STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA :
At HYDERABAD
FA 157 of 2015
AGAINST
CC No. 183 of 2013, DITRCIT FORUM, WARANGAL
Between:
01. India First Life Insurance Co.Ltd.,
Rep.by its Head –Governance
301, B Wing, The Qube,
Infinity Park, Dindoshi-Film City Road,
Malad (East), Mumbai – 400 097. …
02. India First Life Insurance Co.Ltd.,
Rep.by its Branch Manager,
Near Kalyani Hospital, Hanamkonda,
Warangal District. Appellants/Opposite Parties
And
Smt. Gavva Kalavathi,
W/o Late Vijender, age : 30 years,
Occ: House wife, R/o.H.No.16-67,
NTYR Nagar, Amebdkar Nagar,
Enumamula village,
Warangal District Respondent/Complainant
Counsel for the Appellants : M/s. K. Venkateswarlu
Counsel for the Respondent : M/s. G. Rajendra Prasad
Coram :
Honble Sri Justice B. N. Rao Nalla … President
And
Sri Patil Vithal Rao … Member
Wednesday, the Third Day of January,
Two Thousand Eighteen
Oral order : ( per Hon’ ble Sri Justice B.N.Rao Nalla, Hon’ble President )
***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the opposite parties praying this Commission to set aside the impugned order dated 24.07.2015 made in CC 183 of 2013 on the file of the DISTRICT FORUM, Warangal.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainant, in brief, is that she is the wife of deceased life assured Gavva Vijender, who died on 28.09.2012. During his life time, the said Vijender obtained India First Maha Jeevan Gold Plan (Triple Cover Benefit) Policy NO.10290291 from opposite party No.1 for Rs.1,37,000/- + Additional Death Benefits of Rs.2,74,000/- total Rs.4,11,000/- After the death of her husband, as nominee, she submitted all relevant documents to opposite parties for the insured claim. But the opposite parties have repudiated the claim on the ground that the life assured suppressed the pre-existing disease of ‘ Tongue cancer’ at the time of submission of proposal which is concocted and it amounts to deficiency in service. Hence the complaint to direct the Opposite Parties to pay policy amount of Rs.1,37,000/- under the policy with all attending benefits as per policy i.e, Rs.1,37,000/- + Rs.2,74,000/- = Rs.4,11,000/- and Rs.50,000/- towards damages and costs.
4) The Opposite Party No.2 filed the Written Version, which was adopted by first opposite party, while admitting the issuance of policy bearing NO.10290291 to the deceased life assured and receipt of insurance claim on 21.01.2013 from the complainant who is the wife of deceased life assured that the deceased life assured had passed away on 28.09.02012, contended that the opposite parties came to know that through treatment record issued by Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad that Deceased life assured took treatment for Tongue cancer and he was admitted in the said hospital on 24.02.2012 much prior to filling of proposal form. Thus the opposite parties rightly repudiated the claim of the complainant on the ground of suppression of material factsthe deceased by the deceased life assured at the time of taking the policy. Hence, Section 45 of Insurance Act is applicable and prayed to dismiss the complaint.
5) During the course of enquiry before the District Forum, in order to prove her case, the complainant filed her evidence affidavit and got marked Ex.A1 to A-6 and the opposite parties filed evidence affidavit and got marked B1 to B7.
- The District Forum, after considering the material available on record,
held that the opposite parties are jointly and severally liable to deposit in this Forum a sum of Rs.4,11,000/- towards sum assured with Tripple cover Benefit with interest @7.5% p.a. from the date of filing of the complaint i.e, 21.11.2013 till the date of realization and to pay Rs.10,000/-towards damages and costs within one month.
7) Aggrieved by the said order, the opposite parties preferred this appeal before this Commission.
8). Both sides have advanced their arguments reiterating the contents in the appeal grounds, rebuttal thereof along with written arguments. Heard both sides.
9) The points that arise for consideration are,
(i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner?
(ii) To what relief ?
10). Point No.1 :
There is no dispute that the respondent/complainant is the wife of the deceased/life assured Gavva Vijender and during his life time, the said Vijender obtained India First Maha Jeevan Gold Plan (Triple Cover Benefit) Policy NO.10305835 from opposite party No.1 for Rs.1,37,000/- + 2,74,000/- = Rs.4,11,000/-. There is also no dispute that she is the nominee. There is also no dispute that the insurance claim submitted by the respondent/ complainant was repudiated by the appellants’ Insurance company on the ground that the deceased policy holder suppressed the pre-existing disease of ‘ Tongue cancer ‘ at the time of submission of proposal. There is also no dispute that the policy was in force on the date of the death of the policy holder on 28.09.2012.
11) The contention of the respondent/complainant is that the deceased policy holder died on 28.09.2012 due to fever. Whereas, the appellants/opposite parties contended they came to know that through treatment record issued by Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad that DLA took treatment for cancer and he was admitted in the said hospital on 24.02.2012 much prior to filling of proposal form and hence they have repudiated the claim.
12). The District Forum relying on the Ex. B3 i.e, the photostat copy of the treatment record of Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad that deceased life assured took treatment for cancer and admitted on 24.02.2012 much prior to filling of proposal form. Mere production of Ex.B-3 to B-7 would not support the contention of the appellants/Opposite Parties, more particularly, there is no affidavit of the said Doctor. No officer of the Insurance Company is examined to prove the authenticity of the medical treatment of hospital and also the medical certificate and the burden of proof heavily lies upon the Insurance Company. Further, the appellants/Opposite Parties failed to prove that the cause of the death of the deceased was due to Cancer for past one year. Hence repudiation of the claim amounts to deficiency in service. We see no reason to contradict the above opinion of the District Forum in the absence of any cogent evidence, mere production of some unattested, unverified and unauthenticated photocopies, could not have been the basis of holding that the deceased suffered cancer and due to that reason he died.
13). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, this Commission is of the view that there is no infirmity or irregularity in the impugned order. There are no merits in the appeal and hence it is liable to be dismissed.
14). Point No. 2 :
In the result, the appeal is dismissed confirming the impugned order dated 24.07.2015 in CC 183/2013 of 2013 passed by the District Forum, Warangal. There shall be no order as to costs. Time for compliance four weeks.
PRESIDENT MEMBER Dated : 03.01.2018.
