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

 Monday the 7^th day of May, 2012

C.C.No.107/2011

Between:

V.Vasundara, Sister of Late V.Madhusudhana Rao,

H.No.17/89, R.K. Street, Kurnool - 518 001.                                    

…Complainant

                                                    -Vs-      

1. The Branch Manager, Life Insuranc Corporation of India.,

   40/451, Opp. II Town Police Station, Adoni - 518 301.Kurnool District.

2. The Senior Divisional Manager, Life Insuranc Corporation of India,

   Post Box No.10, College Road, 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. T.Sundara Ramaiah, President)

   C.C. No. 107/2011

1.     This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying to direct the opposite parties:-

1.   To pay the assured amount with interest @ 24% per annum;

1.   To pay Rs.15,000/- towards the compensation for causing mental agony and hardship;

1.   To pay costs of the complaint;

And

1. To order any other relief or reliefs that are deems to be fit and proper in the circumstances of the case.

2.    The case of the complainant in brief is as under:- The complainant is the sister of Late V.Madhusudhana Rao.  Late.V.Madhusudhana Rao worked in APSRTC.  While he was in service he insured his life with the opposite parties.  The opposite parties issued Jeevan Mitra (Triple cover endowment plan) Policy bearing No.651755033.  The sum assured under the policy is Rs.50,000/-.  The complainant is the nominee under the policy.  Two years after taking the policy the insured Late.V.Madhusudhana Rao died due to Heart Attack on 13-04-2006.  The same was intimated to opposite party No.1.  After receiving the clam form the complainant who is the nominee under the policy submitted the same to opposite party No.1.  Opposite party No.2 repudiated the claim without any basis stating that the insured suppressed the material facts.  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 Late V.Madhusudhana Rao took policy from opposite party No.1.  The sum assured under the policy is Rs.50,000/-.  The complainant is the nominee under the policy.  The deceased life assured was not in good health condition at the time of the proposal dated           23-07-2004.  The deceased suppressed the material facts and obtained the policy.  The deceased was admitted in NIMS Hospital, Hyderabad on 16-05-2002 for Heart aliments and discharged on 18-05-2002. The assured died on 13-04-2006 due to Heart Problem. The deceased took financial aid for medical attendance of Rs.7,000/- from the employer on 20-04-2002.  The APSRTC Hospital Tarnaka, Hyderabad advised the insured to NIMS Hospital, Hyderabad to take medical attendance and to under to CAG.  The deceased took treatment in NIMS Hospital for Heart aliments from 16-05-2002 to 18-05-2002.  The deceased made deliberate incorrect statement in the proposal form regarding his health conditions.   The opposite parties rightly repudiated the claim of the complainant as the deceased fraudulently suppressed the material facts regarding his health conditions.  The complaint is liable to be dismissed with exemplary costs. 

 4.    On behalf of the complainant Ex.A1 to A3 are marked and sworn affidavit of the complainant is filed.  On behalf of the opposite parties Ex.B1 to Ex.B5 are marked and affidavit of opposite party No.2 is filed.  Ex.X1 is marked by the Commissioner. 

5.     Both sides filed written arguments.

6.     Now the points that arise for consideration are:

1. Whether there is deficiency of service on the part of Opposite Parties?

1. Whether the complainant is entitled for the reliefs as prayed for?

1. To what relief?

7.      POINTS i and ii:- Admittedly Late V.Madhusudhana Rao obtained insurance policy Ex.A1 from the opposite parties.  The sum assured under the policy is Rs.50,000/-.  The period of the policy is from                20-07-2004 to 20-07-2024.  Admittedly the complainant who is the sister of the deceased Late V.Madhusudhana Rao is the nominee under the said policy Ex.A1.  It is the case of the complainant that his brother Late V.Madhusudhana Rao died due to Heart Attack on 13-04-2006, that she informed about the death of Late V.Madhusudhana Rao to the opposite parties, that after receiving the claim form she submitted the same to the opposite parties and that opposite party No.2 repudiated the claim without valid grounds.  Late V.Madhusudhana Rao died on      13-04-2006 is not under dispute. 

8.     It is the case of the opposite parties that the deceased life assured was not keeping good health by the date of the proposal, that he withheld material information in the proposal form dated 23-07-2004 and that the opposite parties are not liable to pay any amount to the complainant.  Admittedly the contract of life insurance is based on good faith.  The insured is bound disclose all material particulars regarding his health condition in the proposal form.  It is for the opposite parties to establish that the insured suppressed the material facts regarding his health and obtained the policy fraudulently.  The opposite party No.2 in its sworn affidavit clearly stated that the deceased was admitted in NIMS Hospital, Hyderabad with Heart Problem on 16-05-2002 and he was discharged on 18-05-2002 after giving treatment for Heart disease.  On the application made by the opposite parties case sheet relating to the deceased Late V.Madhusudhana Rao was sent for.  The NIMS Hospital, Hyderabad submitted the concerned case sheet Ex.X1 of the deceased.  As seen from the case sheet Ex.X1 it is very clear that the deceased was admitted in NIMS Hospital, Hyderabad on 16-05-2002 and discharged on 18-05-2002.  To prove the contents of Ex.X1 Dr.A.Siva Prasad attached to NIMS Hospital, Hyderabad was examined on Commission.  It is stated by Dr.A.Siva Prasad in Chief examination that Late V.Madhusudhana Rao was admitted in NIMS Hospital, Hyderabad under I.P.No.207856 on 16-05-2002 and he was advised angioplasty and stunt to Ostal L.A.D.  It is further stated by him that the patient with the said aliment can suffer from second Heart Attack at any time.  He identified the case sheet as Ex.X1.  From the evidence of the Dr.A.Siva Prasad and contents of Ex.X1 it is very clear that the deceased Late V.Madhusudhana Rao took treatment in NIMS Hospital, Hyderabad from 16-05-2002 to 18-05-2002 for Heart Problem.  It is submitted by the learned counsel appearing for the complainant that the concerned Doctor who gave treatment to the complainant in NIMS Hospital, Hyderabad was not examined and that contents of Ex.X1 are not proved.  In support of his contention he relied on a decision reported in IV (2007) CPJ 163.  In the said decision it is observed that no substantial evidence supported by affidavit of doctor, who treated deceased, filed on record.  Insurance company liable to pay policy amount along with interest.   In the instant case the doctor who gave treatment to the deceased was not examined by the opposite parties.  It is argued by the learned counsel appearing for the opposite parties that the doctor who gave treatment to the deceased could not be examined as he left the Hospital.  Ex.X1 is sent for from NIMS Hospital, Hyderabad.  To prove the contents of Ex.X1 the doctor by name Dr.A.Siva Prasad attached to NIMS Hospital was examined.  Merely because the concerned doctor who gave treatment to the complainant was not examined it cannot be said that the deceased was hale and healthy by the date of taking policy from the opposite parties.  Admittedly the deceased was working as a conductor in APSTRC by the date of obtaining policy from the opposite parties.  It is the case of the opposite parties that the deceased took medical aid of Rs.7,000/- from APSTRC for taking medical treatment.  Ex.B2 is the copy of the letter dated 20-04-2002 under which the deceased was sanctioned medical aid of Rs.7,000/- by the department.  Ex.B3 and Ex.B4 are the letters addressed by the Senior Medical Officer APSRTC, Hospital, Tarnaka to the director of NIMS Hospital, Hyderabad.   In Ex.B3 dated 16-05-2002 and Ex.B4 dated 04-09-2002 it is mentioned that the patient was having Heart disease and he was advised stunt and under go CAG at NIMS Hospital.  He was also advised PTCA + Stunt.  From the above evidence it is very clear that the deceased was suffering from Heart Problem by the date of proposal Ex.B1 and he under went treatment for Heart disease in NIMS Hospital from 16-05-2002 to 18-05-2002.

9.     It is the case of the opposite parties that the deceased with a fraudulently intention suppressed material particulars regarding his health in Ex.B1.  The statement made by the deceased life insured regarding his personal history in Ex.B1 proposal form are reproduced below:

____________________________________________________­­­­­­­­­­­­_____

Personal History                                     Ans. Yes or No If year, give details

_________________________________________________________

(a) During the last five years did            No

     You consult a Medical

     Practitioner for any ailments

     requiring treatment for more

     than a week?

(b) Have you been admitted to              No

     any Hospital or Nursing Home

     For general check up, observation,

     Treatment or operation?

(c) Have you remain absent from          No

     place of work on grounds of

     Health during the last five years?

(d) Are you suffering from or have         No

     you ever suffered from aliment

     Pertaining to lever, stomach,

     Heart, Lungs, Kidney, Brain or

     Nervous system?                   

(e) Are suffering or have you                No

     suffered from diabetes,

     tuberculosis high blood pressure,

     Low blood pressure, Cancer,

     Epilepsy, Hernia, Hydrocele,

     Leprosy or any other disease? 

(f) Do you ever have any bodily            No

     defect or deformity?

(g) Did you ever have any accident                No

     or injury?     

(h) Do you use or have ever used          No

     alcoholic drinks, narcotic or

     any other drugs. Tobacco in

     any form?

(i) What has been your usual                 Good

     State of health?

(j) Have you ever received or               No

     At present availing/ under going

     Medical advice, treatment or tests

     In connection with Hepatitis ‘B’ or

10.    As seen from the above answers given by the deceased life assured, for the question it is very clear that the deceased dishonestly suppressed material facts regarding state of his personal health.  The deceased under went treatment for Heart Problem from 16-05-2002 to 18-05-2002 in NIMS Hospital, Hyderabad.  He did not mention the said particulars in the proposal form Ex.B1 dated 23-07-2004.  The deceased suppressed material particulars regarding his health conditions in the proposal form and obtained the policy fraudulently.  The opposite parties rightly repudiated the claim of the complainant through Ex.A3 repudiation letter dated 25-04-2011.  No deficiency of service is found on the part of opposite parties.  The complainant is not entitled for any relief.

11.    In the result the complaint is dismissed.  The complainant is directed to pay costs of Rs.1,000/- to opposite parties. 

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 7^th day of May, 2012.

Sd/-                                                                                Sd/-

MALE MEMBER                                                                    PRESIDENT

                              APPENDIX OF EVIDENCE

                                    Witnesses Examined

For the complainant : Nil                 For the opposite parties : Nill

List of exhibits marked for the complainant:-

Ex.A1                Photo copy of Policy bearing No.651755033

dated 20-07-2004.

Ex.A2                Photo copy of Death Certificate dated 25-03-2009 issued by

Commissioner, Yemmiganur Municipality.

Ex.A3                Repudiation Letter dated 25-04-2011.

Ex.X1         Photo copy of Case Sheet dated 10-12-2011.

List of exhibits marked for the opposite parties:- 

Ex.B1                Proposal for Insurance on Own Life dated 23-07-2004.

Ex.B2                Photo copy of Letter dated 20-04-2002 of APSRTC.

Ex.B3                Photo copy of Letter dated 16-05-2002 by Medical Officer,

                Tarnaka.

Ex.B4                Photo copy of Letter of Medical Attendance

dated 04-09-2002.

Ex.B5                Photo copy of Coronary Angiogram Report

dated 17-05-2002.

Sd/-                                                                                Sd/-

MALE MEMBER                                                                    PRESIDENT

   // 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               :