BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Thursday the 30th day of October, 2008
C.C.No. 82/08
Between:
B. Lakshmi Devi, W/o. Late B.Rama Chandra Reddy,
R/o. Rampalli (V), Tuggali (M), Kurnool District.
… Complainant
Versus
1. The Branch Manager,Life Insurance Corporation of India,
Dhone Branch, Kurnool District.
2. Life Insurance Corporation of India, Represented by its Divisional Manager,
Kadapa. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri. A. Rama Subba Reddy, Advocate, for the complainant, and Sri. A.V. Subramanyam, Advocate, for the opposite parties and upon perusing the material papers on record, the Forum made the following
ORDER
(As per Sri. K.V.H.Prasad, President)
C.C.No.82/2008
1. This case of the complainant is filed U/s 12 of C.P.Act, 1986 seeking a direction on the opposite parties with joint and several liability to pay to the complainant Rs. 1 lakh and bonus of Rs.10,000/- along with 24% interest from the date of demise of policy holder , Rs.10,000/- as compensation and cost of the case alleging that the complainants husband B.Rama Chandra Reddy holder of policy No.653639952 for an assured amount of Rs.1 lakh with accidental benefit for a period of 16 years commencing the insurance policy with the opposite parties from 28-1-2005 died on 17-10-2006, during subsistence of said policy , with high fever and the claim made by the complainant as beneficiary of the deceased complying all formalities was wrongly repudiated by the opposite parties on the pretext of the suppression by the policy holder as to his earlier suffering and treatment for Tuberculosis , HIV and Asthma prior to obtaining the policy and said repudiation not only amounts deficiency of service and causing mental agony to her but also lead her to this case.
2. In pursuance of the receipt of the notice of this forum as to this case of the complainant the opposite parties caused their appearance through their counsel and contested the case denying any deficiency on their part and there by any of their liability to the complainants claim.
3. The written version of the opposite party No.1 , adopted by the opposite party No.2 , besides questioning the justness and maintainability of the case and requiring strict proof of the complaint averments, allege the policy holder suppressed his earlier suffering and treatment for Tuberculosis, HIV and Asthma while obtaining this policy and the demise of the policy holder being not with high fever as alleged and in view of his declaration in proposal form, when the policy is obtained by fraud and suppression of material fact as to health the policy stands forfeited to the corporation at no liability there under to policy holder and so the repudiation of claim is proper
and just and there by any proper cause of action to the complainant creating liability on the opposite parties to the complainants claim , seeks dismissal of the complaint with costs.
4. In substantiation of the contentions while the complainant side has taken reliance on documentary record in Ex.A1 and sworn affidavit of the complainant , the opposite party side has taken reliance on documentary record in Ex.B1 to B6 and sworn affidavit of the opposite party No.1 .
5. Hence, the point for consideration is whether the complainant has made out the alleged deficiency of the opposite parties in repudiation of the claim and there by their liability to the complainants claim.
6. The Ex.B4 is the policy bearing No.653639952 for an assured amount of Rs. 1 lakh infavour of insured B.Rama Chandra Reddy covering the risk of life from 28-1-2005 to 28-1-2020 and showing his daughter of nominee. The insurance of said policy being not in dispute he does not require any further appreciation then what its contents denotes .
7. The Ex.B3 is the proposal signed by the policy holder for issual of insurance policy concerned in this case . The perusal of the answers of the policy holder to questions to put in Sl.No.11 of Ex. B3 as to personal history indicates that he has declared of his perfect health in negatively answering the questions as to any pre-existing deceases , ailments and treatments. The medical examiners confidential report in Ex.B3 signed by the insurance company Medical Examiner also finds any abnormalities of health as to the policy holder . The opposite parties firstly appears to have doubted as to the normal demise of the policy holder with alleged high fever on the basis of an undated letter of one Bogulu Rama Chandra Reddy S/o. Malla Reddy of Rampalli. The Ex.B6 alleges the policy holder suffering with asthma since 10 to 12 years and undergoing treatment about 4 years ago at Dr.Sreenivasa Reddy, Kurnool . Any endeavour appears from the opposite parties as to proof of said material on said material of Ex.B6 either enquiring with said Dr.Sreenivasa Reddy or causing the affidavits of said Rama Chandra Reddy and Dr. Sreenivasa Reddy into the case to believe the truth therein.
8. The Ex.B5 claim statement alleges as to the nature of illness last complained to deceased was cough and name of the medical attendant during the said last illness was Dr. Jaya Sankar of Government General Hospital, Kurnool . The said Dr.Jaya Sankar as RW.1 gives evidence only in reference to the case sheet in Ex.B1 which concerns to the complaint and treatment the deceased policy holder had with him before demise. What ever he says as to the alleged earlier suffering of the policy holder was a hearsay basing on alleged version of the said patient and not in personal know of the said doctor with reference to any treatment he has given . When such is so any cogent material is placed by the opposite parties as to the earlier suffering and treatment of the policy holder for T.B for six months about two years ago to the Ex.B5 in support to RW.1s evidence to that effect.
9. Even though RW.1 deposes that on 28-9-2006 the said patient ( policy holder) was sent to voluntary counseling testing centre ( VCTC) at Kurnool and he was proved HIV + as per NO.KL / 06 / 5822 dated 28-9-2006 , but it is not remaining of any avail to justify repudiation of claim especially when any such report is filed to go through it and to know since when the said patient is suffering with HIV + and whether it is in know of said person by the time of taking policy to presume any intentional suppression by the policy holder with an ulterior motive to play fraud on the insurance company to have a wrongful gain of the policy .
10. Hence, there being any substantiating material as to the policy holder suffering and treatment earlier to obtaining the policy in Ex.B4 and its intentional suppression in proposal form in answers to personal history being in know of the said ailment and treatment , there appears any justification in repudiation of the claim by the opposite parties vide Ex.A1 .
11. Consequently, there being bonafides in the complainants case and her entitleness for the policy assured amount as beneficiary of the deceased policy holder the case of the complainant is allowed directing the opposite parties with joint and several liability to pay to the complainant the assured amount of Rs. 1 lakh , on account of demise of policy holder during the subsistence of said policy , with entitled benefits and Rs.10,000/- as compensation for mental agony suffered by the complainant at the improper repudiation of the claim , and Rs.5,000/- as cost of the case as the complainant was driven, by the opposite parties by their deficient conduct , to the forum for redressal of her just consumer grievances . Time granted to the opposite parties for compliance of the supra stated order is one month from the receipt of this order. In default the opposite parties shall jointly and severally pay to the complainant the supra stated award amount with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 30th day of October, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :
RW.1. Deposition of RW-1 dated
29-08-2008 (Dr. M. Vijaya Bhaskar)
List of exhibits marked for the complainant:-
Ex.A1. Repudiation letter dated 16-01-2008.
List of exhibits marked for the opposite parties:
Ex.B1. Case sheet of (GGH)
Ex.B2. Certificate of Hospital treatment.
Ex.B3. Proposal for Insurance.
Ex.B4. Policy bond.
Ex.B5. Claimants Statement in claim form.
Ex.B6. Letter of Ramachandra Reddy to LIC Dhone (OP.No.1)
Sd/- Sd/-
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 :
