LIC OF INDIA vs KUCHERLAPATI KRISHNA KUMARI

AGGRIEVED by the order in C. D. No. 14 of 2004 on the file of District Forum, Vizianagaram opposite parties preferred this appeal.

THE brief facts as set out in the complaint are that the complainant''s husband late Kutcherlapati Satyanarayana Raju who is the policy holder took two policies one for Rs. 10,000 on 28. 3. 1996 and another for Rs. 50,000 on 14. 10. 1997 and paid the premium regularly till his death on 1. 2. 1998. He died of cardiovascular failure after which his nominee i. e. , the complainant herein approached the opposite parties for the amounts due under the two policies. Opposite parties issued a cheque for Rs. 11,917 dated 31. 8. 1999 towards full satisfaction of the first policy and failed to pay the amount due under the second policy. The complainant submits that the policy holder''s death was sudden and he never suffered from chronic duodenal ulcer. The endoscopic report dated 20. 1. 1998, 12 days before his death shows that there was no ulcer. The case sheet of ESI Hospital never showed any symptoms of duodenal ulcer. The case sheet of Annapurna Nursing Home never revealed the symptoms of duodenal ulcer and pancreatitis. The complainant submits that the patient died due to cardiovascular failure. The complainant issued a notice to opposite parties on 8. 1. 2000 claiming the amount under the second policy, but there was no response. Hence the complaint, seeking directions to opposite parties to pay the second policy amount together with interest, compensation and costs. Opposite party No. 2 filed counter and opposite party Nos. 1 and 3 adopted the same. Opposite parties submitted that the complainant did not die due to cardiovascular failure and that he suppressed his ill health that he was suffering from duodenal ulcer. The second policy was taken on 14. 10. 1997 and he died on 1. 2. 1998. As per the letter dated 31. 3. 1999 from ESI Hospital Superintendent, he was admitted on 18. 1. 1997 and discharged on 26. 3. 1997 and was treated for chronic pancreatitis. He was on sick leave from 1. 2. 1997 to 30. 4. 1997 i. e. , 89 days. Therefore, they submit that the repudiation is justified.

Based on the evidence adduced, i. e. , Exs. A1 to A2 and Exs. B1 to B6, the District Forum allowed the complaint directing the opposite parties to pay the claim amount of Rs. 50,000 under policy No. 692421368 with interest at 9% per annum from the date of filing of the complaint till the date of realization together with costs of Rs. 1,500.

AGGRIEVED by the said order the opposite parties preferred this appeal. The learned Counsel for the appellants/opposite parties submitted that the life assured was suffering from chronic duodenal ulcer since 3 years prior to the taking of policy which fact he has suppressed. The second policy was taken on 14. 10. 1997 and the insured died on 1. 2. 1998 within a span of 4 months and even the ESI Hospital Superintendent''s letter dated 31. 3. 1999 shows that the insured was admitted in the hospital on 18. 1. 1997 and was discharged on 26. 3. 1997 for treatment of chronic pancreatitis. He further submitted that the deceased took 89 days sick leave from 1. 2. 1997 to 30. 4. 1997 and submitted that there was no deficiency of service on their behalf.

WE have gone through the material on record. It is not in dispute that the life assured had taken two policies one on 28. 3. 1996 for Rs. 10,000 and another for Rs. 50,000 on 14. 10. 1997. It is also not in dispute that he died on 1. 2. 1998 and opposite parties settled the first claim for Rs. 11,917 towards the first policy on 31. 8. 1999. With respect to the second policy it is the contention of the opposite parties that he died within a span of 4 months and that he suppressed that he was treated for chronic duodenal ulcer and also that he was treated for chronic pancreatitis from 18. 1. 1997 to 26. 3. 1997. Opposite parties failed to establish by leading any evidence of the doctor who has treated the life assured that the life assured suffered from chronic pancreatitis whereas Ex. A8, the death report clearly shows that the cause of death is cardiac failure. The x-ray and endoscopic report dated 20. 1. 1998, i. e. , Ex. A3 does not show any ulcer or growth. Ex. A2 death certificate also states that the policy holder died of cardiac arrest. As per Section 45 of the Insurance Act, 1938, the statement must be a material matter or the facts suppressed must be material to disclose. The suppression must be fraudulently made by the policy holder who should have known at the time of making the statement that it was false or that it was material which he sought to have disclosed. In the instant case opposite parties failed to establish that the complainant had fraudulently suppressed his health condition which he had known prior to taking of the policy. It is also pertinent to note that there is also no nexus between the alleged suppression of duodenal ulcer and the cause of death which is cardiac failure. Mere production of doctor certificate enclosed with the application for leave on medical grounds without examining the doctor does not prove that the insured was in fact suffering from the disease and that they have been suppressed by the insured. 1999 (2) ALD (Cons.) 93. The contention of the opposite parties that the life assured went on sick leave from 1. 2. 1997 to 30. 4. 1997 i. e. , 89 days and that he was suffering from chronic pancreatitis is also unsustainable on the ground that merely because the policy holder has taken sick leave does not mean that he was suffering from the said disease when it is not substantiated by any documentary evidence. Opposite parties failed to establish by any documentary evidence or by filing the affidavit of the doctor who has treated the policy holder and has also not chosen to lead any evidence to prove their case and also that there is no nexus between duodenal ulcer and cardiac failure. On the other hand, the complainant established that the policy holder was not suffering from duodenal ulcer, an Advocate Commissioner was also appointed to cross-examine Dr. V. Ashok who performed the endoscopy and he certified that the policy holder did not suffer from duodenal ulcer as on 20. 1. 1998. Therefore, keeping the facts and the material on record in view, we are of the opinion that the act of opposite parties in repudiating the second policy amounts to deficiency of service and, therefore, we confirm the order of the District Forum and dismiss this appeal. In the result, this appeal is dismissed. Time for compliance six weeks. Appeal dismissed.