ZONAL MANAGER, LIC OF INDIA, SOUTH CENTRAL ZONE OFFICE JEEVAN BHAGYA SAIFABAD Vs. BELLAM SHANTI

JUDGEMENT

(1.) This is an appeal preferred by the insurance company against the order of the Dist. Forum directing it to pay the amount covered under the policy together with interest and costs.

(2.) The case of the complainant in brief is that she is the widow of late Bellam Sheshagiri Rao. During his life time he had taken Jeevan Mitra Insurance Policy for Rs. 50,000/- for a period of 20 years. He made his wife the complainant, as his nominee. He had paid the premium for 2003-2004 by way of cash. While so, her husband died on 12.5.2004 due to accident. She had submitted the claim form and also post-mortem certificate, final report etc. After 11 months they sent a cheque for Rs. 3,044/- on the ground that the policy was lapsed. The insurance company having accepted the second yearly premium must be construed that the amount was received and that the policy was not lapsed. Therefore she claimed Rs. 50,000/- together with interest and costs.

(3.) The insurance company resisted the case. It admitted that late Seshagiri Rao during his life time took Jeevan Mitra insurance policy on 21.1.2003 for Rs. 50,000/- and kept his wife the complainant as nominee. The premium due by January, 2003 was paid. However second premium due by January, 2004 was paid on 14.5.2004 after the death of Seshagiri Rao. By the date of payment it was not aware of the death of the assured Seshagiri Rao. The insured had committed suicide on 12.5.2004 by consuming poison evidenced from FIR, post-mortem examination and other documents. Later she submitted a fake death certificate mentioning that he died on 3.6.2004. In the very claim form she had among other things stated that her husband died on 3.6.2004 by committing suicide. Since the death was within two years from the date of taking policy, as per rules, investigation was conducted. The hospital record maintained by BBR hospital shows that he admitted in the hospital on 12.5.2004 wherein it was diagnosed as Monochroto phosphorous poisoning, and died on 12.5.2004 while undergoing treatment in the hospital. Suppressing the very fact she must have obtained the death certificate from Panchayat Secretary, G. S. Machavaram of Medak District showing the death as 3.6.2004. She intends to cheat the insurance company by making false claim. Since the premium was received after the death of the assured an amount of Rs. 3,044/- was refunded through cheque by letter Dt. 31.7.2006 which was encahsed by her. Therefore it prayed for dismissal of the complaint with costs.