BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt.C.Preethi, Lady Member
Monday the 14th day of November, 2006
C.C.No.46/2006
Karanam Nagesh, S/o. K.Bheemappa, Aged 34 years, Hindu,
R/o. Chinna Jonnagiri (Village), Jonnagiri (Post), Thuggali (M), Kurnool district. …Complainant
-Vs-
1. The Divisional Manager,
Life Insurance Corporation of India, Cuddapah.
2. The Branch Manager,
Life Insurance Corporation of India, Tadipatri Branch, Anantapur district.
3. The Branch Manager,
Life Insurance Corporation of India, Kurnool Branch, Kurnool.
…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.Harihara Natha Reddy, Advocate, Kurnool for Opposite Parties No.1, 2, and 3 and stood over for consideration till this day, the Forum made the following:-
ORDER
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 him the assured policy amount of Rs.50,000/- with 18% interest per annum, Rs.10,000/- as compensation, costs of the complainant 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 late Karanam Sailaja, wife of the complainant, who was a holder of L.I.C. policy bearing No.652941712 for Rs.50,000/- commencing from 30.12.2002. The policy holder died on 03.08.2005 due to fever and heart attack, thereafter the death information was given to the opposite parties and the claim form was submitted by the complainant along with relevant documents, but to the dismay of the complainant the opposite parties repudiated the claim on the ground that the policy holder with held correct information as to her health and consulted the Doctors at Sri Sathya Sai Institute Of Higher Medical Sciences on 18.11.1998, 20.11.2000, 30.11.2001, and 29.11.2002 and was diagnosed as requiring surgery for mitral valve replacement prior to the date of proposal. But the complainant submits that his wife did not consult any Doctor or institute for treatment and the above conduct of opposite parties in repudiating the claim amounting to deficiency of service to the complainant. Hence, resorted to the forum for redressal.
3. The complainant in support of his case relied on the following documents viz.,(1)Death certificate of the policy holder issued by Jonnagiri Grama Panchayat, besides to the Sworn Affidavit of the complainant in reiteration of his complaint averments and the above document is marked as Ex.A1 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitablely replied to the interrogatories caused by the opposite parties.
4. In pursuance of the service of the notice of this forum as to the case of the complainant, the opposite parties appeared through their standing counsel, the opposite party No.1 filed written version and opposite party No.2 and 3 adopted the written version of opposite party No.1.
5. The written version of opposite parties even though admit the deceased K.Sailaja and the wife of the complainant as the holder of policy as stated in the complaint for assured sum of Rs.50,000/- but allege the suppression of material facts as to her state of health and treatment she under gone at Sri. Sathya Sai Institute Of Higher Medical Sciences, prior to the proposal and answered negatively to the questionnaire in the serial No.11 of the proposal form and as per her declaration the un true averments found in the said proposal forum makes the contract of insurance null and void, and forfeitures the corporation all the amounts she paid to the corporation. As the claim of the policy for assured amount, consequent to the demise of the policy holder on 03.08.2005 being within two years from the date of commencement of the policy and it amounts to early claim, investigation was taken up and learnt that the said policy holder was unwell and under went treatment and visited Sri Sathya Sai Institute Of Higher Medical Sciences, Cardiology OPD for check up on 18.11.1998 for the first time and also visited on 20.11.2000, 30.11.2001, 19.11.2002 and 08.10.2003, and was diagnosed as requiring surgery for mitral valve replacement, Condition No.5 of the policy also makes void the policy for with holding any material information and forfeiture all the amounts paid to the corporation in the consequence of the said policy infavour of the corporation in view of the nature of the contract made on utmost good faith on the deceased statements of the declaration s as the suppression of any material facts makes the policy null and void, under section 45 of Insurance Act and attracting the forfeiture of the amounts and hence the repudiation of the claim is proper and the action of the opposite parties in the said repudiation of the claim suffers with no deficiency and hence seeks for the dismissal of the complaint with costs.
6. In substantiation of their case opposite parties relied on the following documents. (1)Letter dated:30.01.2006 issued by Sri Sathya Sai Institute Of Medical Sciences to Branch Manager L.I.C. Darmavaram.(2)proposal form dated:30.12.2002 (3)policy bond issued to the deceased (4)Repudiation letter dated:16.02.2006 addressed to the complainant (5)claimant’s statement in claim form A (6)Out patient report dated:18.11.1998 Department of Cardiology of Sri Sathya Sai Institute Of Higher Medical Sciences issued to the deceased.(7) Out patient report dated:20.11.2000 department of cardiology Sri Sathya Sai Institute Of Higher Medical Sciences issued to the deceased (8)out patient report dated:30.11.2001 Department of Cardiology of Sri Sathya Sai Institute Of Higher Medical Sciences issued to the deceased (9)out patient report dated:19.11.2002 department of Sri Sathya Sai Institute Of Higher Medical Sciences issued to the deceased, and (10)out patient report dated:08.10.2003 department of Sri Sathya Sai Institute Of Higher Medical Sciences, besides to the Sworn Affidavit of the opposite party No.1 in reiteration of their written version and above documents are marked as Ex.B1 to B10 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant and also relied on the deposition of Rw1, Dr. A. Jagadish Chandran.
7. Hence, the point for consideration is to what relief the complainant is
entitled alleging deficiency of service on part of opposite parties in repudiating his claim:?
8. The Ex.B4 is the repudiation of the claim of the policy bearing No.652941712, of the deceased K.Sailaja for assured sum of Rs.50,000/-. It says that the claim was repudiated as the policy holder was diagnosed as requiring surgery for mitral valve replacement and had taken treatment prior to the date of proposal at Sri Sathya Sai Institute Of Higher Medical Sciences and had suppressed the above facts relating to her personal statement.
9. The Ex.B6 to B10 are the out patient reports, Department of cardiology issued by Sri Sathya Sai Institute Of Higher Medical Sciences to the deceased K.Sailaja for treatment of mitral valve repair dated:18.11.1998, 20.11.2000, 30.11.2001, 19.11.2002, 18.10.2003, respectively. The deposition of Rw1 Dr.A. Jagadish Chandran of Sri Sathya Sai Institute Of Higher Medical Sciences stated that on 18.11.1998 one patient by name K.Sailaja came to their institute cardiology section as out patient with a complaint of difficulty in breathing and walking and on physical examination and clinical examination the said patient was found with damage to mitral valve of the heart and was put to treatment and was advised for review. Subsequently, on 20.11.2000 the said patient came for review and her condition was found not improved and medicines were changed and advised to visit again. And lastly the said patient visited on 08.10.2003, and on examination she was advised for surgery conforming for necessity for it, as there is no possibilities for further improvement in her condition. The Ex.B2 is the proposal for insurance dated:30.12.2002 of the deceased K.Sailaja for assured sum of Rs.50,000/- filed with the opposite parties for issual of said insurance policy. The corresponding policy issued in pursuance to the said proposal is Ex.B1 saying the commencement of policy from 22.01.2003 for sixteen years with the policy bearing No.652941712. In the Ex.B2 proposal the said policy holder answered all the question in serial No.11 as to her personal history negative besides stating as to usual state of good health. Prior to the taking of policy the policy holder under went treatment at Sri Sathya Sai Institute Of Higher Medical Sciences and the said policy holder ought to have disclosed the said facts within her knowledge in the answer to the question in 11 in Ex.B2. The non discloser of the said fact of treatment in answer to the question in 11 of Ex.B2 certainly amounts to an omission of its discloser on the part of the said policy holder in the said proposal in the contract of insurance of being made under the utmost good faith belief on the declaration made by the complainant any such omission of discloser of material facts makes null and void the very contract of the insurance under section 45 of Insurance Act besides forfeiting the amounts paid by the policy holder in favour of the corporation. In the light of the declaration signed by the said policy holder in Ex.B2 authenticating the correctness of the particulars stated Ex.B2 the said omission in the circumstances appears to be willful and intentional as she has not disclosed the said facts within her knowledge. As the said declaration stipulates of a willingness on the part of the said policy holder to forfeit the amounts paid till then in favour of the L.I.C. in case of error omission in the material furnished in the said proposal and the said non discloser of the material facts as to the treatment she has under gone prior to obtaining the said policy amounts to the intentional omission and the suppression of material facts relating to her personal history within her personal knowledge. Hence, in the circumstances discussed above there appears no error defect are deficiency on the part of opposite parties in repudiating the claim of the complainant preferred on the above policy of his deceased wife. Therefore, in conclusion of above discussion, as the case to complainant is suffering for want of proper cause of action the complainant cannot have any remedy he sought for from the opposite parties.
10. Consequently, there being no merit and force in the case of the complaint is dismissed.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open bench this the 6th day of November, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the Complainant: Nil For the Opposite Parties : Nil
List of Exhibits marked for the complainant:-
Ex.A1 Death certificate.
List of Exhibits marked for the opposite parties:-
Ex.B1 Certificate issued by Sri Sathya Sai Institute of Higher Medical Sciences,
prashantigram, Anantapur (District).
Ex.B2 Proposal for insurance on own life, dated:30.12.2002.
Ex.B3 Original policy bond No.652941712 dated:22.01.2003.
Ex.B4 Repudiation letter, dated:16.02.2006.
Ex.B5 Claimant’s statement claim form A submitted by complainant.
Ex.B6 Out patient report of the policy holder datedL:18.11.1998.
Ex.B7 Out patient report of the policy holder dated:20.11.2000.
Ex.B8 Out patient report of the policy holder dated:30.11.2001.
Ex.B9 Out patient report of the policy holder dated:19.11.2002.
Ex.B10 Out patient report of the policy holder dated:08.10.2003.
MEMBER PRESIDENT
Copy to:
1. Sri. A. Rama Subba Reddy, Advocate, Kurnool.
2. Sri. L. Harihara Natha Reddy, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
