Date of Filing ::18-03-2011
Date of Disposal ::12-08-2015
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM::ONGOLE
Wednesday, this the 12th day of August, 2015
PRESENT: Sri P.V. Krishna Murthy, B.A.,B.L., President
Sri K. UMAMAHESWARA RAO, M.A.,B.L., Member
C.C.No.64/2011
Indlamudi Mohanarao,
son of Ayyappa,
Hindu, aged 50 years,
cultivation,
resident of 4th ward,
D.No.4-1-123,
Kunkalamarru village,
Karamchedu Mandal,
Prakasam District. … Complainant
Vs.
1) The Branch Manager,
Branch Office,
Life Insurance Corporation of India,
Trunk Road,
Ongole.
2) The Senior Divisional Manager,
Divisional Office, Life Insurance
Corporation of India, Jeevan Prakash,
Dargamitta, Nellore.
3) The Zonal Manager,
Life Insurance Corporation of India,
Zonal Office of South Central
Jeevan Bhagya, Secretariat Road,
Saifabad, Hyderabad.
4) The Branch Manager,
Branch Office,
Life Insurance Corporation of India,
Chirala, Prakasam District. … Opposite Parties
This complaint under section-12 of consumer protection Act, 1986, coming on 31-07-2015 before us for hearing in the presence of Sri Pegada Srinivasulu, advocate for complainant and Sri O. Sreenivasa Rao, advocate for opposite parties, and having stood over for consideration till this day and this Forum made the following:
ORDER
(ORDER BY Sri P.V. KRISHNA MURTHY, PRESIDENT)
1. The brief averments of the complaint are as follows:
The wife of the complainant obtained a policy from the first opposite party for Rs.50,000/-. It is a medical claim policy. She paid the premiums regularly. She died on 05-02-2008 due to heart failure and brain ailment in Lalitha Super Specialty Hospital, Guntur. After her death, the complainant filed the claim with the first opposite party. He filed necessary documents also. The opposite parties repudiated the claim stating that the ailment of deceased was suppressed at the time of obtaining the policy. The opposite parties committed a deficiency of service. The opposite parties 3 to 4 are different institutions of Life Insurance Corporation. Hence, the complaint for payment of the sum assured with interest, costs and compensation.
2. The brief averments of the counter of second opposite party are as follows:
The complaint is not maintainable. The allegations made in the complaint are not correct. The deceased obtained a life insurance policy for Rs.50,000/- from the first opposite party. The complainant is the nominee under the policy. Since the death occurred early, the claim was investigated. The opposite party learns that the deceased has not disclosed the facts with regard to heart previous ailment at the time of obtaining the policy. She gave false answers in the proposal form. Thus, material facts were suppressed by the insured. The policy was vitiated. Hence, there is no deficiency of service. Hence, the complaint may be dismissed.
3. The opposite parties 1 and 3 filed memo adopting the counter of the second opposite party.
4. The brief averments of the counter of fourth opposite party are as follows:
The complaint is not maintainable. The allegations made in the complaint are not correct. The claim was investigated. The claim was investigated. After investigation it was found that the deceased obtained the policy suppressing material facts with regard to her health. Hence, the policy was repudiated on that ground. There is no deficiency of service. Hence, the complaint may be dismissed.
5. Now the point for consideration is “Whether the opposite parties committed a deficiency of service?”
6. The complainant filed his chief affidavit and marked Exs.A1 to A6. On behalf of the fourth opposite party Exs.B1 to B4 were marked.
7. POINT:- The complaint is for refund of the sum assured with interest, costs and compensation. Admittedly one Indlamudi Narayanamma, wife of the complainant was covered by insurance policy, for Rs.50,000/- by the Life Insurance Corporation. The assured was hospitalized due to illness and while receiving the treatment she passed away in the hospital on 05-02-2008. The claim preferred by the complainant, i.e., husband of the deceased, was repudiated on the ground that the deceased suppressed material facts with regard to her health while availing the insurance policy. So, the repudiation was on the basis of suppression of material facts. Under law, a contract of insurance is a contract uberimma fide. Any suppression of material fact will invalidate the contract of insurance.
8. The medical record was marked as Ex.A1 and Ex.B1. The deceased was found to suffer from thyroid (hypothyroidism) for the last five years, preceding hospitalization. Ex.A2 and Ex.B2 are one and the same. In the above documents, the deceased answered the questions relating to her health in the negative. The questions were with regard to general check-up, treatment for more than a week, absence from place of work on grounds of health, ailments relating to liver, Stomach, heart, lungs, kindneys, brain or nerves system and diseases like diabetes and tuberculosis, high B.P., low B.P., cancer, epileipsy, hernia, hydrocele, leprosy or any other disease. In the above diseases, Thyroid is not included. The discharge summary under Ex.A1 and Ex.B1 shows that death was due to cardio respiratory arrest. The death was due to heart attack. No material to show that hypothyroidism will cause heart attack directly. There is no nexus between the ailment suffered by the assured and the ailment which caused the death. In the absence of such nexus, it cannot be said that the assured suppressed the material fact relating to her health. The opposite parties also relied upon a decision of the National Commission in revision petition no.4770/2013 (Manager, LICI, Madhugiri Branch Vs. Muddu Lakshmi). In the above decision, it was held that the facts denied should materially influence an insurer in making the contract. Repudiation of the policy on an untenable ground is a deficiency of service. Since the opposite parties committed a deficiency of service they are liable. The point is held accordingly.
9. The complainant is therefore entitled for refund of the amount of Rs.50,000/- with interest at 9% P.a., from the date of complaint till realization along with costs of Rs.2,000/-. The complainant claimed compensation of Rs.20,000/-. Taking into account the circumstances of the case, this Forum is of the view that compensation is not necessary.
10. In the result, the complaint is allowed, ordering the opposite parties jointly and severally to pay Rs.50,000/- (rupees fifty thousand only) with interest at 9% P.a., from the date of complaint till realization, to the complainant along with costs of Rs.2,000/-. The claim for the rest is dismissed.
Dictated to the Stenographer, transcribed by him and corrected and pronounced by us in the Open Forum this the 12th day of August, 2015.
Sd/-xxx sd/-xxxx
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
WITNESS EXAMINED FOR COMPLAINANT:
P.W.1 13-07-2012 Indlamudi Mohana Rao, son of Ayyappa, Hindu, aged 50
years, cultivation, resident of Kunkalamarru, 4th ward, door no.4-1-123, Karamchedu Mandal, Prakasam District.
WITNESS EXAMINED FOR OPPOSITE PARTIES:
-No-
EXHIBITS MARKED FOR COMPLAINANT:
Ex.A1 Photostat copy of medical record issued by Lalitha Super
Specialty Hospital, Guntur, along with consolidated bill.
Ex.A2 05-11-2008 Copy of letter sent to complainant by 2nd O.P.
Ex.A3 06-05-2009 Office copy of legal notice issued to the Ops 2 & 3.
Ex.A4 Two postal receipts nos.5289 & 5290 and two postal
acknowledgments.
Ex.A5 Photostat copy of status report of police no.843219174.
Ex.A6 Photostat copy of death certificate of Indlamudi
Narayanamma.
EXHIBITS MARKED FOR FOURTH OPPOISTE PARTY:
Ex.B1 Photostat copy of discharge summary issued by Lalitha
Super Specialty Hospital, Guntur.
Ex.B2 05-11-2008 Copy of letter sent to complainant by 2nd O.P.
Ex.B3 Death claim issued by 4th O.P.
Ex.B4 Proposal form for LIC’s Market Plus Plan.
Sd/-xxx
PRESIDENT
Copies to:
1) The complainant.
2) The first opposite party.
3) The second opposite party.
4) The third opposite party.
5) The fourth opposite party.
Free copy was issued in dis.no. /date:
//free copy//
