State Consumer Disputes Redressal Commission
Smt. Senapathi Ganga Vizianagaram ... vs Lic Of India And 2 Others Hyderabad on 10 November, 2008
A A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. F.A. 554/2006 against C.C. 186/2004 , Dist. Forum, Vizianagaram Between: Smt. Senapathi Ganga W/o. Late Suryanarayana R/o. Thota Veedhi, Back side of Kanakarao House Bobbili, Vizianagaram Dist. *** Appellant/ Complainant And 1. LIC of India Rep. by its General Manager South Central Office Jeevan Bhagya, Saifabad Hyderabad. 2. LIC of India Rep. by its Divisional Manager (Claims), LIC Building Near RTC Complex, Visakapatnam. 3. LIC of India Rep. by its Branch Manager Parvathipuram, Vizianagaram Dist. *** Respondent/ Opposite Parties Counsel for the Appellant: Mr. K. B. Ramanna Dora Counsel for the Respondent: Mr. Hari Rao Lakkaraju QUORUM: HONBLE SRI JUSTICE D. APPA RAO, PRESIDENT & SMT. M. SHREESHA, MEMBER
MONDAY, THIS THE TENTH DAY OF NOVEMBER TWO THOUSAND EIGHT Oral Order: (Per Honble Justice D. Appa Rao, President) ***** Appellant is the unsuccessful complainant.
The case of the complainant in brief is that her husband late S. Suryanarayana was an employee in Jute mill at Bobbili. He obtained Jeevan Mitra policy for a sum of Rs. 25,000/- on 14.10.2002 mentioning her as his nominee under the policy. While so, on 10.3.2003 when he developed heart ailment he was taken to Sri Venu Gopala nursing home for treatment, however he died in the said hospital on the very same day. When she put in her claim, the respondent insurance company repudiated and therefore she claimed the amount covered under the policy together with compensation of Rs. 5,000/- and costs.
The respondent insurance company resisted the case. However, it admitted that it has issued the policy wherein the complainant was shown as his nominee. After receipt of the claim, investigation was made which revealed that the deceased suffered from Pulmonary tuberculosis with HIV reactive prior to the policy. The insured had suppressed the said fact. The Superintendent of ESI hospital, Visakapatnam informed that the insured was admitted as in-patient in the hospital on 18.6.2002 and was discharged at his request on 29.6.2002. He was treated for Pulmonary tuberculosis with HIV reactive. Since the insured had suppressed the material information with regard to his health the claim was repudiated. There was no deficiency in service on its part and therefore prayed that the complaint be dismissed.
The complainant filed Exs. A1 to A7, while the respondents filed Exs. B1 to B7 besides affidavit evidence in proof of their pleadings.
The Dist. Forum after considering the certificates issued by the Superintendent, ESI Hospital, Visakapatnam under Exs. B3 & B4 opined that the assured had suppressed the ailment rendering the policy ineffective. Accordingly it dismissed the complaint.
Aggrieved by the said decision the complainant preferred this appeal contending that the Dist. Forum did not appreciate the facts in correct perspective. It ought to have seen that the deceased died of heart attack. No details of health was taken from the life assured while issuing the policy. Therefore, she prayed that the appeal be allowed.
It is an undisputed fact that the insured, the husband of the complainant had taken a policy for Rs. 25,000/- on 14.10.2002 evidenced under Ex.B2. It is also not in dispute that he died on 10.3.2003 within five months, while taking treatment for heart ailment. No doubt he died at Sri Venugopala Nursing Home, Bobbili evidenced under death certificate Ex. A6. The complainant could not prove that he died of heart ailment by producing the record from the said hospital.
When she claimed the amount, the insurance company investigated the matter. It was revealed that the assured was admitted as an in-patient in ESI hospital. Visakapatnam on 18.6.2002 for Pulmonary tuberculosis with HIV reactive, and was discharged at his request on 29.6.2002, obviously, within four months of taking policy. Ex. B1 is the proposal form signed by the assured. In the coloumns wherein he has to give declaration as to his personal history, he mentioned that he did not have any ailment for the last five years. He also stated that he was not admitted in any hospital and that he was not suffering from any ailment. It was a medical policy. Dr. V. Gourisankar, an authorized doctor of LIC of India examined him and certified that the insured was not ailing. Obviously, basing on the self declaration of the insured as well as doctor certificate, Ex. B2 insurance policy was issued. Since he died on 10.3.2006 within five months of issuance of policy, the insurance company addressed a letter to the ESI hospital, Visakapatnam.
The Superintendent, ESI hospital, Visakapatnam gave a certificate mentioning that the life assured was admitted in the hospital and that he was suffering from Pulmonary tuberculosis with HIV reactive. It is not known how the panel doctor could give such certificate when he was suffering from such disease. The insurance company also obtained leave particulars of the insured.
In the month of June as well as July, 2002 he was on leave for 26 days and 12 days respectively. Obviously, in those days he was taking treatment in the hospital. Ex. B3 leave particulars co-relate the entries in Ex. B4 certificate issued by the ESI hospital authorities. The complainant could not allege that the entries in Exs. B3 & B4 are false.
A perusal of these documents would undoubtedly indicate that the deceased having suffered from major ailment, discharged himself, obtained the policy and within a few months he succumbed to the ailment. He had suppressed his ailment. We have perused the entire evidence in this case, and we are of the opinion that the assured had suppressed the material fact of his health while taking the policy. The Dist. Forum appreciated the facts in correct perspective. We do not see any merits in the appeal.
In the result the appeal is dismissed. However, in the circumstances of the case no costs.
PRESIDENT LADY MEMBER Dt. 10. 11. 2008.