Surabhi Jyothi, W/o. Late Ramana@Ramanaiah, R/o. Pandithapuram Village, Kamepalli Mandal, Khammam - Complainant(s)
Versus
The Life Insurance Corporation of India, Divisional Office, rep. by its Divisional Manager, Balasamu - Opp.Party(s)
Macha Nagesh Babu, Advocate, Khammam.
10 Aug 2010
ORDER
BEFORE THE DISTRICT CONSUMER FORUM AT KHAMMAM Varadaiah Nagar, Opp CSI Church consumer case(CC) No. CC/09/90
Surabhi Jyothi, W/o. Late Ramana@Ramanaiah, R/o. Pandithapuram Village, Kamepalli Mandal, Khammam
...........Appellant(s)
Vs.
The Life Insurance Corporation of India, Divisional Office, rep. by its Divisional Manager, Balasamudram, Hanamkonda, Warangal Dist. & another The Life Insurance Corporation of India, Khammam Branch, rep. byi ts Branch Manager
...........Respondent(s)
BEFORE:
Complainant(s)/Appellant(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
ORDER
BEFORE THE DISTRICT CONSUMERS FORUM AT KHAMMAM Dated this, the 28th day of July, 2010 CORAM: 1. Sri Vijay Kumar, B.Com., L.L.B. - President, 2. Smt.V.Vijaya Rekha, B.Sc. B.L. - Member 3. Sri R. Kiran Kumar, B.Sc. L.L.B - Member C.C. No.90/2009 Between: Surabhi Jyothi, w/o.late Ramana @ Ramanaiah, age: 26 years, occu: Coolie, r/o.Pandithapuram village, Kamepalli mandal, Khammam District. Complainant and 1. The Life Insurance Corporation of India, Divisional Office, rep. by its Divisional Manager, Balasamudram, Hanamkonda, Warangal District. 2. The Life Insurance Corporation of India, Khammam branch, rep. by its branch Manager, Khammam. opposite parties This C.C. is coming on before us for final hearing in the presence of Sri.M.Nagesh Babu, Advocate for complainant and of Sri.A.Sarath Chandra, Advocate for opposite parties; upon perusing the material papers on record and upon hearing the arguments; and having stood over for consideration till this day, this Forum passed the following: O R D E R (Per Smt.V.Vijaya Rekha, Member) 1. This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. The brief facts of the complaint are that the complainant is the wife of the deceased, Surabhi Ramana @ Ramanaiah. During his life time, the husband of the complainant had obtained Bhima Gold insurance policy vide policy bearing No.687430448, dt.8-2-2006 for an amount of Rs.1,00,000/-. After satisfying the health condition of the deceased, the opposite parties have issued the insurance policy on payment of two installments of premium, which is in force up till 8-2-2026 The complainant being the nominee. The complainant further submitted that on 18-1-2008 her husband died due to viral fever, while undergoing treatment at Government Hospital, Khammam, thus the complainant claimed the insurance amount by submitting necessary documents. Instead of payment, the opposite party repudiated the claim through letter, dt.25-3-2009 without any reasonable cause. It amounts to deficiency of service and as such the complainant approached the Forum and prayed to direct the opposite party to pay an amount of Rs.1,00,000/- together with interest at 24% P.A. from the date of payment of premium and to pay Rs.25,000/- towards damages and costs. Along with the complaint, the complainant filed his affidavit and also filed the following documents, which were marked as Exhibits. Ex.A.1 - Photocopy of insurance policy bearing No.687430448 Ex.A.2 - Photocopy of death certificate Ex.A.3 - Letter, dt.25-03-2009 addressed by the opposite party On being noticed, the opposite party appeared through its counsel and filed counter by denying the averments made in the complaint. In the counter the opposite parties admitted the issuance of policy bearing No.687430448 and denied the other averments by submitting that the deceased/policy holder died on 18-1-2008, which is within two years of commencement of the policy. As such they conducted an investigation as the claim was early claim and during the course of investigation it came to know that the deceased suppressed several material facts related to his health, which directly reflects the continuance of risk at the time of revival of policy and undergone treatment one month prior to revival of policy i.e. on 13-11-2007 the deceased had taken treatment for fever and cough, since one month and undergone medical investigations vide blood test, widal test, x-ray of chest and urine analysis and also followed up his treatment at Government Hospital, Khammam on 8-1-2008 as O.P. with symptoms of chest pain in right side, cough and sputum since 15 days and died due to chronic renal failure/ MIU pneumonia and as such they repudiated the claim of the complainant and there is no deficiency of service on the part of them and prayed to dismiss the complaint. Along with the counter, the opposite parties filed the following documents, which were marked as exhibits. Ex.B.1 - Blood test report, dt.13-11-2007 Ex.B.2 - statement regarding the health condition of the deceased (Form-5-1, 5-2) Ex.B.3 - Blood analysis report Ex.B.4 - Chest x-ray report Ex.B.5 - Blood analysis report Ex.B.6 - Report, dt.14-7-2007 issued by Sneha Diagnostic center. Ex.B.7 - Out patient ticket, Ex.B.8 - Prescription, dt.13-11-2008 Ex.B.9 - Policy revival quotation, dt.18-12-2007 Ex.B.10 - Personal statement regarding the health In support of his averments the complainant filed written arguments with the same averments as mentioned in the complaint. In view of the above submissions made by both the parties, now the point that arose for consideration is, whether the complainant is entitled the relief as prayed for? POINT: As seen from the above averments there is no dispute regarding the issuance of policy bearing No.687430448 in the name of husband of the complainant. The only objection raised by the opposite parties with regard to the concealment of material facts of ill health at the time of revival of policy and as per the contents of their counter, the policy was lapsed and it was revived on 18-12-2007 and the deceased/policy holder was died on 18-1-2008. The opposite parties also contended that the policy holder was died within two years from the date of commencement of policy and after conducting the investigation, it was revealed that the deceased undergone treatment for fever and cough prior to one month of revival of policy and died due to chronic renal failure, MIU pneumonia, but as per Ex.A.3 the opposite parties declared that the policy is void as the deceased had suffered from fever and cough (typhoid) since one month prior to revival of policy and in support of their contention the opposite parties placed Exs.B.1 to B.10. But did not file any medical record to show that the deceased died due to chronic renal failure/MIU Pneumonia. They had only filed prescription, dt.13-11-2008, investigation reports and outpatient ticket dt.8-1-2008 of Government Hospital, Khammam. After having perused Exs.B.7 and B.8, wherein, did not mention about any chronic diseases only mentioned the symptoms as fever and cough. As per prescription, dt.13-11-2008 the deceased had taken treatment for cough and fever and as per out patient card, dt.8-1-2008 of the Govt. Hospital, he had taken treatment for chest pain in right side and fever as an outpatient and even in these two occasions, the doctors did not advise to take any special treatment as inpatient and conducted investigations in normal course, did not advise to go for any special investigations regarding the renal problem and as per Ex.B.7, the deceased/policy holder had taken treatment for cough and chest pain as outpatient in the Govt. Hospital, Khammam prior to 10 days of his death. Apart from these documents the opposite parties failed to file any record of follow up treatment till the date of death of the deceased and as such the objection raised by the opposite party regarding the concealment of material facts at the time of revival of policy is not tenable. Moreover the opposite parties not repudiated the policy on the ground of misrepresentation of material facts at the time of taking the initial policy and not raised any objection regarding the initial concealment of material facts. On this point, we relied a decision of the Honble NCDRC in LIC of India Vs. Gouramma reported in 2009 CTJ 830 Policy not repudiated on the ground that there was misrepresentation in taking the initial policy or initial concealment of some facts .. and opined that no suppression of facts at the time of taking the original policy. In view of the above discussion the contention raised by the opposite parties regarding the validity of policy, is not acceptable and as such the opposite parties cannot escape from their liability to pay the insured amount under policy bearing No.687430448 and the point is answered accordingly. In the result, the C.C. is allowed in part, directing the opposite parties to pay the insured amount of Rs.1,00,000/- (Rupees one lakh only) under policy bearing No.687430448 together with interest at 9% P.A. from the date of declaration of policy as void i.e. 25-3-2009 till the date of deposit, further directed to pay Rs.1,000/- (Rupees one thousand only) towards costs. Typed my dictation, corrected and pronounced by us in the open forum on this 28th day of July, 2010. PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM, KHAMMAM APPENDIX OF EVIDENCE Witnesses examined for complainant: -None- Witnesses examined for opposite parties: -None- Exhibits marked for complainant: Ex.A.1 - Photocopy of insurance policy bearing No.687430448 Ex.A.2 - Photocopy of death certificate Ex.A.3 - Letter, dt.25-03-2009 addressed by the opposite party Exhibits marked for opposite parties: Ex.B.1 - Blood test report, dt.13-11-2007 Ex.B.2 - statement regarding the health condition of the deceased (Form-5-1, 5-2) Ex.B.3 - Blood analysis report Ex.B.4 - Chest x-ray report Ex.B.5 - Blood analysis report Ex.B.6 - Report, dt.14-7-2007 issued by Sneha Diagnostic center. Ex.B.7 - Out patient ticket, Ex.B.8 - Prescription, dt.13-11-2008 Ex.B.9 - Policy revival quotation, dt.18-12-2007 Ex.B.10 - Personal statement regarding the health PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM, KHAMMAM
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