O R D E R
(By Sri D.Shankar Rao, Member)
1. The facts set-out in the complaint in brief are that the husband of complainant Yerrolla Gangaram obtained life insurance policy No.600977166 for sum assured Rs.12,50,000/- under Table plan and term 165-65 form opposite parties 1 & 2. Unfortunately the policy holder Yerrolla Gangaram died on 20-04-2011 due to sudden massive heart attack. The complainant being wife and nominee has claimed with the opposite parties 1 & 2 for sum assured under the policy. The opposite parties 1 & 2 have repudiated the claim on 15-11-2012 on a ground that the deceased policy holder Yerrolla Gangaram had suppressed his health condition in his proposed Form while taking the policy. The deceased policy holder as a civil police constable was very healthy but he died with sudden cardiac arrest. The opposite parties 1 & 2 have failed to react positively and repudiated the claim which amounts to deficiency of service. The opposite parties 1 & 2 are liable to pay the sum assured under the policy along with damages.
2. The opposite parties 1 & 2 have filed their counter and briefly stated that Sri.Yerrolla Gangaram during his life time secured a policy No.600977166 for a sum assured Rs.12,50,000/- under T & T 165-15 from LIC of India branch office Nizamabad commencing the risk from 18-02-2011. On receipt of death claim, the opposite parties have processed it treated as early claim within 3 years period as per procedure laid down and repudiated the same on the ground of suppression of material facts. The enquiry revealed that the deceased life assured Yerrolla Gangaram had suppressed material information regarding his health in question No.11 of proposed form. The life assured died with heart attack on 20-04-2011 within two months 2 days from the date of obtained policy. He was suffering with heart problem prior to taking policy. There is nexus between the cause of death of life assured and the material information regarding his health with held by him. The opposite parties 1 & 2 have indisputable proof that the life assured consulted Dr.LL.R Chouhan, Sri.Saibalaji hospital Banswada in Nizamabad district on 10-01-2011 with a complaint of chest-pain. He was diagnosed with Myocardial infraction and give primary treatment and he was referred to higher centre Kamareddy. The life assured committed breach of contract under the policy and the opposite parties 1 & 2 are not liable to pay the death claim and the repudiation is justifiable.
3. During enquiry, the complainant filed her evidence affidavit as PW1 and got marked exhibits A1 to A3 documents and closed her evidence.
The opposite parties 1 & 2 have filed the evidence affidavit of their Secunderabad Divisional office Manager K.Madan Mohan Rao as RW1 and examined the Dr.LL.R.Chauhan as RW2 and marked exhibits B1 to B4 documents and closed their evidence.
4. Heard Arguments.
5. The points for consideration are:-
1) Whether there is any deficiency of Service on the part of opposite parties 1 & 2 in repudiation of claim under the policy ?
2) To what relief?
6. POINT No.1 & 2 : There is no dispute that the life assured Yerrolla Gangaram obtained LIC’s Jeevan Saral (with profits) policy No.600977166 in Ex.B4 for sum assured Rs.12,50,000/- from LIC of India. It is also not in dispute that the complainant is nominee as she is being wife of life assured policy holder. It is also not in dispute that the life assured Yerrolla Gangaram died with heart attack on 20-04-2011.
It is disputed that the life assured Yerrolla Gangaram had suppressed his past medical history of chest pain and obtained the policy.
In order to prove the case the complainant filed her own evidence affidavit as PW1 and she relied upon Ex.A1 to A3 documents. The opposite parties 1 & 2 have also filed the evidence affidavit of their Secunderabad Divisional Manager K.Madan Mohan Rao as RW1 and got examined the doctor LL.R. Chauhan as RW2 who issued Ex.B1 & B2 documents supporting to their contention and also relied up on Ex.B3 & B4 documents.
The opposite parties 1 and 2 have raised the dispute that the life assured had suppressed his past history of medical treatment and knowingly obtained the policy by fraud. Further pleaded that the suppressed medical history was revealed in enquiry. Hence the onus against opposite parties 1 and 2 to prove the same.
We have heard the arguments of counsel for the parties and perused the exhibits on both sides and verified the entire record. The counsel for opposite parties 1 and 2 vehemently argued that the evidence of Dr.LL.R.Chauhan who examined as RW2 and who issued Ex.B1 & B2 documents are sufficient to proof that the life assured had suppressed his health history and obtained the policy by fraud.
The counsel for complainant has strongly objected the documents in Ex.B1 & B2 and vehemently argued that the Ex.B1 & B2 documents have no basic record. He further argued that it is revealed in the cross-examination of RW2 that the exhibits B1 & B2 are created for the purpose of avoiding the death claim. The life assured never consulted any Doctor nor taken treatment in any hospital before or after taking the policy. The life assured died on 20-04-2011 with sudden heart attack but the death may be within 2 months 20 days from the date of commencement of the policy on 08-02-2011. Though it is early claim but it cannot be attributed as false claim. However the opposite parties 1 & 2 have failed to produce the cogent and valid evidence that the life assured had suppressed his past medical history and obtained policy.
We have scanned the Ex.B1 & B2 documents as well as the cross-examination of RW2. Ex.B1 is showing without date and contended that the life assured come with chest pain, shortness of breath sweaty on 10-01-2011 and he was diagnosed as Myocardial infraction and given primary treatment and refer him to higher centre Kamareddy. Ex.B1 was issued in the name of Sri Sai Balaji hospital main Road, Gandhari, District Nizamabad. It is mentioned that the RW2 qualification is MBBS (OSM) consultant Surgeon. He also admitted in his cross-examination that he is general surgeon but not heart specialist. Further he admitted that he has no records pertaining to life assured Y.Gangaram in his hospital on 10th January 2011 and he cannot say what basis he has mentioned the date & month in Ex.B1 as 10th January 2011.
Ex.B2 is notarized affidavit executed on non judicial stamp paper of Rs.10/- in two numbers by RW2 contended that the Ex.B1 was issued by him. The Ex.B2 is not disclosing the name of RW2 in the stamp papers purchased column. There is no signature of RW2 on First page of stamp paper in Ex.B2. It was notarized on 16-05-2012 but it signed by RW2 as a deponent of Ex.B2 on 25-05-2012. The RW2 admitted in his cross-examination that he did not go to any notaries office and signed in any register of notary and also admitted that he signed on Ex.B2 on 25-05-2012.
Therefore in view of aforesaid mentioned discussion of Ex.B1 & B2 and verification of RW2 cross-examination, we are of the considered view that the Ex.B1 & B2 and the RW2 evidence are not established that the life assured Yerrolla Gangaram had consulted with RW2 Doctor on complaint of chest pain on 10-01-2011 and he was diagnosed as Myocardial infraction since there is no hospital record and RW2 doctor is not qualified as heart specialist. Hence we are not inclined to accept the version of opposite parties 1 and 2 that the life assured Yerrolla Gangaram had suppressed the material information of his past history of medical treatment that he was suffering with Myocardial infraction heart decease while filling the information under question 11 of proposed form and obtained policy by fraud. In the light of Hon’ble Apex court judgment between P.Venkat Naidu V/s LIC of India & another reported in 2011 CPJ IV SC-6, the opposite parties have failed to produce any tangible evidence to prove that the deceased life assured Yerrolla Gangaram with held information about his hospitalization and treatment. Therefore we are of the considered view that the complainant is entitled the death claim of her husband under the policy for sum assured Rs.12,50,000/- with interest and costs of the complaint and the opposite parties 1 & 2 are liable to pay the case.
The complainant has not adduced any evidence how she is entitled for compensation and damages in addition to the death claim under the policy sum assured under the policy.
7. IN THE RESULT, the complaint is allowed in part as under:-
- The opposite parties 1 & 2 are directed to pay Rs.12,50,000/- with 9% interest P.A under Ex.B4 policy from the date of repudiation of claim on 15-11-2012 till realisaiton to the complainant.
- The opposite parties 1 & 2 are further directed to pay Rs.2,000/- to the complainant towards costs of the complaint.
Typed to dictation, corrected and pronounced by the Member in Open Forum on this the 28th day of November 2014.
