1. JURISDICTIONAL facts as culled out from the materials placed on record may in brevity be referred to in order to understand the crux of the issue arising for consideration before ever the respective case of the parties is adverted to.
2. ONE R. Indira (since deceased) took a policy of life insurance with the Life Insurance Corporation of India. The first opposite party is the Senior Divisional Manager, L.I.C. of India, Thanjavur while the second opposite party is the Branch Manager, L.I.C. of India, Rock Fort Branch, Tiruchirappalli. The policy was for a sum of Rs. 25,000/-. The policy was for a period of 20 years commencing from 28.12.1992 and terminating by 28.12.2012. Her mother namely R. Thangaponnu (complainant) was the nominee under the policy. The assured Indira died on 21.7.1993. At the time of her death, she was aged 26 years. The primary cause of her death was stated to be Angina Pectoris. The secondary cause of her death was stated to be heart attack. ONE Dr. N. Chinnaiah, M.B.B.S., (M.S.), Joint Director of Health Service, Trichy issued the Death Certificate certifying that the deceased insured died due to heart attack.
The complainant subsequent to the death of the assured made a claim with the opposite parties on 22.3.1995. The opposite parties did not honour the claim for pretty long. As a matter of fact, the opposite parties repudiated the claim so made by the complainant after the lapse of two years on the ground that the deceased assured committed suicide by consumption of poison and she did not die as a consequence of heart attack.
In such a backdrop and setting, the complainant knocked at the doors of the Forum below alleging deficiency in service on the part of the opposite parties and claiming certain reliefs as prayed for in the complaint.
3. THE opposite parties in pith and substance would contend that there was no deficiency in service on their part. What they would further contend is that the deceased assured suppressed certain vital facts relatable to her health in the proposal and that apart the deceased died not due to heart attack but committed suicide by consumption of poison. As such the complaint is liable to be dismissed.
The Forum below after taking into consideration the materials placed on record, recorded a finding that there was deficiency in service on the part of the opposite parties in repudiating the claim as made by the complainant and consequently directed the opposite parties to pay to the complainant, the nominee under the policy, an amount of Rs. 25,000/- with interest at 12% per annum from the date of claim, namely 22.3.1995 the date of payment and compensation of Rs. 2,000/- for mental agony and suffering with costs of Rs. 500/-.
4. AGGRIEVED by the order as above, the opposite parties resorted to the present action by engaging a Counsel of their choice namely learned Counsel Mr. R.S. Ramanathan.
On service of process the respondent/complainant entered appearance through a Counsel of her choice, namely learned Counsel M/s. Hema Sampath.
We heard the arguments of learned Counsel Mr. R.S. Ramanathan appearing for the appellants/opposite parties and learned Counsel Mr. A. Palaniyappan representing learned Counsel M/s. Hema Sampath appearing for the respondent/complainant.
5. FROM the pith and substance of the arguments of learned Counsel appearing for the respective parties the one and only question that crops up for consideration is as to whether the order of the Forum below is sustainable in law on the facts and in the circumstances of the case.
6. THERE is no pale of controversy that the assured deceased R. Indira took a policy of insurance for an amount of Rs. 25,000/-. Yet another fact about which there is no dispute is that the complainant R. Thangaponnu, her mother, was the nominee under the policy. The further admitted fact is that the policy was to enure for a period of 20 years commencing from 28.12.1992 and terminating by 28.12.2012. It is also an undisputed fact that the deceased insured R. Indira died on 21.7.1993.
It is the positive case of the complainant that the deceased insured died due to heart attack as evidenced by the Death Certificate under Ex. A7 issued by Dr. N. Chinnaiah, M.B.B.S., (M.S.), Joint Director of Health Service, Trichy. On the other hand, it is the case of the opposite parties that the deceased assured did not die of heart attack, but she committed suicide by consumption of poison. In order to support such a stand, the opposite parties placed reliance upon the certificates Exs. B1 and B2 issued by the very same doctor, who issued the Death Certificate under Ex. A7.
If the assured deceased died of heart attack, it is incumbent upon the opposite parties to honour their commitment by paying the amount due under the policy Ex. A1 to the complainant/nominee-mother. If the assured deceased committed suicide by consumption of poison, the nominee-mother/complainant will not be entitled to any claim under the policy. The moot question that arises for consideration in such a situation is as to whether the deceased died of heart attack or committed suicide by consumption of poison. The deceased assured was first seen by Dr. N. Chinnaiah, M.B.B.S., (M.S.), Joint Director of Health Service, Trichy when she was in a precarious condition in the sense of being her cause of death. It was he, who issued the Death Certificate under Ex. A7 after the death. In the said Death Certificate he had clearly expressed his opinion that she died of heart attack. The complainant/nominee made the claim as early as 22.3.1995 with the opposite parties for the amount due under the policy. The opposite parties Insurance Company did not respond to the claim made for pretty long and obtained Exs. B1 and B2 certificates from the very same doctor, who issued Ex. A7 certificate to the effect that the deceased committed suicide by consumption of poison. The further sordid fact is that the said doctor when examined by the complainant, stated in his chief examination that the deceased assured died of heart attack. The said doctor had the guts and temerity to say in cross-examination that the deceased committed suicide by consumption of poison. He would further say in cross-examination that since the personnel belonging to the Life Insurance Corporation of India came and told him that the people in the village told them that the deceased committed suicide by consumption of poison and upon the basis of the statement so furnished by them, he issued certificates Ex. B1 and B2 that the deceased committed suicide by consumption of poison. The answers given in cross-examination by the said doctor cannot at all be expected to commend acceptance at our hands. The reasons are rather obvious. The said doctor gave certificate under Ex. A7 based upon his findings on examining the deceased shortly prior to her death and subsequently to her death. The certificate so issued is entitled to weight of credence in preference to the certificates he had issued under Exs. B1 and B2 inasmuch as those certificates were issued long subsequent to her death and that apart the basis for the issuance of the certificates was the information furnished by the L.I.C. officers having been collected from the people of village. It is rather unfortunate that a Government doctor like him had issued two certificates expressing contradictory opinion. The said doctor, it appears, is no longer in service and, therefore it is, we are unable to send a copy of this order to the Government for taking disciplinary action against him. It appears the said doctor is practising subsequent to his retirement. His Registration No. is 16279. This is a fit case for taking action against him by the Medical Council of India. We rather feel, such a medical personnel should not be allowed to practise the profession of medicines. We, therefore, recommend to the Medical Council of India to initiate suitable disciplinary action against him and in case the rule permits for suspension of his practice, we do hope that the Medical Council of India will suspend his practice in an appropriate fashion.
7. WE are also not happy with the opposite parties'' way of obtaining Exs. B1 and Ex. B2 certificates from the said doctor. Their conduct on the facts and in the circumstances of the case deserves condemnation at our hands. The opposite parties ought to have either accepted or rejected the claims as made by the complainant within a reasonable time from the date of the claim made by her. The act of the opposite parties in resorting to obtain certificates under Exs. B1 and B2 and rejecting the claim after pretty long time would, we rather feel, definitely tantamount to deficiency in service on their part. In this view of the matter, the findings of the Forum below on such aspect of the matter cannot at all be stated to be not sustainable in law.
The Forum below after all directed the opposite parties to pay the amount due under the policy to the complainant/nominee-mother with interest at 12% per annum from the date of the claim, namely 22.3.1995 till date of realisation and compensation of Rs. 2,000/- for mental agony and sufferings with costs Rs. 500/-. Such an award on the facts and in the circumstances of the case cannot at all be stated to be unreasonable calling for interference.
8. FOR the reasons as above, the appeal deserves to the dismissed.
In fine, the appeal fails and the same is dismissed. We, however, make no order as to costs on the facts and in the circumstances of the case. We, however, make it crystal clear that the award as passed by the Forum below and confirmed by us is required to be complied with by the opposite parties within a month from the date of receipt of our order or otherwise the complainant would be at liberty to invoke the provision of Section 27 of the Consumer Protection Act, 1986 (for short the Act, 1986). Note : The Registry is directed to send to copy of the order to the Medical Council of India/Tamil Nady. Appeal dismissed.
