Karnataka

Kolar

CC/28/2015

Sr.Srinivasa.B - Complainant(s)

Versus

HDFC Life Insurance Company Limited - Opp.Party(s)

Sri.B.Kumar

28 Feb 2017

ORDER

Date of Filing: 12/08/2015

Date of Order: 28/02/2017

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, D.C. OFFICE PREMISES, KOLAR.

 

Dated: 28^th DAY OF FEBRUARY 2017

PRESENT

SMT. PRATHIBHA.R.K., BAL LLM, PRESIDENT

SMT. A.C. LALITHA, BAL., LLB           ……  LADY MEMBER

CONSUMER COMPLAINT NO :: 28 OF 2015

Sri.Srinivasa.B @ Srinivasappa,

S/o. Changalarayappa,

Aged About 33 Years,

R/at: House No.80, Majara

Upparahalli, Byatanuru, Mulbagal

Taluk, Kolar District.

(Rep. by Sri.G.N. Narayanaswamy, Advocate)                      ….  Complainant.

 

- V/s -

M/s. HDFC Life Insurance Company

Limited, Balaji Building, 2^nd Cross,

M.G. Road, Kolar.

(Rep. by Sri.N.G.Vasudeva Murthy, Advocate)            …. Opposite Party.

-: ORDER:-

 

BY SMT. PRATHIBHA.R.K, PRESIDENT

01.   The complainant has preferred this complaint as envisaged Under Section 12 of the Consumer Protection Act, 1986 against the OP seeking directions against the OP to pay Rs.4,24,410/- towards maturity amount, to pay Rs.2,50,000/- towards loss of estate and Rs.2,50,000/- towards damages along with costs.

 

02.   The facts in brief:-

(a)    It is contention of the complainant that, the complainant is an agriculturist and his parents Sri.Changalarayappa and Narayanamma were owning properties at Palamner and also in Mulbagal.  The complainant’s father had 3 acres in Byrakur Village, Mulbagal, and complainant’s mother had 5 acres and 4 cents of agricultural lands in Jangapalli Village, Gandarajpalli, Gangavaram Mandal, Palamner Taluk, Andhra Pradesh.  The annual agricultural income of the complainant’s parents is Rs.20,33,933/- and Rs.7,61,619/- for the years 2013-2014 and 2012-2013 respectively. 

 

(b)    The complainant further submits that, during the life time of Late Smt. Narayanamma, she had obtained an insurance policy bearing No.16852700, dated: 14.05.2014 from the OP-Insurance Company for an assured sum of Rs.4,24,410/-.  The annual premium towards the said insurance policy was Rs.34,000/- and the period is fixed for 15 years.  The first premium of Rs.34,000/- was paid by Smt.Narayanamma during her life time.  The OP has also issued the insurance policy after accepting the proposal towards the said insurance policy submitted by the mother of the complainant. 

 

(c)    Further complainant submitted that, on 19.08.2014 Smt. Narayanamma, mother of the complainant, complained of chest pain and was immediately she was taken to Dr.K.Kadirappa, a Civil Surgeon at Srinivasa Nursing Home, Palamner, Chittor District, Andhra Pradesh.  After examination Dr. K.Kadirappa referred her to higher hospital as she was suffering from Myocardial Infraction.  As per the advice of Dr. K.Kadirappa, complainant tried to shift Smt.Narayanamma through 108 Ambulance to R.L. Jalappa Hospital, Kolar, but while on the way near Mulbagal she succumbed.  Immediately complainant rushed to Manohara Sai Gowda Memorial Hospital, Mulbagal, where the doctor declared her dead and the cause of death may be due to massive heart attack. 

 

(d)    Further contention of the complainant is that, claim was submitted to the OP towards above said policy and the OP has repudiated the same through letter dated: 02.01.2015. 

 

(e)    The complainant further contention is that, in spite of several approaches and requests made by the father of the complainant Sri.Changalarayappa, the OP instead of settling the claim, repudiated the claim, holding Smt. Narayanamma died on account of breast cancer.  The father of the complainant could not withstand this attitude of the OP and due to stress and strain given by the OP he died on 29.04.2015. 

 

(f)     Further complainant’s submission is that, due to the demise of both father and mother complainant became an orphan and was thrown to the street.  The complainant submitted that, One Smt. Narayanamma, W/o. Narayanappa, residing at Upparahalli, Mustur Post, who belongs to same village has visited Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011.  The OP by referring to the above document has repudiated the claim of the complainant.  So contending, the complainant has filed this complaint seeking the above set-out reliefs against the OP.

 

(g)    Along with the complaint the complainant has filed following copies of documents:-

(i) Copy of the ROR issued by Mee Seva, AP.

(ii) Copy of the Pass-book issued by the Government Office of AP.

(iii) Certificate issued by Deepthi.A.V., Chartered Accountant.

(iv) Policy Acceptance Letter dt: 23.05.2014 issued by the OP with policy schedule and terms and conditions.

(v) Claim Form-B of Reliance Life Insurance issued by Dr.K.Kadirappa, Palamner, Chittoor District.

(vi) Certificate dated: 10.10.2014 issued by Dr.Doddabadre Gowda, Manohara Sai Gowda Memorial Hospital, Mulbagal.

(vii) Death certificate dated: 17.10.2014 of Smt. Narayanamma.

(vii) Repudiation letter dated: 02.01.2015 issued by the OP.

(viii) Death certificate of Sri.B.Chengalrayappa

(ix) First Premium Receipt issued by Bajaj Allianz Life Insurance Company with policy acceptance proforma.

(x) Personal Protect Policy issued by ICICI Lombard General Insurance Company.

(xi) Patient’s ID Card and Election card of Narayanamma, W/o. Narayanappa.

 

03.   In response to the notice issued from this Forum, counsel for OP appeared and filed his version by resisting the claim of the complainant in toto.

 

(a)    The OP submitted that, the details regarding the properties owned by the parents of the complainant are not within the knowledge of this OP.  The annual income of parents enclosed along with the complaint is put to strict proof.  It is true that the allegations made in the complaint that, the mother of the complainant Smt. Narayanamma during her lifetime had obtained policy bearing No.16852700 for an assured sum of Rs.4,24,410/- for a period of 15 years and Rs.34,000/- was paid towards annually and the said proposal was accepted by this OP.  Further allegation of the complainant that, on 19.08.2014 Smt. Narayanamma died because of chest pain and she was diagnosed by Dr.K.Kadirappa at Chittor, Andhra Pradesh and thereafter the said Doctor referred her to higher hospital are totally denied by this OP.  Further allegation that, as per the advice Smt.Narayanamma in 108 Ambulance while shifting to R.L. Jalappa Hospital, Kolar, on the way near Mulbagal, she lost her breath and immediately complainant rushed to Manohara Sai Gowda Hospital, at Mulbagal, where the doctor declared her death and the cause of death may be massive heart attack are totally denied by this OP.

 

(b)    Further contention of the OP is that, the allegation made in Para-9 of the complaint that, complainant’s mother died on 19.08.2014 is admitted but the cause of death due to massive heart attack is put to strict proof.  The allegations at Para-10 that claim was repudiated in the policy No.16852700 on 02.01.2015 vide claim repudiation letter by stating that, Non-disclosure of previous ailments of Intraductal Carcinoma prior to the date of this policy can be substantiated by the Hospital records issued by Kidwai Memorial Institute of Oncology, Bangalore.  The allegation made in the complaint that, the father of the complainant could not withstand the torture given by the OP is put to strict proof.  The further allegations of the complainant that, the complainant became orphan and thrown to street due to the attitude shown by this OP are all incorrect and denied by this OP.  Further allegation made in the complaint that, one Sri.Narayanamma W/o. Narayanappa who is also resident of same village has visited the Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011 and the OP by referring the above case has repudiated the claim is herewith denied by this OP.   

 

(c)    OP further contended that, after following the rules and procedure of the insurance company and only on the procedure and verification of all the medical documents of the deceased Narayanamma, the OP has rejected the claim of the complainant as deceased Narayanamma died due to breast cancer and the same was not disclosed by the deceased at the time of issuance of policy.  So contending the OP has prayed for dismissal of the present complaint as there is no any deficiency in service on the part of this OP.

 

04.   On 22.10.2016 counsel for complainant has filed affidavit evidence by way of examination-in-chief and on 25.11.2016 Sri.B.G. Kumar, Associate Manager-Legal, on behalf of OP has filed his affidavit evidence. 

 

05.   On 19.12.2016 counsel for complainant has submitted written arguments along with Memo and list of documents.  On the very same day counsel appearing for complainant has also produced another Memo with following citations:-

(i) III (2014) CPJ 221 (NC)

(ii) IV (2014) CPJ 124 (PUNJ)

(iii) III (2015) CPJ 478 (NC)

(iv) I (2014) CPJ 36 (NC)

(v) II (2014) CPJ 7B (CN) (UP).

 

06.   On 29.11.2016 counsel appearing for OP has submitted its written arguments along with Memo and following list of documents:-

(i) Copy of the Repudiation Letter issued to complainant dated: 02.01.2015.

(ii) Copy of case summary sheet of Smt. Narayanamma issued by Kidwai Memorial Institute Of Oncology, Bangalore.

(iii) Copy of the Surgical Case Record dated: 15.03.2011 issued by Kidwai Memorial Institute Of Oncology, Bangalore.

(iv) Copy of the Out Patient Department dated: 15.03.2011 issued by Kidwai Memorial Institute of Oncology, Bangalore.

(v)      Copy of the order in R.P. No. 50/2011 and 51/2011 passed by the Hon’ble NCDRC, New Delhi.

(vi)     Copy of policy dated: 23.05.2014.

 

07.   Therefore the points that do arise for our consideration in this case are:-

 (A) Whether the complainant has proved  

     deficiency in service on the part of the 

      OP?

 (B) Whether the complainant is entitled for the reliefs sought for in the complaint?

(C)   What order?

 

08.   Findings of this District Forum on the above stated points are:-

POINT (A) & (B):- In the Negative

POINT (C):-  As per the final order

for the following:-

 

REASONS

POINTS (A) & (B):-

09.   On perusal of the pleadings along with documents, affidavit evidence and written arguments produced by both the parties it is an admitted fact that, the complainant’s mother Smt.Narayanamma, W/o. Changalarayappa, had obtained an insurance policy bearing No.16852700 on 14.05.2014 from the OP-Insurance Company for an assured sum of Rs.4,24,410/- and the annual premium towards the said insurance policy was Rs.34,000/-.  Further it is an admitted fact that, the period of the said policy is fixed for 15 years and the first premium of Rs.34,000/- was paid by complainant’s mother Smt.Narayanamma during her life time to the OP.  Further it is also an admitted fact that, the OP – Insurance Company has also issued the insurance policy after accepting the proposal towards the said insurance policy submitted by the mother of the complainant Smt.Narayanamma during her life time. 

 

(b)    Furthermore it is also an admitted fact that, on 19.08.2014 the complainant’s mother Smt. Narayanamma was declared as dead and to substantiate this contention complainant has produced Death Certificate dated: 17.10.2014 of Smt. Narayanamma, W/o. Changalarayappa, issued by Thasildhar, Mulbagal Taluk.   It is further an admitted fact that, after the death of Smt. Narayanamma complainant being a nominee of the above said policy has submitted claim form with all relevant documents to the OP-Insurance Company.  The OP-Insurance Company had repudiated the claim through letter dated: 02.01.2015 holding that, “after investigations it is established that, the Life Assured Smt. Narayanamma was suffering from intraductal Carcinoma prior to the policy issuance and the same was not disclosed in the application dated: 14.05.2014 and hence the claim of the complainant is rejected”. 

 

(c)    On perusal of the allegations made in the complaint, it reveals that, on 19.08.2014 Smt. Narayanamma mother of complainant complained of chest pain and immediately she was taken to Dr.K.Kadirappa a Civil Surgeon at Srinivasa Nursing Home, Palamner, Chittor District, Andhra Pradesh.  After examination Dr. K.Kadirappa referred her to higher hospital as she was suffering from “Myocardial Infraction”.  As per the advice of Dr. K.Kadirappa, complainant tried to shift Smt.Narayanamma through 108 Ambulance to R.L. Jalappa Hospital, Kolar, but while on the way near Mulbagal she succumbed.  Immediately complainant rushed to Manohara Sai Gowda Memorial Hospital, Mulbagal, where the doctor declared her death and reported that, the cause of death may be massive heart attack.  To substantiate his contention the complainant has produced notarized copy of the “Claim Form B-Medical Attendant Certificate by the last treating doctor” dated: 21.10.2014, wherein Dr.K.Kadirappa, M.B.B.S., Ex. Civil Asst. Surgeon, Srinivasa Nursing Home, Palamaner, Chittoor District, Andhra Pradesh, at serial No.06 has mentioned that, “Myocardial Infarction” and at Sl. No.16 it is mentioned that, the patient was advised to go to R.L. Jalappa Hospital for expert opinion and treatment.  On perusing the other document issued by Manohara Sai Gowda Memorial Hospital and Laparoscopic Training Centre, Mulbagal, dated: 10.10.2014 it is mentioned as follows:-

“This is to certify that, SMT. Narayanamma native of Majara Upparahalli Village, Mulbagal Taluk, Kolar District, brought to our hospital, “DEAD” ON 19.08.2014 AT 800 pm along with dead body Mr.Srinivas, S/o. Narayanamma accompanied.

CAUSE OF DEATH:         Most probably the cause of death may be massive heart attack.”

 

Per contra, the OP in its version has submitted that, on verification of all the medical documents of the deceased Smt.Narayanamma, the OP has rejected the claim of the complainant as deceased Smt.Narayanamma died due to “Breast Cancer” which is a pre-existing disease and the same was not at all disclosed by the deceased Narayanama while at the time of issuance of the policy.  To substantiate this contention the OP has produced Case Summary Sheet, Surgical Case Record and copy of the Out-patient Department issued by Kidwai Memorial Institute Of Oncology, Bangalore-29.  The date of registration of patient is mentioned as 15.03.2011.  On careful perusal of the “Case Summary Sheet” it is clearly mentioned that, the patient Name is Mrs. NARAYANAMMA aged about 56 years and her Husband’s Name is Changalarayappa, and her Attender’s Name is Srinivas.  In the relationship column it is clearly mentioned as “Son”.  The nature of illness is LUMP ® Breast.  The second document produced by the OP is “Surgical Case Record” wherein which under the heading “complaints and duration” it is mentioned as “Lump in Right Breast – 3 months, No Nipple discharge, h/o pain.  Further the past history is mentioned as HPR Intraductal carcinoma.  Further in the copy of out-patient department dated: 15.03.2011 issued by the Kidwai Memorial Institute Of Oncology, Bangalore, the nature of illness is mentioned as Lump (R) Breast.  There is also a note stating as “please make file for surgery” is mentioned.  Hence there is no doubt that in the year 2011 itself the complainant’s mother Smt. Narayanamma, W/o. Changalarayappa, was suffering from Breast Cancer. 

 

(d)    Further the complainant has submitted that, One Smt. Narayanamma, W/o. Narayanappa, who is also residing in the same village had visited Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011.  The OP had come to the wrong conclusion that, the complainant’s mother had not disclosed the ailments/pre-existing diseases while at the time of obtaining the said policy and had falsely repudiated the claim of the complainant. 

 

(e)    The complainant further submitted that, on humanitarian consideration and as a rustic villager complainant took Smt. Narayanamma, W/o. Narayanappa, who is also residing in the same village and who is suffering from Breast Cancer was taken for treatment to Kidwai Medical Institute of Oncology, Bangalore, on 15.03.2011.  While so when the hospital authorities questioned about the name of the husband and residence.  Without knowing the fact the complainant had given his name as son and the name of Narayanamma husband as Sri.Changalarayappa instead of Sri.Narayanappa.

 

(f)     Complainant further submitted that, the patient Smt.Narayanamma W/o. Narayanappa had sworn to an affidavit dated: 07.05.2015 that, there was a mistake mentioned in the certificates of the hospital as her husband’s name and her son’s name and was submitted before the Hospital authorities for correction.  The hospital authorities after verifying Aadhar Card, I.D. Card and other documents have directed to change the name.  

 

(g)    Based on the facts and circumstances of the above case, the repudiation made by the OP-Insurance Company on 02.01.2015 is legal and valid.  The OP-Insurance Company has produced documents to show that, the complainant’s mother died due to Cancer.  Further the OP had also furnished documents to show that, the complainant’s mother Late. Smt. Narayanamma, wife of Changalarayappa had taken treatment at Kidwai Hospital on 15.03.2011.  However the complainant submitted that, he had taken one Smt. Narayanamma wife of Sri.Narayanappa to the Kidwai Hospital on 15.03.2011 and that the complainant had given the Narayanamma’s name as Narayanamma W/o. Changalarayappa instead of Narayanamma W/o. Narayanappa and that he had also given wrong details of the assistant as Srinivas and relationship as Son is only a make believe story.  It is not known as to how a mistake had arouse while the complainant had given wrong details while he admitted Smt. Narayanamma who was the complainant’s neighbor in the village. 

 

(h)    Further we cannot understand after lapse of long period that is from 15.03.2011 to 07.05.2015 why this Smt. Narayanama W/o. Narayanappa kept silent without giving any requisition letter to the Kidwai Hospital authorities with regard to the change of husband’s and son’s names in the hospital records?  It is very pertinent to note that, the OP-Insurance Company had repudiated the claim on 02.01.2015 itself.  After repudiating the claim, one Smt. Narayanamma, W/o. Narayanappa, had submitted her requisition on 07.05.2015 for correction in change of husband’s name and son’s name in the hospital records. 

 

(i)     In view of the above facts and circumstances, it is clear that, Smt. Narayanamma, W/o. Changalarayappa, was suffering from Breast Cancer before taking the policy.  And she has suppressed the real facts and falsely obtained the policy.  Hence we came to the conclusion that, there is no deficiency of service on the part of the OP. Accordingly we answered to the issue Nos. (A) & (B) in the negative. 

 

POINT (C):

10.   We proceed to pass the following:-

ORDER

01.   The complaint filed by the complainant is hereby dismissed.  No orders as to costs.

 

02.   Send a copy of this order to both parties free of cost

 

(Dictated to the Stenographer in the Open Forum, transcribed by him, corrected and then pronounced by us on this 28^th DAY OF FEBRUARY 2017)

 

                                                      

 

LADY MEMBER                                    PRESIDENT