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
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Thursday the 10th day of February, 2005
C.D.No.66/2004
Smt.B.Lakshmi Devi,
W/o Late B.Maheswara Reddy,
R/o Chabolu Village,
Pothulapadu Post,
Nandikotkur Mandal,
Kurnool District. . . . Complainant represented by his counsel
Sri A.Prabhakar Reddy. Advocate.
-Vs-
1. The Divisional Manager,
LIC of India,
Cadapa.
2. The Branch Manager,
LIC of India,
Atmakur Branch,
Kurnool District. . . . Opposite parties 1 and 2 represented by their
Counsel Sri M.L.Srinivasa Reddy.Advocate.
O R D E R
(As per Smt C. Preethi, Lady Member)
1. This CD complaint of the complainant is filed under section 12 of C.P. Act, 1986, seeking a direction on the opposite parties to pay total policy amount of Rs.1,51,976/- with 24% interest per annum from 28-01-2002, Rs.10,000/- as compensation for mental agony and cost of the case.
2. The brief facts of the complainants case is that the complainant’s husband by name B.Maheswara Reddy, working as Driver in APSRTC at Nandikotkur Depot, insured his life with opposite parties under policy bearing No.652179141 for assured sum of Rs.50,000/- with accidental benefit and nominated the complainant/wife as his nominee. The insured died due to Hear Attack on 28-01-2002 at about 4.00 P.M. at Chabolu Village Nandikotkur Taluq. After the demise of her husband the complainant submitted all relevant necessary papers to the opposite parties for settling the claim under the above said policy but the opposite party repudiated the claim on 29-03-2003 stating that the insured suppressed the fact of his ill-health and gave wrong answers to the questions mentioned in the proposal form. But the complainant submits that her husband was of sound health and did not suffer from any aliment before or at the time of taking policy. Therefore, there is deficiency of service on part of the opposite party in repudiating the claim of the complainant.
3. In support of her case the complainant filed the following documents Viz (1) Repudiation letter of opposite parties, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents is marked as Ex.A1 its appreciation in this case and caused interrogatories to third party affidavit of Dr.A.Vasantha Kumar.
4. In pursuance to the notice of this case of the complainant, the opposite parties appeared before this Forum and contested the case. The opposite party No.1 filed written version and opposite party No.2 adopted the written version of opposite party No.1.
5. The written version of opposite parties questions the maintainability of complainant’s case either in Law or on facts. The written version of opposite parties admits the deceased B.Maheswar Reddy has taken a policy on his life for assured sum of Rs.50,000/- under Salary Saving Scheme vide policy bearing No.652179141 and nominated his wife/complainant as his nominee. The complainant informed the death of B.Maheswar Reddy on 28-01-2002 due to Heart Attack and preferred a claim. As the claim arose within 5 months from the date of commencement of policy investigation was conducted, which revealed that the deceased was a known Heart Patient and has taken treatment for heart ailment at Gowri Gopal Apollo Hospital from 12-02-1999 to 18-02-1999 with IP No.5070 and was treated by Dr.A.Vasantha Kumar, M.D., Heart Specialist and the said fact is confirmed by the employer of the deceased. The deceased also availed leave and also reimbursement of medical expenses under the medical benefits scheme for sickness from 14-02-1992 to 11-05-1999. The employer also paid an amount of Rs.8,242/- towards reimbursement of medical bills.
6. The deceased knowingly did not disclose the details of sickness prior to the proposal in the proposal form and submitted it to the opposite party. The deceased answered all questions negatively and stated his usual state of health as good.
7. The opposite parties are not liable to pay insured amount to the complainant as the deceased B.Maheswar Reddy violated condition No.5 which makes the contract of insurance as void abilities and all the amounts paid were forfeited and no amount is payable towards the policy. Therefore the repudiation of claim was made on justifiable grounds and after due application of mind and there is no deficiency of service on part of opposite parties and therefore seeks for the dismissal of complaint with costs.
8. The opposite party in support of its case relied on the following documents Viz (1) Policy bearing No.652179141 of the deceased B.Maheswar Reddy. (2) Proposal Form for taking Insurance Policy of B.Maheswar Reddy. (3) Letter dated 14-12-2002 of G.G. Hospital to opposite party. And (4) Certificate of Employee under claim Form-E besides to the sworn affidavit of opposite party No.1 in reiteration of its written version as defence and the above documents are marked as Ex.B1 to Ex.B4 for its appreciation in this case. The opposite parties also relied on two third party sworn affidavit of Dr.Y.Anthoni Reddy and Dr.A.Vasantha Kumar and the third party of Dr.A.Vasantha Kumar suitably relied to the interrogatories caused by the complainant.
9. Hence, the point for consideration is to what relief the complainant is remaining entitled alleging deficiency of service on part of opposite parties.
10. It is not in dispute that the deceased B.Maheswar Reddy has taken an Insurance Policy Jeevan Mithra (Triple Cover Endowment Plan) with profits (With Accident Benefit), vide policy bearing No.652179141 (Ex.B1) by submitting proposal form dated 30-08-2001 (Ex.B2). On the demise of policyholder on 28-01-2002 the complainant/wife/nominee put forth the claim for policy amount under the above said policy, but the claim was repudiated by opposite party No.2 vide Ex.A1 dated 29-03-2003 stating that the policy holder with held correct information regarding his health at the time of effecting the assurance and that he had suffered from heart problem and consulted a medical man and had taken treatment from a Hospital and also availed leave on sick grounds several occasions prior to the date of proposal.
11. The opposite parties in support of its contention brought on record Ex.b3, letter dated 14-12-2002 of Gowri Gopal Hospital to Branch Manager, LIC of India, Kurnool, referring to the enquiring of B.Maheswar Reddy, it envisages the patient by name B.Maheswar Reddy, RTC Driver, resident of Chabolu Village, admitted in their hospital on12-02-1999 under the care of Sri.Dr.A.Vasantha Kumar, M.D., Heart specialist and the said patient was discharged on 18-02-1999. In support of the above exhibit the opposite party relied on the third party affidavit of Dr.A.Vasantha Kumar. The said doctor submits that the patient B.Maheswar Reddy, S/o B.Nagi Reddy, RTC Driver, resident of Chabolu Village was admitted with heart complaint in Gowri Gopal Hospital vide IP No.5070 on 12-02-1999 and discharged on 18-02-1999 and said patient was treated by him for heart disease. The said third party affidavit was questioned by the complainant by causing interrogatories. The answers to the said interrogatories were given by the opposite party and not by the third party Dr.A.Vasantha Kumar, to whom the interrogatories were caused, as per Order XI Rule 8 and 9 of CPC the answers to the said interrogatories not being in the form of a sworn affidavit of the said person. Hence the third party affidavit of Dr.A.Vasantha Kumar is discarded and cannot be relied upon as the interrogatories are not being in accordance with the mode prescribed in Appendix Form No.2 as required under CPC.
12. The other third party affidavit of Dr.Y.Anthony Reddy, Executed Director of Gowri Gopal Hospital, Kurnool submits that the patient by name B.Maheswar Reddy was admitted in their hospital Vide IP No.5070 on 12-02-1999 and discharged on 18-02-1999 under the care of Dr.A.Vasantha Kumar. In substantiation to the above contentions no material is placed by the opposite party as to the treatment taken by the deceased B.Maheswar Reddy. From the contents of the affidavit relied by opposite party does not inspire any confidence as no documents or any direct evidence showing the complainant actually taken treatment for any disease have been put forth on record by the opposite party. In the absent of any document, any evidence produced on record, primary or secondary regarding treatment taken by the complainant before the submission of proposal form it cannot be said that the opposite party has proved on record that the deceased have taken treatment prior to the submission of proposal. Therefore the third party affidavit of Dr.Y.Anthony Reddy cannot be looked into nor it can inspire any confidence.
13. The Ex.B4 is the certificate of employer under claim Form-E. The opposite parties in Ex.A1 submitted that the deceased B.Maheswar Reddy availed sick leaves on several occasions and Ex.B4 envisages the deceased availed leave on two occasions, first leave before the commencement of the policy and another leave after the commencement of the policy and Rs.8,242/- was reimbursed to the deceased by the employer on production of medical bills but no date is mentioned as when the said reimbursement of amount was made. The complainants counsel rightly rebutted the above contention by placing reliance on the Uttaranchal State Consumer Disputes Redressal Commission, Deharadun, reported in II (2004) CPJ 2004 Page582 between LIC of India -Vs- Lakshmi Karnataka, where in it was held that repudiation of claim of insured who was on frequent medical leaves and taken treatment for appendicitis, such contention is not acceptable, as employees often take leave, on medical ground off and no to consume leaves, and merely taking medical leaves is no ground to presume that the insured suffering from appendicitis. Insurance Company has to prove the fact of actual illness. In this case, merely filing Ex.B3 and Ex.B4 and affidavit of Dr.Y.Anthony Reddy and Dr.A.Vasantha Kumar does not means that the contends there of are necessarily true, no document is produced by opposite parties about the prior existence of heart treatment by the deceased, mere assertion or oral testimony in respect of heart treatment prior to taking policy neither inspires any confidence nor can be acted upon and relied upon. Onus is on the opposite parties to substantiate their plea that the deceased has concealed material facts of his heart treatment before taking policy or at the time of submitting proposal form. Hence, absolutely there is no material on record in support of the contentions of opposite parties in repudiating the claim of the complainant. For want of substantiating material in support of opposite parties contentions, the act of repudiation of the claim of the complainant by the opposite party as is remaining without justifiable excuse.
14. Having regard to over all consideration, there is no hesitation to hold the opposite parties have miserably failed to substantiate that the complainant before taking the policy or at the time of submitting proposal form, knew that he was suffering from heart ailment and the deceased suppressed these facts from opposite parties. Therefore, in their circumstances the said conduct of opposite parties in repudiating the claim of the complainant is certainly amounting to failure on part of opposite parties in performing the statutory duty in repudiating the claim and there by amounting to deficiency of service and there by entitling the complainant to the claim, as the bonafidies of the complainants claims are not otherwise disturbed.
15. In the result, and in sum up of the above discussions, the complaint is allowed directing the opposite parties 1 and 2 to pay to the complaint assured amount under the policy of the deceased B.Maheswar Reddy with 12% interest from the date of demise of the deceased till realization along with Rs.5,000/- as costs of the complaint within one month from the date of receipt of this order.
Dictated to the Stenographer, Typed to the dictation corrected by us, pronounced in the open court this the 10th day of February, 2005.
Sd/-
Sd/- PRESIDENT Sd/-
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses examined
For the complainant:- Nil For the opposite parties:- Nil
List of exhibits marked for the complainant:-
Ex.A1 Repudiation letter dated 29-03-2003 of opposite party to the complainant.
List of exhibits marked for the complainant:-
Ex.B1 Policy bearing No.652179141 of deceased B.Maheswara Reddy.
Ex.B2 Proposal for insurance on own life of Bonthala Maheswara Reddy.
Ex.B3 Letter dated 14-12-2002 of G.G. Hospital to opposite party.
Ex.B4 Certificate of Employees under claim Form-E along with three Medical Certificates.
Sd/-
Sd/- PRESIDENT Sd/-
MEMBER MEMBER
