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 28th day of September, 2012
C.C.No.153/2011
Between:
K. Raghunatha Reddy, S/o. Late K.Ramachandra Reddy,
H.No.1/125, R/o. K.Muchumarri Village- 518 422, Pagidyala Mandal, Kurnool District.
…Complainant
-Vs-
- The Branch Manager,LIC of India, Branch Office,
D.No.1851, Near New Bus Stand, Atmakur- 518 422.Kurnool Dist.
- The Senior Divisional Manager,LIC of India, Divisional Office,
College Road, P.B.No.10, Kadapa - 516 004
...Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri. M.Sivaji Rao, Advocate for complainant and Sri.I.Anantha Rama Sastry, Advocate for opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. M.Krishna Reddy, Male Member) C.C. No.153/2011
1. The complainant filed this complaint under section 11 and 12 of C.P. Act, 1986 seeking a direction on opposite parties for the payment of:-
- Assured amount with other benefits on the policy with interest @24% per annum;
- Rs.10,000/- as compensation for causing mental agony and hardship;
- Cost of the case.
2. Summury of the complainant’s case is that he is the son and nominee of assured. His father submitted proposal to opposite parties on 22-03-2009 for a LIC policy. The assured amount is Rs.1,00,000/-. The policy number is 655357425. Opposite party accepted the policy which came in to force from 28-02-2009. The insured died on 02-03-2010. The cause of death is heavy fever. Till the date of death the insured paid premium regularly. After the death of the insured, the complainant being the nominee submitted claim to opposite parties. Opposite parties repudiated the claim on the ground that the deceased has not disclosed correct information about his health condition at the time of proposal without any cogent material. Thus being aggrieved, the complainant filed a case before this Forum.
3. Opposite party No.2 filed written version rebutting the allegations made in the complaint. Justifying the repudiation of the claim, it was pleaded that the insured while taking the policy had failed to disclose that he had been suffering from Ca. Bronchus with Lung. Liver Mets now with pneumonia for which he had taken treatment from Apollo Hospital, Jubilee Hills, Hyderabad with I.P.No.6406 on 20-02-2010. He had previous history of Diabetic. The investigation revealed that the insured was not in good health prior to taking of the policy and died on 02-03-2010. The insured made false declaration and gave incorrect answers to column 11, regarding health condition. Applying section 45 of Insurance Act 1938, opposite party No.2 repudiated insurance claim, as the policy holder was guilty of a fraudulent suppression of material facts relating to his health. It is submitted that a contract of insurance is contract uberrima fides and there must be complete god faith on the part of assured. The opposite party having substantial evidence to prove the assured suppressed material facts in the proposal, prayed for the dismissal of the complaint with exemplary costs. Opposite party No.1 filed a memo adopting the written version of opposite party No.2.
4. Both parties filed sworn affidavits. The complainant filed documents marked as ExA1 and A2 and opposite parties filed documents marked as Ex.B1 to B3 to prove their cases. The third party deposition filed by commission is marked as Ex.X1.
5. Both sides filed written arguments.
6. Hence the points for consideration are:
- Whether the complainant made out a case against opposite parties to prove deficiency?
- Whether the complainant is entitled for any reliefs?
- To what relief?
7. POINTS i and ii :- Admittedly the father of the complainant had taken a life policy bearing No.6553574225 for a sum of Rs.1,00,000/- from opposite parties on 22-03-2009, which came into force from 28-02-2009. Ex.B2 is the policy and Ex.B1 is the proposal for insurance. According to the policy, insured appointed his son K.Raghunatha Reddy as nominee. The insured died on 02-03-2010 due to Ca. Bronchus. Before his death the insured took treatment from 20-02-2010 in Apollo Hospital, Hyderabad with I.P.No.6404, Ex.X1 is the case sheet. Till the date of death the insured paid premium regularly and the policy was in force on the date of death. The complainant being the nominee of the deceased policy holder submitted claim to opposite parties. Opposite parties repudiated the claim on the ground that insured suppressed the material facts relating to his health. Ex.A1/Ex.B3 the repudiation letter. The allegations of fraudulent misrepresentation and suppression of material facts made in the proposal by the insured were denied by the complainant. The burden of proving that the insured had made false representations and suppressed material facts is undoubtedly on the opposite party corporation. Ex.X1 which was filed by opposite parties discloses that the insured took treatment in Apollo Hospital, Hyderabad for Ca. Bronchus from 20-02-2011, the date after 11 months from the date of submission of proposal by the insured. The contention of opposite parties that the insured failed to disclose that he had been suffering from Ca. Bronchus while taking the policy is not acceptable. Opposite party No.1 also applied section 45 of Insurance Act in the written argument to repudiate the claim of the complainant. To fulfill section 45 the policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose. Opposite parties failed to produce any material that assured suppressed material facts about the Ca. Bronchus due to which he died that he had known at the time of submitting the proposal. All the citations filed by opposite parties do not find any substance supporting their contention. For the reasons stated above opposite parties are not justified in repudiating the claim.
8. Point No.iii:-The complainant claimed the assured amount of Rs.1,00,000/- and other policy benefits with 24% per annum interest. As per the policy condition, on life assured’s death during the policy term excluding last policy year, LIC is liable to pay sum assured with accrued guaranteed additions. So the complainant is entitled for assured amount of Rs.1,00,000/- with accrued guaranteed additions. Interest at 12% per annum is sanctioned on the awarded amount from the date of repudiation. Rs.5,000/- is allowed as compensation for causing mental agony by repudiating the claim.
9. In the result, the complaint is partly allowed directing the opposite parties 1 and 2 jointly and severally to pay the sum assured amount of Rs.1,00,000/- and accrued guaranteed additions with interest 12% per annum on the awarded amount from the date of repudiation, Rs.5,000/- as compensation for mental agony and Rs.500/- as cost of the case. The time for compliance is six weeks from the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 28th day of September, 2012.
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 Repudiation Letter dated 19-10-2010.
Ex.A2. Death Certificate issued by Gram Panchayat Secretary,
K.Muchumarry Village, Padigala Mandal, Kurnool District
dated 20-03-2010.
Ex.X1 Photo copy of Case Sheet dated 22-06-2004.
List of exhibits marked for the opposite parties:-
Ex.B1 Photo copy of Proposal Form dated 22-03-2009.
Ex.B2 Policy bearing No.655357425 along with Case Record issued
by Apollo Hospital, Jubilee Hills, Hyderabad.
Ex.B3 Office copy of Repudiation Letter dated 19-10-2010.
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 :
Copy was dispatched on :
