DISTRICT FORUM :: KADAPA
PRESENT: SRI P.V. NAGESWARA RAO, M.A., LL.M., PRESIDENT,
SRI S. ABDUL KHADER BASHA, B.Sc., MEMBER
Tuesday, 01st July 2008
CONSUMER COMPLAINT No. 132 / 2007.
K. Suresh Kumar, S/o Venkatapathi, Hindu,
aged 38 years, Residing at D. No. 7/132,
Ammavarisala Street, Badvel Town,
Kadapa District. ….. Complainant.
Vs.
1) Claims Review committee,
Bajaj Allianz Life Insurance Co. Ltd., 5th floor,
Ashoka Plaza, Corporate Software park. S.No. 32/3,
Nagar Road, Vimanagar, Pune - 411 006.
2) The Manager, Bajaj allianz Life Insurance Co. Ltd.,
D.No. 22/468, B.S. Complex, Gandi road,
Proddatur town, Kadapa Dist. …….. Respondents.
This complaint coming on this day for final hearing on 24-6-2008 in the presence of Sri P. Raghunatha Reddy, Advocate for complainant and Sri D.V.S. Prasad, Advocate for respondents and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Sri P.V. Nageswara Rao, President),
1. Complaint filed under section 12 of the Consumer Protection Act.
The brief facts of the complaint is as follows:- The wife of the complainant namely Karnati Renuka had taken a policy No. 18574201, dt.28-3-2006 with assured amount of Rs. 2,50,000/- payable to her nominee, in case of death from the respondents company. A policy was issued in her name with the complainant as a nominee. Smt. Renuka died on 9-5-2007 while the policy was in force. The complainant as her nominee submitted the claim form along with necessary documents. He received a letter dt. 01-9-2007 from the respondents repudiating the claim on the ground of non-disclosure of material facts. The deceased Renuka was not suffering from Carcinoma of left breast (cancer). Therefore, the question of disclosing the facts in proposal form would not arise. Smt. Renuka paid installments regularly towards policy. The respondentd after the death of the policy holder i.e. Renuka had issued a statement dt. 31-5-2007 showing the account value of Rs. 98,050.31Ps. including the premium paid by the deceased Renuke. The deceased died on account of heart stroke and to that effect the doctor, who treated her, had issued a certificate that she died on account of Acute Myocardial infraction (heart stroke). The respondents enquired the doctor namely Dr. J. Lakshmi, Sri Lakshmidurga Hospital, Badvel on 9-5-2007. The doctor declared the death on account of heart stroke. However, the claim of the complainant was rejected without any basis on the ground that the death was occurred on account of cancer. The complainant’s wife had never suffered from such disease. On 5-10-2007 the complainant got issued legal notice with the respondents to pay Rs. 2,50,000/- being the assured sum along with interest @ 18% p.a. The respondent did not give reply to the notice. It amounted to deficiency of service and negligence. It created mental agony to the complainant. Thus the complaint was filed for Rs. 2,50,000/- under the policy with interest @ 18% p.a. from the date of death till the date of payment along with Rs.98,050.31Ps and Rs.25,000/- towards mental agony and Rs.5,000/- towards costs
The respondents 1 & 2 filed a counter that the petition was bad for joinder of unnecessary party i.e. R1. The R1 did not issue the policy nor repudiate the claim of the complainant. The Head office of R2 had to repudiate the claim. The present petition was bad for non-joinder of necessary parties and mis-joinder of unnecessary party. The complainant made a false claim on the ground that the deceased died on account of heart attack. The policy holder was suffering from cancer since 2005 before taking policy. The real fact was not disclosed in the proposal form suppressing the material particulars. It was the duty of the life assured to furnish all the details of her health. Then the respondent would consider whether to issue the policy or not. But in the proposal form dt. 25-3-2006 the insured declared herself to be quite healthy and never suffered from any ill health. She was given treatment at Jakka Sujathamma cancer detection center, Nellore from 7-11-2007 till the 1st week of May 2007 and she was operated on 8-6-2006. In May 2007, Renuka the life assured reported in a morbid condition with severe pleural effusion and multiple Metastatic in the right lobe of liver and the hospital gave supportive symptomatic treatment. She was later shifted to Badvel and died at home. So the death was not due to heart attack. But due to cancer. The cause of death was on account of cancer which she was suffering even before commencement of the policy and so the insured suppressed the material facts. It was a fraud committed by the deceased to get illegal gain. If really the previous health and treatment was revealed, the policy would have been rejected. It was not correct that the repudiation of the claim was illegal and created deficiency of service. Therefore, the complainant was not entitled to the claim. The respondents had repudiated the claim on the ground of suppression of material facts. Thus there were no merits in the complaint and it was dismissed with costs.
On the basis of the above pleadings the following points are settled for determination.
i. Whether there is any deficiency of service on the part of the respondents?
ii. Whether the complainant is entitled to the relief as prayed for?
iii. To what relief?
5. On behalf of the complainant Ex. A1 to A7 were marked and on behalf of the respondents Ex. B1 to B7 were marked.
6. Point Nos. 1 & 2 The wife of the complainant was Smt. K. Renuka, who had taken a policy from the respondents bearing No. 0018574201 commenced on 28-3-2006 and the same was assured for Rs. 2,50,000/- nominating the complainant as her nominee. The Xerox copy of the policy was Ex. A1. The policy holder namely Smt. K. Renuka died on 9-5-2007 while the policy was in subsistence. After the death of Smt. K. Renuka the complainant submitted a claim form to the respondents for the policy amount of Rs. 2,50,000/- with interest @ 18% p.a. from the date of death till payment. The Xerox copy of death claim statement submitted by the complainant was Ex. A7, dt. 3-7-2007. Ex. A7 included death claim statement, cremation report of the dead body, medical attendant / hospital treatment certificate, certificate from usual / family doctor, death claim discharge form, know your customer form and voters identify card. Except voters identity card, the other certificates were in proforma issued by the respondent company. The proforma have been filled up by Dr. J. Lakshmi, Sri Lakshmidurga Hospital, Badvel. Thus forms have been sent to the doctor by the complainant on 3-7-2007. The complainant signed in all the forms, except certificate from usual doctor and medical attendant certificate and cremation report. The cause of death of Smt. K. Renuka shown under Ex. A7 was on account of Acute Myocardial infraction. In medical attendant certificate it was shown by Dr. J. Lakshmi that Smt. K. Renuka had consulted 1st time on 25-12-2005 and was taking treatment on 10-4-2006, 15-10-2006, 21-12-2006, 4-2-2007, 26-4-2007 and 8-5-2007. Prior to her death she was under observation in hospital on 8-5-2007 and she was discharged at 10.00 p.m on 8-5-2007 but died on 9-5-2007 at 3.45 a.m. The complainant filed Ex. A3 a Xerox copy of death certificate of Smt. K. Renuka and filed a Xerox copy of statement of account issued by the respondents under Ex. A6. The complainant got issued a notice to the Claims Review Committee of the respondents on 5-10-2007 after the complainant received repudiation letter dt. 01-9-2007. The copy of repudiation letter was Ex. A2. Ex. A5 was postal receipt. The Xerox coy of the notice was Ex. A4.
7. The Respondents filed a Xerox copy of proposal form under Ex. B1 dt. 25-3-2006 signed by the policy holder Smt. K. Renuka, in which under Sl. No. 14 it was noted that she was not ever been treated or currently under treatment for any of the diseases mentioned in the said column including cancer under column No. 14 H. But the respondents filed Ex. B6 & B7. Ex. B6 was Xerox copy of certificate issued by the Indian Red Cross Society cancer hospital, Nellore that Smt. K. Renuka had reported to the hospital on 7-11-2005 with a complaint of tumor in the left breast. Hence, FNAC confirmed duct cell carcinoma of left breast and she was diagnosed for carcinoma left breast T4bNxMx. She was given pre operative RT and CT (FEC.6 cycles) + Radio castration. Response was satisfactory and patient was offered surgery which was done on 8-6-2006 and the patient was free of diseases till October 2006, at which time patient complaint of pain in back and the CT scan was done on 17-2-2006 which revealed multiple cystic lesions involving vertebral bodies and posterior elements. She was started on palliative Radio therapy to the spine. Ex. B7 was Xerox copy of pathology report of IRCS Jakka Sujathamma Cancer Detection Center, Nellore in which impression was left breast mass aspirate showing features suggestive of “duct cell carcinoma”. The respondents filed a Xerox copy of letter Ex. B2 sent by the complainant on 13-6-2007 that his wife Smt. Renuka died on account of heart Stroke on 9-5-2007. Ex. B3 was Xerox copy of certificate issued by IRCS Jakka Sujathamma Center Detection center, Nellore about her disease. Ex. B4 was Xerox copy of repudiation letter. The similar letter was filed by the complainant under Ex. A2.
8. The case of the complainant was the insured Smt. K. Renuka died on account of Acute Myocardial infraction (heart stroke) and she never suffered Carcinoma of left breast (cancer). But Ex. B3, B6 and B7 were very clear that Smt. K. Renuka had a disease of cancer by 7-11-2005. The pathology report under Ex. B7 was also dt. 7-11-2005. But the copy of Ex. B7 was issued on 13-6-2008 and copy of Ex. B6 was issued on 14-6-2008. So as on 7-11-2005 the insured was suffering from cancer and the proposal form under Ex. B1 was on 25-3-2006. Knowing fully well that the insured was a cancer patient, she did not mention her cancer disease under Sl.No. 14H in Ex. B1. She answered that she had no such disease. But by the time of proposal form she had such disease but purposefully suppressed the material facts. Even Dr. J. Lakshmi did not mention the cancer disease of Smt. K. Renuka in her reports under Ex. A7, but simply noted Acute Myocardial infraction.
9. The respondents relied upon F.A. No. 1677/2007 R. Uma Devi Vs. Bajaj Allianz Life Insurance Co. Ltd., and another dt. 21-11-2007 that the material facts was suppressed i.e. liver disease prior to taking the policy. So the respondents were justified in repudiating the claim and suppression of material facts was violation of terms and conditions of the policy, on that ground the appeal was dismissed. The Xerox copy of order was under Ex. B5.
10. At this juncture it was also to be noted that the insured should have intimated her change of health condition even after submission of proposals before issue of 1st premium receipt. It was reported in I (2008) CPJ 455 (NC) Saramma Varghese Vs. LIC of India in that context the policy rendered invalid. Similarly in I (2008) CPJ 133 (NC) Sabnam Devi and others Vs. LIC of India and others on the ground of suppression of material facts repudiation of the claim was justified. In 2008 ACJ 456 (SC) P.C. Chacko and another Vs. Chairman LIC of India and others. It was held under section 45 of Insurance Act that the LIC was justified in repudiating the claim on the ground of fraudulent suppression of material facts. In these circumstances the insured i.e. the deceased Smt. K. Renuka suppressed the material facts of her earlier cancer at the time of giving proposal for taking the policy from the respondents in 2006. Therefore, the complainant is not entitled to any claim and the repudiation was justified. There was no deficiency of service on the part of the respondents.
11. Point No. 3. In the result the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 01st July 2008
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant : NIL For Respondents : NIL
Exhibits marked for complainant:-
Ex. A1 X/c of insurance policy issued by the Respondents.
Ex. A2 X/c of repudiation letter, dt. 1-9-2007.
Ex. A3 X/c of death certificate issued by Municipal Commissioner, Badvel.
Ex. A4 X/c of legal notice from complainant’s advocate to the Respondents,
dt. 5-10-2007.
Ex. A5 Postal receipt.
Ex. A6 X/c of statement issued by the respondents, dt. 31-5-2007.
Ex. A7 The X/c of death claim statement, dt. 3-7-2007.
Exhibits marked for Respodnent.
Ex. B1 X/c of proposal form of deceased policy holder, Dt. 25-3-2006.
Ex. B2 X/c of death intimation from the complainant, dt. 13-6-2007
Ex. B3 X/c of certificate issued by IRCS Jakka Sujathamma Cancer Detection
Center, Nellore
Ex. B4 X/c of rejection letter dt. 01-9-2007
Ex. B5 X/c of order in F.A. No. 1677/2007 of A.P. State commission,
dt. 21-11-2007.
Ex. B6 X/c of certificate issued by the Indian Red Cross Society cancer
hospital, Nellore dt. 14-6-2008
Ex. B7 X/c of certificate issued by the Indian Red Cross Society cancer
hospital, Nellore dt. 13-6-2008.
MEMBER PRESIDENT
Copy to :-
1) Sri P. Raghunatha Reddy, Advocate , Kadapa.
2) Sri D.V.S. Prasad, Advocate, Kadapa.
1) Copy was made ready on :
2) Copy was dispatched on :
3) Copy of delivered to parties :
B.V.P. - - - -
