C.C. No. 01 of 2009th June 2009 C.C. No. 01 of 2009nd respondent. The complainant’s husband had no C.C. No. 01 of 2009 C.C. No. 01 of 2009rd policy was C.C. No. 01 of 2009 C.C. No. 01 of 2009 C.C. No. 01 of 2009th June 2009

8

APPENDIX OF EVIDENCE

Witnesses examined.

For Complainant

PW1 B. Usha Rani, dt. 15-5-2009

PW2 T. Munirama Prasad, dt. 29-5-2009.

For Respondent : NIL

Exhibits marked for Complainant : -

Ex. A1 X/c of Proposal form No. 0017160745, dt. 4-3-2006.

Ex. A2 X/c of Proposal form No. 0020465750, dt. 19-4-2006.

Ex. A3 X/c of Proposal form No. 0035971837, dt. 12-1-2007.

Ex. A4 X/c of Death certificate issued by the Municipal Commissioner,

Proddatur.

Ex. A5 X/c of letter from R3 to complainant, dt. 9-7-2007.

Ex. A6 X/ of letter from respondents to complainant.

Ex. A7 Certificate issued by Dr. G. Prabhakar Reddy, sujata Nursing Home,

Proddatur, dt. 2-5-2009.

Ex. A8 Letter from LIC of India to complainant, dt. 28-3-2007.

Ex. A9 Inland letter card from R2 to policy holder.

Ex. A10 X/c of policy No. 0017160745 issued by the respondents.

Ex. A11 X/c of policy bearing No. 0020465750 issued by the respondents.

Ex. A12 X/c of policy bearing No. 0035971837 issued by the respondents.

Exhibits marked for Respondents: -

Ex. B1 X/c of Proposal form No. 0035971837, dt. 12-1-2007.

Ex. B2 X/c of Proposal form No. 0020465750, dt. 19-4-2006.

Ex. B3 X/c of Proposal form No. 0017160745, dt. 4-3-2006.

Ex. B4 X/c of letter from complainant dt. 8-5-2007.

Ex. B5 X/c of case sheet issued by Rotary Homeo Hospital, Proddatur.

Ex. B6 X/c of letter issued by Dr. G. Prabhakar Reddy, Sujata Nursing Home,

dt. 7-5-2007.

MEMBER MEMBER PRESIDENT

Copy to :-

1) Sri K. Guru Murthy, Advocate.

2) Sri D.V.S. Prasad, Advocate.

1) Copy was made ready on :

2) Copy was dispatched on :

3) Copy of delivered to parties :

B.V.P. - - -

DISTRICT FORUM :: KADAPA

PRESENT SRI P.V. NAGESWARA RAO, M.A., LL.M., PRESIDENT

SMT. B. DURGA KUMARI, B.A., B.L.,

SRI S. ABDUL KHADER BASHA, B.Sc., MEMBER

Wednesday, 17

CONSUMER COMPLAINT No. 01 / 2009

Biyyam Usha Rani, W/o Late Biyyam Damodhar Reddy,

aged about 42 years, Resident of D.No. 24/742,

Guravaiah Thota, Proddatur – 516 360,

Kadapa district. ….. Complainant.

Vs.

1. Bajaj Allianz Life Insurance Co. Ltd., Rep. by its

Branch manager, Branch Office, Proddatur.

2. Bajaj Allianz Life Insurance Co. Ltd., Rep. by its

Branch Manager, Branch Office, near 7 Roads, Kadapa.

3. Bajaj Allianz Life Insurance Co. Ltd., Regd. And head office,

Rep. by its Manager, G.V. Plaza, Airport road, Yerrawada,

Pune – 411 006. ….. Respondent.

This complaint coming on this day for final hearing on 16-6-2009 in the

presence of Sri K. Guru Murthy, Advocate, for complainant and Sri D.V.S. Prasad,

Advocate, for respondents and upon perusing the material papers on record, the

Forum made the following:-

O R D E R

(Per Sri P.V. Nageswara Rao, President),

1. Complaint filed under section 12 of the Consumer Protection Act 1986.

2. The brief facts of the complaint is as follows:- The complainant was the

wife of Biyyam Damodhar Reddy, who was hale and healthy prior to the death. On

4-3-2006 the R1 took a proposal form for life insurance from the deceased Damodhar

Reddy along with a cheque bearing No. 281473, for Rs. 20,000/-, dt. 4-3-2006 on

ING Vysya Bank Ltd., towards proposal deposit. The Kurnool branch issued a receipt

dt. 6-3-2006. The R1 issued first premium receipt dt. 9-3-2006 duly accepting the

proposal for life insurance covering the date of risk from 9-3-2006 subject to the

terms and conditions. The sum assured was Rs. 1,00,000/- under the policy No.

0017160745 on 10-3-2006. The basic benefit in case of death was Rs. 1,00,000/-.

The complainant was the beneficiary of 100% share to the sum assured.

2

3. On 19-4-2006 the R1 obtained another proposal form for life insurance

from the deceased Damodhar Reddy along with Rs. 5,000/- towards proposal deposit

and issued receipt dt. 24-4-2006 for sum assured Rs. 50,000/- commenced from

24-4-2006 under policy No. 0020465750. The basic benefit under the policy in case

of death was Rs. 50,000/-. The complainant was beneficiary of 100% share to the

sum assured.

4. On 12-1-2007 the R1 obtained another proposal form from the deceased

Damodhar Reddy for life insurance along with a cheque for Rs. 15,000/- vide cheque

No. 162277, dt. 11-1-2007 towards proposal deposit and a receipt dt. 17-1-2007 was

issued by Hyderabad branch accepting the proposal. The sum assured was

Rs. 1,50,000/- under policy No. 0035971837 commenced from 17-1-2007. The

death benefit was Rs. 1,50,000/-. The complainant was nominee as wife of

Damodhar Reddy. The respondent company received Rs. 40,000/- and issued three

policies i.e. Rs. 1,00,000/-, Rs. 50,000/- and Rs. 1,50,000/- totaling Rs. 3,00,000/-

by 18-1-2007. In case of death of the insured the company had to pay

Rs. 3,00,000/- to the complainant. The policy holder namely Damodhar Reddy died

suddenly on 24-4-2007 due to heart attack in his house. The death intimation was

given to R1 and R1 received all relevant documents to settle the claim. On 6-2-2008

the R1 gave Xerox copy of letter dt. 9-7-2007 that the claim was rejected under two

police Nos. 0017160745 & 35971837 and said to be refunded the account value

under one policy No. 20465750 without receiving any cheque. The reason was the

deceased had B.P. and was a Sugar patient and same was not disclosed. It was only

to escape the liability. The respondents received a letter dt. 12-2-2008 from the

complainant addressed to the 2

sugar and B.P. at any time. The alleged diseases were not the diseases and it was

only created by the respondents to evade payment. Thus the respondents were liable

to pay amount to the complainant. The LIC of India had also settled a claim after the

death of the husband of the complainant under his policy. Thus the complaint was

1

3

filed for Rs. 3,00,000/- under three policies with interest @ 24% p.a. from 20-4-2007

till payment jointly and severally and Rs. 1,50,000/- towards compensation for

deficiency of service and Rs. 5,000/- towards costs.

5. The respondents filed a counter denying that the policy holder namely

Biyyam Damodar Reddy died on account Diabetes Mellitus and Hyper tension (BP)

and was suffering from 2003 and he did not reveal in the proposal forms suppressing

the material facts. The contract of insurance was utmost good faith on the part of

the parties. The assured had to furnish all details of his health condition before

taking the policy. The contract of insurance was entered with the deceased solely on

the declaration given in the proposal form dt. 4-3-2006, for the policy No.

0017160745 and another policy No. 0020465750, dt. 9-4-2006 and policy No.

0035971837, dt. 12-1-2007. The assured made himself declared that he was hale

and healthy. He suppressed the material particulars in the proposal forms. The

complainant suppressed all the material in complaint but simply mentioned that the

assured died due to heart attack on 24-2-2007 was not correct. The assured was

suffering from B.P. and Diabetes Mellitus since 2003 and was taking treatment from

Dr. T. Muniram Prasad at Rotary Homeo Hospital, Proddatur and Dr. G. Prabhakar

Reddy, Sujatha Nursing Home, Proddatur and the death was due to the said two

diseases suffering from even before commencement of the policy. The policy would

have been rejected. The assured would have reveled the facts of his ill health. Thus

the claim was repudiated on 9-7-2007. The death due to heart attack was the

thinking of the complainant but he died due to complications developed on account

of B.P. and Diabetes. It was not correct that the claim was rejected with a view to

escape the liability under the policy No. 0020465750. The life assured apart from

paying the premium of Rs. 5,000/- and also paid topups of Rs. 10,000/- and that the

assured died before next renewal premium. As such the respondents had refunded

the topups amount by way of cheque to the complainant. It was not correct that the

LIC of India settled the claim on the death of the assured. There were no policies

4

obtained from LIC of India. In case the LIC of India had committed a mistake it was

not necessary that the respondents also should commit mistake. Under Section 45

Insurance Act the company would repudiate the claim within two years

commencement of the policy, in case the assured had suppressed the facts both his

previous health condition. Therefore, there were no merits and thus the complaint

may be dismissed with costs.

6. On the basis of the above pleadings the following points are settled for

determination.

i. Whether there is any negligence and deficiency of service on the

part of the respondents?

ii. Whether the complainant is entitled to the relief as prayed for?

iii. To what relief?

7. On behalf of the complainant Ex. A1 to A12 were marked and PW1 &

PW2 were examined. On behalf of the respondents Ex. B1 to B6 were marked. No

written arguments were filed by both parties.

8. Point No. 1 & 2 The complainant was the wife of one Biyyam Damodar

Reddy, who died on 24-2-2007 at Proddatur. She was examined as PW1. The Xerox

copy of the death certificate was Ex. A4. During the life time the deceased Damodar

Reddy took three policies and submitted the proposal forms to the respondent

mentioning the complainant as his nominee. Ex. A1 is the Xerox copy of proposal

from for Rs. 1,00,000/- sum assured under proposal No. 0017160745 on 4-3-2006.

The Xerox copy of corresponding policy issued by the respondents was Ex. A10. He

took another policy for sum assured Rs. 50,000/- and submitted a proposal form

bearing No. 0020465750, dt. 19-4-2006. The Xerox copy of proposal form was Ex.

A2 and its corresponding Xerox copy of policy was Ex. A11. The 3

obtained by the deceased Damodhar Reddy for sum assured for Rs. 1,50,000/- and

submitted a proposal form bearing No. 00035971837, dt. 12-1-2007. The Xerox copy

5

of proposal form was Ex. A3 and its corresponding Xerox copy of policy was Ex. A12.

So the respondents company issued three policies to the deceased Damodhar Reddy

during his life time. By the date of his death on 24-2-2007, the three policies were

issued.

9. Subsequent to the death of Damodhar Reddy, due to heart attack at his

hosue his wife namely Smt. B. Usha Rani, who was the complainant in the present

case as nominee submitted all the relevant documents to the R1 to settle the claim of

Rs. 1,00,000/-, Rs. 50,000/- and Rs. 1,50,000/-. But the respondents repudiated

the claim for two polices under Ex. A10 & A12 on the ground that the insured

Damodhar Reddy did not disclose his previous history of hypertension and diabetes

mellitus, in the proposal forms as he was suffering from them since October 2003

and with regard to another policy under Ex. A11 for Rs. 50,000/- the respondents

refunded Rs. 10,409/- by way of cheque No. 008312 dt. 14-6-2007. The Xerox copy

of repudiation letter was Ex. A5. The complainant made a request f o r

reconsideration of the claim under three policies but the respondents addressed a

letter that a decision would be intimated within a month. The Xerox copy of letter

was Ex. A6. The complainant filed Ex. A7 a certificate issued by Sujatha Nursing

Home, Proddatur that Damodhar Reddy was brought to the Nurshing Home on

24-2-2007 at 6.00 p.m and by that time he was found dead. The complainant

received insurance policy amount of Damohar Reddy from LIC of India of

Rs. 1,69,400/-. Ex. A8 was particulars of the claim amount issued by LIC of India

Proddatur. Ex. A9 was premium receipt in the name of Damodhar Reddy for the

policy under Ex. A10.

10. The respondents filed Ex. B1, B2, B3 the Xerox copies of proposal forms

in three policies in the name of Damodhar Reddy. Ex. A1 to A3 and Ex. B3, B2, B1

were one and same. The respondents contended that the deceased died due to hyper

tension and Diabetes Mellitus and was suffering since 2003 and failed to disclose in

the proposal forms under Ex. A1 to A3. Therefore, the claim of the complainant was

6

repudiated. The said two diseases were common ailments to many people now a

days. There was no proof from the respondents that the deceased was suffering from

two ailments since 2003. There was no documentary proof. More over the

respondents argued that the deceased was undergoing treatment at Rotary

Homeopathy Hospital, Proddatur and ffrom Sujatha Nursing Home, Proddatur. Dr.

G. Prabhakar Reddy of Sujatha Nursing Home, Proddatur issued a certificate under

Ex. A7 that the deceased was not known to him and he never gave treatment at any

point of time. Similarly Dr. T. Munirama Prasad, Rotary Homeopathy doctor was

examined by the complainant as PW2 because the respondents filed Ex. B5a Xerox

copy of case sheet with prescriptions in the name of the deceased Damodhar Reddy

to prove that Damodhar Reddy was Diabetic with hypertension and was taking

treatment at Rotary Homeo Hospital, Proddatur. But the PW2 Dr. T. Muniram

Prasad, had denied Ex. B5 and also the handwriting in Ex. B5. The PW2

categorically stated that he never treated Damodhar Reddy and he did not know such

person mentioned in Ex. B5 and it was not issued by him. Apart from it under Ex.

B5 the name of the medicines was 1) Servent, 2) Sweating, 3) Convetre and

4) Diainel. It was argued that there were no such medicines either in Homeopathy or

Allopathy. Therefore, the Ex. B5 was created document for the purpose of case by

the respondents to avoid the payment of the claim. In addition to it the respondents

filed Ex. B4 a Xerox copy of letter addressed by the complainant as PW1. On

8-5-2007 that her husband was addicted to drinking and was in the habit of

smoking and he was suffering from hypertension and diabetes. No woman, as wife

should not write such type of letter to the insurance company. Even the husband

had all worldly vices a wife should not reveal to any person including her parental

people. It was the system in Hindu marital life.

11. The PW1 denied Ex. B4. The respondents filed Ex. B6 a Xerox copy of

letter issued by Sujatha Nurshing Home, dt. 7-5-2007 that Dr. Prabhakar Reddy

treated the deceased, who was suffering from Diabetes and hyper tension. It was the

7

duty of the respondents to examine Dr. G. Prabhakar Reddy, to prove the contents of

Ex. B6 when PW1 filed Ex. A7. It was not done so. So there was no proof to Ex. B6.

In this case the complainant was examined as PW1, who expressed that at the time

of taking the policies her husband was hale and healthy and he never suppressed his

diseases in the proposal forms. She denied her signature in Ex. B4 and also the

contents. She denied that her husband was addicted to liquor and in the habit of

smoking.

12. The respondents refunded Rs. 10,409/- by way of cheque dt. 14-6-2007

under policy No. 0020465750 i.e. Ex. A11. But the respondents had rightly refunded

the amount of Rs. 10,409/- with regard to the policy under Ex. A11 because the date

of commencement of the policy as per Ex. A11 was dt. 24-4-2006 and the next due

date of premium was 24-4-2007. The insured died before payment of the premium

on 24-4-2007. Therefore, it was not a concluded contract. The policy Ex. A11 was

lapsed for non-payment in view of the death of the insured on 24-2-2007. Therefore,

the respondents refunded Rs. 10,409/- by way of cheque as mentioned in Ex. A5. In

view of it the complainant is not entitled to any benefit under the policy bearing No.

0020465750 under Ex. A11. The complainant is entitled only for other two policies

under Ex. A10 and Ex. A12 totaling Rs. 2,50,000/-. Hence, the points are answered

accordingly.

13. Point No. 3 In the result, the complaint is allowed, directing the

respondents 1 to 3 jointly and severally liable to pay Rs. 2,50,000/- (Rupees Two

lakhs Fifty Thousand Only) without any interest, compensation and costs, payable

within 60 days from the date of receipt of this order. The rest of the claim is

dismissed.

Dictated to the Stenographer, transcribed by him, corrected and pronounced

by us in the open forum, this the 17

MEMBER MEMBER PRESIDENT