This C.C. is coming on before us for hearing in the presence of Sri Kilaru Laxmi Narasimha Rao,  Advocate for complainant and of Sri G. Sita Rama Rao, Advocate for opposite parties No.1 & 2; upon perusing the material papers on record; upon hearing and having stood over for consideration, this Forum passed the following:-

O R D E R

(Per Smt.V.Vijaya Rekha, Member)

This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. 

2.      The brief facts as stated in the complaint are that the complainant No.1 is the wife of deceased, Amarneni Umamaheshwar Rao, the complainants No.2 and 3 are the sons and the complainant No.4 is the mother.  During his life time, the deceased / husband of the complainant No.1 had taken Bajaj Allianz Capital Unit gain insurance policy, vide policy No.0065208367 from the opposite parties for a term of 20 years.  For which, he paid Rs.50,000/- to the opposite parties on 12-09-2007 towards yearly premium, on the same day, the policy was came into existence.  Thereafter, the policy holder was died on 20-10-2007 due to sudden cardio respiratory arrest at New Life Hospital, Khammam.  Then, the complainant No.1 being the nominee, submitted the claim form to the opposite parties for death benefits. The opposite parties repudiated the claim by stating that the deceased was diagnosed as Hodgkins disease and had underwent Chemotherapy and due to non disclosure of same in the proposal form, rejected the claim.  The complainant further submitted that the cause of death was due to cardio respiratory arrest and as such it is the duty of the opposite parties to pay the policy amount as assured and also submitted that the rejection of claim is amounts to fraud therefore, by alleging the deficiency of service, filed the present complaint and prayed to direct the opposite parties to pay death benefits under policy @ Rs.5,00,000/- together with interest @ 24% per annum from the date of death and costs.

3.      Along with the complaint, the complainant filed affidavit and photocopies of following documents, those were marked as Exhibits A1 to A14.

Ex.A1:- Photocopy of Premium Receipt.

Ex.A2:- Photocopy of Policy documents along with units statement and other

            particulars.

Ex.A3:- Photocopy of Preliminary Report on death claim.

Ex.A4:- Photocopy of Claim Form.

Ex.A5:- Photocopy of Cremation Report.

Ex.A6:- Photocopy of Death claim discharge form.

Ex.A7:- Photocopy of Employer certificate.

Ex.A8:- Photocopy of Leave Particulars.

Ex.A9:- Photocopy of Medical Attendant / Hospital treatment certificate.

Ex.A10:- Attested copy of Death Certificate.

Ex.A11:- Attested copy of Legal Heir Certificate.

Ex.A12:- Photocopy of Repudiation Letter dt.13-08-2008.

Ex.A13:- Photocopy of Letter to the opposite parties addressed by the

              complainant No.1 with postal acknowledgements.

Ex.A14:- Photocopy of Letter to the opposite parties addressed by the

              complainant No.1.

4.      On being noticed, the opposite parties appeared through their counsel and filed counter by denying the averments as mentioned in the complaint. 

5.      In the counter the opposite party denied all the averments of the complaint by submitting that the present complaint is not maintainable either in law or on facts and the contract of insurance is a contract of indemnity.  According to the Indian Contract Act, if there is any violation, the contract becomes void and also stated that in the present case, there is no deficiency of service on the part of insurance company, therefore, the complaint is not admissible.  The opposite party further stated that the deceased was died due to Hodgkin’s disease, by suppressing the same, obtained the policy and as such there is no liability on the part of opposite party and stated that the present complaint is having several complicated issues and as such the Forum has no jurisdiction to entertain this matter and prayed to dismiss the complaint with costs. 

6.      During the course of proceedings, opposite parties filed the following documents by filing a petition under order 8 rule 3 R/w 151 of C.P.C., among which, some were marked as exhibits on behalf of the opposite parties, those were relevant to the present case.

Ex.B-1:- Attested copy of Repudiation Letter dt. 13-08-2008 (also marked on behalf of complainants).

Ex.B-2:- Attested copy of Letter dt. 04-05-2009 addressed by the opposite parties to the complainants regarding the rejection of claim.

Ex.B-3:- Attested copy of Policy document with terms & conditions.

Ex.B-4:- Attested copy of Initial unit statement.

Ex.B-5:- Attested copy of Policy Schedule.

Ex.B-6:- Attested copy of First Premium Receipt.

Ex.B-7:- Attested copy of Order dt. 26-02-2008 issued by R.T.O., Khammam.

Ex.B-8:- Attested copy of Letter dt. 05-07-2008 addressed by the complainant to the opposite party No.1.

Ex.B-9:- Attested copy of Employer Certificate.

Ex.B-10:- Attested copy of Leave Particulars.

Ex.B-11:- Attested copy of Proposal Form.

Ex.B-12:- Attested copy of Preliminary Report on death claim

Ex.B-13:- Attested copy of Patient Admission Record of Indo-American Cancer Hospital, Hyderabad.

Ex.B-14:- Attested copy of Discharge Summary of Indo-American Cancer Hospital, Hyderabad.

7.      Both the parties filed written arguments by reiterating the same averments as stated supra.  The complainant No.1 also filed chief affidavit.

8.      In view of the above submissions, now the point that arose for consideration is,

          Whether the complainant is entitled to the relief

                   as prayed for?

Point:-                

9.      According to the aforesaid averments and basing on the material on the record, there is no dispute regarding the issuance of policy and also not in dispute that the policy holder was died within one year from the date of proposal i.e. within the period of policy anniversary, the only dispute is with regard to the suppression of pre-existing disease at the time of proposal.  It is the case of the complainants that the husband of the complainant No.1 had obtained Bajaj Allianz Capital Unit gain insurance policy on 12-09-2007 by paying Rs.50,000/- towards yearly premium, during the policy was in force, the insured was died due to sudden cardio respiratory arrest, despite payment of death benefits, the opposite parties repudiated the claim.  On the other hand the opposite parties averred that the diseased / policy holder had obtained the policy by suppressing the pre-existing disease at the time of taking of policy and as such there is no liability on the part of them, in support of their averments, placed exhibits B-1 to B-14, Exhibits B-13 and B-14 are the hospital record, containing the admission record and discharge summary of Indo-American Cancer Institute, Hyderabad from 30-06-2007 29-09-2007, those were clearly stated that the deceased / insured was taken continuous treatment for Hodgkin’s disease and underwent repeated Chemotherapies and other required treatment for his disease.  Exhibit B-7 is the order copy, issued by Regional Transport Officer, who is the employer of the deceased / policy holder, regarding the availment of leaves prior to date of death, clearly indicate that the insured was admitted in the Hospital for taking treatment prior to the date of proposal i.e. from 30-06-2007 to 29-09-2007 and also clear that the insured was suffering from cancer by the time of taking policy on 30-08-2007.  Thus, it becomes clear that the policy obtained by giving wrong answer on material issue. As policy was obtained by misrepresentation regarding the previous ailment, the opposite party has not committed any deficiency of service in repudiating claim.  But as far as the entitlement of other death benefits regarding the payment of regular premium fund value and top-up premium fund value is concerned, it is an admitted fact that the opposite parties collected Rs.50,000/- towards yearly premium from the deceased / policy holder, within few days he died due to ill health, but the opposite parties refused to pay the other death benefits along with the policy amounts, is not just and fair practice.  Withholding of huge amounts of common people is not justifiable and is also against the principles of natural justice.  Therefore, it is held that the opposite parties cannot escape from their liability in payment of  regular fund value and the top-up premium fund value, if any, to the complainant No.1, being the nominee as the deceased / policy holder was died before the policy anniversary i.e. the date of death was within 38 days from the date of existence of policy.  Therefore, the point is answered accordingly in favour of the complainant by holding that the opposite parties are liable to pay regular premium fund value and the top-up premium fund value, if any, as per section 6 (a)(1) of terms & conditions of the policy.

10.    In the result, the complaint is allowed in part directing the opposite parties to pay regular premium fund value and top-up premium fund value, if any, under Bajaj Allianz Capital Unit Gain plan to the complainant No.1 as on the date of repudiation i.e. 13-08-2008 together with interest @9% P.A. till realization.  Further directed to pay Rs.1,000/- towards costs within one month from the date of receipt of this order.

           Typed to my dictation, corrected by me and pronounced by us, in this Forum on this the 29^th day of January, 2015.                                                            

                     FAC President              Member

District Consumer Forum, Khammam

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant:-                                                 For Opposite party:-   

       -None-                                                                       -None-

DOCUMENTS MARKED:-

For Complainant:-                                                           For Opposite party:-   

FAC President              Member

District Consumer Forum, Khammam.