YAQU BEE Vs. LIFE INSURANCE CORPORATION OF INDIA

JUDGEMENT

(1.) AGGRIEVED by the order in C.D. No. 24/2004 on the file of District Forum, Adilabad the complainant preferred this appeal.

(2.) THE brief facts as set out in the complaint are that the complainant is a wife of late Md. Gulam Dastagiri who worked as driver in A.P.S.R.T.C., Adilabad Depot and during his life -time he obtained a 15 years Jeevan Surabhi Policy with Profits and Accident Benefits from opposite parties vide policy No. 683033851 dated 28.3.2002 for a sum of Rs. 40,000 for which the complainant is the nominee. The deceased was healthy when the policy was issued. On 2.9.2002 the deceased fell ill and consulted a doctor at Adilabad and thereafter he was referred to Hyderabad and finally died on 21.6.2003. Thereafter the complainant filed her claim application before opposite party No. 1, but received a letter from opposite party No. 2 on 28.10.2003 stating that the claim is being repudiated and if she is unsatisfied with the repudiation she can file an appeal before opposite party No. 3 within one month. Accordingly, the complainant filed her appeal before opposite party No. 3 on 24.11.2003 requesting them to consider her claim. On 8.12.2003 the opposite party No. 3 sent a letter to the complainant stating that her representation would be reviewed before the Zonal Claims Review Committee. But thereafter she did not receive any communication. Hence, the complaint seeking direction to the opposite parties to pay the sum assured covered under the policy together with interest at 12%, compensation of Rs. 25,000 and other costs.

(3.) THE opposite parties filed counter submitting that the medical records indicate that the life assured was a known hypertension patient since four years and he died on 21.6.2003 within period of one year two months from the date of commencement of the policy. The treatment record discloses that he was suffering from blood cancer and that he was admitted in NIMS for treatment. He was admitted in NIMS on 6.9.2002 and discharged on 14.10.2002. There was suppression of material facts with regard to the health condition and hence the opposite parties are justified in repudiating the claim vide their letter dated 22.10.2003. This was later confirmed by the Zonal Office Review Committee. Hence, there is no deficiency in service on their behalf.