BEFORE THE A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION
AT HYDERABAD.
FA 1068/2010 against C.C. 184/2009, Dist. Forum-II, Visakapatnam
Between:
M/s. Birla Sun Life Insurance Company Ltd.
Rep. by its Branch Manager
1st Floor, Easwar Paradise
Dwarakanagar Main Road
Visakapatnam. *** Appellant
O.P.
And
Charakapu Chinna Rao
S/o. Rama Rao
Age: 33 years, D.No. 64-24-34
Gullapalem, Sriharipuram
Malkapuram Post
Visakapatnam. *** Respondent/
Complainant
Counsel for the Appellants: Mr. E. S. Kumar.
Counsel for the Respondent: Admission Stage
CORAM:
HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT SMT. M. SHREESHA, MEMBER.
&
SRI R. L. NARASIMHA RAO, MEMBER
TUESDAY, THIS THE TWENTY SIXTH DAY OF OCTOBER TWO THOUSAND TEN
Oral Order: (Per Hon’ble Justice D. Appa Rao, President)
*****
1) Having heard the learned counsel for the appellant, and having perused the material on record, we are of the opinion that the matter can be disposed of at the stage of admission.
2) This is an appeal preferred by the opposite party insurance company against the order of the Dist. Forum directing it to pay Rs. 2 lakhs covered under the policy together with compensation of Rs. 10,000/- and costs of Rs. 2,000/-.
3) The case of the complainant in brief is that the appellant insurance company issued a life insurance policy in favour of his son for Rs. 2 lakhs commencing from 6.12.2005. While so he died suddenly on 27.1.2006 due to cardiac arrest preceded by dehydration. When he made claim the same was repudiated on the ground that he did not disclose correct information about the income and details of family insurance in his proposal form. Assailing the repudiation he filed the complaint claiming Rs. 2 lakhs together with compensation of Rs. 25,000/- and costs.
4) The insurance company resisted the case. While admitting issuance of policy it alleged that as soon as intimation was received it had appointed a surveyor who after enquiry found that the assured was a daily wage earner and that there was no coverage of insurance policies. In view of suppression of material fact the claim was repudiated, and therefore prayed that the complaint be dismissed with costs.
5) The complainant in proof of his case filed his affidavit evidence and got Exs. A1 to A6 marked while the insurance company filed Exs. B1 to B4.
6) The Dist. Forum after considering the evidence placed on record opined that the repudiation by the insurance company on the ground that he had suppressed his income as well as particulars of family insurance was unjust and therefore directed it to pay Rs. 2 lakhs covered under the policy together with compensation and costs.
7) Aggrieved by the said order, the insurance company preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that the assured had worked as a daily wage earner in dock labour yard evidenced from the report of the surveyor equally so with regard to family insurance particulars. Since there was material suppression of these facts he was not entitled to the amount.
8) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
9) It is an undisputed fact that the appellant insurance company had issued a policy covering the risk of the assured for a sum of Rs. 2 lakhs. It is also not in dispute that he suddenly died on 27.1.2006 due to dehydration followed by cardiac arrest. When the complainant claimed the amount the insurance company appointed a surveyor who on enquiry found that the deceased was working with dock labour yard on daily wages of Rs. 150/-. Therefore his statement that he was earning about Rs. 1, 20,000/- per annum was false. It may be stated herein that the investigator except alleging that he was a labourer could not file any certificate from the dock yard to show that he was only a daily wages earner. The complainant has categorically stated that he was also having income from agriculture besides other income. The insurance company cannot repudiate the claim basing on the report of the surveyor without surveyor establishing the facts by furnishing evidence. It is not as if surveyor’s report ex-facie has to be accepted. They gather information obviously at the instance of the insurance company suggesting for repudiation. In fact it is without any basis. A perusal of the report would show that there is no substantial evidence to state that the particulars issued by the assured in his proposal form was incorrect.
10) The next contention was that in the family insurance particulars he has mentioned that his father was having policies for Rs. 5,50,000/- while his mother for Rs. 1 lakh. The surveyor could not gather any evidence to that affect. It is not in dispute that contract of insurance was based on doctrine of Uberrima fides i.e., utmost good faith. Otherwise it would be a good ground for recession of the contract. We may state that non-disclosure should be a material fact. Admittedly the insurance policy was given when mooted through an agent who after verification recommended for the policy and ultimately policy was issued. It has become a routine for the insurance companies to repudiate the claims on irregular grounds having no compunction for issuing policies when they are submitted for its acceptance. The form appended by the agent discloses that it was verified by him and on satisfaction of these facts the policy was accepted. Obviously when the deceased died within a few days after payment of the premium the insurance company intend to repudiate the claim as it did not receive sufficient premium. We have perused the entire record and we are of the opinion that the Dist. Forum has rightly appreciated the facts in correct perspective. We do not see any merits in the appeal.
11) In the result the appeal is dismissed at the stage of admission. No costs. Time for compliance four weeks.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
3) ________________________________
MEMBER
Dt. 26. 10. 2010.
*pnr
“UP LOAD – O.K.”
