BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Sri.Y.Reddappa Reddy, M.A., L.L.M., President,
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Tuesday the 3rd day of March, 2015
C.C.No.67/2012
Between:
S.Sankaramma,
M/o Late S.Seshaiah,
Hindu, Aged about 56 Years,
H.No.4-241, Balapalapalli Village,
Bethamcherla Mandal,
Kurnool District. …Complainant
-Vs-
1. The Authorized Signator,
Reliance Life Insurance Company Limited,
Reliance House, 6th Floor, No.6,
Haddows Road, Nungambakkam,
Chinnai-600 006.,
2. The Branch Manager,
Golden Multi Services,
D.No.40/385,
U-Con Plaza, Kurnool-518 002.
3. The Branch Manager,
RLIC, Height Insurance Services Limited,
75C, Park Street, 4th Floor,
Unit 4/4, Kolkata-700 016.
4. Reliance Life Insurance Company Limited,
Represented By its Managing Director,
H Block, 1st Floor,
Dhirubhai Ambani Knowledge City,
Navi Mumbai-400 710,
Maharastra. …OPPOSITE PARTies
(Amended as per Order in IA No.102/2012 dated 20-12-2012 and Amended as per Order in IA.No.25/2013 dated 09-04-2013)
This complaint is coming on this day for orders in the presence of Sri.M.Sivaji Rao, Advocate for complainant and Sri.M.Murali Mohan, Advocate for opposite parties 1 and 4 and Sri.M.Azmathulla, Advocate for opposite party No.2 and opposite party No.3 called absent and set exparte and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member,)
C.C. No.67/2012
1. This complaint is filed under section 11 and 12 of Consumer Protection Act, 1986 praying:-
- To direct the opposite parties jointly and severally to pay the assured amount with profits with interest at the rate of 24% from the date of death.
- To pay a sum of Rs.25,000/- towards compensation for causing mental agony and hardship.
- To grant compensation of Rs.20,000/- for mental worry.
- To pay costs of this complaint.
- To pass any other order or orders that are deem to the fit and proper circumstances of the case.
2. The facts of the complainant in brief run as follows:- The complainant is the mother of Late S.Seshaiah. On 30-11-2011 S.Seshaiah insured his life with the opposite parties 1 and 4 through opposite parties 2 and 3 under the policy bearing No.19529935 for assured sum of Rs.2,00,000/- with annual premium of Rs.17,889.43/- for a period of 16 years. The complainant is the nominee under the policy. On 04-12-2011 the insured died, due to Heart Attack. The complainant who is the mother and nominee under the policy submitted the claim to opposite parties. The opposite party illegally repudiated her claim on a false ground of suppression of material facts with regard to his health in the Proposal Form. There is no nexus of alleged disease tuberculosis with the cause of death. At the time of taking policy the insured was hale and healthy. There is a deficiency of service on the part of opposite parties and caused mental agony. Hence this complaint.
3. Opposite parties 1 and 4 filed one and the same written version stating that the complaint is not maintainable. It is admitted that the Life Assured Late.Sri.Sankati Seshaiah had obtained Reliance Cash Flow Plan Policy bearing No.19529935 for an assured sum of Rs.2,00,000/- and the complainant is the nominee under the policy. It is also admitted that the complainant submitted claim form to opposite parties and the opposite parties repudiated the claim on 23-04-2012 for non discloser of material facts. It is submitted that after enquiry and investigation, it was found that the deceased was already diagnosed for tuberculosis and he had under gone treatment for tuberculosis at TB Unit Bethemcherla, in the year 2009 vide patient No.2009/446 and the deceased life assured had knowledge about the disease, and deliberately concealed the said facts in the proposal form. The deceased life assured violated the terms and conditions of policy. The opposite parties rightly repudiated the claim of the complainant. There is no deficiency of service on the part of opposite parties 1 and 4. Hence the complaint is liable to be dismissed against opposite parties 1 and 4.
Opposite party No.2 filed written version stating that the complaint is neither just nor maintainable either in law or on facts. It is submitted that the opposite party No.2 has no relation with opposite party No.1. The complainant wrongly impleaded the opposite party No.2. There is no cause of action against this opposite party No.2. The complaint is liable to be dismissed against opposite party No.2.
Opposite party No.3 called absent and set exparte.
4. On behalf of the complainant filed Ex.A1 to Ex.A3 are marked and sworn affidavit of complainant and third party affidavits of Bellari Seshasayanna and Dr.B.Vara Prasad are filed. On behalf of opposite parties filed Ex.B1 to Ex.B7 are marked and sworn affidavit of opposite parties 1 and 2 are filed.
5. Complainant and opposite parties 1 and 4 filed written arguments.
6. Now the points that arise for consideration are:
- Whether there is deficiency of service on the part of opposite parties?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINTS i and ii:- Admittedly the insured Sankati Seshaiah obtained the Life Insurance policy from opposite parties 1 and 4 through opposite parties 2 and 3 under Ex.A1 and Ex.B2 for an assured sum of Rs.2,00,000/- with annual premium of Rs.17,889.43 Ps., for a period of 16 years. Ex.B1 is the photo copy of proposal form and Ex.B3 is the photo copy of policy terms and conditions. The deceased insured died on 04.12.2011 due to Heart Attack Ex.A2 is the Death Certificate issued by Civil Assistant Surgeon Government General Hospital, Kurnool.
Admittedly the complainant submitted claim form to opposite parties. the opposite parties repudiated the claim on 23.04.2012, on the ground that the deceased insured suppressed the material facts regarding his health at the time of taking policy, the repudiation letter is marked as Ex.A3=Ex.B7. It is the case of the complainant that the insured was hale and healthy, suddenly he got chest pain and he was admitted to Surgical Day Care Clinic, Kurnool, where Dr.B.Vara Prasad was declared him dead. There is no intentional suppression with regard to his health by insured. It is the case of opposite parties 1 and 4 that the Life Assured availed Reliance Cash Flow Plan (Ex.A1=Ex.B2). In the proposal form (Ex.B1) is the life assured had given wrong answers, when the following specific questions (28, 29) were asked to him regarding his health. During the investigation, it was found that the life assured was suffering from Pulmonary Tuberculosis in the year 2009 and was taken treatment at T.B. Unit, Bethamcherla under the revised national tuberculosis control programme till August, 2010 vide patient No.2009/446 which is marked as Ex.B5. The Life Assured had deliberately concealed the said fact in the proposal form with an intention to deceive the opposite parties. So this policy shall be void, all the claims to any benefits shall seize and all the monies shall be forfeited. The investigation report in marked as Ex.B4 and affidavit of investigator is marked as Ex.B6. The opposite parties rightly repudiated the claim of complainant on 23.04.2012 under Ex.B7=Ex.A3. The learned counsel appearing for opposite party No.1 and opposite party No.4 contended that the above police issued on the representation of the insured and he ought to have made full disclosure of all the relevant facts. But the insured suppressed the material facts regarding his pre existing disease of tuberculosis and had taken treatment in the year 2009. It is a violation of terms and conditions of policy. There is no deficiency of service on the part of opposite party No.1 and opposite party No.4 and they are not liable to pay amount to the complainant. He cited decision of Supreme Court in Life Insurance Corporation of India and others -Vs- Asha Goel (Smt) and Another (2001) SCC page 160, Export Credit Guarantee Corporation of India -Vs- Garg Sons International I (2013) SCALE page 410 where in it was held that the contract of Insurance are Uberrimae fides and every fact of material must disclosed or providing any false or incorrect information in the policy is a violation of the Insurance contract.
The Opposite party No.2 in his sworn affidavit stated that the complainant wrongly impleaded opposite party No.2 as a party in this present complaint. This opposite party has no relationship with opposite party No.1. There is no cause of action against this opposite parties.
The learned counsel appearing for the complainant argued that the insured died, due to Heart Attack in surgical Day-Care Clinic, Kurnool Dr.B.Vara Prasad declared him dead. The opposite parties repudiated the claim, on the ground that insured alleged to be taken treatment for pre existing disease, tuberculosis. There is no nexus between the cause of death and the disease as alleged by opposite parties. He relied on decisions reported in (a) IV (2012) CPJ 646 (NC) Life Insurance Corporation -Vs- Priya Sharma. Where in it was held the onus to prove is on the Insurance Company to prove the pre existing disease of insured, not examined any doctor to prove this fact, the repudiation not justified.
(b) IV (2007) CPJ 244 (AP) A.Venkata Ravi Kishore -Vs- Life Insurance Corporation of India and Another,
(c) (2011) III CPJ 418 (NC) Life Insurance Corporation and Another -Vs- Ashok Manocha it was held that medical certificates produced by produced by petitioner not proved on record production of document is different from proof of same.
Admittedly the opposite parties issued policy bearing No.19529935 in favour of the Insured deceased, under Ex.A1=Ex.B2 and the complainant submitted claim form to opposite parties and the opposite parties repudiated the same under Ex.B7=Ex.A3 on 23.04.2012, on the ground that the insured/deceased suppressed the material facts regarding his health and insured/deceased had taken treatment for tuberculosis in the year 2009. The opposite parties produced Ex.B5 the photo copy of revised National Tuberculosis Control Programme issued by the Primary Medical Centre, Bethamcherla. But the burden is on the opposite parties to prove the alleged suppression of material facts by insured by evidence. The opposite parties did not examine neither the doctor nor an affidavit of a doctor, who treated the patient, is filed. The complainant filed Third party affidavit of Bellari Seshsayana, who is the Sarpanch of three Villages, Kolumulapalli, Balapalapalli and P.Kottala. He stated in his affidavit that he knows the insured, resident of Balapala Palli Village, and he died on 04.12.2011 due to Myocardial Infarction, in Surgical Day Care Clinic, Kurnool. The complainant also filed an affidavit of a doctor Dr.B.Vara Prasad, Civil Assistant surgeon in Government General Hospital, Kurnool, and running a clinic in the name of Surgical Day Care Clinic in Kurnool. He stated in his affidavit that the insured/deceased brought to his clinic with complaint of chest pain and breathlessness and within few minutes patient died. The cause of death may be due to myocardial infarction he also issued Death Certificate. As per the third party affidavits, it is evident that the Insured/deceased died due to Heart Attack. There was no credible proof of the fact that the deceased/Insured was suffering from any pre existing disease as contended by the opposite parties and the nexus between cause of death and the alleged illness was not established. The opposite parties could not establish that the insured concealed the material facts with regard to his health at the time of taking policy. We consider all the material available on record and in the light of above decisions we hold the opinion that there is a deficiency of service on the part of opposite parties. Hence the complainant is entitled for an assured amount of Rs.2, 00,000/- under the said policy.
10. Point No.iii:- The complainant claimed for amount of Rs.2,00,000/- with 24% interest from the date of death and for sum of Rs.25,000/- towards mental agony. We consider all material available on record, facts and circumstances of the case, we are of the view that the complainant is entitled for an amount for amount of Rs.2,00,000/- with 9% interest per annum form the date of complaint i.e., on 14.08.2012 till the date of realization and further entitled compensation of Rs,5,000/- towards mental agony.
11. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay an assured amount of Rs.2,00,000/- with interest at 9% per annum from the date of complaint i.e., on 14.08.2012 till the date of realization and further direct to pay compensation of Rs.5,000/- towards mental agony and Rs.1,000/- as costs of the case. Time for compliance is one month from the date of receipt this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 3rd day of March, 2015.
LADY 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 Photo copy of Policy Schedule.
Ex.A2 Photo copy of Death Certificate issued Civil Assistant Surgeon,
Government General Hospital, Kurnool.
Ex.A3 Photo copy of Repudiation Letter dated 23-04-2012.
List of exhibits marked for the opposite parties:-
Ex.B1 Photo copy of the Common Proposal Form for Life Insurance.
Ex.B2 Photo copy of Policy Schedule.
Ex.B3 Photo copy of Policy terms and conditions.
Ex.B4 Photo copy of Investigation Report dated 27-01-2012.
Ex.B5 Photo copy of (Form-C) Revised National Tuberculosis Control Programme issued by the Primary Medical Centre, Betamcherla.
Ex.B6 Affidavit of Investigator of the Insurance Company.
Ex.B7 Photo copy of Repudiation Letter dated 23-04-2012.
LADY 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 :
Copy was dispatched on :
