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 19th day of April, 2005
C.D.No. 115/2004
Vadde Hari Kumar,
S/o. V.Pullanna,
R/o. 12-119,
Kothapeta,
Dhone (M), Kurnool Dist. . . . Complainant represented by his counsel
Sri A.Prabhakara Reddy, Advocate
-Vs-
1.The Divisional Manager,
L.I.C of India,
Cuddapah.
2.The Branch Manager,
L.I.C of India,
Dhone Branch,
Kurnool Dist. . . . Opposite parties 1&2 represented by their
Counsel Sri P.Sivaprasada Reddy,Advocate
C.D.No. 115/2004
(As per Smt C.Preethi, Member)
- 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 policy amount of Rs. 50,000/- with 24% interest from the date of death of the deceased,
Rs. 10,000/- as compensation and costs of this complaint.
2. The brief facts of the complainants case is that the complainant is brother of Late Vadde Ravi, who insured his life with opposite parties under policy bearing No. 653290895 on 21.7.2003 for assured sum of Rs. 50,000/- with accidental benefit. The complainant was nominated as nominee under the said policy. The insured on 1.8.2003 died due to vomits and diarrhea. The complainant, thereafter submitted claim form with all relevant documents for settlement. To the dismay of the complainant the opposite parties repudiated the claim on 31.12.2003 on the ground that the insured suppressed the fact of his illhealth and gave wrong answers to the questions mentioned in proposal form. The complainant filed an appeal before the Zonal Manager of opposite parties for reconsideration, and the Zonal Manager ordered to pay 50% of sum assured on ex-gratia basis, even that
amount was not paid to the complainant. The complainant further submits that his brother never suffered from any ailment before taking the policy and the repudiation of opposite parties in arbitrary and illegal, which constrained the complainant to seek redressal in this Forum.
3. In support of his case the complainant filed the following documents Viz (1) repudiation letter of opposite party to the complainant dt 31.12.2003 and (2) letter dt 20.7.2004 of opposite party to the complainant, besides to the sworn affidavit of the complainant in reiteration of his complaint avernments and above documents are marked as Ex A.1& A.2 for its appreciation in this case and caused interrogatories to opposite party No.1 and suitablely replied to the interrogatories caused by the 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 contested the case. The opposite party No.1 filed written version and opposite party No.2 filed adoption memo adopting the written version of opposite party No.1
5. The written version of opposite parties admits the deceased V. Ravi has taken a policy bearing No. 653290895 on 21.7.2003 by submitted a claim form for Rs. 50,000/-. The nominee informed the opposite parties about the death of the insured on 1.8.2003 due to vomittings and motions and preferred a claim. As the claim was an early claim investigation was conducted which revealed that deceased insured was suffering from fever since 20.7.2003 and it is evident from claim form B, B1 submitted by complainant and F.No. 5152 given by Dr K.Pitchi Reddy, stating that insured was suffering from fever and chills and has taken treatment for the said ailments which amounts to suppression of material facts, as the insured declared himself to be quite healthy in the proposal form for obtaining the said policy. As per the declaration executed by the insured and the untrue statings made by him in the proposal dt 20.7.2003 the contract was declared null and void, and all the amounts paid were forfeited and no amount is payable towards the policy contract.
6. The opposite parties further submits that on representation to the Zonal Office, it admitted the claim for 50% (Rs. 25,000) of the sum assured on ex-gratia basis and the said amount was paid to the complainant in full and final settlement of the claim in respect of the policy on 7.6.2004 in F.No. 5170-A. Hence, seeks for the dismissal of complaint with costs.
7. In substantiation of its case the opposite parties relied on the following documents Viz (1) Proposal for insurance on the life of Vadde Ravi (2) policy No. 653290895 of deceased Vadde Ravi (3) Medical attendance certificate dt 20.11.2003 of deceased (4) certificate of Hospital Treatment of deceased Vadde Ravi (5) questionnaire to be completed by Medical Practioner (6) repudiation letter dt 31.12.2003 of opposite party to the complainant and (7) receipt of complainant dt 4.6.2004 before making an Ex-gratia payment, besides to the sworn affidavit of opposite party No.1 in reiteration of his written version as defence and the above documents are marked as Ex B.1 to B.7 for its appreciation in this case and caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
8. Hence, the point for consideration is to what relief the complainant is remaining entitled alleging deficiency of service and deficient conduct on part of opposite parties:-
9. The replies of opposite parties to the interrogatories caused by the complainant being not in a form of the sworn affidavit as contemplated under Order XI, Rule 8&9 of CPC and Appendix –C, Form No.3, they are not remaining worthy of consideration.
10. The material facts that emerge from the averments, the contends of documents are that the complainant is the nominee of the deceased V.Ravi, who insured his life with opposite parties for Rs. 50,000/-. The deceased V.Ravi died on 1.8.2003 due to vomittings and diarrhea. On the claim preferred by the complainant the opposite party No.1 repudiated the claim stating that the insured was suffering from high fever and had taken treatment from a Doctor and on appeal to Zonal Manager, the claim was considered for 50% of sum assured as exgratia payment and said amount was paid to the complainant on 7.6.2004. After receiving the said amount the complainant filed his present complaint. The main contention of the opposite parties is that the complainant received the exgratia amount of Rs. 25,000/- and singed the discharge voucher as full and final settlement of the claim on 7.6.2004 without any protest and filed this complaint. It was contended by the opposite parties that the insured died within 10days of commencement of policy and he suppressed material facts about his illhealth that he was suffering from high fever prior to the proposal, hence the complainant/ nominee is entitled to claim only ex-gratia payment to the tune of 50% of sum assured which the opposite parties has paid and accepted by the complainant/ nominee without any objection. The Medical Attendants Certificate in Ex B.3 shows that the insured died in his house, and nothing more could be drawn from the said exhibit as all the questions are answered as ‘NO’ by the doctor who gave the said certificate. The certificate of Hospital treatment in Ex B.4 shows that the insured was suffering from high fever from date of admission on 20.7.2003. The questionnaire to be filled by the doctor who treated the deceased in Ex B.5 shows that the deceased was suffering from high fever. All the above exhibits in unitone says that the deceased/ insured was suffering only from high fever, for every human being Fever is something which is an illness, which occurs now and then. Therefore, one cannot expect a person to make mentions of these instances. Therefore, taking the broad aspect of this case, the only reason for repudiation of claim is that is was an early claim and that the insured has taken treatment for high fever. Further, the exhibits marked by the opposite parties did not reveal that the deceased actually under went any such treatment as in-patient or for any course of time at any particular Doctor or any particular doctor for high fever. Therefore, the opposite parties cannot clutch at a non-existing straw to say that there was suppression of material facts. The certificate in Ex B.3, B.4 and B.5 clearly shows that the deceased was suffering from high fever only. Therefore the burden is upon the opposite parties to show that there was suppression of material facts. They have failed to prove that the deceased was aware that he was suffering from any serious illness on the date when he sent the proposal suppressing the same he submitted proposal. Therefore, the certificates in Ex B.3, B.4 & B.5 issued by Dr.K.Pitchi Reddy, is not helpful to establish the contention that there has been any suppression of material particulars regarding his health condition. If at all, it shows that the deceased under went treatment for high fever. Fever is a common thing in these days of stress and strain. Therefore, one cannot attach any significance to it in the sense that it amounts to suppression of material particulars regarding health conditions. Therefore, the opposite parties have to pay the assured amount to the complainant.
11. The complainant in support of his case relied on the following judgements (1) LIC of India Vs V.R.Anagayarkanmi, Tamil Nadu State Commission, reported in I (2005) CPJ Pg 284, wherein, it was held that minor ailments if not disclosed does not amount to suppression of material facts, onus is on the insurance to prove suppression of material fact and when it is not proved, repudiation is not proper (2) LIC of India and Anr Vs Ram Narayan Yadav, reported in I (2005) CPJ Pg 257, Bihar State Commission, where in it was held that when LIC allowed 50% of sum assured and settled the claims on ex-gratia payment basis and the nominee received the said amount in full and final settlement of claim without protest and the complainant/ nominee filed the complaint for balance, Forum relied on policy bond and the complainant is entitled to get entire policy amount with bonus.
12. To sum up, following the afore mentioned decisions and discussions made above and having regards to over all consideration, there is no hesitation to hold opposite parties miserably failed to substantiate that the deceased suppressed material facts about his health condition before taking the policy and the complainant/ nominee accepting the 50% of assured amount as ex-gratia amount, in full and final settlement of claim is not entitled to balance assured amount. This contention of opposite parties is rejected. Therefore, in the said circumstances the opposite parties in settling the claim of the complainant to 50% of assured amount as exgratia amounts is wholly arbitrary and unjust and amounts to deficiency of service on their part and the complainant iscertanly remaining entitled to the balance assured amount.
13. In the result, the complaint is allowed, directing the opposite parties to pay the remaining assured amount of Rs. 25,000/- under the policy bearing No. 653290895 to the complainant with 12% interest from the date of demise of the deceased till realization and Rs. 1,000/- as costs, within a month of receipt of this Order.
Dictated to the Stenographer Typed to the dictation corrected by us pronounced in the Open Court this the 19th day of April, 2005.
Sd/-
PRESIDENT
Sd/- Sd/-
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant For the opposite parties
-Nil- -Nil-
List of Exhibits Marked
For the complainant For the opposite parties
Ex A.1 Repudation letter dt 31.12.03 Ex B.1 Proposal for insurance co Own
Of opposite party to the complainant life of Vadde Ravi.
Ex A.2 Letter dt 20.7.2004 of opposite Ex B.2 Policy No. 653290895 of
Party to the complainant. Deceased Vadde Ravi.
Ex B.3 Medical attendance certificate
Dt 20.11.2003 of deceased.
Ex B.4 Certificate of Hospital Treatment
Of deceased Vadde Ravi.
Ex B.5 Questionnaire to be completed by Medical Practioner.
Ex B.6 Repudation letter dt 31.12.2003
Of opposite party to the complainant.
Ex B.7 Receipt of complainant dt 4.6.04 before making an Exgratia payment.
Sd/-
PRESIDENT
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MEMBER MEMBER
