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

Wednesday the 1^st day of April, 2015

C.C.No.114/2013

Between:

Golla Pedda Saidu,

S/o Ranganna,

H.No.3-48, Veerapuram Village,

Gadwal Mandal-509 125.

Mahaboob Nagar District.                                                       …Complainant

-Vs-

1. Allegro Capital Advisor Private Limited,

   Represented by its Manager,

   9^th Floor, "Residency No.2”,

  Residency Road,

   Bangalore-560 025
 

2. DLF Pramerica Life Insurance Company Limited,

    Represented by its Managing Director cum CEO,

    4^th Floor, Building No.9, Tower B,

    DLG City, Phase III,

   Cyber City, Gurgoan-122 002.                                     …OPPOSITE PARTIES

This complaint is coming on this day for orders in the presence of Sri.P.Siva Sudarshan, Advocate for complainant and opposite party No.1 called absent and set exparte and Sri.N.Narayana Reddy, Advocate for opposite party No.2 and upon perusing the material papers on record, the Forum made the following.                                          

ORDER

(As per Smt. S.Nazeerunnisa, Lady Member)

C.C. No.114/2013

1.       This complaint is filed under section 11 and 12 of Consumer Protection Act, 1986 praying:-

1. To pay the policy amount a sum of Rs.4,28,500/- to the complainant with interest at 24% per annum from the date of death of policy holder i.e., 06.08.2011 to till the date of realization.

2. To grant a sum of Rs.10,000/- towards mental agony.

3. To grant a sum of Rs.5,000/- towards costs of the complaint.

       And

4. To grant any other relief as the Honourable Forum deems fit and proper in the circumstances of the case.

2.    The case of the complaint in brief is as under:- The complainant is the son of Ranganna. On 22.07.2011, Late Ranganna insured his life with opposite party No.1 for an assured sum of Rs.2,14,450/- in policy bearing No.000076414 with its annual premium of Rs.20,225/-.  As per the policy condition the policy holder or his nominee is entitled for a double policy amount of Rs.4,28,500/-. The insured died on 06.08.2011 due to chest pain and death is natural one.  The complainant being a nominee under the policy submitted the claim form to opposite parties.   The opposite parties did not pay the policy amount.   On 09.04.2012 the opposite party No.2 repudiated the claim of the complainant, on the ground that the deceased/insured suppressed the correct information regarding his health at the time of taking the policy.  But the insured never suffered from any cancer as alleged by the opposite parties.  His death is natural.  The opposite parties not settled the assured amount without any reason and lawful cause.  There is deficiency of service on the part of opposite parties.  Hence the complaint.

3.       Opposite partyNo.1 called absent and set exparte.

 Opposite party No.2 filed written version stating that the complaint is neither maintainable in law nor on facts.  It is admitted that the life assured Ranganna obtained the insurance policy from opposite parties under DLF pramerica assure money + plan” bearing No.000076414 for an assured sum of Rs.2,14,450/-  by paying the annual premium of Rs.20,225/- policy term is 20 years.  It is submitted that after the death of insured on 06.08.2011 the complainant made a death claim to opposite parties.  The opposite parties conducted the investigation and during the investigation it was found that the Deceased Life Assured was suffering from liver problem since prior to filling the proposal form, he underwent liver function test prior to proposal sign date, the Laboratory Reports of Prime Diagnostic Services dated 09.06.2011 and 15.06.2011 reveals that DLA was suffering from liver problem prior to obtained the policy and insured suppressed the same at the time of taking policy.  The contract of insurance is based on utmost good faith.  The insured is obliged to give full and correct information on all matters and non-disclosure of material facts in obtaining the said policy, he is violated terms and condition of policy and the opposite parties rightly repudiated the claim of the complainant.  There is no deficiency of service on the part of opposite parties.  Hence the complaint is liable to be dismissed.

4.       On behalf of the complainant Ex.A1 to Ex.A4 are marked and sworn affidavit of the complainant is filed. On behalf of opposite parties Ex.B1 to Ex.B8 are marked and sworn affidavit of opposite party No.2 is filed.

5.       Both sides filed Written Arguments.

6.       Now the points that arise for consideration are:

1. Whether there is deficiency of service on the part of opposite parties?

2. Whether the complainant is entitled for the reliefs as prayed for?

3. To what relief?

7.      POINTS i and ii:  Admittedly the life assured/deceased Ranganna obtained the insurance policy from opposite parties under “DLF Pramerica Assurance Money + Plan” bearing No.000076414 for an assured amount of Rs.2,14,450/- with its annual premium of Rs.20,225/- for a term of 20 years with its date of commencement is 22.07.2011 and the complainant is the nominee under the policy.  The photo copy of policy is marked as Ex.A1=Ex.B1. The insured died on 06.08.2011 due to chest pain.  The photo copy of Death Certificate issued by Registrar of Birth and Death, G.P.Veerapuram Village, Gadwal Mandal, Mahaboob Nagar District dated 29.08.2011 is marked as Ex.A3=Ex.B5.  The complainant being the nominee under the policy submitted a claim form to opposite parties.  The photo copy of Death Claim is marked as Ex.A2=Ex.B2.   It is the case of the complainant that the policy is DLF Pramerica Assurance Money + Plan The life assured nominee is entitled for double policy the opposite parties repudiated the claim of the complainant under Ex.A4=Ex.B8 dated 09.04.2012, on the ground that the deceased suffered from liver problem prior to proposal signing date, the life insured/deceased suppressed the material fact in regard to his health condition and obtained policy.  But the deceased never suffered from any disease as alleged by the opposite parties.  It is the case of the opposite party No.1 that the opposite parties conducted investigation during the investigation it was found that the insured/deceased had undergone liver function tests in prime Diagnostice Services dated 09.06.2011 and 15.06.2011 but this fact was not disclosed in the proposal form.  The photo copy of Medical Diagnostic Reports is marked as Ex.B6 and Ex.B7.  Such non-disclosure of material facts makes the contract void. Therefore the opposite parties are not liable to pay any claim of the complainant.

          The learned counsel appearing for the opposite parties contended that the contract of insurance is based on good faith, in case of any such deliberate misrepresentation, the contract of insurance would become void, and the amounts paid there under shall be forfeited. He cited decisions LIC of India             -Vs- B.Chandravathamma AIR 1971 AP Page 41, P.C.Chako and another -Vs- LIC of India and others (2008) 1 SCC Page 321.

8.       The learned counsel appearing for the complainant argued that except filing of the Medical Reports, the opposite parties did not examined any Doctor and at least not filed any affidavit of a doctor, the opposite parties not proved that the insured suppressed his ill health at the time of taking policy.  He cited a decision reported in IV (2012) CPJ Page 646 (NC) Life Insurance Corporation of India -Vs- Priya Sharma  and others where in the Honorable National Commission held that onus to prove that insured was suffering from pre-existing disease is on the insurance company, doctor not examined to prove the fact  and repudiation is not justified.  In IV (2014) CPJ Page 580 (NC) ICICI Prudential Life Insurance Company Limited  -Vs- Veena Sharma and another the Honourable National Commission held that the insurance company required to prove with credible evidence that the complainant was suffering from pre-existing disease and had knowingly failed to disclose the same.  Mere production of discharge card not enough, repudiation not justified.

      There is no dispute with regard to issuance of policy bearing No.00076414 for an assured sum of Rs.2,14,450/- in favour of the life assured and the complainant is the nominee under the policy and the opposite parties repudiated the claim under Ex.A4=Ex.B8, on the ground that the insured suppressed the material fact in regard to his health conditions, as he was suffering from liver problem and was diagnosed for the said problem in the prime diagnostic services dated 09.06.2011 and 15.06.2011 prior to obtained the policy.  To support their version the opposite party, filed Ex.B6 and Ex.B7 Diagnostic Reports, but it is only a Diagnostic Reports the opposite party did not choose to examine any doctor, who treated the insured or not file any affidavit of any doctor.  Mere diagnostic Reports are not sufficient to hold that insured had under gone treatment for the alleged disease of cancer or liver problem, prior to taking the policy.  The opposite parties could not establish that the life assured/deceased suppressed the material facts in regard to his health condition at the time of taking policy.  We persued all the material available on record and in the light of above decisions we hold that there is deficiency of service on the part of opposite parties and cause mental agony to the complainant.  The complainant is entitled for an assured amount of Rs.2,14,450/- with death benefits under the above policy and further entitled for compensation of Rs.5,000/- towards mental agony.

10.     In the result, the complaint is partly allowed directing the opposite parties jointly and severally liable to pay an assured amount of Rs.2,14,450/- with death benefits  with interest at 9% per annum from the date of complaint i.e., on 14.11.2013 to till the date of realization and further direct to pay a sum of Rs.5,000/- as compensation towards mental agony and Rs.1,000/- as costs of the case.  The time for compliance is one month from the date of receipt of this order. 

          Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 1^st day of April, 2015.

          Sd/-                                                                                         Sd/-

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 bearing No.000076414

Ex.A2           Photo copy of Death Claim Application Form dated 12.09.2011.

Ex.A3           Photo copy of Death Certificate dated 29.08.2011.

Ex.A4          Photo copy of Repudiation Letter dated 09.04.2012.

List of exhibits marked for the opposite parties:-

Ex.B1                   Photo copy of Policy bearing No.000076414

Ex.B2          Photo copy of Death Claim Application Form Received dated 16.09.2011.

Ex.B3          Photo copy of Last Medical Attendant’s Report

Ex.B4                   Photo copy of Death Certificate Claim Received dated 16.09.2011.

Ex.B5          Photo copy of Death Certificate dated 29.08.2011 verified by Panchayat Secretary.

Ex.B6          Photo copy of Medical Record issued by Prime Diagnostic Services dated15.06.2011.

Ex.B7                   Photo copy of Medical Record issued by Prime Diagnostic Services.

Ex.B8                   Photo copy of Repudiation Letter dated 09.04.2012.

          Sd/-                                                                                         Sd/-

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                    :