BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.

F.A.No.398/2012 against C.C.No.509/2010 District Forum-I,  Visakhapatnam.

Between

Smt.Adduri Chandra Kantham

W/o.late Apparao, Hindu,

Aged about 50 years, Occ:Housewife,

R/o.Kothapeta, Nakkapalli,

Visakhapatnam.                                                          …Appellant/

                                                                                      Complainant

          And

1. Shriram Life Insurance Company

    Limited, rep. by its Branch Manager

    Balaji Road, Opp:Andhra Bank

    Tuni, E.G.Dist.,

2. Shriram Life Insurance Company

    Limited, rep. by its Divisional Manager,

    M.V.P.Colony, Double Road,

    Visakhapatnam.

3. Shriram Life Insurance Company

    Limited, rep. by its Asst.General

    Manager, Regd. Office 3-6-478,

    3^rd floor, Anand Estate, Liberty

    Road, Himayathnagar

    Hyderabad-29.                                                         Respondents/

                                                                                      Opp.parties.

Counsel for the Appellant      :  M/s G.L.Nageswararao.

Counsel for the Respondents:  M/s.K.R.R.Associates.

QUORUM:  SMT.M.SHREESHA, HON’BLE Incharge President

AND

SRI S.BHUJANGA RAO, HON’BLE MEMBER.

WEDNESDAY, THE TWENTY FOURTH OF APRIL,

TWO THOUSAND THIRTEEN

Order (Per Smt.M.Shreesha, Hon’ble Incharge President)

***

Aggrieved by the order in C.C.No.509/2010 on the file of District Forum-I, Visakhapatnam, the complainant  preferred this appeal.

        The brief facts as set out in the complaint are that the complainant is the wife of one Mr.Adduri Appa Rao, who during his life time took SHRI PLUS policy bearing No.LN110700029603 for Rs.3,00,000/- for a period of 15 years.  The term of premium payable is 3 years only at Rs.40,000/- per year and after verification and satisfaction of all material papers and on receipt of 1^st instalment of Rs.40,000/- dated 21-3-2007, the opposite parties issued the policy bond on 28-3-2007 and the complainant was the nominee under the said policy.  The complainant submitted that her husband paid the 2^nd instalment of premium of Rs.40,000/- on 29-3-2008 but unfortunately died on 12-8-2008 at his residence.  The complainant submitted that subsequently on 13-11-2008 she made an application along with all required documents and surrendered the policy for payment of the claim amount and she received a letter dated 27-12-2009 from opposite party No.3 repudiating her claim.  Thereafter the complainant sent a legal notice on 27-10-2009 to the opposite parties to which they issued a reply with false averments.  Hence the complaint for a direction to the opposite parties to pay the claim amount of Rs.3,00,000/- to the complainant together with compensation of Rs.50,000/- and costs.

        3^rd opposite party filed counter resisting the complaint and submitted that the complaint is not maintainable as the complainant cannot be termed as ‘consumer’ as per section 2(1)(d) of the Consumer Protection Act, 1986.  Opposite party No.3 admitted the issuance  of the policy to the deceased Mr.Appa Rao and that the complainant was the nominee under the said policy.  Opposite party No.3 submitted that they issued the policy on the basis of the information furnished with regard to his health condition in good faith and the complainant informed about the death of the policy holder on 12-8-2008 and the opposite parties through their investigator furnished claim form to the complainant to resubmit the same along with relevant documents but she did not choose to do so.  The investigator, Mr.Ram Murthy of Hyderabad conducted investigation which revealed  that the deceased policy holder is a known diabetic Nephropathy and diabetic Retinopathy Grade-III as per medical records of safe Emergency hospital, Kakinada and also Sneha Hospital and even the statement given by the complainant and one Kasulu on 09-12-2008 to the investigator would reveal that the deceased policy holder is diabetic for the last 15 years and was on regular medication for the same.  Opposite party No.3 submitted that non disclosure of these material facts as to the previous health condition of the policy holder as required under proposal form amounts to suppression and hence they have rightly repudiated the claim 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  A13 and B1 to B18 and the pleadings put forward, the District Forum dismissed the complaint.

        Aggrieved by the said order, the complainant preferred this appeal.

        Both sides filed written arguments.

        The facts not in dispute are that the complainant’s husband had taken Shri Plus policy commencing from 28-3-2007 for a sum of Rs.3,00,000/- for a term of 15 years.  The opposite parties also issued Ex.A1 policy bond and the complainant’s husband had paid two premiums evidenced under Exs.A2 and A3. While so, on 12-8-2008 the life assured died and the complainant who is the nominee made a claim on 13-11-2008 evidenced under Ex.B4.  The opposite parties repudiated the claim on 27-12-2008 evidenced under Ex.A5/B13 letter on the ground that the life assured suppressed pre-existing health problems. 

        It is the respondents/opposite parties case that the policy holder suppressed diabetic Nephropathy and diabetic Retinopathy Grade-III and these facts were not disclosed by the policy holder in Ex.B1 proposal form in Question 25 where the medical history of the life assured was asked and the proposer answered ‘no’.  The learned counsel for the respondents/opposite parties relied on Exs.B10 to B12 which are the discharge summary of Safe Emergency hospital and Sneha hospital, Kakinada dated 17-4-2008 and 12-4-2008 respectively. Ex.B10 is the discharge summary of Safe Emergency hospital dated 12-4-2008 which clearly states that the policy holder/patient was a known diabetic and known hypertensive.  The hospital treatment record and the investigation reports filed show that the policy holder was diabetic and the lab reports dated 14-4-2008 show that Serum Creatinine level was also on the higher side.  The respondents relied on Exs.B8 and B9 which are the letters written by the complainant herein and one Mr.Kasulu who is the nephew of the deceased stating that the policy holder was suffering from diabetes for the last 15 years and was hypertensive since one year.  A brief perusal of the affidavit and the written arguments show that the said Kasulu and the complainant herein stated they were forced by the investigator to sign the letters but they never denied Ex.B10 discharge summary of Safe Emergency hospital dated 12-4-2008 which clearly states that the policy holder/patient was a known diabetic and known hypertensive.  Keeping in view Exs.B8 and B9 letters and also Exs.B10 and B11 and the treatment record which shows that the deceased is a known diabetic, we are of the considered opinion that the repudiation by the opposite parties is justified as the health condition of the policy holder was not stated in the proposal form.

        In the result this appeal fails and is accordingly dismissed.  There shall be no order as to costs.

                                                                INCHARGE PRESIDENT.

                                                                MEMBER.

JM                                                             Dt.24-4-2013.