy and that the repudiation of claim by the opposite parties is not just and proper. To support his contention he cited decisions.
1. 2001 CPJ (2) Page 246 (NC)
2. 2002 CPJ (2) Page 24 (NC)
3. 2007 CPJ (4) Page 446 (NC)
4. 2007 CPJ (3) Page 278 (AP)
5. 2007 CPJ (4) Page 163 (AP)
In all the above cases doctor was not examined to support its version. But in the present case the doctor and the Director of Hospital, who issued case sheets of life assured is examined on behalf of opposite parties to establish its version. The facts of above cases are not applicable to the present case.
The leaned counsel appearing for the opposite parties contended that the assured not paid the premiums regularly so both the policies were lapsed and the policies were revived on 08-12-2009. The life assured made deliberately mis statement and suppressed the material fact of his ill health in Ex.B7. To support his version he cited a decision reported in I (2012) CPJ 223 (NC) where in it was held that insurance policy is contract entered between parties in utmost good faith and concealing of any information of giving in correct information amounts to violation of terms and conditions. In such cases, insurance company is entitled to repudiate the claim. The facts of the above case is similar to the present case that the life assured had suppressed the material fact of his health at the time of revival of the two policies in Ex.B7 dated 27-12-2009. Mr.Kantha Reddy the doctor and Director of Vishwa Bharathi Hospital, Kurnool is examined on behalf of opposite parties. He deposed that the life assured G.Naganna was admitted in his hospital on 27-10-2009 and discharged on 28-10-2009 after Chemotherapy (Cancer) treatment. He also stated that during his treatment he died in his hospital on 14-02-2010 and his hospital issued case sheets Ex.B3, Ex.B4, Ex.B8 to Ex.B11.
8. As seen from Ex.B3 to Ex.B11 it is very clear that the life assured was suffering from Cancer Prior to revival of policies. The complainant is not entitled to the benefits under the said policies. The life assured paid four premiums under the first policy and three premiums under the second policy. The opposite parties are liable to pay the paid up value amount under the two policies. The opposite parties did not pay even paid up value under the both policies.
9. In the result, the complaint is dismissed without costs. However the opposite parties are directed to pay paid up value of Rs.34,860/- under the first Policy bearing No.654236783 and Rs.60,000/- under the second policy bearing No.654629254 to the complainant, within one month from the date of order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 1st day of June, 2012.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant:-Nill For the opposite parties:-RW1
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Jevan Anand Policy bearing
No.654236783.
Ex.A2 Photo copy of LIC’S Money Plus Policy bearing
No.64629254.
Ex.A3 A bunch of Premium receipts (Nos.4).
Ex.A4 A bunch of Premium receipts (Nos.3).
Ex.A5 Photo copy of Form No.3784 Claim Form – B Medical
Attendant’s Certificate.
Ex.A6 Photo copy of Form No.3816 Claim Form – B1
Certificate of Hospital Treatment.
Ex.A7 Certificate by Employer Policy No.654236783.
Ex.A8 Office copy of Legal Notice dated 21-03-2011.
Ex.A9 Postal Acknowledgement.
Ex.A10 Photo copy of Sale Deed dated 04-11-2004.
List of exhibits marked for the opposite parties:-
Ex.B1 Jevan Anand Policy bearing No.654236783.
Ex.B2 LIC’S Money Plus Policy bearing No.64629254.
Ex.B3 Photo copy of Form No.3784 Claim Form – B Medical
Attendant’s Certificate.
Ex.B4 Photo copy of Form No.3816 Claim Form – B1
Certificate of Hospital Treatment.
Ex.B5 Letter by opposite party No.2 to complainant
dated 04-06-2011.
Ex.B6 Letter by opposite party No.2 to complainant
dated 04-06-2011.
Ex.B7 Personal Statement regarding health.
Ex.B8 Case Sheet of G.Naganna issued by Viswa Bharathi
Super Speciality Hospital, Kurnool.
Ex.B9 Case Sheet of Naganna issued by Viswa Bharathi Super
Speciality Hospital, Kurnool.
Ex.B10 Case Sheet of G.Naganna issued by Viswa Bharathi
Super Speciality Hospital, Kurnool.
Ex.B11 Case Sheet of Naganna issued by Viswa Bharathi
Super Speciality Hospital, Kurnool.
RW1 Deposition of Dr.Kantha Reddy
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//
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Complainant and Opposite parties :
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