CHAVVA BALA YENGAMMA Vs. LIFE INSURANCE CORPORATION OF INDIA, REP. BY ITS SENIOR DIVISIONAL MANAGER, KADAPA

JUDGEMENT

(1.) The District Forum in C.D.No.37/2003 vide its order dt.19.1.2005 dismissed the complaint without costs. Aggrieved by the said order the complainant preferred F.A.No.410/2005 which was dismissed by this Commission. Aggrieved by that order the complainant preferred R.P.No.2691/07 before the National Commission wherein the Commission observed that the State Commission after noting the case pleaded by the parties arrived at the conclusion without discussing the evidence or recording the findings on the basis of the evidence and remanded the matter back to the Commission for a fresh decision in accordance with law.

(2.) The brief facts as set out in the complaint are that the complainant's husband namely Chavva Chinna Venkata Reddy, S/o.C.V.Nagi Reddy had taken insurance policy, the risk commencing from 15.4.98 for a period of 15 years, the sum assured being Rs.5 lakhs. On 12.9.98 the policy holder died in his native village on account of jaundice and the complainant herein who is the nominee completed all the formalities and claimed the benefits under the policy. The opposite party vide letter dt.31.8.2002 repudiated the claim on the ground that the policy holder suppressed material facts about his health. The complainant submits that her husband was hale and healthy till he died with jaundice. There is another person by name Chavva Venkata Reddy, S/o.Konda Reddy who took treatment in Apollo Hospital, Chennai and died in Kasnur village of Simhadripuram mandal on 15.8.98. There are a number of persons by name Chavva Venkat Reddy in the village and Venkat Reddy is a common name in Himakuntala Village. The medical records clearly discloses that the patient's name is Chavva Venkataa Reddy whereas the policy holder's name is Chavva Chinna Venkat Reddy. The date and place of death is also different. The opposite party repudiated the claim based on medical records of third party after four years. Chavva Venkata Reddy's nephew gave letter dt.12.1.2001 stating that his uncle has taken treatment in Apollo Hospital, Chennai and medical records pertains to his uncle. But the opposite party unjustly repudiated the claim. Hence the complaint seeking direction to the opposite party to pay the basic sum assured i.e. Rs.5 lakhs together with bonus and other benefits, interest and costs.

(3.) Opposite party filed counter admitting issuance of the policy to Chavva Chinna Venkata Reddy for a sum assured of Rs.5 lakhs and the nominee being Bala Yengamma. Opposite party contends that the policy holder died on 12.9.98 due to post complication of liver disease and malignancy in lungs. As the life assured died within 3 month from the date of proposal i.e. 30.6.98 opposite party investigated the claim and found that the life assured Sri Chinna Venkata Reddy had chronic diseases even prior to the proposal. He was admitted on 20.7.98 in Cancer Institute, Madras under I.P.No.98/05307 for complaint of multiple necrosis in lungs with secondaries in liver, c/o of Dysponea and Adenopathy. The life assured was identified as husband of C.Yengamma. The opposite party contends that Chavva Venkata Reddy, S/o.C.Konda Reddy was admitted in Apollo Cancer Hospital. Chennai on 21.7.98 and discharged on 31.7.98, whereas the life assured was admitted in Cancer Institute (WIA), Chennai on 20.7.98. Only after ascertaining the identity of the life assured the claim was repudiated. The proposal is dt.30.6.98 and the risk was accepted on 22.7.98 whereas the life assured was admitted in Cancer Institute on 20.7.98 itself. The opposite party has to investigate the matter in all angles without the cooperation of the complainant which is the ground for delay for repudiation and hence there is no deficiency in service on their behalf. The District Forum based on the evidence adduced i.e. Exs.A1 to A4 and B1 to B8 dismissed the complaint without costs and this was confirmed by the State Commission in F.A.No.410/05. Aggrieved by this order the complainant preferred R.P.No. 2691/07 and the National Commission vide its order dt.10.8.011 set aside the order of the State Commission and remitted the matter back to the Commission to give a reasoned order discussing the evidence and recording the findings based on the evidence. Heard both sides.