STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA :
At HYDERABAD
FA 620 of 2014
AGAINST
CC No. 5 of 2013, DISTRICT FORUM, NALGONDA
Between :
The Deputy Manager,
SBI Life Insurance Company Ltd
5-3-338/1, 2nd floor, Kayjee Mansion,
R.P. Road, Secunderabad – 3 .. Appellant/opposite party
And
- Smt. Piroj Swathi, W/o late P. Narsing Rao,
Aged about 33 years, Occ : housewife
- Piroj Susuritha, , D/o late P. Narsing Rao,
Aged about 10 years,
- Piroj Namratha, D/o late P. Narsing Rao,
Aged about 6 years, Occ : Student
- Piroj Mallikarjuna, S/o Late P. Narsing Rao
Aged about 3 yers,
All are R/o H.No. 1-3-57/58, Kisan Nagar
Bhongir Town and Mandal, Nalgonda District .. Respondents/complainants
Counsel for the Appellant : M/s. Gosala Srinivasa Rao
Counsel for the Respondents : M/s. V. Gourisankara Rao
Coram :
Honble Sri Justice B. N. Rao Nalla … President
And
Sri Patil Vithal Rao … Member
Monday, the Eighteenth Day of December
Two Thousand Seventeen
Oral order : ( per Hon’ ble Sri Justice B.N.Rao Nalla, Hon’ble President )
***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the opposite party praying this Commission to set aside the impugned order dated 20.12.2013 made in CC 5 of 2013 on the file of the DISTRICT FORUM, Nalgonda.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainants, in brief, is that husband of the first complainant , Piroj Narsinga Rao has applied for housing loan to the State Bank of India, Bhongir Branch and he was sanctioned loan. As a part of procedure, her husband became member of the scheme under Master Policy for the loanees of State Bank of India and he obtained the policy bearing No. 93000002007 vide Ex.A-1 from the opposite party for the assured sum of Rs.6,20,470/- after satisfying with his health condition and subjecting him to medical tests. Later, her husband died on 31.08.2010. The insurance claim submitted by her was repudiated by the opposite party on the ground that that the deceased had suppressed the factum of her husband suffering from severe systemic hypertension and left Ventricular hypertrophy which amounts to deficiency in service. Hence the complaint to direct the opposite party to pay a sum of Rs.6,20,470/- towards the sum assured, Rs.50,000/- towards mental agony with interest @ 18% pa and costs of Rs.5,000/- .
4) The Opposite Party opposed the above complaint by way of written version and submitted that it insures the lives of group of individuals who are customers of the banks and other financial institutions and in the process of the same; it insured the life of the deceased. There is no direct contract between the deceased and the opposite party and the contract is only between the bank and the opposite party and the certificate of insurance is issued in the name of the bank. It is a non-medical policy but not a medical one. It repudiated the insurance claim on the ground of suppression of treatment undergone by the deceased in Kamineni Hospital, Hyderabad, from 03.06.2004 to 08.07.2004 for “ severe systemic hypertension and left ventricular hypertrophy “ . The Ombudsman had dismissed their claim and the complaint is barred by time. Hence prayed to dismiss the complaint.
5) During the course of enquiry before the District Forum, in order to prove their case, the complainants filed evidence affidavit and got marked Ex.A1 to A-10. The Opposite Party marked Ex.B1 to B-20.
6) The District Forum, after considering the material available on record, allowed the complaint and the opposite party is directed to clear the loan outstanding in the account of the deceased as on the date of his death on 31.08.2010 and subsequent interest accrued thereon till the amount is credited to the loan account with the State Bank of India, Bhongir branch. The opposite party shall credit the amount directly to the loan account of the deceased. In addition, the opposite party shall pay a sum of Rs.5,000/- towards deficiency of service and Rs.2,000/- towards costs within one month.
7) Aggrieved by the said order, the opposite party preferred this appeal before this Commission.
8). Both parties have advanced their arguments reiterating the contents in the appeal grounds, rebuttal thereof along with written arguments. Heard both sides.
9) The points that arise for consideration are,
(i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner?
(ii) To what relief ?
10). Point No.1 :
There is no dispute that the deceased husband of the first respondent/ complainant is the member of the scheme of the State Bank of India in question and he obtained the policy bearing No. 93000002007 vide Ex.A-1 from the opposite party for the assured sum of Rs.6,20,470/- covering the period from 09.06.2010. There is also no dispute that while the policy was in force the deceased died on 31.08.2010. There is also no dispute that the claim submitted by the respondents/complainants was repudiated on the ground that the deceased suppressed the treatment undergone in Kamineni Hospital, Hyderabad, from 03.06.2004 to 08.07.2004 for “ severe systemic hypertension and left ventricular hypertrophy “. There is also no dispute that the deceased life assured took treatment during the above said period in Kamineni Hospital.
11) Counsel for the appellant/opposite party argued that that there was no previty of contract between the appellant/opposite party and the deceased and that the certificate of Insurance was issued in favour of the Bank and that the policy was a non-medical and that the deceased underwent treatment for the above ailment and that the deceased suppressed the same in the proposal form and that the claim was rightly repudiated and that the Ombudsman also rightly dismissed the complaint and that the complaint was barred by resjudicata
12) Counsel for the appellant/opposite party argued that the life assured soon after issuing the certificate of insurance dated 09.06.2010 hardly survived for two months 21 days only. The deceased life assured was suffering from and was under the treatment of severe systemic Hypertension and Left Ventricular Hypertrophy much prior to the date of submitting membership i.e.,, 26.05.2010. Ex. B4 Discharge summary dt. 08.06.2004 issued by Kamineni Hospital, where he underwent treatment speaks that the life assured was admitted in the hospital on 03.06.2004 and was discharged on 08.04.2004 and he was diagnosed as severe systemic hypertension, mildly elevated serum createnine, CAG – Myocardial bridging of LAD and Concentric LVH and further reveals that “Angiogram” was done on 07.06.2004 to the life assured and in the Angiogram report it is reported that there is a Myocardial Bridging of LAD and the deceased life assured willfully suppressed the same with a malafide intention.
13). The District Forum observed that Ex.A-1 proposal form was signed on 26.05.2010.i., 6 years subsequent to taking the alleged treatment. In Ex.B4, Discharge Summary, Department of Cardiology, it is stated as “ a 30 years young male patient admitted with history of shortness of breath of few hours duration. Patient is not known hypertensive, not a known diabetic, no past history of CAD “. From the above, it is evident that the deceased life assured is not a known hypertensive and no past history of CAD except for the period from 03.06.2004 to 08.07.2004 and after six years thereafter only he took the Insurance policy. Hence the contentions of the appellant/opposite party that he is suffering from chronic ailment is not proved and hence its contention that the deceased life assured suppressed the material facts do not stand the ground. As per the insurance policy, in the event of death of the Member, the Sum Assured will be payable. The sum assured is the loan amount outstanding for the month during which the death occurs, as specified in the Certificate of insurance issued to each member on his/her admission. In case of death of an insured group member, the sum assured, as defined in the Certificate of Insurance, is payable to the group master policyholder, provided that the group master policy holder is a regulated entity otherwise the benefits will be payable to the nominee or to a person directed by a court of competent jurisdiction. Hence the contention of the appellants that the benefits under the master policy cannot be extended to the respondents/complainants or to her husband is not acceptable. We do not find any irregularity in the impugned order passed by the District Forum.
14). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, this Commission is of the view that there are no infirmities or irregularities in the impugned order and there are no merits in the appeal and hence it is liable to be dismissed.
15). Point No. 2 :
In the result, the appeal is dismissed confirming the impugned order dated 20.12.2013 in CC 05 of 2013 passed by the District Forum, Nalgonda. There shall be no order as to costs. Time for compliance four weeks.
PRESIDENT MEMBER Dated : 18.12.2017.
