NCDRC

NCDRC

RP/2892/2011

SBI LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

D. LEELAVATHI & ANR. - Opp.Party(s)

MR. KAPIL CHAWLA

20 Jan 2012

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 2892 OF 2011
 
(Against the Order dated 22/06/2011 in Appeal No. 1154/2009 of the State Commission Andhra Pradesh)
1. SBI LIFE INSURANCE CO. LTD.
2nd florr Tuner Morrison Building, GN Vidhya Marg Fort,
Mumbai - 400023
Mahrastra
...........Petitioner(s)
Versus 
1. D. LEELAVATHI & ANR.
Late D Kesavulu, D.No - 8/114 Prakashnagr,Near Teja School
Kadapa
AP
2. The Manager,State Bank of India
Yerramukkapali Branch
Kadapa
AP
...........Respondent(s)

BEFORE: 
 HON'BLE MR. ANUPAM DASGUPTA, PRESIDING MEMBER

For the Petitioner :MR. KAPIL CHAWLA
For the Respondent :MR. B. VENKATA RATNAM

Dated : 20 Jan 2012
ORDER

ANUPAM DASGUPTA This revision petition has been filed by the petitioner (SBI Life Insurance Company Limited) against the order dated 22.06.2011 of the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad (in short, he State Commission in First Appeal no. 1154 of 2009 filed by the respondent/complainant challenging the order dated 22.09.2009 of the District Consumer Disputes Redressal Commission, Kadapa (in short, he District Forum. By the said order, the District Forum had dismissed the complaint while, by its impugned order the State Commission set aside the order of the District Forum, allowed the appeal of the respondent/complainant and directed the petitioner to waive the loan amount payable under the insurance policy and also pay compensation of Rs.20,000/- to the respondent/complainant towards mental agony caused to her due to the petitioner deficiency in service in repudiating her claim, and cost of Rs.5000/-. 2. The complainant is the widow of D. Kesavulu who was working as the Station Manager, Tirumalapur, Chennai Division, South Central Railway at the relevant point of time. He availed of a housing loan of Rs.5,95,000/- on 08.02.2006 from the State Bank of India, Yerraukkapalli Branch, Kadapa and also the SBI Life Insurance Super Suraksha Scheme by paying a premium of Rs. 41,899/-. The latter Scheme provided the benefit that in case of death of the borrower policy holder/ member of the Scheme, the loan would be waived and the documents deposited with the insurer/lender Bank would be released/ returned. 3. The borrower/life assured died due to heart attack (cardiac and respiratory failure) at Kadapa on 08.02.2007. The complainant thereafter submitted the claim forms along with the supporting documents and the insurance certificate to the opposite parties (OPs) requesting waiver of the housing loan availed of by her deceased husband and return of the documents. However, the petitioner/OP repudiated the claim by its letter dated 12.12.2008 stating as under: e have referred the matter to our Claims Review Committee and the Committee had decided to repudiate the claim. We have indisputable evidence to prove that late Dokka Kesavulu was suffering from Hypertension, Diabetes, Coronary Artery Disease prior to our policy. The history of Hypertension, Diabetes and Coronary Artery Disease was not disclosed in the good health declaration, given by late Dokka Kesavulu at the time of taking insurance cover. Had the said history been disclosed to us, we would not have given him the insurance cover. We are unable to pay the claim in view of the reasons given above. However, we may write to us for further details. Ombudsman also look into cases where a claimant has a grievance regarding claim settlement 4. Aggrieved by this repudiation, the nominee of the insurance policy/widow of the deceased Kesavulu filed a consumer complaint before the District Forum. The complaint was resisted by the OPs, including the petitioner, on the grounds that there were out-patient tickets/cards of the Rajiv Gandhi Institute of Medical Sciences (RIMS) Government General Hospital, Kadapa showing that the deceased was suffering from hypertension, diabetes as well as coronary artery disease and was under treatment therefor. However, that he was suffering from these diseases was not disclosed by him while filling the Good Health Declaration Form which was mandatory for availing of the insurance. Moreover, Dr. C. Jamal Basha, Civil Assistant Surgeon, Government General Hospital, RIMS had given a letter to the Investigator (M/s. Satyam Investigators, appointed by the petitioner to investigate the claim) to the effect that the deceased Kesavulu used to visit the Hospital now and then for treatment of hypertension and diabetes during the period 2005-2007. The petitioner claimed that in view of non-disclosure of these material facts regarding his status of health/pre-existing diseases, at the time of seeking the insurance policy, the petitioner was justified in repudiating the nominee claim for indemnification in terms of the terms and conditions of the insurance policy in question. 5. On appreciation of the pleadings, evidence and documents brought on record, the District Forum dismissed the complaint by its order dated 22.09.2009. 6. On re-appraisal of the same evidence, however, the State Commission concluded to the contrary. It is useful to recapitulate the findings and observations of the State Commission: (i) Copies of the out-patient tickets/cards for 10.05.2005, 20.06.2005 and 08.02.2006 purporting to be issued by the out-patient department (OPD) of the RIMS Government General Hospital, Kadapa were not trust-worthy because, on the other hand, the original railway records produced by the respondent/complainant showed that Kesavulu was present on duty at Railway Station, Tirumalapur on the days on which he was shown to have received the out-patient treatment at RIMS, Government General Hospital at Kadapa. (ii) As regards the report of the Investigator claiming that Dr. C. Jamal Basha informed him that the deceased sed to visit the hospital now and then for treatment of hypertension and diabetes during the period 2005-2007and o this fact Dr. C. Jamal Basha, Civil Assistant Surgeon issued a letter in writing which is herewith enclosed as Annexure 9 the State Commission observed that the same Doctor had actually signed the Medical Attendant Certificate dated 18.03.207 in which he categorically wrote that the deceased died a udden deathand he did not have any pre-existing ailment and he was not undergoing any treatment prior to his death. In view of this, the petitioner ought to have filed the original letter that, according to the Investigator, was given by Dr. C. Jamal Basha and claimed to have been enclosed as Annexure 9 with his report. (iii) The State Commission further observed that the complainant had alleged that the photocopies of the out-patient tickets were created for the purpose of repudiation of her claim. Even in the face this allegation, there was no attempt on the part of the petitioner to examine the doctor(s) of RIMS, Government General Hospital, Kadapa who had issued the out-patient tickets in the name of the deceased Kesavulu. (iv) For these reasons, the State Commission came to the conclusion that the petitioner was not justified in repudiating the claim of the respondent/complainant and passed the order already noticed. 6. I have heard the learned counsel for the parties and also gone through the original records of the State Commission as well as the District Forum. 7. On careful examination of the records, I am in complete agreement with the finding of fact of the State Commission: (i) First, the crucial letter of Dr. C. Jamal Basha, Civil Assistant Surgeon, RIMS Government General Hospital to the alleged effect that the deceased used to come to his hospital for treatment of hypertension and diabetes during the period 2005-2007 was not filed before the District Forum, though the Investigator signed report was filed and the said report referred to have enclosed the letter of Dr. C. Jamal Basha as Annexure 9. (ii) Secondly, the State Commission has rightly observed that the photocopies purporting to be the out-patient tickets/cards of deceased Kesavulu at the RIMS Government General Hospital, Kadapa do not bear the signature of any attending physician at the OPD nor was any Doctor produced before the District Forum to prove these documents. On the other hand, the complainant produced the signed records of attendance of the deceased at the Railway Station, Tirumalapur on the days that he was alleged to have gone to Kadapa for treatment at the RIMS Government General Hospital, Kadapa. (iii) In my opinion, it was also necessary for the petitioner to examine the Investigator who had signed the Investigator report and ask him to produce the statement attributed to the complainant that her husband used to go to the Government General Hospital for check-up of BP. In fact, for proper adjudication of the dispute, the District Forum ought to have suo motu directed the OPs to not only produce the Investigator as a witness but also Dr. C. Jamal Basha, in view of the clear and unambiguous certificate dated 18.03.2007 issued by the said Doctor stating that the death of Kesavulu was natural and he did not suffer from any disease prior to his death. 8. In view of the foregoing, I have no hesitation in holding that this petition does not make out any ground to establish that the order of the State Commission suffers from any jurisdictional error, legal infirmity or material irregularity that may warrant interference under section 21 (b) of the Consumer Protection Act, 1986. 9. The revision petition is accordingly dismissed, with no order as to cost.

 
......................
ANUPAM DASGUPTA
PRESIDING MEMBER

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