GURRAM VARALAKSHMI Vs. LIC OF INDIA

JUDGEMENT

(1.) Petitioner, Smt. Gurram Varalakshmi, filed complaint C.D. No. 414 of 1994 before the District Forum, Khammam, praying for a direction to the Insurance Company for payment of dues under endowment assurance policy with profit for a sum of Rs. 2 lakh taken by her husband during his life-time. The policy was for 20 years with profits and accidental benefits commencing from 28.1.1991 having maturity date on 28.1.2011. However, her husband expired due to cardiac arrest on 27.7.1991 at Vandana Nursing Home. The claim made by the petitioner was repudiated by the L.I.C. by their letter dated 31.3.1994 on the ground that the insured had withheld material information about his health.

(2.) The District Forum by judgment and order dated 27.9.1997 allowed the complaint and directed the L.I.C. to pay Rs. 2 lakh with interest at the rate of 9% p.a. and costs of Rs. 5,000.

(3.) Against that judgment and order the L.I.C. preferred First Appeal No. 159 of 1998, before the State Commission, Andhra Pradesh. The State Commission relied upon the affidavit of Dr. C.S. Raman, Eye Specialist, who was earlier working with the Apollo Hospital as Consultant in Ophthalmology. He has stated that on 14.9.1990 the deceased came to him for eye treatment, while examining him he learnt that he was suffering from diabetes and defective vision. This affidavit was filed on the basis of case sheet dated 14.9.1990 of Apollo Hospital. The State Commission further observed that the death certificate of Vandana Nursing Home only reveals that the deceased died on 27.7.1991 and does not give any other information. Further, the complainant herself filed the details of the previous six policies taken by the insured from 28.12.1996 to 28.3.1997 for the sums varying from Rs. 3,000 to Rs. 40,000. Therefore, going for a policy of Rs. 2 lakh and suppressing several diseases for which treatment was taken raises doubts about the genuineness of the claim. Hence, the appeal was allowed and the order passed by the District Forum was set aside.