BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
F.A.No.868 OF 2010 AGAINST C.C.NO.61 OF 2009 DISTRICT FORUM ONGOLE PRAKASAM DISTRICT
Between:
- Shriram Life Insurance Co.Ltd.,
Regd. Off: 3-6-478, III Floor,
Anand Estate, Liberty Road,
Himayathnagar, Hyderabad
- The Branch Manager
Shriram Chits (P) Limited
Kandukur Branch, Kandukur
Appellants/opposite parties
A N D
Divi Madhavi W/o Divi Krishna Acharyulu
Kandukur Road, Singarayakonda (V&M)
Prakasam District
Respondent/complainant
Counsel for the Appellants M/s K.Rajeshwara Rao
Counsel for the Respondent M/s Verriyya
QUORUM: SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER
AND
SRI THOTA ASHOK KUMAR, HON’BLE MEMBER
WEDNESDAY THE ELEVANTH DAY OF JULY
TWO THOUSAND TWELVE
Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)
***
1. The opposite parties are the appellants.
2. The respondent’s son had obtained “Shri Plus (SP)” insurance policy bearing No.LN80600099774 for the period from 28.12.2002 for the sum assured `6,25,000/-. The insurance policy was issued under ‘Unit Linked Insurance Plan Scheme’. The respondent’s son died on 4.2.2008 and after the death of her son she lodged claim with the appellant-insurance company. The appellant paid a sum of `8 lakh and the respondent filed complaint seeking balance amount under claim, an amount of `3,64,445/- which was awarded by the District Forum.
3. The version of the respondent is that she was a subscriber of the chit conducted by the second appellant chit fund company and she was holding ticket number 34 for the chit amount of `5,00,000/-. The chit period was for 50 months with the chit commencement in the month of September, 2002 and concluding in Septemeber,2006. The second appellant chit fund company induced her to invest an amount of `5,00,000/- under Shri Plus single premium unit linked insurance plan scheme and assured her that it would fetch her 125% minimum sum assured and the value of the units . At the time of issuing the insurance policy, the second appellant raised objection as to her age and suggested her to obtain the insurance policy in the name of her son. The respondent accepted the suggestion of the second appellant and accordingly, her son was examined by the doctors of the appellants and the second appellant paid the amount on22.09.2006 to the first appellant after obtaining her signature on the vouchers. Insurance Policy was issued showing the fund section as Balance Fund.
4. It is contended that the appellants collected the amount from the respondent on 22.09.2006 and issued the insurance policy on 28.10.2006. The respondent’s son suddenly died in the month of March,2008. The appellants delayed settlement of her claim on the premise that her son concealed his ill health at the time of obtaining the insurance policy and by pressurizing her obtained her signature on letter dated 23.09.2008 addressed to the second appellant requesting it to settle the claim for `8,00,000/-. The letter was prepared by the second appellant who paid a tentative amount of `8,00,000/- and promised her that within sixty days they would pay balance claim an amount of `3,46,445/-. She waited till the month of December,2008 and requested the second appellant to pay the balance claim amount which they refused to pay stating that she executed the documents for settlement of claim for `8,00,000/- and as such the respondent got issued notice on 7.01.2009 which was received by the appellants and did not evoke any response from them.
5. On behalf of the first appellant insurance company it is contended that the District Forum has no jurisdiction to entertain the complaint and that the respondent is not a consumer within the meaning of Sec.2(1)(d) of the C.P.Act. It is contended that at the time of taking the policy the first appellant suggested late Naresh to fill the proposal form with correct details regarding his health condition preexisting diseases if any, and basing on the information providing in the proposal form the insurance company has accepted risk under non-medical on his life and issued the policy in good faith. The respondent has not submitted claim form within stipulated period and the appellant-insurance company closed the claim on 11.2.2008. Thereafter she submitted the claim forms. The primary cause of death was mentioned as acute lympoblastic leukomia and secondary cause as relapse. The appellant company conducted preliminary investigation which revealed that the insured was subjected to severe health problems and had taken the policy with ill motive.
6. The first appellant company addressed letter dated 23.8.2008 requesting the respondent to send the medical case sheet and diagnostic report of the insured and the respondent negotiated with the first appellant company and requested for payment of exgratia. On humanitarian grounds and keeping in view of single premium of Rs.5 lakh, the first appellant company accepted their request letter dated 23.9.2008 for payment of exgratia amount including fund value. The first appellant company paid Rs.8 lakh as exgratia and the respondent executed discharge voucher. The investigation revealed that the respondent's son was subjected to severe health problem and he was admitted to NIMS. He suppressed his preexisting disease and suppressed the material fact.
7. The respondent has filed her affidavit and the documents Exs.A1 to A12. On behalf of the appellants, the Assistant General Manager, of the appellant no.1 filed his affidavit and the documents Exs.B1 to B13.
8. The District Forum has allowed the complaint on the premise that the respondent had executed the document dated 23.9.2008 under undue influence and mere execution of discharge voucher would not estope her from claiming further amount from the appellants .
9. The opposite parties filed the appeal contending that the insured had not furnished correct details of his health condition and that the investigator submitted his report dated 21.7.2008 which revealed that he was subjected to severe health problems before taking the policy and knowing the investigation done by the insurance company the respondent negotiated with the appellants and requested for payment exgratia. A sum of `8 lakh which include `5,39,445/- towards fund value and `2,60,555/- towards exgratia amount was paid to her towards full and final settlement of the claim. The investigation revealed that the policy holder was subjected to severe health problem before getting admitted to NIMS. The discharge voucher was not obtained by exercising undue influence.
10. Written arguments have been submitted by the counsel for the appellants and the respondent.
11. The points for consideration are:
1. Whether the appellants rendered deficient service in repudiating the claim?
2. To what relief?
12. POINT NO.1 The facts not in dispute are that the respondent subscribed to the chit conducted by the second appellant chit fund company and on the advice of the second appellant she opted for obtaining insurance policy as also that the advice of the second appellant she obtained the insurance policy in the name of her son as person of her age was not entitled to obtain the insurance policy. It is not disputed that the appellants settled the claim for Rs.8 lakh. The respondent's contention is that she was promised by the first appellant insurance company that the balance amount would be paid to her afterwards.
13. The contention of the appellant-insurance company is that the respondent's son suppressed the fact of his suffering from leukomia. The past history of the patient noted in the discharge summary issued by the NIMS reads as under:
“Had fever 2 months ago – told to have typhoid fever and “jaundice” (white jaundice)” No C/o ../pale stool..coloured urine”
14. A perusal of the medical record would show that the respondent was not admitted to any hospital nor was treated by any doctor prior to the time he was admitted to the NIMS. The contention of the learned counsel for the appellant insurance company that the respondent's son suppressed the fact has not been substantiated.
15. Coming to the question of the discharge voucher submitted by the respondent, the District Forum upheld her contention that she was not aware of the contents of the letter and that the first appellant insurance company promised her that the balance claim amount would be paid to her afterwards. A perusal of letter dated 23.9.2008 would show that it is written in English and the respondent had signed it in Telugu. It is contended by the respondent that the letter was drafted by the appellant-insurance company. The statement of the respondent was not denied by the appellant-insurance company.
16. The appellant insurance company has been contesting the claim of a helpless mother of the deceased insured. It is not known how and when the respondent executed the document in favour of the first appellant insurance company restricting her claim to a sum of `8 lakh. The reason for acceptance of the settlement of the claim for `8 lakh, as assigned by the first appellant insurance company is that the respondent apprehended repudiation of her claim on the basis of investigation initiated by the appellant insurance company and she apprehended that the investigation would reveal suppression of material fact regarding the health condition of her son at the time of submitting the proposal, cannot be accepted as the investigation of the case did not reveal any adverse circumstance relating to suppression of the health condition of the insured.
17. As aforesaid, there has been no evidence placed on record by the appellant to show that the insured was suffering from any pre-existing disease at the time of submitting the proposal and the medical record issued by the NIMS Hyderabad does not speak any ill-health and treatment therefor pertaining to the deceased son of the respondent. The first appellant insurance company has not discharged its obligation to prove the facts basing on which it has repudiated the claim for balance amount of `3,64,445/-.
18. For the foregoing reasons, we do not find any infirmity in the order passed by the District Forum in regard to the deficiency in service on the part of the appellants in the matter of repudiation of the balance claim.
20. In the result, the appeal is dismissed confirming the order of the District Forum. The costs of the proceedings quantified at `3,000/-. Time for compliance four weeks.
MEMBER
MEMBER
Dt.11.07.2012
KMK*
