State Consumer Disputes Redressal Commission
Lic Of India Miryalaguda Nalgonda ... vs Jonnalagadda Bhagyamma W/O Late ... on 31 July, 2013
A. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD FA 676/2012 against CC 68 of 2001 on the file of the District Consumer Forum, Nalgonda. Between : 1) The Life Insurance Corporation of India, Miryalguda Branch. Represented by its Branch Manager, R/o Miryalguda Town, Nalgonda District. 2) The Senior Divisional Manager, Secunderabad Division, LIC of India, Near: Indira Park, Hyderabad. .Appellants/Opposite Parties. And Jonnalagadda Bhagyamma W/o Late Mahender Reddy, Age: 38 years, Occ: Bill Collector in Gram Panchayath, Devarakonda, R/o Devarakonda Village and Mandal, Nalgonda District. .. Respondent/complainant Counsel for the Appellants : M/s. Srinivas Karra Counsel for the Respondent : M/s. V. Gourishankara rao Coram ; Sri R. Lakshminarasimha Rao Honble Member
And Sri T. Ashok Kumar .. Honble Member Wednesday, the Thirty First Day of July Two Thousand Thirteen Oral Order : ( As per Sri T. Ashok Kumar , Honble Member ) ****
1. This is an appeal preferred by the opposite parties as against the orders dated 23.05.2012 in CC 68 of 2011 on the file of the District Consumer Forum, Nalgonda. For convenience sake, the parties as arrayed in the complaint are referred to as under :
2. The brief facts of the complaint are that the complainants husband by name, Jonnalagadda Mahender Reddy obtained two Insurance policies vide Policy bearing No.602093911 for Rs.1,00,00/- and another policy bearing No.602048039 for Rs.50,000/-- in the year 2001 and 2004 respectively, covering his life risk during his life time and he died on 24-06-2007 in Kamineni Hospital, Hyderabad due to LV dysfunction and sudden cardiac arrest. The Complainant lodged claim with the Opposite Parties to pay the matured amount covered under the said two policies enclosing all the relevant documents.
The Opposite Parties repudiated the claim vide letter dated 03-11-2009 informing the Complainant that the policy was declared void as the policy holder made deliberate statements at the time of revival of one of the two policies and obtained the second policy by suppressing earlier disease and hospitalization. Her deceased husband was admitted in the hospital for regular check-up and it cannot be treated as serious disease. The treatment taken by the deceased was only as a precautionary measure and he did not suffer from any disease and that her husband did not suppress any material facts and that there is deficiency in service on the part of the Ops in paying the insured amount and hence the complaint to pay Rs.1,50,000/- covered under the two policies and Rs.10,000/- towards expenses and costs.
3. .OP filed counter opposing the claim of the complainant and denying the allegations made in the complaint and the brief facts of the counter are as under Admitted that the deceased had taken one policy bearing No.602048039 for a sum of Rs.51,000/- on 26-05-2004 and also secured another policy bearing No.602093911 for a sum of Rs.1,00,000/- commencing the risk from 14-03-2007. The first policy was lapsed on account of non-payment of premium from May, 2005 and the same was revived on 24-07-2006. At the time of revival of the policy, the deceased suppressed his diseases. The deceased also obtained another policy on 14-03-2007 for a sum of Rs.1,00,000/- by submitting a fresh proposal. The deceased however died on 24-06-2007, within few months of his taking the subsequent policy. After receipt of the claim, the Ops investigated into the cause of death of the deceased and came to know that the deceased did not disclose he material information while reviving the policy and he suppressed the material facts and therefore they repudiated the claim and thus prayed to dismiss the complaint.
4. Both sides filed evidence affidavit reiterating their respective pleadings and Ex. A-1 to A-6 were marked on behalf of the complainant and Ex. B -1 to B -10 were marked for the OP.
5. Having heard both sides and considering the evidence on record, the District Forum allowed the complaint and directed OPs to deposit a sum of Rs.1,50,000/- (Rupees One lakh and fifty thousand only) covered under the two policies mentioned in the complaint and a sum Rs.5,000/- (Rupees Five thousand only) towards deficiency of services with interest @ 9% p.a. from the date of the complaint till realization and a sum of Rs.2,000/- (Rupees two thousand only) towards costs within one month.
6. Feeling aggrieved with the said order the opposite parties filed this appeal on several grounds and mainly contended that the District Forum failed to see that the deceased life assured suppressed treatment taken for Hemiplegia ie for paralysis which could leads to heart Attack and also suppressed the treatment at NIMS and that the life insurance is a contract on Utmost Good faith and the suppression of material facts would vitiates the contract and that there is no deficiency in service on their part and thus prayed to allow the appeal and set aside the impugned order.
7. Heard both sides with reference to their respective contentions in detail.
8. Now the point for consideration is whether the order of the District Forum is sustainable ?
9. There is no dispute that one late Jonnalagadda Mahender Reddy, husband of the complainant had obtained a policy bearing No. 602048039 for Rs. 50,000/- in the year 2001 from the OP and that it was in lapsed condition from May, 2005 to 24.7.2006 and that on a personal declaration of his health the said policy was revived on 24.7.2006 and that he also taken another Non-medical policy bearing No. 602093911 for a sum of Rs. One lakh from the OP on 14.3.2007 and that on 21.6.2007 he was admitted in Kamineni hospital with complaint of chest pain and that died on 24.6.2007 while undergoing treatment for heart ailment. It is true that in Ex. B4 personal statement for revival of the policy regarding his health the deceased life assured has stated that he was keeping good health and that he did not suffer any illness or undergo operation or ECG etc. In Ex. B2 proposal form for obtaining policy for Rs.one lakh he declared that he did not suffer any illness during the last five years nor did he admit in any hospital or nursing home for the diseases of liver, stomach, heart, lungs, kidneys, brain or nervous system and that he was keeping good health.
According to the complainant, the deceased did not suppress any material facts regarding his ailment to the OP in connection with the said policies. Whereas the Ops plea is that when the policy was in lapsed condition the deceased life assured was admitted in NIMS as inpatient from 21.9.2005 till he was discharged on 23.09.2005 for Hemiplegia and that he suppressed vide Ex. B2 and B4. The document in Ex. B1 discharge summary and evidence of RW.1 doctor Rupam Borgohain disclose is that the deceased was admitted 21.09.2005 in the hospital as inpatient as he had stroke with hemiplegia/paralysis due to right parieto frontal and as per the records maintained by the NIMS hospital he had passed head injury with right hemiplegia ten years before the current stroke and that the said patient was treated by him and that he was discharged on 23.09,.2005. Ex. B1 discharge summary also reveals that the deceased had head injury about ten years prior to 21.09.2005 and that suffered hemiplegia ten years back. It is true that the deceased did not mention about the said treatment which he had undergone between 21.09.2005 to 23.09.2005 for hemiplegia in Ex. B2 and B4. In a decision IV 2011 CPJ 6 (SC) between P. Venkata Naidu and LIC of India, the Honble Supreme Court of India, wherein the deceased had undergone prior treatment for abdominal pain and after obtaining the policy died of cardiac problem it was held that suppression of treatment for abdominal pain cannot be a ground for repudiation of the policy where the deceased died on account of cardiac problem, a disease which has no relation to abdominal pain with which the deceased was suffering.
10. In this case, the OP did not substantiate with any experts evidence or material that the said treatment for hemiplegia had nexus with the cause of the death of the deceased and that deliberately he suppressed the said aspects for wrongful gain. In the cross examination, RW.1 has deposed that as per the patients history the head injury was of ten years old and in general the past ten years and head injury does not cause heart attack. The said statement is against the defence. The District Forum discussed the case at length with reference to several decisions and arrived at a right conclusion in allowing the complaint. The said decision of the Honble Supreme Court supports the case of the complainant herein. Therefore, we are also satisfied to hold that repudiation of the claim of the complainant is not tenable in the eye of law. Absolutely there are no reasons much less valid reasons to set aside the order.
11. In the result, the appeal is dismissed confirming the order of the District Forum. There shall be no order as to costs in the Appeal.
MEMBER MEMBER DATED : 31.07.2013.