Date of filing:26.11.2011
Date of disposal:20.03.2014
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTAPUR.
PRESENT: - Sri S.Niranjan Babu, B.A., B.L., President (FAC)
Smt. M.Sreelatha, B.A.,B.L., Lady Member
Thursday, the 20th day of March, 2014
C.C.No164/2011
Between:
S.Jarina,
W/o Late S.Jabir,
D.No.1-1-776,
Indiragandhi Nagar,
2nd Road Extension,
Anantapur. … Complainant
Vs.
1. Assistant General Manager,
Shriram Life Insurance Company Limited,
Regd. Office 3-6-478, 3rd Floor, Anand Estate,
Liberty Road, Himayatnagar,
Hyderabad.
2. The Branch Manager,
Shriram Life Insurance Company Limited,
Subash Road,
Anantapur. … Opposite Parties
This case coming on this day for final hearing before us in the presence of Sri J.Narayanaswamy Advocate for the complainant and Sri N.R.K.Mohan and Sri A.Suresh Kumar, Advocates for the Opposite Parties 1 & 2 and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:
O R D E R
Smt. M.Sreelatha, Lady Member: - This complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986 against the opposite parties 1 & 2 claiming a sum of Rs.3,75,000/- towards the policy assured amount with interest and Rs.10,000/- towards mental agony and costs of the complaint.
2. The brief facts of the complaint are that: - The complainant’s husband by name S.Jabir has taken insurance policy bearing No.LN081000009444 on 11.01.2010 by paying yearly premium of Rs.50,000/- towards first installment. The term of the policy is for a period of 15 years and the date of maturity is 11.01.2025. At the time of taking the policy by the complainant’s husband from the opposite party, the opposite party obtained a medical certificate about his health. The deceased S.Jabir was doing business and he was earning a sum of Rs.1,50,000/- towards income per Annam. As per the policy conditions if the policyholder dies the sum assured of Rs.3,75,000/- will be paid to the nominee. The above said S.Jabir died on 17.01.2011 due to sudden illness. The complainant is the nominee for the above said policy. The complainant made representation for settlement of the claim with the opposite party after the death of policyholder. But after lapse of three months the opposite party wrote a letter to the complainant stating that the complainant husband was suffering with Diabetes since 20 years and Hypertension since 6 years. The above said illness not disclosed to the opposite party it means to suppression of material facts. Hence, the claim is repudiated on 29.10.2009. The deceased was hale and healthy at the time of taking the policy and the Apex Court also clearly mentioned that diabetes and Hypertension are not chronic deceases. Hence, the repudiation of the claim by the opposite party amounts to deficiency of service and the complainant is entitled the claim made in the complaint.
3. The 1st opposite party filed counter by denying all the allegations made by the complainant and taken plea that at the time of taking the policy the deceased was supplied with a proposal form and requested to fill the same with correct details with regard to the health condition. Basing on the information filled by the deceased policyholder the company has accepted the risk on the life of the deceased policyholder and the policy issued in good faith.
4. The opposite party submits that the nominee in her letter dt.20.04.2011 has intimated that her husband i.e., policyholder S.Jabir has died on 17.01.2011. The policy was taken on 11.01.2010 i.e., within one year the policyholder died. The opposite parties made enquiries with one private investigator by name Zubair. The investigator submitted his report dt.21.04.2011 and in that report he revealed that the life assured was suffering with breathlessness and was shifted to Government Hospital, Anantapur for treatment while treatment was giving on in the hospital the policyholder died at hospital. The investigator collected the case sheet from the hospital clearly shows that the policyholder suffering with diabetes since 20 years and Hypertension since 6 years.
5. Basing on the above pleadings, the following points that arise for consideration are:-
- Whether there is any deficiency of service on the part of the opposite parties 1& 2?
ii) To what relief?
6. In order to prove the case of the complainant, the complainant has filed his evidence on affidavit and marked Exs.A1 to A4 documents. On behalf of the 1st opposite party, the 1st opposite party filed evidence on affidavit and marked Ex.B1 to B7 documents.
7. Heard both sides
8. POINT NO 1:- The Mater was remanded by the Hon’ble A.P.State Commission, Hyderabad in first appeal No.680/2012 in its order dt.22.04.2013. The above appeal preferred by the opposite parties in the C.C. and they are the appellant in the above appeal. The Hon’ble A.P.State Commission disposed the case with an observation that the opposite parties filed case sheet with regard to health condition of the deceased/policyholder. The A.P.State Commission was observed with their need be to look into the contents of the case sheet when we consider the justification of repudiation of the claim. The District Forum observed in the case sheet about over writing the appellant/opposite parties has to prove it by examining the doctor/filing his affidavit. Hence the matter remanded to this Forum to dispose of the matter within a period of three months from the date of receipt of order.
9. The burden is on the opposite parties to prove that the deceased/policyholder was suffered with hypertension and Diabetes at the time of taking the policy. The opposite parties merely filed the case sheet issued by the Government Hospital with material alterations in the name and the father’s name and the age the same was observed by this Forum while disposing the mater. The opposite parties contended in the appeal that they have to prove the suppression of material facts by examining the doctor. Though there is direction from A.P.State Commission while remanding the matter that the matter shall be disposed off three months. But the opposite parties failed to examine the doctor though the matter was remand to this Forum on 28.05.2013 from the date of receiving the matter the Forum has given ample opportunities to the opposite parties to adduce evidence and prove their case. But the opposite parties did not turn to examine the doctor or to file the affidavit of the doctor who issued the case sheet and the opposite parties on relied the case sheet they have repudiated the claim. The investigator produced the above case sheet to the opposite parties, the opposite parties filed the case sheet and not come forward to prove the case. Though the burden is casted on the opposite parties. The Forum was earlier observed that the opposite parties repudiate the claim without any reasonable ground and the opposite parties also failed to prove that the deceased/policyholder was suffering with Diabetic and Hypertension since long back. In the above circumstances we are of the opinion there is no changed circumstances to modified the order that the opposite parties have to implement the order passed by this Form on 18.07.2012, the order the Forum has restricted the liability of the opposite parties 1 & 2 pay a sum of Rs.3,75,000/- with interest @9% p.a. from the date of death of the deceased i.e., 17.01.2011 till the date of realization and also to pay a sum of Rs.2000/- towards deficiency of service and a sum of Rs.1000/- towards costs of the above said order shall be complied within 30 days.
10. In the result the complaint is allowed by directing the opposite parties 1 & 2 to pay a sum of Rs.3,75,000/- to the complainant with interest @ 9% p.a. from the date of death of the policyholder i.e.,17.01.2011 till the date of realization and also to pay a sum of Rs.2,000/- towards deficiency of service and also to pay a sum of Rs.1,000/- towards costs of the complaint within 30 days from the date of this order.
Dictated to the Steno, transcribed by him, corrected and pronounced by us in open Forum, this the 20th day of March, 2014.
Sd/- Sd/-
LADY MEMBER PRESIDENT (FAC)
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
ON BEHALF OF THE COMPLAINANT:
NIL
ON BEHALF OF THE OPPOISITE PARTIES
-NIL-
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Ex.A1 Repudiation letter dt.30.04.2011 issued by the 1st opposite party to the
complainant.
Ex.A2 Photo copy of policy covering letter dt.11.01.2010 issued by 2nd opposite
party to the complainant.
Ex.A3 Policy schedule Shri Plus vide policy No.LN081000009444 issued by the
opposite parties.
Ex.A4 First premium receipt issued by the opposite parties to the deceased
S.Jabir.
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES
Ex.B1 Proposal form submitted by the deceased S.Jabir to the 1st opposite
party.
Ex.B2 Policy schedule Shri Plus vide policy No.LN081000009444 issued by the
opposite parties.
Ex.B3 First premium receipt issued by the opposite parties to the deceased
S.Jabir.
Ex.B4 Letter dt.14.02.2011 submitted by the complainant to the 1st opposite
party.
Ex.B5 Report dt.21.04.2011 submitted by Zubair and Company, Hyderabad to
the opposite parties.
Ex.B6 Repudiation letter dt.30.04.2011 issued by the 1st opposite party to the
complainant.
Ex.B7 Photo copy of case sheet relating to deceased S.Jabir.
Sd/- Sd/-
LADY MEMBER PRESIDENT (FAC)
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR
