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
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Tuesday the 16th day of August, 2011
C.C.No.24 /2011
Between:
S.Sadiq Vali, S/o. Late Shaik Khaleel Sahab,
9/617, Main Road, Peapully Post-518 221, Kurnool District.
…Complainant
-Vs-
1. The Branch Manager, Life Insurance Corporation of India,
Branch Office, 8-84-5-1,Behind S.B.I, DHONE-518 222,Kurnool District.
2. The Senior Divisional Manager,Life Insurance Corporation of India, Divisional Office,
Post Box No.10, College Road, Kadapa District - 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 L.Hari Hara Natha Reddy, Advocate for opposite parties 1 and 2 for upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No. 24/2011
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 amount and other benefits on the policy with interest @ 24% per annum;
(b) To pay the compensation of Rs.20,000/- for causing mental agony and hardships;
(c) To pay the costs of this complaint;
And
- To order any other relief or reliefs that are feels deem to be fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as under:- Late Shaik Khalel Sahab father of the complainant obtained insurance policy bearing No.65406101 from the opposite parties. The sum under the policy is Rs.1,00,0000/-. The complainant father who is the insured died on 02-04-2009 due to heart attack. After the death of the insured the complainant who is the nominee under the policy submitted claim to opposite party No.1. The opposite party No.2 by its letter dated 23-12-2010 repudiated the claim on the ground that the deceased withheld correct information regarding his health. The repudiation of the claim of the complainant is not justified. There is deficiency of service on the part of the opposite parties. 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 under law. It is admitted that the opposite party No.2 issued policy bearing No.65416101 in favour of Shaik Khaleel Sahab who is the father of the complainant. The complainant informed the opposite parties that the assured expired on 02-04-2009 due to heart attack. During the course of investigation it was revealed that the assured was not keeping good health prior to the date of the proposal. The deceased was suffering from heart problem and joint pains since five years prior to the date of proposal. The deceased took treatment from Dr.S.Devi Dayananda Singh since three years prior to the taking of the policy. The said Doctor issued Form No.5152 stating that the deceased was suffering from heart problem and joint pains since five years. The deceased took the policy suppressing his ill health. The contract of insurance is a contract of at most good faith. The deceased suppressed the material information and obtained the policy to gain wrongfully. The claim of the complainant was repudiated on justifiably ground. There is no deficiency of service. The complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to A3 are marked and sworn affidavit of the complainant and third party affidavit of Dr.S.Devi Dayanand Singh are filed. On behalf of the opposite parties Ex.B1 to B4 are marked and sworn affidavit of opposite party No.2 is filed.
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?
(c) To what relief?
7. POINTs 1 and 2:- Admittedly the complainants father Late Shaik Khaleel Sahab obtained life insurance policy bearing No.65416101 from the opposite parties. The sum assured under the policy is Rs.1,00,000/-. It is also admitted that the complainant is the nominee under the policy Ex.B2. It is the case of the complainant that on 02-04-2009 the insured died due to heart attack. The prove the death of the insured the complainant relied on Ex.A2 death certificate issued by Executive Officer Peapully Village of Kurnool District. In Ex.A2 it is mentioned that Shaik Khaleel Sahab father of the complainant died on 02-04-2009.
8. Admittedly after the death of the assured the complainant who is a nominee under the policy made a claim to the opposite parties. The second opposite party repudiated the claim of the complainant under Ex.A3 da ted 23-12-2010 stating that the insured suppressed the material information regarding his health in the proposal form. It is for the opposite parties to establish that the insured suppressed the material particulars regarding his health in the proposal form. The opposite parties relied on Ex.B4 Form No.5152 said to have been given by Dr.S.Devi Dayanand Singh of Peapully Village. The opposite parties did not choose to file the affidavit of the said Doctor to establish that he issued Ex.B4 Form No.5152 and that the insured was suffering from heart problem and joint pains before the issuance of the policy by the insurance company in favour of the insured. On the other hand the complainant filed the affidavit of Dr.S.Devi Dayanand who is a R.M.P. Doctor where in it is stated that Ex.B4 Form No.5152 is not connected to the insured and that the insured never took treatment from him at any time. There is no medical evidence on record to show that the deceased was suffering from heart problem at the time when he submitted proposal to obtain the insurance policy. In the absence of medical evidence that the insured was suffering from heart elements, the contention of the opposite parties that the insured suppressed the material facts regarding his health cannot be accepted. The repudiation of the claim of the complainant by the opposite parties is not justified. Admittedly the policy was in force by the date of the death of the insured. The sum assured under the policy is Rs.1,00,000/-. The complainant who is a nominee under the policy is entitled to the assured amount of Rs.1,00,000/- along with other benefits.
9. In result, the complaint is partly allowed directing the opposite parties jointly and severally to pay assured amount along with other benefits to the complainant within two months from the date of the order along with cost of Rs.500/-.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 16th day of June, 2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties : Nill
List of exhibits marked for the complainant:-
Ex.A1 Status report of policy No.654516101.
Ex.A2. Photo copy of death certificate issued by Executive
officer panchayat secretary peapully, Kurnool District,
dated 15-09-2009.
Ex.A3 Repudiation letter dated 23-12-2010.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal of the deceased life assured
dated 28-03-2007.
Ex.B2 Police bond bearing No.654516101 of the deceased
life assured.
Ex.B3 Office copy of Repudiation letter dated 23-12-2010.
Ex.B4 From No.5152 submitted by the Dr.S.Devi Dayananda
Singh dated 16-01-2010.
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 :
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