BEFORE THE DISTRICT CONSUMER FORUM AT NALGONDA
PRESENT: SRI D.SINGARA CHARY, B.A., LL.B.,
PRESIDENT.
SRI K.VINODH REDDY, B.Sc.,
MALE MEMBER.
SMT.CH.A.LATHA KUMARI, M.A.,M.Sc.,LL.M.,
FEMALE MEMBER.
. . .
WEDNESDAY, THE SEVENTEENTH DAY OF APRIL, 2013
CONSUMER COMPLAINT No. 70 OF 2012
Date of 1st appearance: 18-01-2013
Date of Disposal: 17-04-2013
Between:
1. Chittipolu Uma W/o Late Shivaiah @ Shiva, Age: 22 years,
Occ: Hotel Business,
2. Chittipolu Manikanta S/o Late Shivaiah @ Shiva, Age: 5 years,
3. Chittipolu Manamma W/o Niranjan, Age: 60 years,
Occ: Hotel Business,
(Complainant No.2 being minor, rep.by his mother and natural
guardian Chittipolu Uma, i.e. Complainant No.1 herein).
All are R/o H.No.5-367, Ward No.2, Thallagadda, Miryalguda
Town, Nalgonda District.
…Complainants.
AND
- ICICI Prudential Life Insurance Company Limited, Branch Office,
Dharani Complex, 1-4-249/39, NH Bypass Road, Near: New
Bus Stand, Suryapet Town, Nalgonda District, Pin:508 213. Represented by its Authorized Signatory.
- ICICI Prudential Life Insurance Company Limited, Central Claims Department, 1st Floor, Vinod Silk Mills Compound,
Ashok Nagar, Chakravarthi Ashok Road, Kandivali (East),
Mumbai-400 101. Represented by its Authorized Signatory.
…Opposite Parties.
This complaint coming on before us for final disposal on this day, in the presence of Sri K.Anantha Reddy, Advocate for the Complainant, and Sri M.S.Rao, Smt.P.Nithya, Advocates for the Opposite Parties, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:
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ORDER OF THE FORUM DELIVERED
BY SRI D.SINGARA CHARY, PRESIDENT
1. The Complainant No.1, the wife, the Complainant No.2, the son and the Complainant No.3, the mother of late Chittipolu Shivaiah who insured his life under Ex.A-1 for a sum of Rs.5,00,000/- and under Ex.A-2 for a sum of RS.1,00,000/-, have filed this complaint Under Section 12 of Consumer Protection Act to direct the Opposite Parties to pay the above sums with damages for deficiency of services.
2. The facts leading to the filing of this complaint are as follows:
On the persuasions of one P.Ramprasad, the agent of the Opposite Parties, the deceased Chittipolu Shivaiah obtained policies Exs.A-1 and A-2 for the sums stated above. He signed blank forms at the instance of the above agent and the agent did not explain the contents of the said document. The above policies were to commence from 25-11-2009 and 22-07-2009 respectively. On 12-04-2010 the deceased died of sun stroke. When the claim was lodged, the Opposite Parties instead of settling and paying the amount, have repudiated it on the ground that prior to obtaining the policy the deceased was admitted in Kamineni Hospital, Narkatpally with severe damage of liver on account of alcoholism and that the deceased had suppressed the said fact in his proposal forms. The repudiation was communicated to the Complainants under letter Ex.A-4.
3. The Opposite Parties have filed a lengthy written version and the sum and substance thereof is that the deceased was a chronic alcoholic on account of which his liver was damaged and that he was
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admitted in Kamineni Hospital, Narkatpally on 17-05-2009 with severe damage of liver. He was however, got discharged against the medical advise. The brother of the deceased and the deceased also signed the declaration in the hospital that they were getting the deceased discharged at their risk and the hospital authorities are not responsible for the consequences. It is also stated that the brother of the deceased also gave a statement that the deceased was a chronic alcoholic and had suffered severe damage to the liver. The investigator appointed by the Opposite Parties had filed investigation report Ex.B-10 to the effect that the deceased knowing fully well about his diseases had obtained the policies anticipating his death. The Opposite Parties ultimately submitted that the repudiation was justified and as such the complaint is liable for dismissal.
4. The Complainant No.1 filed her proof affidavit. While the Complainants marked Exs.A-1 to A-4, the Opposite Parties marked Exs.B-1 to B-10.
5. The point for consideration is:
Whether the repudiation is justified?
6. POINT:
It is not in dispute that the deceased had obtained two policies Ex.A-1 and A-2 on 25-11-2009 for a sum of Rs.5,00,000/- and on 22-07-2009 for a sum of Rs.1,00,000/- respectively. The repudiation is rested on the ground that the deceased was admitted in Kamineni Hospital, Narkatpally for treatment of liver cirrhosis on 17-05-2009
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under Ex.B-7, the copy of the admission register. The Opposite Parties rely on Ex.B-7 which also contains a declaration signed by the deceased and his brother that the deceased was admitted in the hospital and that the deceased was an alcoholic and that his condition was serious and that they were getting him discharged at his risk. According to the Opposite Parties, the deceased had suppressed his disease while signing the proposal forms Exs.B-1 and B-2.
7. In a decision reported in LIC of India Vs.Kalva Subhadramma ( (2009) (3) ALD 790 ) it was held towards the end of the judgment that the insurance company has to first establish that the contents of the proposal form were read over and explained to the proposer and only after understanding the same he had signed; and then only the question of suppression of material facts arises. The Hon’ble High Court of Andhra Pradesh held that in cases where suppression of disease is proved, the insurance company must establish that the agent who obtained signatures of the insured on the proposal forms had explained the contents of the forms and until then the plea of suppression cannot be pressed into service. In this case, there is no proof that the contents of the proposal forms Exs.B-1 and B-2 were read over and explained to the insured. Even though the deceased had signed in English in the proposal form from the way in which he signed, it cannot be inferred that he knew English more particularly the contents of the proposal forms Exs.B-1 and B-2.
8. An investigation into the claim was ordered and Sri M.S.Prasad had made investigation and submitted Ex.B-10. He obtained the record from Kamineni Hospital, Narkatpally, through which the above said
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facts came into light. The investigation report indicated that the deceased died of sun stroke and that the Government also paid ex-gratia under Apathbandhu Pathakam or some other scheme. The investigator stated in Ex.B-10 that the family members of the deceased by influencing the local people, created a story that the death was on account of sun stroke, but as a matter of fact it was on account of liver damage which the deceased had suppressed in the proposal forms Exs.B-1 and B-2. The Government is generally slow in making payments in such situation. The Government only after due enquiries will pay amounts under such schemes. When once the Government had recognized that the death of the deceased was due to sun stroke and had paid ex-gratia under Apathbandhu Pathakam, it must be concluded that the death of the deceased was due to sun stroke. The report of the investigator Ex.B-10 that the family members of the deceased with the influence of the local residents had painted a picture of accidental death of the deceased due to sun stroke, has no basis. He has not collected any material to show that the case of death as exposed before the Government to secure ex-gratia is fabricated. Therefore, we have no hesitation to hold that the deceased died due to sun stroke and not on account of the direct result of liver damage for which he had taken treatment in Kamineni Hospital, Narkatpally.
9. In a decision reported in LIC of India Vs.Naseem Bano ( III (2012) CPJ 208 ) the Hon’ble National Commission held that where the deceased died of a disease than that was allegedly suppressed, the suppression has no bearing while settling the claim.
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10. In view of the above facts and circumstances, we hold that the death of the deceased has no nexus with the liver damage which he is said to have suppressed in Exs.B-1 and B-2. When once there is no such nexus, the insurance company is liable to pay the amount. Thus we hold that the repudiation of the claim is not justified.
In the result, the complaint is allowed and the Opposite Parties are directed to deposit in this Forum a sum of Rs.6,00,000/- (Rupees Six Lakhs only) representing the sum assured under Exs.A-1 and A-2 with bonus, if any, and a sum of Rs.5,000/- (Rupees Five thousand only) towards deficiency of services with interest @ 9% p.a. from the date of the complaint till realization and a sum of Rs.2,000/- (Rupees Two thousand only) towards costs. On such deposit, a sum of Rs.1,00,000/- (Rupees One lakh only) each is apportioned in favour of the Complainants No.1 and 3 and a sum of Rs.4,00,000/- (Rupees Four lakhs only) is apportioned in favour of the Complainant No.2. The sum of Rs.4,00,000/- apportioned in favour of the Complainant Nof.2 shall be kept in fixed deposit with State Bank of Hyderabad, Prakasham Bazar Branch, Nalgonda till he attains majority. The amount representing the deficiency of services and costs shall also be paid to the Complainant No.1.
Dictated to Steno-Typist, transcribed by him, corrected and pronounced by us in the open Forum on this 17th day of April, 2013.
PRESIDENT
MEMBER
FEMALE MEMBER
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APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For Complainants: For Opposite Parties:
Affidavit of the Complainant No.1. None.
EXHIBITS MARKED
For Complainants:
Ex.A-1 Dt.25-11-2009 Xerox copy of Policy Certificate of
Policy No.12941989.
Ex.A-2 Dt.22-07-2009 Xerox copy of Policy Certificate of
Policy No.12244372.
Ex.A-3 Dt.29-04-2010 Xerox copy of Death Certificate.
Ex.A-4 Dt.02-02-2011 Repudiation Letter.
For Opposite Parties:
Ex.B-1 Dt.20-07-2009 Xerox copy of Policy Application vide
No.RC 00100786.
Ex.B-2 Dt.20-11-2009 Xerox copy of Policy Application vide
No.33622865.
Ex.B-3 Dt. Xerox copy of Terms and Conditions of
Smart Kid Policy Document .
Ex.B-4 Dt. Xerox copy of Terms and Conditions of
Crisis Cover Policy Document.
Ex.B-5 Dt.06-01-2011 Xerox copy of letter addressed by the
Opp.Party No.2 to the Complainant No.1.
Ex.B-6 Dt.02-02-2011 Xerox copy of letter addressed by the
Opp.Party No.2 to the Complainant No.1.
Ex.B-7 Dt.17-05-2009 Xerox copy of Admission Record, issued by
KIMS, Narkatpally pertaining to the deceased
Ex.B-8 Dt. Xerox copy of Claimant’s Statement Forms
under Policy Nos.12244372 and 12941989.
Ex.B-9 Dt.17-05-2009 Xerox copy of Statement of brother of the
Life Assured.
Ex.B-10 Dt.20-12-2010 Xerox copy of Investigation Report.
PRESIDENT
DISTRICT CONSUMER FORUM
NALGONDA
TO
1). Sri K.Anantha Reddy,
Advocate for the Complainants.
2). Sri M.S.Rao, Smt.P.Nithya,
Advocates for Opposite Parties.
