Date of filing: 22.12.2011.
Date of disposal: 12.12.2013.
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM - II:
VIJAYAWADA, KRISHNA DISTRICT
Present: Sri A. M. L. Narasimha Rao, B.Sc., B. L., President
Smt N. Tripura Sundari, B. Com., B. L., Member
Sri S. Sreeram, B.A., B.L., Member
Thursday, the 12th day of December, 2013
C.C.No.3 of 2012
Between:
1. Smt.M.Lalitha Siva Jyothi, W/o(Late) Pulipati Srinivasa rao, R/o D.No.76-8/5-13 A, Hanumaiah Street, Bhavanipuram, Vijayawada-520 012.
2. Pulipati Devi Sri Lakshmi Pravallika, D/o Late Pulipati Srinivasa Rao, R/o D.No.76- 8/5-13 A, Hanumaiah Street, Bhavanipuram, Vijayawada-520 012.
3. Pulipati Bhavana D/o Late Pulipati Srinivasa Rao, R/o D.No.76-8/5- 13 A, Hanumaiah Street, Bhavanipuram, Vijayawada-520 012.
….. Complainants
[
And
1. Asst.Divisional Manager (PLI), O/o. Chief Post Master General, A P Circle, 4th floor, Dak Sadan, ABIDS, Hyderabad-1.
2. Senior Superintendent of Post Office, Vijayawada-520 001.
. … Opposite Parties.
This complaint coming on before the Forum for final hearing on 5.12.2013, in the presence Sri D. Ravi Kiran, advocate for complainants; Sri L.L Narasimham, advocate for opposite parties and upon perusing the material available on record, this Forum delivers the following:
O R D E R
(Delivered by Hon’ble President Sri A. M. L. Narasimha Rao,)
1. This complaint is filed under Section 12 of the Consumer Protection Act, 1986 for a direction to the opposite parties to pay the policy amount of Rs.1,00,000/- with interest, compensation of Rs.10,000/- and costs of Rs,3,000/-.
2. The averments of the complaint in brief are as follows:
Pulipati Srinivasa Rao a resident of Bhavanipuram, Vijayawada took a postal life insurance policy under policy No.AP-YS-400784-US for an assured sum of Rs.1,00,000/- effecting from 15-03-2010. He paid a sum of Rs.463/- as monthly premium and continued to pay the premium every month. The policy is known as Yugal Surakha (joint life endowment assurance). While the policy was in force the policy holder Srinivasa Raio was affected with cancer and while undergoing chemo-theraphy he died of cardiac arrest on 8.4.2011. The complainants are the wife and minor daughters of the deceased Srinivasa Rao. As legal heirs they are entitled to the insured amount of Rs.1,00,000/-. They submitted a claim on 13.5.2011 to the opposite parties. The 1st opposite party sent a letter dated 19.9-2011 repudiating the claim of the complainants on the ground that the deceased Srinivasa Rao had pneumonia even prior to taking the policy and he suppressed such material fact. The policy holder did not suppress any material fact. The cause of death is different from the illness said to have not been disclosed by the deceased. The repudiation is unfair and unjust. The opposite parties committed deficiency of service and the complainants are entitled to the policy amount and compensation with costs.
3. The opposite parties initially did not appear with proper vakalat and this Forum had disposed of the CC basing on the material available. Later the opposite parties preferred an appeal to the A.P. State Consumer Dispute Redressal Commission in F.A.No.657/2012 which was allowed on 13.5.2013 and the case was remitted to this Forum for fresh disposal giving opportunity to both sides to lead evidence.
4. On receipt of further notices from this Forum the opposite parties appeared and filed their version in brief as follows:
The complainant’s husband took Postal life insurance policy bearing No. AP-YS-400784-US in the name of self and his wife i.e., the 1st complainant. The complainant’s husband i.e., the policy holder had availed medical leave for 15 days from 6.6.2008 to 20.6.2008 and for 15 days from 24.10.2008 to 7.11.2008 and further from 7.11.2008 to 16.11.2008 in connection with pneumonia. Dr. Mohan Rao Memorial Super Specialty Hospital and Dr. Ravindranath of Lata hospital issued medical certificates dated 24.10.2008 and 17.11.2008. The said medical certificates were obtained three years prior to taking policy from the opposite parties. The policy holder had not furnished these details at the time of taking policy and he had given false information. The 1st complainant also intimated that the policy holder had suppressed the fact that he was suffering from pneumonia. In view of suppression of fact the claim cannot be admitted and the amount paid through different premia stands forfeited to the government. Therefore the complainants are not entitled to the policy amount. This complaint is liable to be dismissed.
5. The complainants affidavit filed earlier is taken as the evidence of the complainant along with documents earlier marked by her as Exs.A1 to A5. Senior Superintendent of posit offices, Vijayawada filed his affidavit on behalf of the opposite parties and it is received as evidence of DW-1. Though it is stated in Para.4 of the written version that the medical certificates issued by Dr. Mohan Rao Memorial Super Specialty Hospital and Dr. Ravindranath of Lata hospital were enclosed with the written version, we do not find any such documents attached to the written version. No document is marked on behalf of the opposite parties.
6. Heard the arguments advanced by the learned counsel for the complainant and the opposite parties. The opposite parties also filed memorandum of written arguments.
7. The points for determination are:
- Whether the opposite parties are justified in repudiating the claim on the ground of suppression of material facts and in forfeiting the premium paid by the policy holder?
- Whether the complainant is entitled to the reliefs claimed?
Point No.1:
8. The parties are not in dispute as regards the policy taken by Pulipati Srinivasa Rao husband of the 1st complainant and about the death of the policy holder while the policy was inforce. The policy holder was affected with cancer and died of cardiac arrest while undergoing chemo-therapy for cancer treatment. According to the opposite parties the policy holder was suffering from pneumonia in the year, 2008 and that the policy holder while taking policy in the year, 2010 did not disclose about his aliment and thereby suppressed the material facts. Whenever the insurance company or insurer is alleging the suppression of material fact they must primafacie show that the material fact did exist and it was not disclosed by the policy holder at the time of proposal having knowledge of such fact by then. It is alleged that the policy holder had taken medical certificate for 15 days on one occasion in the month of June, 2008 and for 22 days at another time from 24.10.2008 till 16.11.2008 in connection with pneumonia and medical certificates were issued by Dr. Mohan Rao Memorial Super Specialty Hospital on 24.10.2008 and and Dr. Ravindranath on 17.11.2008. If these documents are available and if they are produced by the opposite parties certainly the complainant may have to explain how such documents came into existence. But these documents are not filed by the opposite parties. In absence of those documents this Forum cannot merely accept the allegation in the version of the opposite parties. A statement in the affidavit of the opposite parties is not sufficient to prove such fact.
9. The opposite parties seem to have made reference to Ex.A3 in support of their case. Ex.A3 is nothing but a reply given by the opposite parties. Ex.A4 is a medical certificate issued by Apollo Caner Hospital on 17.6.2011. That short medial certificate reads as follows:
“This is to certify that Mr. Srinivasa Rao.P, aged: 41 yrs/M registered in this hospital with Reg. No: APJL1280586 was diagnosed to have Carcinoma Rectosigmoid post op.
He has undergone surgery on 18/12/10.
He has received External Radiation Therapy from 24/01/11 to 05/03/11 and also received 1 cycle chemotherapy on 07/04/2011
He died on 8th Apr’ 11 suddenly due to cardiorespiratory arrest.”
As per the above certificate the deceased Srinivasa Rao had undergone a surgery on 18.12.2010 and he had Carcinoma Rectosigmoid post op. That means the deceased had cancer at the region of large intestine around the junction of the sigmoid colon and the rectum. This may have nothing to do with pneumonia from which the policy holder alleged to have suffered in the year, 2008. The cause of death noted in the medical certificate Ex.A4 does not show any scope for the relation between the pre-existing pneumonia if any and cause of death. Therefore we are of the opinion that the opposite parties had not satisfactorily established that the policy holder had suppressed material fact and consequently we hold that the repudiation on that ground is not justified. This point is answered in favour of the complainant.
Point No.2:
10. In view of the answer on point no.1 the complainants are entitled to policy amount of Rs.1,00,000/- and interest thereon from 19.9.2011 the date of repudiation till payment at the rate of 9% p.a., and the complainant shall also be entitled to costs assessed at Rs.2,000/-
11. In the result, this complaint is allowed in part and the opposite parties 1 and 2 are directed to pay the policy amount of Rs.1,00,000/- (Rupees one lakh only) with interest thereon at the rate of 9% p.a., from 19.9.2011 till payment and also costs of Rs.2,000/- (Rupees two thousand only) to the complainants. The opposite parties shall comply with the award within 30 days from the date of receiving copy of the award. The claim for the rest of the reliefs is dismissed without costs.
Dictated to steno, N. Hazarathaiah, transcribed by him, corrected by me and pronounced by us in the open Forum, this the 12th day of December, 2013.
PRESIDENT MEMBER MEMBER
Appendix of evidence
Witnesses examined
For the complainant: -None- For the opposite party:-None
Documents marked
On behalf of the complainant:
Ex.A1 copy of acceptance letter of PLI proposal with schedule for Yugal Surakha policy.
Ex.A2 copy of pass book.
Ex.A3 19-9-2011 A letter dated addressed by the Assistant Divisional Manager, PLI, Hyderabad.
Ex.A4 copy of medical certificate issued by Dr. Vijay Anand P. Reddy of Apollo Cancer Hospitals, Hyderabad.
Ex.A5 A blank proforma of Yugal Surakha policy
On behalf of the opposite parties: -Nil-
PRESIDENT
