BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
and
Smt C.Preethi, M.A., LL.B., Member
Thursday the 12th day of October, 2006
CC.No. 63/2006
M. Lakshmi Devi, S/o. Late M. Maruthi, Aged 36 years,
R/o. D.No. 4-107, Near Rama Temple, Tuggali (V) and (P), Kurnool Dist. . . . Complainant
-Vs-
1.The Divisional Manager, LIC of India, Kadapa.
2.The Branch Manager, LIC of India,
Adoni Branch, Kurnool Dist. . . . Opposite parties
This complaint coming on this day for orders in the presence of Sri A.Rama Subba Reddy, Advocate, Kurnool for complainant, Sri L. Hari Haranatha Reddy, Advocate, Kurnool for opposite party No.1 and 2, and stood over for consideration till this day the Forum made the following:-
O R D E R
(As per Smt C.Preethi, Hon’ble Lady Member)
1. This consumer complaint of the complainant is filed under section 12 of C.P. Act 1986, seeking a direction on the opposite parties to pay to the complainant the assured amount of Rs.1,00,000/- with benefits and with 24% interest per annum, Rs.10,000/- as compensation, costs of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s husband Late M. Maruthi insured his life with opposite parties for Rs.1,00,000/- vide policy bearing No. 653785908 on 21.2.2005 and nominated, the complainant as his nominee. On 14.5.2005 the insured died due to heart pain and the same was intimated and claim form was submitted to opposite parties on 14.11.2005 and complied all requirement. But to the dismay of complainant the opposite parties repudiated the claim stating that the insured gave false statement in the proposal form with regard to his health and the insured has taken treatment for Oesophagus Cancer during 9.11.2004 to 15.12.2004 at Government General Hospital, Kurnool. The complainant further submits that the deceased has not suppressed any treatment from the opposite parties, the Panel Doctor of opposite parties gave a certificate to the effect that the health condition of the deceased was good. Hence, the repudiation by opposite parties is arbitrary and capricious and without basis. Hence, the complainant resorted to the Forum for redressal.
3. The complainant in support of her case relied on the following documents Viz (1) attested xerox copy of policy bearing No. 653785908 issue to the M. Maruthi and (2) repudiation letter dated 9.4.2006 of opposite parties addressed to the complainant, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex A.1 and A.2 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitably replied to the interrogatories caused by opposite party.
4. In pursuance to the notice of this Forum as to this case of the complainant the opposite parties appeared through their standing counsel and opposite party No.1 filed written version, opposite party No.2 adopted the written version of opposite party No.1.
5. The written version of opposite parties admits the complainant’s husband M. Maruthi has submitted a proposal dated 21.2.2005 and a policy was issued bearing No. 653785908 for Rs.1,00,000/- and nominated the complainant as his nominee. The insured in his statement regarding his health replied to question numbers 11 (a) to (i) declared negatively that the information regarding his health and other particulars are true and agreed that if any untrue averments were found in his statement the contract of insurance shall be declared null and void and all the monies paid therein shall be forfeited to the corporation. The complainant informed the death of the insured due to heart pain and preferred a claim. As the death aroused within two years from the date of commencement of policy investigation was conducted and it revealed that the insured was suffering from Cancer before the taking the policy and was admit in Government General Hospital for the decease of Oesophagus Cancer as in patient from 28.10.2004 to 26.11.2004 and from 9.12.2004 to 15.12.2004. Hence, it is clear that the insured suppressed the fact of his illness prior to taking the policy and had taken the policy with malafied intention to get wrongful gain. Therefore, the repudiation of claim by opposite parties was made on justifiable ground and after due application of mind and seeks for the dismissal of complaint with costs.
6. In substantiation of their case the opposite parties relied on the following documents Viz (1) proposal of the insured dated 21.2.2005(2) policy bond bearing No. 653785908 issued by opposite parties to the insured and (3) claim form A and claim statement dated 14.11.2005, besides to the sworn affidavit of the opposite party No.1 and the above documents are marked as Ex B.1 to B.3 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and suitable replied to the interrogatories caused by the complainant and relied on the deposition of RW1 and Ex X.1 case sheet of the insured.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:-
8. The Ex A.2 is a repudiation of the claim of the policy bearing No. 653785908 of the deceased for assured sum of Rs.1,00,000/-. It says that the claim was repudiated as the policy holder M. Maruthi had taken treatment for Oesophagus Cancer and was admitted in Government General Hospital, Kurnool i.e prior to the date of policy and the same was suppressed by the policy holder in the facts relating to his personal statement.
9. The Ex X.1 is the case sheet issued by Government General, Hospital Kurnool for the admission of M. Maruthi (deceased policy holder and husband of complainant) for taking treatment. It shows the particulars of date of admission as 28.10.2004 and discharged on 25.11.2004, the said patient was under the care of Dr. Vishnu Prasad Rao. The deposition of Dr. Vishnu Prasad Rao (RW1) says that the patient M. Maruthi was admitted with IP NO. 37678 in Gastroentology ward on 28.10.2004 and the patient was transferred to his unit on 2.11.2004 after necessary investigations with diagnosis of growth in the Gastro Oesophagus region for Surgical management and was posted for surgery on 18.11.2004, a pallative feeding Jejunostomy was performed as a tumor present at G.E function was fixed and in operable and patient was discharged on 26.11.2004. The Ex B.1 is the proposal of the deceased policy holder for assured sum of Rs.1,00,000/- with his declaration dated 21.2.2005 filed with the opposite parties for issual of said insurance policy. The corresponding policy issued in pursuance of said proposal is Ex B.2/A.1, showing commencement of said policy from 21.2.2005 for 20 years with policy bearing No. 653785908. In the Ex B.1 proposal form the said policy holder answered all the questions at question No. 11 as to his personal history negatively, besides stating as to the usual state of health as good and not suffering from any illness or decease requiring treatment for a week or more or operation. As the treatment for Gastro Oesophagus by the policy holder from 28.10.2004 to 26.11.2004 appearing in Ex X.1 as occurred prior to the proposal date, i.e 21.2.2005, the non mention by the deceased policy holder under going the said treatment within his knowledge in the declaration as to his good health at the time of taking policy amounts to non disclosure of the said fact of the treatment in answer to the question No. 11 in Ex B.1 is certainly amounts to an omission of its non disclosure on the part of the policy holder in the said proposal of contact of insurance being made under the utmost good faith and belief and the declaration made by the complainant that any such omission of disclosure of material facts makes null and void and the very contract of insurance under section 45 of Insurance Act, besides forfeiting the amounts paid by the policy holder infavour of the corporation there by the said policy holder remained guilty of suppression or with holding the material information as to the said treatment he has underwent from 28.10.2004 to 26.11.2004 at Government Hospital, Kurnool are within his knowledge.
10. Hence, in the circumstance discussed above there appears no error or defect or deficiency on the part of LIC (opposite parties) in repudiating the claim of the complainant preferred on the policy No. 653785908 of her deceased husband.
11. Therefore, in conclusion of the above discussion as the case of the complainant is suffering for want of proper cause of action, the complainant cannot have any remedy as she sought for from the opposite parties.
12. Consequently, their being no merit and force in the case of the complaint it is dismissed.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open bench this the 12th day of October, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties
RW1 Deposition of Dr. Vishnu
Prasad Rao, dt 22.8.06
List of exhibits marked for the complainant:-
Ex A.1 Attested xerox copy of policy bearing No.653785908 issue to the M. Maruthi.
Ex A.2 Repudiation letter dated 9.4.2006 of opposite parties addressed to the
Complainant.
Ex X.1 Case sheet of Government General Hospital, Kurnool.
List of exhibits marked for the opposite parties:-
Ex B.1 Proposal of the insured dated 21.2.2005.
Ex B.2 Policy bond bearing No. 653785908issued by opposite parties to the insured.
Ex B.3 Claim form A and claim statement dated 14.11.2005.
MEMBER PRESIDENT
Copy to:-
1.Sri A. Rama Subba Reddy, Advocate, Kurnool.
2.Sri L. Hari Haranatha Reddy, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
