BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
FA.No.853/2011 against C.C.No.136/2009 District Forum, Guntur.
Between
Nunna Ravi Babu S/o.Venkateswarlu
Aged about 35 years, Indian,
R/o.Rudravaram Village,
Muppalla Mandal, Guntur District. ..Appellant/
Complainant
And
1. Bajaj Allianz Life Insurance Co. Ltd.,
Rep. by its Authroized Signatory
G.E.Plaza, Airport Road, Yerrawada
Pune, Maharashtra-411 006.
2. Bajaj Allianz Life Insurance Company Ltd.,
Rep. by its Authorized Signatory
Office at 4/2, Arundelpet,
Guntur. Respondents/
O.Ps.
Counsel for the Appellant : M/s. Y.V.Narasimhacharyulu
Counsel for the Respondents : M/s. G.Anand Kumar
QUORUM: THE HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT,
SMT.M.SHREESHA, HON’BLE MEMBER,
AND
SRI S.BHUJANGA RAO, HON’BLE MEMBER.
TUESDAY, THE THIRTY FIRST DAY OF JULY,
TWO THOUSAND TWELVE
Order (Per Smt.M.Shreesha, Hon’ble Member)
***
Aggrieved by the order in C.C.No.136/2009 on the file of District Forum, Guntur, the complainant preferred this appeal.
The brief facts as set out in the complaint are that the complainant’s father during his life time took a policy bearing No.0033454550 in Bajaj Allianz Capital Unit Gain Plan for a sum of Rs.2,50,000/- through 2nd opposite party and received Rs.50,000/- as premium for 1st year and issued the policy on 23-12-2006. The complainant submitted that prior to the issuing of the policy, the 2nd opposite party personnel enquired about the health and other particulars and after thorough satisfaction issued the policy. The complainant submitted that his father died on 10-3-2007 and never suffered any disease and made a claim to the opposite party being the nominee along with relevant documents. The complainant submitted that the opposite parties issued a letter dated 05-11-2007 to the complainant alleging that the insured suffered from deflated nasal septum and chronic obstructive pulmonary disease and asthma which fact was not disclosed. Thereafter the complainant again appealed to opposite parties stating that the contents of letter dated 05-11-2007 are baseless and requested to settle the claim but 2nd opposite party by letter dated 16-10-2008 simply repudiated the claim. Hence the complaint got issued a notice on 14-2-2009 and filed the complaint to pay the claim amount of Rs.4,66,375/- with subsequent interest at 18% p.a. from the date of application till realization.
Second opposite party filed version which was adopted by 1st opposite party resisting the complaint. It submitted that the Forum has no jurisdiction to entertain the complaint and that the complainant is not a ‘consumer’. Opposite party No.2 submitted that the policy is based on the principle of good faith and rely on the declarations and statement made by the assured in the proposal form and issued the policy for Rs.2,50,000/- by receiving premium of Rs.50,000/- on 23-12-2006. Opposite party No.2 submitted that the insured has intentionally not disclosed the ailment with which he was suffering prior to making the proposal and hence rightly repudiated the claim. It submitted that the assured was suffering with asthma since three years prior to the issuance of policy and has taken treatment from various hospitals and treated by Dr.P.Sridhar Reddy, Vamsi Speciality Hospital and also consulted Dr.Kanumuri Srinivasa Rao Nursing Home at Satenapalli on 14-11-2006. The insured was having knowledge that he was suffering from the above diseases by the time of furnishing proposal to the opposite party on 21-12-2006 and had given answer to question 14 in negative with regard to his health condition and submitted that if the assured had disclosed the asthma and treatment for DNS and COPD at the time of proposal of policy, the opposite party could have asked for other relevant medical reports and considered the proposal with other terms and conditions. Opposite party No.2 submitted that the life assured did not disclose the material facts and hence it repudiated the claim on 05-11-2007 and he died within 3 months due to hearth attack and as per the information available, COPD can be treated but there is no permanent cure and submitted that there is no deficiency in service and prayed for dismissal of the complaint.
Based on the evidence adduced i.e. Exs.A1 to A8 and B1 to B27 and the pleadings, the District Forum dismissed the complaint.
Aggrieved by the said order, the complainant preferred this appeal.
The facts not in dispute are that the complainant’s father, Munna Venkateswarlu took a policy evidenced under Ex.A1 for an amount of Rs.2,50,000/- the risk commencing from 23-12-2006 to 23-12-2016. While so on 10-3-2007, the life assured died while attending to his agricultural works and the complainant made a claim with the opposite parties, which was repudiated on 05-11-2007 vide Ex.A3 on the ground that the life assured suppressed deflected nasal septum and chronic obstructive pulmonary disease and also asthma. The complainant vide Ex.A4 dated 14-8-2008 represented his claim to the Claims Review Committee which was rejected vide Ex.A5 dated 16-10-2008. Thereafter the complainant got issued a legal notice vide Ex.A6 dated 14-2-2009 denying any suppression of material facts. It is the complainant’s case that the life assured died of heart attack while attending to his agricultural works.
It is the opposite parties case that in the proposal form, Ex.B1, the life assured never declared the treatment underwent by him for asthma and deflected nasal septum. Ex.B7 is the burial report which states that the life assured died of heart attack. It is the opposite parties case that their investigator in his report stated that the life assured was having asthma problem and had taken treatment from Dr.K.Srinivasa Rao and they have procured the case sheet of Kanumuri Nursing Home in which it is stated that the life assured had a deviated nasal septum and the diagnostic reports filed show that he had border line diabetes. The case history does not state that the patient had history of pulmonary disease or that the patient was in the knowledge of his deflected nasal septum and it also does not state anywhere that there is a nexus between the said suppression and the cause of death. The opposite parties did not choose to file the affidavit of the doctor who has furnished Ex.B17. Section 45 of the Insurance Act, stipulates as follows:
Policy not to be called in question on ground of mis- statement after two years. No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement 2[ was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made] by the policy- holder and that the policy- holder knew at the time of making it that the statement was false 3[ or that it suppressed facts which it was material to disclose]:
Even in the instant case, the opposite parties have not filed any documentary evidence to substantiate their contention that the life assured had wilfully and fraudulently suppressed deflected nasal septum, pulmonary disease and also did not establish the nexus between the alleged suppression and the cause of death which is heart attack. We rely on the decision of the National Commission in 1996(3) CPR 229 (NC) in SMT.B.CHINNAMMA v. DIVISIONAL OFFICER, LIC OF INDIA that ‘when the assured underwent treatment for peptic ulcer and died of heart attack which has no nexus with the peptic ulcer, repudiation made by the insurer is arbitrary. It is also stated that the so called ailment for which the deceased was treated in the hospital during the said period had no nexus whatsoever with the cause of death. It is stated in the death certificate that he died of ‘heart stroke’” It is also pertinent to note that R.W.2 deposed before the Forum and only stated that he prescribed medicine relating to diabetes and for cough and cold but never stated that the patient was in the knowledge of being asthmatic or suffered from pulmonary disease or deflected nasal septum. Therefore, we are of the considered view that in the absence of any documentary evidence to establish fraudulent suppression, the repudiation by the opposite parties is unjustified and we hereby direct the opposite parties to pay to the complainant, the sum assured of Rs.2,50,000/- together with interest at 9% p.a. from the date of repudiation till the date of realization together with costs of Rs.3,000/- within four weeks from the date of receipt of this order.
In the result this appeal is allowed in part and the order of the District Forum is set aside and the complaint is allowed in part directing the opposite parties to pay to the complainant, the sum assured of Rs.2,50,000/- together with interest at 9% p.a. from the date of repudiation till the date of realization together with costs of Rs.3,000/- within four weeks from the date of receipt of this order
Sd/-PRESIDENT.
Sd/-MEMBER.
Sd/-MEMBER.
JM Dt.31-7-2012
