BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
FA 443 of 2013 against CC No. 48 of 2011 , District Consumer Forum-I, Chittoor.
Between
1. J. Baby W/o Late J. Velan, aged 36 years, House – wife
2. Minor V. Sai Priya D/o Late J. Velan, aged 16 years
3. Minor Sai Purushotham S/o Late J. Velan, aged 15 years
Minors 2 & 3 are represented by their mother and guardian
Smt. J. Baby, the appellant no. 1 herein
All are residing at D.No.21-644, Sugar Factory
Colony, Kalavagadda, Near Chittoor Sugar Factory,
Chittoor – 517001…. Appellant/Complainant
And
1. The Branch Manager, HDFC Standard Life Insurance
Company Ltd., Office situated at Opp. Devi Theatre,
Kattamanchi Road, Chittoor – 517001.
2. The HDFC Standard Life Insurance Company Ltd.,
Rep. by its Authorized Signatory, holding office at
Ground and 1st Floor, Gupta Garments Building,
S.P.7A Thiru Vika Industrial Estate, Guindy,
Chennai – 600032.
3. The HDFC Standard Life Insurance Company Ltd.,
Rep. by its Authorized Signatory, holding office at
Ramon House, H.T. PAREKH Marg, 169 Back Bay,
Reclamations Church Gate,
Mumbai – 400020… Respondents/opposite parties
Counsel for the Appellant : Mr. D. Seshasayana Reddy
Counsel for the Respondents : Mr. S. Gopal Singh and Associates
QUORUM:
HON’BLE SRI JUSTICE GOPALA KRISHNA TAMADA, PRESIDENT
AND
SRI R. LAKSHMINARASIMHA RAO, HON’BLE MEMBER
FRIDAY, THE ELEVENTH DAY OF JULY, TWO THOUSAND FOURTEEN
Oral Order : ( As per Sri R. Lakshminarasimha Rao , Hon’ble Member )
1 The complainants are the appellants.
2 The facts of the case leading to the filing of the appeal are that the husband of the first appellant during his life time obtained life insurance policy bearing number for a sum of Rs. 5 lakhs for the period commencing from 13.11.009 and he died on 19.6.2010. After the death of the insured, the appellants submitted claim which was repudiated on the ground that the insured suppressed material particulars about his previous ill health at the time of submitting the proposal. Challenging the repudiation of their claim, the appellants filed the complaint seeking for the sum assured with interest @ 18% pa and an amount of Rs.50,000/- towards damages.
03 The respondent-Insurance company resisted the claim on the premise that the insured suppressed the fact of his previous ill heath and he died shortly after obtaining the insurance policy. The respondent has contended that the claim investigation disclose that the insured was suffering from cancer and the claim was rightly repudiated as also there was no deficiency in service on the part of respondent insurance company.
04 The first appellant in support of their case filed her affidavit and the documents Ex. A1 to A3. On behalf of the respondent insurance company, its Branch Manager filed his affidavit and examined Dr. C. Arun kumar, Civil surgeon, Government Head Quarters Hospital, Chittoor. Ex. B-1 to B-3 had been marked on the side of the respondent. Case sheet of the deceased husband of the appellant no. 1 is marked Ex. X-1.
05 The District Forum dismissed the complaint on the premise that the insured gave answer in negative to the questionnaire in the proposal that whether he had undergone or recommended to undergo any medical examination. The District Forum observed that the insured was suffering from ‘ cancer’ and he suppressed the fact to obtain the insurance policy. The District Forum opined that there was no deficiency in service on the part of the respondent insurance company in the matter of repudiation of the claim.
06 Aggrieved by the order of the District Forum, the complainants have filed appeal contending that the insured died due to cardiac arrest and not due to suffering from cancer. The appellants contended that RW. 2 had not stated that the first appellant’s husband died due to cancer and his evidence is not helpful to the case of the respondent insurance company. Further, the appellants have contended that the policy was issued n 13.11.2009 and the insured died on 9.6.2010 due to heart attack and the policy was in force at the date of incident and as such the respondent is liable to pay the sum assured to them.
07 .The learned counsel for the respondent insurance company filed written submissions.
08 .The point for consideration is whether the order of the District Forum suffers from misappreciation of facts or law ?
09. The facts which have been admitted and which do not require any discussion are that on 13.11.2009 the respondent insurance company had issued Life Insurance Policy for a sum assured of Rs.5,00,000/- in favour of the first appellant’s husband and the insured died on 19.06.2010. The appellants had lodged claim for payment of the sum assured under the policy.
10 The respondent -insurance company repudiated the claim on the premise that the insured gave negative reply to the questionnaire in the proposal as to whether he suffered from cancer or tumor and he had given incorrect statement as to is occupation that he was proprietor of Velu Financiers and actually he was under the employment with Chittoor Cooperative Sugars limited
11. The learned counsel for the appellant has contended that the respondent Insurance company failed to establish that the insured suffered from cancer. He has submitted that an opinion of the doctor which is mere suspicion cannot be made platform by the respondent to reject the claim of the appellants. The learned counsel for the respondent has submitted that the deceased was diagnosed to be suffering from Peri Anal Mass Cancer in Rectum and he undergone treatment therefor. The learned counsel supported the order of the District Forum.
12 There is no denial of the fact that the first appellant’s husband submitted proposal wherein he replied in negative to the question as to whether he had undergone medical examination and suffered from Tumor or Cancer. A perusal of the O.P. Chit dated 19.08.2009 issued by District Head quarters hospital, Chittoor goes to show that the insured was suffering Peri Anal Mass and the doctor suspected it to be cancer in Rectum. The doctor had also noted that the insured was suffering from pain in stomach and he prescribed medicine. The prescription of Krish Artho Care issued by Dr. S. M. Kishore would establish the contention of the respondent that the insured consulted medical practitioner and undergone X-ray and also the doctor prescribed medicine.
13 The case record of the Government Hospital coupled with the evidence of Dr. C. Arun Kumar establish the fact that the insured was diagnosed to be suffering from cancer. The doctor has stated that he suspected the disease to be cancerous and advised the insured to go to higher centre for further treatment. In his cross examination, the doctor stated that on clinical examination and basing on symptoms he suspected that the insured was suffering from cancer. He stated that except touching the mass with his finger he had not done any other tests such as blood test and biopsy.
14 The doctors statement would support the case of the respondent that the insured was subjected to medical examination and he suffered Peri Anal Mass in Rectum. It is true, the doctor RW.2 had not advised for biopsy. However, he referred the first appellant’s husband to higher centre. It is to be noted that suppression of the ill health of the first appellant’s husband whether it was diagnosed to be a case of cancer or not, is material fact for the respondent insurance company to determine the contract of insurance. We do not find any infirmity in the conclusion arrived at, by the District Forum that there was no deficiency in service on the part of the respondent Insurance Company.
15 The policy issued in favour of the first appellant’s husband is a regular premium unit linked life insurance policy and it is mentioned in the policy that the policy will participate in the investment performance of the funds of the HDFC Standard Life Insurance company Limited. It is also found mention in the policy that the Unit Linked policy is different from traditional insurance policy and it is subjected to investment risk in investment portfolio which has to be borne by the policy holder. It is not known whether the fund value is paid to the appellants. Both the parties are silent on the aspect. Usually, in the matter of claim related to unit linked life insurance policy, the insurance company would pay the fund value and in its discretion repudiate the claim for the sum assured. In so far as the sum assured, the repudiation of the claim is held justified and as such the appeal is liable to be dismissed.
16 In the result, the appeal is dismissed confirming the order of the District Forum. There shall be no separate order as to costs.
PRESIDENT
MEMBER
DATED : 11.7.2014.
