Between:

D.Swamy Naik, H/o Late D.Govindammma,

D.No.2-352-D, Sugalithanda, Ahobilam Village and Mangal – 518 543,

Kurnool District.                                                 

…Complainant

                                                    -Vs-      

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

Near Mahaboob Talkies, H.No.3-48,Banaganapalli Branch – 518 124, Kurnool District.

2.   Life Insurance Corporation of India,Represented by its Divisional Manager,

Post Box No.10, D.No.1-55,Jeevan Prakash Building, College Road,

Kadapa District – 516 002. 

                                                               ...Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri. V.Venkateswara Reddy, Advocate for complainant and Sri.L.Hari Hara Natha Reddy, Advocate for opposite parties and upon perusing the material papers on record, the Forum made the following.

                                              ORDER

(As per Sri. M.Krishna Reddy, Male Member President (FAC))                                                             C.C. No.68/2012

1.     This complaint is filed by the complainant under section 12 of C.P. Act, 1986 seeking a direction on opposite parties for the payment of :-

(a)          Rs.50,000/- with bonus and interest @ 24% per annum from the date of death of insured;

(b)          Rs.20,000/- as compensation for mental agony;

(c)           Cost of the case.

2.    The complainant is widower and nominee of Late.D.Govindamma who insured her life with opposite parties.  She took three policies from opposite parties with the details as given below:

The insured D.Govindamma died on 29-01-2011 due to Heart Attack.  The three policies mentioned above are in force on the date of her death.  The complainant submitted death intimation and claim forms pertaining to the above three policies to opposite party No.1 who settled policy No.1 and 2 and repudiated policy No.3.  Aggrieved by the decision of opposite parties with regard to policy No.3 the complainant filed this case against opposite parties in this Forum praying a direction for the grant of appropriate reliefs.

3.     Opposite party No.2 filed written version denying his liability to complainant’s claim.  Opposite party No.1 adopted written version of opposite party No.2.  Opposite parties averred that Deceased Life Assured (DLA) Late.D.Govindamma submitted proposal on 18-03-2011 by paying premium of Rs.3,096/- at Banaganapalli, Branch Office seeking insurance for Rs.55,655/-.  Opposite parties accepted the proposal and issued policy No.655652639 with 24-03-2010 as date of commencement and D.Swamy Naik, her husband as nominee.  At the time of submitting the proposal under personal history at Col.11 she declared that she was keeping Good Health and signed.  She died on 29-01-2011 due to Heart Problem.  As the claim is less than one year from the date of commencement of the policy, it was treated as early claim and investigated.  During investigation it was found that she was suffering from Heart Problem and took treatment in Government General Hospital, Kurnool.  The details of her admission are, Date of Admission on 31-08-2010, I.P.No.38930, Date of Discharge on            29-01-2011, cause of death: Heart Disease.  The case history in the case sheet discloses that she was suffering from Heart Disease Six Months prior to the date of her insurance proposal.  DLA was a known case of IHD, ASMI with LVD with LBBB.  At the time of submitting the proposal DLA suppressed this fact and answered “No” to Col.No.11 (a) to (f) & (j) and good to (i).  According to the declaration of the proposer in the event of with holding of any information or giving untrue information, the contract becomes null and void under section 44 of Insurance Act, 1938, since Insurance in a contract of utmost good faith.  In view of the reasons said above opposite parties prayed for the dismissal of case against them with cost as there is no deficiency of service on their part. 

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.B4 are marked and sworn affidavit of opposite party No.2 is filed. 

5.     Both sides filed written arguments and submitted oral arguments.

6.     Now the points that arise for consideration are:

                     i.        Whether the complainant made out a case against opposite parties to prove deficiency?

                    ii.        Whether the complainant is entitled for any reliefs?

                  iii.        To what relief?

7.      POINTS i and ii:- Admittedly Deceased Life Assured has taken policies bearing Nos.653043588 and 655643254 and the claim amount under these policies have been paid.  The claim regarding Jeevan Saral with Profits Policy bearing No.655652369 for Rs.55,655/- commencing from 24-03-2010 for which nominee is D.Swamy Naik, husband of deceased was repudiated, Ex.A1/Ex.B2 is Jeevan Saral with Profits Policy.  Ex.A2 is Death Certificate of Life Assured, Ex.A3/Ex.B2 is repudiation letter.  According to opposite parties the reason for repudiation is Life Assured made deliberate incorrect statement about her health in the policy proposal - Ex.B1.  As recorded in Ex.B4 the Case Sheet of Deceased Life Assured prepared by Government General Hospital, Kurnool dated 31-08-2010, she was a known case of IHD, ASMI with LVD, with LBBB, history of chest pain since Six Months (i.e.,28-02-2010)  prior to the date of admission in the Hospital, she did not disclose all these facts in the proposal.  In terms of policy, Insurance is a contract of utmost good faith.  Opposite parties contended that the Life Assured violated the contract, there is no liability on them for any payment under the policy.  In the order reported as IV (2007) CPJ 163, of A.P. State Commission it is stated that in the absence of any substantional evidence supported by affidavit of the doctor who has treated the patient or deposition of medical doctor who has treated the deceased it can not be stated that the Life Assured willfully and fraudulently suppressed the disease prior to the issuance of policy which he was allegedly suffering from.  According to IV (2008) CPJ 89 (NC) History recorded in the case sheet of hospital where life assured was admitted can not be treated as evidence, as the doctor recording that history was not examined as witness or his affidavit filed.  In the present case opposite parties relied on the material to disclose suppressed fact is the past history recorded in case sheet dated 31-08-2011 (Ex.B4).  To support what is noted in the case sheet neither the doctor who recorded the case sheet was examined nor his affidavit filed.  Hence the previous history recorded in the Ex.B4 is not enough to consider it as legally tenable evidence to support the rejection of complainant’s claim.  Therefore opposite parties failed to establish that the suppression facts about Deceased Life Assured health in the proposal was fraudulently made.  Taking in to consideration of these facts and circumstances of the case the Forum hold that the deficiency of service on the part of opposite parties proved and the complaint is allowed.

8.      Point No.iii:- The opposite parties are directed to settle the policy amount with benefit on death together with interest at 9% per annum from the date of death of repudiation till the date of realization.  Cost of the case is Rs.1,000/-.

9.     In the result the complaint is partly allowed directing the opposite parties jointly and severally to pay policy amount with death benefits together with interest at 9% per annum from the date of repudiation i.e., 13-03-2012 till the date of realization.  Cost of the case is Rs.1,000/-.  Time for compliance is one month from the date of this order.

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 14^th day of June, 2013.

Sd/-                                                                          Sd/-

LADY MEMBER                                                                PRESIDENT (FAC)

       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 policy bearing Nos.653043588, 655643257

                and 655652639.

Ex.A2                Photo copy of Death Certificate issued dated 04-02-2011.

Ex.A3                Photo copy of Repudiation Letter dated 13-03-2012.

List of exhibits marked for the opposite parties:-

Ex.B1                Photo copy of Proposal Form dated18-03-2010.

Ex.B2                Policy bearing No.655652639.

Ex.B3                Repudiation Letter dated 13-03-2012.

Ex.B4                Photo copy of Case Sheet issued by Government General

                Hospital, Kurnool dated 31-08-2010.

Sd/-                                                                          Sd/-

LADY MEMBER                                                               PRESIDENT (FAC)          

    // 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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