This complaint coming up before us for final hearing on 03-06-11 in the presence of Sri M.Sravan Kumar, advocate for complainant and of Sri G.Erukala Reddy, advocate for opposite party, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following:
O R D E R
Per Sri M.V.L.Radha Krishna Murthy, Member:
This complaint filed under section 12 of the Consumer Protection Act, 1986 praying to pay the assured amount of Rs.3,00,000/- with accrued benefits and interest from the date of death of deceased till the date of payment, for a compensation of Rs.1,00,000/- towards mental agony and for costs.
The averments of complaint in brief are as follows:
The husband of complainant taken a policy for life assurance from opposite party by paying premium of Rs.60,000/- per annum. The policy was commenced on 09-03-07 with maturity date 09-03-2017. The husband of the deceased also paid Rs.60,000/- towards annual premium for the year 2008. Later due to ill health he joined in the hospital on 25-09-08 and later died on 11-10-08. The complainant informed about the death of her husband to the opposite party and the opposite party sent claim form to her. The complainant submitted the claim form duly filled in along with claimant’s statement, death certificate, original policy document and other documents required by opposite party. Later complainant approached opposite party for payment of policy amount but the opposite party postponed the matter. Finally 19-02-10, the opposite party repudiated the claim of the complainant on the ground that the deceased did not disclose Diabetes Mellitus and High Blood Pressure in the proposal form dt.06-03-07, even though he was having the same since three years. Thus the opposite party repudiated the claim due to non disclosure of material facts. The deceased answered all the questions in proposal form while taking policy and he has not suppressed any fact from disclosure more particularly the diabetes and high blood pressure. The opposite party erroneously repudiated the claim on the ground of non disclosure of material fact. Thus there is deficiency of service on the part of opposite party in repudiating the claim. Hence, the complaint
The opposite party filed its version affidavit and the contents thereof in brief are as follows:
The complaint of the complainant is false, frivolous and vexatious. The complaint is not a consumer complaint since the complainant is not a consumer. The complaint is not filed within the period of limitation. There is no deficiency of service on the part of opposite party. There is no mention about the illness in the proposal form and the life assured suppressed this fact in the proposal form. The life assured submitted proposal form without disclosing his health condition. The opposite party issued policy for a total value of Rs.3,00,000/- and the date of commencement of policy is 09-03-07. The date of maturity is 09-03-2017. The life assured was suffering with kidney problems and for treatment he used visit hospitals at Guntur and Hyderabad and he was treated in the following hospitals viz. 1. Guntur Cancer Institute, Guntur 2. Bommidala Cancer Institute, Guntur 3. NRI Hospital, Mangalagiri 4. Apollo Hospitals, Jublilee Hills, Hyderabad. The complainant concealed such material fact and obtained policy from opposite party. Such details are very material in the proposal from and deliberately gave false information in the proposal form and on the basis of said false information opposite party accepted the proposal and issued policy. Hence, policy is void. There is no deficiency of service on the part of opposite party. The investigations of opposite party revealed that the life assured was a known diabetic. He has also taken treatment sometimes in Sri Sai Hospitals, Guntur from August, 2006 to October, 2008 and he was also treated as inpatient for sometimes. He expired on 11-10-08 in that hospital. The life assured was admitted on 11-09-08 in Apollo Healthy City, Hyderabad. The complaints of D.M. C.K.D.State III, N.P.D.R., Ischemic Optic Retinopathy, Hypothyroid, L.V.Dysfunction. The complainant has given a statement to opposite party stating that her husband has been coming to Guntur from time to time for last six years prior to his death on complaint of ill health and he was under medication during that period. The life assured has been under medication from 2002 onwards, which fact was not disclosed by him at the time of taking policy from opposite party. Hence, the opposite party has repudiated the claim. Hence, the complaint may be dismissed with costs.
The complainant filed affidavit in support of the allegations made in the complaint reiterating the same.
On behalf of complainant Ex.A1 to A8 are marked. On behalf of opposite party Ex.B1 to B7 are marked.
Now the points for consideration are
- Whether the complaint is barred by limitation?
- Whether there is any deficiency of service on the part of opposite party?
- To what relief the complainant is entitled to?
POINT No.1
The opposite party has repudiated the claim of complainant on 19-02-10 and the complaint is filed before this Forum on 14-09-10. Hence, the complaint is in time. This issue is answered in favour of complainant and against the opposite party.
POINT No.2
It is not in dispute that the life assured i.e., the husband of complainant had obtained life insurance policy from opposite party and during the subsistence of policy the life assured was died on 11-10-08 at Sri Sai Hospital, Guntur. The complainant is the wife/nominee of the life assured. Hence, the complainant is a consumer and complaint is a consumer complaint.
It is not in dispute that the complainant made a claim with opposite party for the assured amount. As seen from Ex.A4=Ex.B7 dt.19-02-10, the claim of the complainant was repudiated by opposite party on the ground that various investigations and various medical certificates confirm that the deceased life assured had history of diabetes mellitus and high blood pressure since 3 years and he was under treatment for the same and the said facts are known to the deceased life assured and were not disclosed in the proposal form dt.06-03-07. Hence, the claim of complainant was repudiated due to non disclosure of material facts. As seen from Ex.B1 proposal form, it was submitted by the deceased life assured on 06-03-07. As seen from Ex.B2, the policy that was issued by opposite party was commenced with effect from 09-03-07. As seen from Ex.B6 death certificate, the deceased life assured was died on 11-10-08. Thus the deceased life assured died after 18 months from the date of commencement of policy. As seen from Ex.B6 discharge summary, the deceased life assured was suffering with illness since 8 months. A perusal of Ex.B5 copy of statement of complainant discloses that her husband deceased insured has been suffering from BP and Sugar for the last one year and now and then has been visiting the New Life Hospital at Guntur for the last six months prior to his death. Thus it reveals the life assured was suffering from BP and Sugar for the last one year prior to his death. But the contention of opposite party as mentioned in the repudiation letter (Ex.B7), the deceased life assured had history of diabetes mellitus and high blood pressure since 3 years. But no evidence is placed by the opposite party in support of the said contention that the life assured was having history of diabetes mellitus and high blood pressure since 3 years. Further the opposite party had not placed any evidence in support of the contentions made in their version that the life assured was suffering with Kidney problems and for the treatment he was visiting various hospitals at Guntur and Hyderabad. Therefore, in the absence of any evidence in support of the repudiation made by opposite party, it can be safely concluded that the repudiation made by the opposite party is not proper and tenable. The opposite party had not placed any evidence in support of their contention that the life assured had history of diabetic mellitus and high blood pressure since 3 years and that the life assured had knowledge about the same at the time of submitting proposal form for obtaining policy and that he had suppressed the said fact and did not disclose the same in the proposal from. Therefore it cannot be said that the life assured had suppressed material facts and did not disclose the same in the proposal form.
During the course of arguments the learned counsel for complainant relied on the following decision in support of his case:
- 2009 (3) CPR 290 between Life Insurance Corporation of India and another Vs. Smt.Chatri Devi, wherein the Himachal Pradesh State Commission, Shimla held that
Where claim under life insurance policy was repudiated on ground that insured suppressed material fact of he suffering from tuberculosis and deceased insured died of cancer, it would be for insurer to establish by leading, cogent and acceptable medical evidence that there was direct nexus between tuberculosis and cancer.
- 2009 (4) CPR 423 between the Senior Divisional Manager, Life Insurance Corporation of India and others Vs. Ramandeep Kaur and another, wherein Punjab State Commission, Chandigarh held that
Hypertension could not be said to be a material disease and insurance company would not be justified in repudiation of claim on ground of suppression of the fact.
- 2009 (1) CPR 208 (NC) between Smt.Vanitaben Retilal Fulbaria Vs. LIC of India, wherein the National Commission, New Delhi held that
Where respondent company failed to prove that deceased had taken policies by withholding relevant and true facts in the proposal form, then repudiation of claim by insurance company was held unjustified.
In view of the facts and circumstances of the case as already discussed above, in the absence of any evidence in support of contention of opposite party it can be safely concluded that the life assured had not suppressed any material fact and that the repudiation made by opposite party is not proper and tenable. Thus, we find deficiency of service on the part of opposite party in repudiating the claim of complainant. Accordingly this issue is answered in favour of complainant and against the opposite party.
POINT No.3
The complainant claimed for the insured amount of Rs.3,00,000/- with all accrued benefits thereon and interest from the date of death of deceased till the date of payment and also claimed compensation of Rs.1,00,000/- towards mental agony and costs. The compensation claimed by the complainant is too high and imaginary. Therefore, we are of the opinion that apart from awarding the assured amount of Rs.3,00,000/- with all accrued benefits thereon and interest from the date of repudiation i.e., 19-02-10 till the date of realization and awarding compensation of Rs.10,000/- towards mental agony suffered by complainant and Rs.2000/- towards costs of complaint would meet the ends of justice. Accordingly this issue is answered in favour of complainant.
In the result, the complaint is allowed in part in terms as indicated below:
- The opposite party is hereby directed to pay an amount of Rs.3,00,000/- to the complainant towards assured amount with all accrued benefits thereon along with interest at 9% p.a. from the date of repudiation i.e., 19-02-10 till the date of payment.
- The opposite party is further directed to pay an amount of Rs.10,000/- to the complainant towards compensation for the mental agony suffered by the complainant.
- The opposite party is further directed to pay an amount of Rs.2,000/- to the complainant towards costs of complaint.
- The above orders shall be complied within a period of six weeks from the date of receipt of copy of this order, failing which the amounts ordered in item No.2 and 3 shall also carry interest at 9% p.a. till the date of realization.
Typed to my dictation by the Junior Steno, corrected by us and pronounced in the open Forum, this the 9th day of June, 2011.
Sd/- x x x Sd/- x x x Sd/- x x x
MEMBER MEMBER PRESIDENT
