Karnataka

Tumkur

CC/163/2019

Shri Adishesha T R - Complainant(s)

Versus

HEAD CLAIMS ,THE MANAGER , SBI Life Insurance Company Limited - Opp.Party(s)

R BALAJI AND ASSOCIATES.

20 Nov 2020

ORDER

Complaint filed on: 27-09-2019

                                                      Disposed on: 20-11-2020

 

 

BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, TUMAKURU

 

CC.No.163/2019

 

DATED THIS THE 20^th DAY OF NOVEMBER, 2020

 

 

PRESENT

 

 

SRI.C.V.MARGOOR, B.Com, L.L.M, PRESIDENT

SMT.NIVEDITA RAVISH, B.A., L.L.B, LADY MEMBER

 

Complainant: -

       

                                                Shri.Adishesha.T.R

S/o late Ramachandraiah.T,

Rajanna Angadi Circle,

Thimmanahalli,

Chikkanayakanahalli Taluk,

Tumkur district,

Karnataka -572 228

 

(By Sri.R.Balaji Singh & Associates, Advocates)

 

V/s

 

Opposite party:-       

 

Head Claims,

The Manager,

SBI Life Insurance Co. Ltd,

Central Processing Centre,

Kapas Bhavan, Plot No.3A,

Sector No.10,

CBD Belapur, Navi Mumbai,

Pin: 400 641

(By Sri.G.S.Narayana, Advocate)

 

      

ORDER

 

SRI.C.V.MARGOOR, PRESIDENT

 

This complaint is filed to direct the Opposite party-SBI Life Insurance Co.Ltd (hereinafter called as OP) to pay the sum assured maturity value of the Life Insurance policy bearing No.56060202510 dated 28-10-2013 amounting to Rs.1,50,000=00  with interest at 12% p.a. till the date of payment and Rs.25,000=00 towards pain, sufferings and mental agony caused to the complainant.

 

2. It is the case of complainant that his father late Ramachandraiah.T. was holding SBI Life policy bearing No.56060202510 from the OP. The said policy was obtained on 22-10-2013 for sum assured Rs.1,50,000=00 by paying premium amount of Rs.15,000=00 on the said date. The father of complainant was expired on 22-11-2013. After the death of Ramachandraiah.T the complainant has approached the OP for payment of sum assured Rs.1,50,000=00 but the OP has repudiated the claim and on the contrary issued cheque for Rs.9,806=00. Hence, this complaint.    

         

3. The OP after the service of notice appeared through its learned counsel and filed detailed written version admitting that late father of complainant was holding SBI Life policy for Rs.1,50,000=00 by paying premium amount of Rs.15,000=00 on 22-10-2013. Late father of complainant was died within one month from the date of taking SBI Life policy. The father of complainant has suppressed material facts in respect of his previous diseases and he was suffering from diabetes, septicemia and hypoxia prior to taking SBI Life policy. The OP has rightly repudiated the claim of complainant since his father had suppressed the material facts while taking the policy.

 

4. The next contention of OP is that this Forum is not having territorial jurisdiction since the OP is doing business at Mumbai. On amongst other grounds, the OP asked to dismiss the complaint.

 

          5. The complainant filed his affidavit in lieu of evidence and produced ten documents in support of his case. On behalf of OP its authorized representative Smt.Dhanya.K.P. W/o Unnikrishnan.K.P filed affidavit evidence and got marked Exs.R1 to R11 documents.  

 

          6. We have heard the oral arguments in addition to written brief submitted by the complainant and the points that would arise for determination are as under:

1)      Whether the complainant proves that repudiation of his claim by the OP is illegal and arbitrary?

2)      Is complainant entitled to the reliefs sought for?  

7. Our findings on the aforesaid points are as follows:

Point No.1: In the negative   

Point No.2: As per final order for the below;

 

REASONS

 

          8. Point No.1 to 2: The learned counsel for the complainant have vehemently argued that the deceased Ramachandraiah.T father of complainant was holding SBI Life policy commencing from 22-10-2013. Unfortunately the deceased was died on 22-11-2013 due to severe cardiac arrest. The learned counsel further submitted that before his demise the insured was hale and healthy and he had no health issues on the date of demise. The policy holder was aged about 59 years and before availing the policy the deceased has underwent for full medical checkup wherein he was certified that the deceased was hale and healthy. The learned counsel for the complainant argued that the deceased has furnished all the particulars to the OP at Thimmanahalli village at the time of taking the policy and after verification of details the policy was given to the deceased.

 

9. The OP has not disputed that the deceased Ramachandraiah.T father of complainant had taken SBI Life policy for Rs.1,50,000=00 by paying premium amount of Rs.15,000=00 on 22-10-2013. The policy term was 10 years. The death of deceased Ramachandraiah.T as on 22-11-2013 is not in dispute as it is supported by the death certificate produced by the complainant. It shows that the insured father of complainant was died within one month from the date of taking SBI Life policy.

 

          10. The OP has produced Ex-R1 Proposal form submitted by the deceased Ramachandraiah.T father of complainant on 8-10-2013. The OP has highlighted the some clauses of column No.13 of Ex-R1. The clause No.4 of column no.13 is with regard to medical details of insured as to whether during the last 10 years have you undergone or advised to undergo hospitalization or an operation or any investigation or tests or medical treatment. Clause No.13 says do you have high blood pressure or have you ever suffered or treated or have you have been advised to undergo investigation for high blood pressure. Clause-14 of column No.13 says do you have diabetes or have ever suffered or treated or have you been advised to undergo investigation for diabetes. The insured has given answer to all the three questions as “No”. Further with regard to heart disease the father of complainant stated as “No”. Before issuing the policy the deceased has undergone medical examination by the insurer doctor. The deceased stated his age as 58 years and his answer to question No.2 are you currently on any medication – “No”. For all other questions with regard to heart and other diseases the insured stated as “No”. The deceased stated that diabetes seen in two years.

 

11. The OP has marked Ex-R4/1 of the medical examination details given by the father of complainant before the insurer doctor on 10-10-2013. The OP after receiving Ex.R3 death claim submitted by the complainant on 18-12-2013 has made claims investigation and during investigation the OP came to know that the insured has suppressed the material facts with regard to his health. The OP has produced Ex.R5 treatment taken by the insured in Dr.K.Narasimhaiah Super Speciality Hospital, Tumkur. According to Ex-R5 the insured was admitted as in patient on 23-2-2013 at 3.00 p.m. and discharged on 28-2-2013 for heart disease, diabetes etc.  It is recorded in Ex.R5 that the deceased was suffering from diabetes i.e. T2DM since six years, septicemia LRT1 and severe hypoxia. The OP has marked Ex-R6 for examining the insured Ramachandraiah.T on 23-2-2013 for T2DM by Narayana Hrudayalaya Hospital. The complainant has not denied the contents of Exs.R5 and R6. Ex.R5 indicates that the deceased Ramachandraiah.T was suffering from diabetes from the last six years, further he had septicemia and severe hypoxia. It shows that the deceased Ramachandraiah.T had heart disease 10 months prior to taking SBI Life policy for Rs.1,50,000=00. The Insured has suppressed the fact of septicemia and severe hypoxia and existence of diabetes for the last six years. The insured has not disclosed all the above disease in Ex.R1 proposal form. On the contrary while examining by the insurer doctor on 10-10-2013 only disclosed about diabetes i.e. seen in two years. But his own medical record Ex.R5 of Dr.K.Narasimhaiah Hospital, Tumkur indicates that the deceased was suffering from diabetes for the last six years.

 

          12. It was the duty of insured to disclose all the material facts with regard his health prior to taking policy. The OP relied upon the case of Grasim Industries Ltd –vs- Agarwal Steel (Civil Appeal Nos.5995/2004, 7477/2004 and 1733/2005) of the Hon’ble Supreme Court dated 20-10-2009 wherein it is held that “when a person signs a document, there is a presumption, unless there is proof of force or fraud, that he has read the document properly and understood it and only then he has affixed his signatures thereon, otherwise no signature on a document can ever be accepted”. Further the OP relied upon the case of Mithoolal Nayak –vs- LIC of India and Mayadevi –vs- LIC of India (Rev. No.2091/2007) vide order dated 31-5-2011 wherein the Hon’ble Supreme Court held that “even if the life to be assured is examined by a doctor of the insurer, the insured is not absolved from his responsibility of disclosure of material facts in a contract of insurance”. In the case on hand the insured – the father of complainant has not disclosed his diseases which were existing prior to taking policy.

 

          13. The Hon’ble Supreme Court in the case of LIC of India and others –vs- Asha Goel and another 2001 (2) SCC 160 under Section 45 of Insurance Act, 1938 held that “the suppression of material information even after the expiry of two years of taking the policy could not be condoned. Every material fact must be disclosed otherwise there is a good ground for rescission of contract”. In this case the father of complainant though he was suffering from diabetes for last six years, had heart disease and hypoxia ten months prior to taking policy vide Ex.R5 document even then he has not disclosed in Ex.R1 proposal form. During the examination by the doctor of insurer the father of complainant only informed that diabetes seen in two years. The said statement is also against Ex.R5 medical record of Dr.K.Narasimhaiah Super Speciality Hospital, Tumkur. Considering the medical record of insured the OP has repudiated the claim of complainant vide Ex.R8 letter dated 1-2-2014. We do not find any illegality in the repudiation of claim by OP since the deceased insured has suppressed the material facts of his disease while taking the policy.

 

          14. The OP has taken contention that this Forum/ Commission has no territorial jurisdiction as the OP is running business at Mumbai. But the deceased has paid premium amount at Tumkur and it shows that part of cause of action has arisen within the territorial jurisdiction of this Forum as such this Forum is having jurisdiction to entertain the complaint. The complaint is liable to be dismissed even on the ground of limitation. The OP has sent repudiation intimation to the complainant on 1-2-2014 but this complaint has been filed on 1-10-2019 after expiry of two years from the date of cause of action. The complainant has not filed application to condone the delay in filing this complaint after the expiry of limitation period of two years from the date of cause of action dated 1-2-2014. The complaint is liable to be dismissed on the ground of suppressing the material facts by the deceased insured and point of limitation. Accordingly, we proceed to pass the following;

 

ORDER

 

The complaint filed by Shri.Adishesha.T.R. S/o late Ramachandraiah.T is dismissed without cost.

 

Furnish the copy of order to the complainant and opposite party at free of cost.