BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD

F.A.No.960 OF 2012 AGAINST C.C.NO. 33 OF 2011 DISTRICT FORUM-I KRISHNA AT MACHILIPATNAM

Between:

The Divisional Manger

Divisional Office, Shriram Life
Insurance Corporation, Vijayawada

                                                        Appellant/opposite party                                                                                                      

        A N D

1.   Udathu Narayana Rao S/o Satyanarayana
Aged about 50 years, Pvt Employee,
R/o Koduru Village, Koduru Mandal

2.   Udhathu Basavamma W/o Narayana Rao
Aged 46 years, House Wife, R/o Koduru Village
Koduru Mandal

Respondents/complainants

Counsel for the Appellant                      M/s KRR Associates

Counsel for the Respondents                 M/s D.Vallabha Rao

QUORUM:   SRI R.LAKSHMINARASIMHA RAO, HON’BLE I/C PRESIDENT

                        SRI THOTA ASHOK KUMAR, HON’BLE MEMBER

AND

    SRI S.BHUJANGA RAO, HON’BLE MEMBER

TUESDAY THE THIRTY FIRST DAY OF DECEMBER  

                                TWO THOUSAND THIRTEEN

Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble I/c President)

***

1.             The opposite party insurance company is the appellant.  The respondents’ son Srinivasa Rao during his life time obtained life insurance policy bearing No.MP100600082004 from Gudivada Branch of Shriram Life Insurance Corporation and the policy bearing no.L4100800122551 from Cherlapalli branch of Shriram Life Insurance Corporation and he appointed the respondent no.1 and the respondent no.2 respectively as his nominees for the purpose of sum insured therein.

2.             The insured died on 4.2.2009.  The respondents submitted claim and as the claim was not settled the respondents got issued notice on 24.1.2011 and filed the complaint later.

3.             The appellant resisted the claim contending that the insured obtained life insurance policy which is a unit linked policy commencing from 19.8.2008 with annual premium of `10,000/- for an assured sum of `1,50,000/- and he suppressed his health condition in the proposal form.  The first respondent informed the appellant that their son died of typhoid and second respondents addressed letter dated 4.7.2009 informing the appellant that their son died due to fever, loose motions and chest pain.

4.             The appellant submitted that the claim investigation revealed that the insured was suffering from HIV +  a further enquiry had shown that he died of complications of HIV (AIDS).  The appellant requested the respondent to submit medical record of the treatment undergone by the insured and sent reminders on 5.6.2010 and 30.6.2010 and 20.1.2010 and there was no response from the respondents.  The appellant, as such had not taken decision either admitting or rejecting the death benefit under the policy.

5.             The first respondent filed his affidavit and the documents, Exs.A1 to A4 and on behalf of the appellant insurance corporation, its Assistant General Manager filed his affidavit and the documents, Exs.B1 to B12. 

6.             The District Forum allowed the complaint on the premise of failure of appellant insurance corporation to settle the claim and closing the claim on unsound and unreasonable grounds.

7.             Aggrieved by the order of the District Forum,  the opposite party insurance company has filed   appeal contending that there is inconsistence in  pleas in the version of the respondents as regards to the death of the insured and the claim investigation had shown that the insured was suffering from HIV + which he had not disclosed in the proposal form.  It is contended that he was hospitalised and treated in Assisi Hospital and Dermatological Centre, Community Care Centre prior to taking the insurance policy. 

8.             The point for consideration is whether the order of the District Forum vitiated by misappreciation of fact or law?

9.             Issuance of insurance policy  in favour of the respondents’ son and his death on 4.2.2009 are the facts which are beyond any dispute.  The contention of the learned counsel for the appellant insurance corporation is that the insured died as a result of complications HIV (AIDS).  The appellant had made the investigation report dated 27.9.2009 and photo copy of medical attendant certificate, claim form B dated 20.2.2009 made basis in support of the indecisive stage of the claim.  The District Forum has opined that the appellant had not adduced cogent evidence to support its plea that the insured suppressed his health condition at the time of taking the insurance policy.

10.            The District Forum has observed that the investigator’s report though bears significance, yet it was based on the investigation personal observation and hearsay evidence and also that the investigator had not mentioned the names of the persons whom he made enquiry with and he has not filed his affidavit in support of his enquiry made with regard to the death of the insured.  The investigator had not made any observation as to whether the insured was suffering from HIV prior to taking the first life insurance policy in the year 2006 or before obtaining the second life insurance policy. 

11.            The District Forum has discussed the facts and circumstances under which failure of the appellant insurance corporation in the matter of its indecisiveness as to settle or repudiate the claim and this Commission this Commission does not find any infirmity in the findings returned by the District Forum.  The appellant except issuing letter to the respondents, has not made out any case to repudiate the claim even though the investigator  filed his report  without  there being any cogent evidence as to the nature of the treatment and period of treatment that the insured stated to have undergone. 

12.            In Venkata Naidu Vs LIC of India IV (2011) CPJ 6 (SC) the Hon’ble Supreme Court held that the insurance company has to prove by cogent evidence that the insured did not disclose correct facts relating to his illness and in the absence of tangible evidence to prove that the deceased had withheld information about his hospitalization and treatment, the repudiation of claim is not justified.  It was also held that there should be nexus between the cause of the death and the disease concealed by the insured. 

13.            For the foregoing reasons, we are of the view that the appellant has not substantiated  its case that the insured suppressed that he was suffering from HIV + prior to the time of submitting the claim form.  The appeal as such cannot be held to have any substance. 

14.            In the result the appeal is dismissed confirming the order of the District Forum.  There shall be no separate as to costs.  Time for compliance four weeks.

                                                                                Sd/-

I/C PRESIDENT

        Sd/-

                                                                            MEMBER

                                                                                Sd/-

                                                                     MEMBER

                                                                   Dt.31.12.2013

కె.ఎం.కె.*