BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Friday the 30th day of January , 2009
C.C.No. 129/08
Between:
Y. Ravindra Babu, S/o. Late Y. Subramanyam,
H.No.77/1/7A, Pancharathna Colony, Z.P.School Road, Kallur Estate, Kurnool-518 002. … Complainant
Versus
- Shri Ram Life Insurance Company Limited, Represented by its Branch Manager,
Shri Ram Chits Office - II, H.No.50-843, Plot No. 6, Upstairs, Gayatri Estate, Kurnool-518 002.
- Assistant General Manager, Shri Ram Life Insurance Company Limited,
H.No.3-6-478, 3rd Floor, Anand Estates, Liberty Road, Himayatnagar, Hyderabad-500 029. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri.P.Siva Sudharshan, Advocate, for the complainant, and Sri.B.V.Ramana Reddy , Advocate for opposite party No.1 and Sri.S.V.Krishna Reddy , Advocate, for the opposite party No. 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. C.Preethi, Lady Member)
C.C.No.129/08
1. This consumer complaint of the complainant is filed U/S 11 and 12 of C.P.Act, 1986 seeking a direction on opposite parties to pay policy amount of Rs.3 lakhs with 24% interest p.a , Rs.10,000/- towards mental agony , Rs.2,000/- towards cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainants father Y. Subramanyam insured his life with opposite parties for Rs. 3 lakhs and the policy bearing No. LN 08070086565 was issued by opposite parties and the said policy commenced from 04-05-2007. The policy holder Y. Subramanyam died on 28-09-2007 due to heart attack and a claim was preferred by the complainant as nominee with all relevant documents but the opposite parties replied on 31-01-2008 stating that the policy holder with held correct information regarding his health at the time of issue of the policy and repudiated the claim of the complainant . But the complainant submits that the policy holder never suppressed any facts regarding his health and his death was a natural one and alleges deficiency of service on part of opposite parties.
3. In support of his case the complainant relied on the following documents viz., (1) claim repudiation letter dated 31-03-2008 , (2) certificate of death dated 02-11-2007 and (3) claim form “B” , besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A3 for its appreciation in this case and replies to the interrogatories exchanged.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties appeared through their standing counsel and contested the case by filling separate written versions.
5. The written version of opposite party denies all the allegations in the complaint and submits that the complainant had made opposite party No. 1 in this present complaint without any factual basis and no relief is prayed by the complainant against opposite party No. 1 and opposite party No. 1 is not a proper party to grant relief as prayed by the complainant and it is a mere service provider by collecting premium amount on behalf of Sreeram Life Insurance Company Limited and forwarding proposal form / claim form to the concerned company which is the proper party and lastly seeks for the dismissal of complaint against opposite party No. 1.
6. The written version of the opposite party No. 2 denies all the allegations but admits the late Y. Subramanyam has taken a policy bearing No. LN 08070086565 from opposite party for Rs. 3 lakhs which
has commenced from 04-05-2007 . It further submits that at the time of taking the policy the deceased policy holder did not disclose his health conditions , pre-existing decease and habits etc., in the proposal which are specifically enumerated in Clause.25 of proposal form . The complainant who is the son and the nominee of the policy holder informed the opposite party as to death of the policy holder on 28-09-
2007 due to heart attack . Thereafter , the complainant submitted claim form but failed to submit medical records pertaining to the treatment of the deceased policy holder. As it is an early claim the opposite parties conducted investigation which revealed that the deceased policy holder was a diabetic and having a habit of smoking and drinking since long time which were not disclosed in the proposal form under Clause.25. As the deceased disclosed the above the policy would not have been issued . Hence the claim of the complainant was repudiated vide their letter dated 31-03-2008. As the deceased policy holder concealed material facts at the time of the taking the policy , the policy has now become
void and un impossiblely and not legally binding on the opposite parties and the opposite parties are not reply to pay any amount to the complainant and seeks for the dismissal of complaint with exemplary cost.
7. In substantiation of their case the opposite parties relied on the following documents viz.,(1) proposal for unit linked insurance ,(2) Sree plus policy schedule (3) first premium receipt (4) letter dated 31-03-2008 addressed to G.Ramurthi , besides to the sworn affidavit of opposite party No. 2 in reiteration of his written version averments and the abovedocuments are marked as Ex.A1 to A4 for its appreciation in this case and replies to the interrogatories exchanged.
8. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties ?.
9. It is a simple case of the complainant that his father Y.Subramanyam has insured his life with opposite parties for Rs.3 lakhs . The Ex.B1 is the proposal for unit linked insurance for taking the policy by the deceased Y. Subramanyam . The Ex.B2 is the Shri Plus scheme issued to the deceased Y. Subramanyam for Rs. 3 lakhs by the opposite parties. The Ex.B3 is the first premium receipt issued by opposite parties to the deceased as to receiving of premium towards the policy in Ex.B2.
10. The policy holder died on 28-09-2007 and a claim vide Ex.A3 dated 01-12-2007 was preferred by the complainant as nominee and the claim was repudiated by opposite parties on 31-03-2008 vide Ex.A1. In
the Ex.A1 it is stated by the opposite parties that the policy holder was having pre-existing health problem and he did not reveal , the same in the proposal for taking the policy and the complainant / nominee is not entitled to the death benefit under the policy.
11. The main contention of opposite parties is that the deceased Y.Subramanyam was having pre existing health problem and suppressed the said material facts of his health at the time of taking the policy, the opposite parties strongly contended that the policy holder concealed the above said material facts and hence they are absolutely justified in repudiating the claim of the complainant . The opposite parties in support of their contentions as to their repudiation that the policy holder was having pre existing health problem no document is placed on record , except mere allegation that the policy holder concealed material facts, nothing is on record to substantiate their contention. Except filling Ex.B1 to B4 no document is on record to show that the deceased policy holder was having pre existing decease prior to taking the policy. No doctor has been examined nor any affidavit of any medical expert has been produced to show that the deceased was suffering with any pre existing decease at the time of taking the policy. In the absence of any supporting material to substantiate the contentions of opposite parties it cannot be said the deceased policy holder was having pre existing decease and the same has been concealed by the policy holder in the proposal for taking the policy.
12. The other contention of opposite parties is that the policy holder did not disclose his health conditions, pre existing decease and habits which are specifically enumerated in Clause 25 of the proposal form. Clause 25 in the proposal form ( Ex.B1) requires the policy holder to fill up his personal medical history when there is no personal medical history, the policy holder is not expected to fill up the said column. The opposite parties strongly contended that the policy holder was having habit of drinking and smoking which lead to the death of policy holder due to heart attack . But there is no material on record to show the alleged nexus between the alleged habits and actual cause of death.
13. The Ex.B4 is the letter of one Y. Rama devi dated 31-03-2008 addressed to G. Ramurthi stating that the policy holder was having habit of drinking and smoking and he later on stopped drinking. The opposite parties relied on the said Ex. B4 to show that the policy holder was having habit of drinking , but in the said letter itself it is stating that he stopped drinking . Hence, the opposite parties cannot rely on the said exhibit , which does not support the case of the opposite parties.
14. In the instant case there being any material on record as to the pre-existing health problem to the policy holder either before or at the time of taking the policy. Hence, the conduct of opposite parties in
repudiating the claim arising on the policy of the deceased Y.Subramanyam is totally unjust and amounts to deficiency of service and the complainant is remaining entitled to the policy amount of the
deceased Y. Subramanyam and the opposite parties by their avoiding conduct put the complainant to lot of mental agony and also to seek redressal in this forum. Hence the opposite parties are liable to pay compensation of Rs. 30,000/- and Rs.10,000/- as costs of the case besides to the assured amount.
15. In the result, the complaint is allowed directing the opposite parties 1 and 2 to pay to the complainant the assured amount of Rs. 3 lakhs along with net asset value of the units of the policy holders account and Rs.30,000/- as compensation for mental agony and Rs.10,000/- as costs of this litigation, within one month from the date of receipt of this order. In default, the opposite parties 1 and 2 shall pay the supra award amount with 12% interest p.a from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 30th day of January , 2009
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Claim repudiation letter dated 31-03-2008.
Ex.A2. Certificate of death dated 02-11-2007.
Ex.A3. Claim form ‘B”.
List of exhibits marked for the opposite parties:
Ex.B1. Proposal for unit linked insurance.
Ex.B2. Sri Plus policy schedule.
Ex.B3. First premium receipt.
Ex.B4. Letter dated 31-03-2008 addressed to G.Ramurthi.
Sd/- Sd/-
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
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