State Consumer Disputes Redressal Commission
Lic Of India Ltd., vs Mrs. B. Srikanthadevi, on 15 June, 2022
13efore the Btate Consumer
Diaputen Hedressl
(constituted under the Consumer Proteetion Commission
Aot, 2019)
of Telangana, Eruvaka
Building, Khairathabad at Hyderabad
F'A NO.38 OF 2017 AGAINST CC
ON THE FILC OF DIBTRICT
NO.244 OP 2013
COMMI9SION I, I1YDERABAD
Bctwee
LIC of ldin L.,
Representcd by its Bramli Mannget,
C.B. 10, Door No.5 2 210,
1st 1'loor, lHyelerhartlhi,
Sccunderabal 500 00:3,
.Appellun1/0pposite putly
And
Mrs.B.Srikantha Devi W/o late G.3. Murthy,
aged 39 ycars, Oce: Cloveren Service,
R/o A-13, Railway Quarter,
Sitaphalmandi, Secunderabl 500) O61
Rcpolcnt/Couplainan
Counsel for the Appcllant Sri K.R., Shurm
Counscl for the Respondent Sri K.Venkut Ruo
CORAM Hon'ble Sri Justico MSK Jaiswal Presidont and Smt Moena Ramanathan Momber Wednesday, the fiftoonth day of June Two Thousand Twenty Two Oral Order This is an appcul prclerred by the Opposite party uggrieved by the orders dated 16.11.2015 pussed by the District Consumer Forum-1, Hyderabad in CC No.241/2013 in purtly allowing the complaint and directing the Opposite party to pay Rs.8,00,000/- ulong with interest 9% p.a. from the date of repudiation i.c., 18.0M.2011 till reulisation to pay compcnsation of Rs.20,000/- and costs of Rs.5,000/- granting time of (30) days lor complinnce.
22) For the sake of convenience, the parties are referred to as arrayed in the complaint.
3) It is the case of Complainant that her husband Govindu Satyanarayana Murthy obtained Jeevan Mitra (triple cover endowment plan) with profits (with accident an assured benefit) policy bearing for No.641547881 sum of Rs.2,00,000/-, which commenced on 15.06.2009 by paying the premium of Rs.4,900/- 13.06.2009 under receipt on No.1127118 and the proposal given on 03.06.2009, to which, the Complainant was shown as nominee
4) On 15.06.2009 the life assured left for his duties but he did not turn-up even in late hours resulting which, the Complainant and her family members were making efforts to trace him but in vain. Hence, they lodged a complaint with the Police, Chilkalaguda bearing FIR No.381/2009.
5) As things stood thus, one D.Ravinder, Deputy Sarpanch of Thimmapur having noticed an unknown accident while driving motor-cyclist met with road motor-cycle No.AP09R-9229 sustained lying on road on 15.06.2009 at injuries about 2200 hours, shifted him to Government Hospital, Shadnagar in 108 ambulance who succumbed to injuries subsequently on 20.06.2009 at 8.00 am while treatment. Accordingly, a undergoing police complaint was lodged No.132/2009 for the offence under Section 304-A of IPC. bearing FIR The deceased was buried at the local burial ground as unknown person.
6) While making efforts to trace the life assured, through Police, Kottur that an unknown person who met Complainant learnt with road traffic accident on 15.06.2009 at Thimmapur on National Highway died on 20.06.2009 while undergoing treatment.
Immediately she approached the Police concerned and verilied the photographs, wrist watch, spectacles, etc., shown by the Police and identified it to be the deceased policy holder. The Tahsildar, Farooqnagar exhumed the life assured which was identified by the family members on which, the family members of Complainant performed the last rites.
7) When the family members were in grief, in the 3rd week of November 2009 they reccived the renewal notice from Opposite party and 3 only then they came to know of the policy and accordingly submitted the claim on 22.11.2009 by furnishing all relevant letters, to which, the Opposite party repudiated the claim on 18.04.2011 on the ground that the proposal for insurance was back dated as 15.06.2009 and was submitted with manipulated medical report at their branch office through a Development Officer, without furnishing any document to that effect.
The lite assured nor any person influenced any person to manipulate the records of Opposite party. Despite seeking to furnish the proof regard to manipulation, the Opposite party failed. On complaint, the Insurance Ombudsman turned down the claim with unsustainable grounds. Hence, complaining the acts of Opposite party to be deficient, ied the present complaint with a prayer to pay Rs.8,00,000/- towards the policy benefits together with interest @ 18% p.a. from 20.06.2009 til realisation; to pay Rs.50,000/- towards compensation and costs of Rs.5,000/.
9) Opposite party filed its written version admitting issuance of the policy in question but contended that the proposal form was submitted to them only on 16.06.2009 as per the inward serial list.
The policy holder met with an accident on 15.06.2009 at 2200 hours and died on 20.06.2009 at 8.00 am. The family members/nominee of the deceased policy holder with connivance of agent, got managed the medical report which is an essential requirement for completion of the proposal as the name of M.S. Govardhan was struck off and mentioned it as M.S.Govind by forging the signature of doctor. They issued the original policy bond on 20.06.2009.
10) The accident occurred on 15.06.2009 and the proposal waas
submitted on 16.06.2009 suppressing the material accident to the
deceased policy holder, hence the claim is
untenable and not
maintainable. Mere payment of premium amount does
not mean that
the policy was approved and it cannot be taken as concluded contract.
They sent the renewal notice in a routine manner. Since it is an early claim, they conducted an enquiry and their investigations revealed that the nominee or some persons on her behalf played fraud and succeeded in processing the proposal and obtaining the policy. Hence, prayed to dismiss the complaint as there is no deficiency of service on their part.
11) During the course of enquiry before the District Forum, in order to prove her case, the Complainant filed her affidavit evidence as PW1 and got marked the documents Ex.Al to A15. On behalf of Opposite party, one V.Vijaya Saradhi, its Manager (L & HPF), filed his affidavit evidence as RW1 and got marked the documents Ex.B1 to B9.
12) The District Forum after considering the material available on record, allowed the complaint bearing CC No.244 of 2013, by orders dated 16.
11.2015, as stated, at paragraph No.1, supra.
13) Aggrieved by the said orders, the Appellant preferred the present appeal contending that the forum below failed to appreciate the fact that the claim of Respondent is beyond the policy conditions and it failed to understand the fact that to gain unlawfully, the Respondent has prepared the entire screenplay. It further failed to understand the fact that the contract is unconcluded because as on date of policy bond, the life assured was no more.
publishing the Hence, prayed to allow the appeal by setting aside the orders impugned.
14) The point that arises for consideration is whether the order as passed by the District impugned Commission suffers from any error or irregularity or whether itl is liable to be set aside, modified or interfered with, in any manner? To what relief?
15) The main stay of the case of Appellant is that the policy was obtained by managing the agent of insurance company and the proposal form was received by it in the inward section only on 16.06.2009 and the signature of the doctor was forged by manipulating the record in connivance with the officials of the Appellant/LIC and its agent.
16) The crucial aspect that is to be considered is as to whether the repudiation of the claim of he Complainant as made by the Appellant vide Ex.A8 can be sustained.
17) For clarity, we would like to extract as to what is mentioned in the repudiation letter Ex.A8, which reads as under.
"We may, however, state that the above answers were false.
We have reasons to believe that as per FIR 132/09 dated 20.06.2009 of Kothur Police Station under Mahaboobnagar district, on 15.6.2009 at 2200 hours the deceased life assured 5 drove motor cycle bearing No.AP 09R-9229 in a rash negligent manner and and fell down on N.H.7. He sustained severe njuries and Health Centre, shifted in 108 Ambulance to Community Whle Shadnagar on the same day i.e., 15.6.2009.
undergoing treatment, the life assured died on 20.6.2009 at about 0800 hrs. It is further established that the deceased life assured's PIR 381/2009 family members filed a complaint vide dated 17.6.2009 at Hyderabadstating that Chilkalguda Police Station, the deceased life assured missing from 15.6.2009 from 2.30 PM onwards. was Theproposal Jor insurance was back dated submitted with as 15.6.2009 and was manipulated medical report at our Branch Office through a Development Oficer. n fact, the was under Medical Examination one, but whereas proposal without deceased life assured at appearing before the Medical Examiner Hyderabad, the medical report was manipulated and submitted at our Branch Office 10, Secunderabad. t is quiet impossible in which the manner the proposal was back dated and medical examination has been done at Hyderabad when the life assured had met road accident and was under
treatment at Shadnagar Community Health Centre.
t is, therefore, evident that he had made deliberate mis-
statements and withheld correct regarding the accicdent and state of hisinformation from us health at the time of effecting the assurance and also the proposal was back dated and medical report was intention to claim the policy manipulated with a fraudulent money. Hence, in terms the Policy Contract and the declarations contained in the of proposals for assurance we hereby repudiate the claim forms of and accordingly we are not liable for any payment under the above policies and all monies that have been consequence thereof belong to us... paid in
18) How far the insurance comnpany Appellant/LIC could justify its repudiation needs to be considered with reference to the evidence documentary that is produced by both the Respondent/Complainant and the Appellant/Opposite party.
19) It may be recalled that the specific stand of the Appellant is that the proposal was submitted on 16.06.2009 by suppressing the fact that the life assured has met with an accident on 15.06.2009 itself and was admitted in the hospital. In support of its contention, reliance is placed upon Ex.B3 which is purported to be an extract of the Inward Register maintained by the Appellant insurance It company. shows that the proposal of the life assured was submitted by the agent on 16.06.2009.
Not only the authenticity of Ex.B3 cannot be vouchsafed, since it is only a page out of the Inward Register of the insurance company, we see several manipulations and corrections in the said entries. Serial numbers arc corrccted, dates arc nanipulatcd and solcly on the basis of Ex.B3, it cannot be concluded that the proposal was submitted on 16,06.2009 even though thc lifc assured met with an accident on 15.06.2009. The evidence of the person who madc the entrics/ maintaincd the Inward Register is not filed to throw light about the corrections and/or over-writings.
20) That apart, the cntrics in Ex.B3 become documents that are part of the suspicious if the other rccord are carcfully perused.
21) Ex.AI is the reccipt
issucd by the
Corporation showing the fact that the Appellant Life Insurance
lifc assured has
premia of Rs.4,900/- on paid the initial
13.06.2009. This is the
bearing No.1 127118 issucd by the proposal deposit receipt
the Appcllant itself. It clearly shows that
premium that is required for issuance of the
13.06.2009. policy was paid on
22) Ex.A3 is the policy bond by which the contract of concluded. This is a crucial insurance was docurnent and neither of the contend anything that is parties can contrary as to what is mentioned in policy bond. In Ex.A3, in the Ex.A3 column of proposal number mentioned as No.777, dated and date, it is 03.06.2009. The policy bond was 16.06.2009 and the insurance issued on coverage was effective from 15.06.2009. It is evident from Ex.A3 that the proposal was dated 03.06.2009 but not any date subsequent thereto as is sought to be contended by the Appellant/LIC. This policy was issued after having vide Ex.Al on accepted the premia 13.06.2009, which was efective from 15.06.2009.
23) Ex.B1 is the proposal said to have been submitted assured to the Appellant insurance by the life company. In this proposal form, there is a rcfercnce to the payment made under Ex.Al towards the initial premia made on 13.06.2009. This also. shows that the Officer of the Appellant insurance Development company has certified the same on 15.06.2009.
24) In view of the above, we find it difficult to sustain the submission of the Appellant insurance company that in the proposal form Ex.B1, the life assured has suppressed the fact that he met with an accident in the late hours of 15.06.2009. The record shows that the life assured has 7 met with an accident at 2200 hours of proposal form was filled-up on 15.06.2009 and when the had any 15.06.2009, it cannot be believed that he pre-monition of meeting with an accident on late hours. That the same day at apart, it is also on record that immediately after having8 met with an accident, the life assured went into coma out of did not come which, he out till 20.06.2009 when he succumbed to the Sustained.
injuries Therefore, the life assured cannot be said to be guilty of having suppressed that he met with an accident on 15.06.2009 and submitted the proposal on 16.06.2009 at a time when the life assured was admittedly lying on the death bed in a coma in a hospital far away from Hyderabad.
25) The other submission of the learned counsel appearing for the Appellant/LIC is that the policy was issued based on the medical examination by its panel doctor by name Dr.M.R.P.Murthy. Ex.B2 is said to be the medical examination report of the life assured.
It is signed by the doctor on 03.06.2009 certifying that the proposer qualifies for the life insurance. Even though this is dated 03.06.2009, the submission of this medical report along with proposal is made on 15.06.2009 after the premia was paid on 13.06.2009. In Ex.B2, originally it was issued in the name of M.S.Goverdhan and the said name M.S.Goverdhan is struck-off and the name of the life assured namely S.M.Govindu is written. In Ex.B2, the Medical Officer Dr.M.R.P. Murthy has endorsed that as per his diary records, no corrections were made by him and the corrections made in the medical records are not by him and the signature is not that of his. The learned counsel submitted by relying on it that the medical fitness certificate is also tampered with but however, we are not inclined to disbelieve the medical certificate as it is originally issued by the doctor vide Ex.B2.
26) If the entire record is carefully analysed, we have no hesitation in holding that Ex.B2 the medical fitness certificate is in respect of the life assured himself. For example, in the medical fitness certificate Ex.B2, the height and weight of the person examined is mentioned as 175 cms and 78 kgs respectively. The same readings are recorded in the proposal Ex.B1 stating that the height of the life assured is 175 cms and the weight is 78 kgs. Furthermore, the medical fitness certificate also places on record the girth of the abdomen as 86 cms, chest 94 cms on full expiration 99 cms. All these readings exactly tally with what is mentioned in the proposal form which also places on record the girth of the abdomen, girth of the chest on expiration and 94 Cms and inspiration as 86 cms, 99 cms. The medical fitness certificate Ex.B2 also makes a note of the fact that there is a mole on the right leg. Similar entry is also there in the proposal Ex.Bl which also records that the life assured had a mole on the right leg. If really Ex.B2 the medical fitness not in certificate wasS respect of the life assured, such been tallied with the physical features would not have person.
27) What could be gathered from the above is that at times men lie but the may documents do not. All the Ex.B2 medical fitness descriptions that are mentioned in certificate exactly tallies with that of the ife assured as furnished in the proposal Ex.B1.
has been corrected as Merely because the name S.M.Govindu instead of be said that the said M.S.Goverdhan, it cannot medical examination is not that of the life assured but some other person. We have no hesitation in Medical Fitness Certificate is that of holding that Ex.B2 the the proposer.
28) When the entire documents are carefully perused, the grounds on which the claim of the Respondent/Complainant is repudiated cannot be sustained. The District Forum has properly appreciated all the aspects in proper perspective and granted the reliefs to the Respondent/ Complainant. Upon re-appraisal of the evidence on record, we do not see any reason to take any view other than that has been taken by the District Forum. The impugned order, is, therefore, liable to be confirmed and the appeal be dismissed.
29) In the result, the appeal lails and is accordingly dismissed but in the circumstances, the parties to bear their own costs.