DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTAPUR. PRESENT: - Sri C.Thyagaraja Naidu, B.Sc., B.L., President Smt.S.Lalitha, M.A., M.L., Lady Member, Friday, the 19th day of February, 2010 C.C.NO.121/2008 Between: N.Ramanatham Setty S/o Venkataravanappa Setty D.No.6-15, Main Road Nallacheruvu Village & Mandal Anantapur District. … Complainant. Vs. 1. ING Vysya Life Insurance Co. Ltd., rep. by its Director/Customer Service & Risk Officer, ING Vysya House 6th floor, No.22, M.G. Road Bangalore. 2. The Branch Manager, ING Vysya Life Insurance Co. Ltd., Subash Road Anantapur. … Opposite Parties. This case coming on this day for final hearing before us in the presence of Sri N.P.Sreenivasulu, Advocate for the complainant and Sri T.Bharath Bhushan Reddy, Advocate for the opposite parties 1 & 2 and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following. O R D E R Sri C.Thyagaraja Naidu, President: - This complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986 against the opposite parties 1 & 2 to direct them to pay a sum of Rs.3,27,000/- with interest @ 18% p.a. from 15-12-2007 till the date of realization for the death of Samanthakamani under Freedom Plan Policy. 2. The brief facts of the complaint are that - The wife of the complainant Smt.Samanthakamani (hereafter referred to as the deceased) has taken new Freedom Plan Policy bearing No.00765464 on10-08-2007 from the 2nd opposite party and the risk commences from 10-08-2007 to 10-08-2028. The said policy covers the life risk of the deceased, who is wife of the complainant. Under the said policy, a sum of Rs.3,15,000/- has to be paid in the event of death of the deceased. The complainant is a nominee under the said policy. On the date of taking policy, the deceased was hale and healthy. While so, the deceased died on 15-12-2007 due to high fever. After death of the deceased, the complainant has sent the proposal claiming the amount to the 2nd opposite party alongwith required documents in original. The 1st opposite party has repudiated the claim under the said policy with all false and frivolous grounds without any reason and has sent letter on 03-06-2008. Subsequently also they have sent another letter dt.10-07-2008 repudiating the claim of the complainant. Hence, the complainant has filed this complaint to direct the opposite parties 1 & 2 to pay the amount of Rs.3,27,000/-, which includes the sum assured under policy of Rs.3,15,000/-, for mental agony of Rs.10,000/- and costs of the complaint of Rs.2,000/-. 3. The opposite parties 1 & 2 filed counter and contended that the opposite parties constrained to repudiate all liability under the policy on account of the life assured (Mrs.Samanthakamani) having with held material information that she was suffering from Plasma Cell Myeloma (Blood Cancer) prior to proposal of the policy. The damages claimed are arbitrary, without basis and is an abuse of the process of law. The complainant has failed to make out a case of deficiency of service as alleged or otherwise within the meaning of Consumer Protection Act, 1986, hence the present complaint is not maintainable on that score also. The opposite parties have not violated any of the provisions of Consumer Protection Act as alleged by the complainant. The opposite parties denied all the averments mentioned in the complaint and contended that the complaint filed by the complainant is liable to be dismissed with exemplary costs. 4. Basing on the above pleadings, the points that arise for consideration are:- 1. Whether the repudiation of the claim of the complainant by the opposite parties 1 & 2 is justified or not? 2. To what relief? 5. In order to prove the case of the complainant, the complainant has filed evidence on affidavit and got marked Exs.A1 to A8. On behalf of the opposite parties 1 & 2, the 1st opposite party filed evidence on affidavit in support of their defence and got marked Exs.B1 to B7. 6. Heard both sides. 7. POINT NO.1 - The counsel for the complainant contended that the evidence on affidavit of the complainant and the documents marked on behalf of the complainant clearly goes to prove the fact that the deceased who obtained freedom plan policy from the 2nd opposite party under Ex.A1 and the date of risk commences from 10-08-2007 and the date of maturity of the policy is 10-08-2028. Subsequently, the deceased died on 15-12-2007 as per Ex.A6 Death Certificate issued by the Medical Officer, P.H.C. Nallacheruvu, Anantapur District. Thereafter, the complainant, who is the nominee of the insured, submitted the claim application for payment of the insured amount to the opposite parties, but the opposite parties have repudiated the claim of the complainant on false grounds under Ex.A7, which amounts to deficiency of service on the part of the opposite parties. He further contended that except oral contention of the opposite parties that the deceased died on account of previous disease of her health and that she has suppressed the same before obtaining the policy, but they have not placed any proof to prove the said fact. Therefore, the said oral contention of the opposite parties can not be accepted. In support of his contention, he placed reliance in the reported decisions: 1. 1990 STPL (LE) 15429 SC between Life Insurance Corporation of India Vs. Smt.G.M.Channa Basemma, wherein it was held that “ The burden of proving that the insured had made false representations and suppressed material facts is undoubtedly on the Corporation.” 2. AIR 2001 Supreme Court 549 between Life Insurance Corporation of India and others Vs. Smt.Asha Goel and another, wherein it was held that “ Insurance Act (4 of 1938), section 45 – Life Insurance Corporation Act (31 of 1956), section 30 – Repudiation of claim by insurer – Merely on grounds that deceased had withheld correct information regarding his health at time of effecting insurance with corporation – Not proper – Matter of repudiation of policy should not be dealt with in a mechanical and routine manner but should be one of extreme care and caution.” 8. The counsel for the opposite parties contended that the insured, who obtained Freedom Plan Policy on 10-08-2007.had suppressed her previous diseases and in the proposal form, she has answered for the questions (1) Have you ever suffered from any of the following? Caner, tumor growth or other Malignancy, answer ‘No’ (2) Have you ever had or are you currently suffering from any illness, impairment or disability not yet mentioned above, answer ‘No’ (3) Have you ever had or are you currently undergoing any form of medical treatment, investigation, test or follow ups at a hospital or clinic? Answer ‘No’ and (4) Have you consulted any medical practitioner within the last 12 months for any condition other than minor impairments such colds or flu? Answer ‘No ‘. But in fact, the investigation done by the opposite parties reveals that life assured was diagnosis of Plasma Cell Myeloma (Blood Cancer) with Pathological Fracture left L/3 Humerus before applying for policy. He contended that Ex.B4 Medical Certificate issued by St.John’s Medical College Hospital, Bangalore to the opposite parties clearly proves the fact that the deceased was admitted in the said hospital for treatment in respect of Plasma Cell Myeloma with Pathological fracture Left L/3 Humerus on 12-08-2006 and she was discharge on 24-08-2006. Therefore, the opposite parties repudiating the claim of the complainant are justified and that therefore the complaint is liable to be dismissed with costs. 9. Having regards to the arguments advanced by the counsels for the complainant and the opposite parties and also on perusal of the evidence on affidavits of both parties and the documents marked on behalf of both parties and on perusal of the decisions cited by the counsel for the complainant, we have no hesitation to come to conclusion that the opposite parties have failed to prove their contention for the following reasons. 10. The opposite parties did not examine the Doctor who treated the deceased Shamanthakamani at St.John’s Medical College Hospital, Bangalore and issued Ex.B4 to prove that the deceased had Plasma Cell Myeloma with Pathological fracture Left L/3 Humerus and that she was treated for the said ailment from 12.08.2006 with O.P.No.20171929, I.P.No.723158. Therefore, the oral evidence on affidavit of the opposite party No.1 that the deceased had suppressed her previous diseases in the proposal form and that the deceased died on account of Plasma Cell Myeloma with Pathological fracture Left L/3 Humerus cannot be accepted. 11. On the other hand, the evidence on affidavit of the complainant clearly goes to prove the fact that the deceased died on 15-12-2007 due to high fever. Ex.B3 certificate issued by the Medical Officer, PHC Nallacheruvu goes to prove that the deceased died due to high fever. Further the evidence on affidavit of the complainant goes to prove that he has submitted the claim form Ex.A4 to the 2nd opposite party alongwith required documents in original and the opposite parties have repudiated the claim in respect of the policy obtained by the deceased with all false and frivolous grounds without any reasons. 12. Therefore, considering the said facts and circumstances and the principles laid down in the above decisions cited by the Counsel for the complainant, we have no hesitation to hold that the complainant has proved that the deceased died due to high fever on 15-12-2007 and that the repudiation of the claim of the complainant is not justified which amounts to deficiency of service on the part of the opposite parties. Therefore, the opposite parties 1 & 2 are liable to pay to the complainant a sum of Rs.3,15,000/- with interest @ 9% p.a. from the date of filing of this complaint i.e. 25-10-2008 till the date of payment. Accordingly, this point is answered. 13. POINT No.2 – In the result, the complaint filed by the complainant is allowed directing the opposite parties 1 & 2 jointly and severally to pay to the complainant a sum of Rs.3,15,000/- (Rupees three lakhs and fifteen thousand only) with interest @ 9% p.a. from the date of filing of this complaint i.e. 25-10-2008 till the date of payment with costs of Rs.3,000/- (Rupees three thousand only) within one month from the date of this order. Dictated to the Steno, transcribed by him, corrected and pronounced by us in open Forum, this the 19th day of February, 2010. Sd/- Sd/- LADY MEMBER PRESIDENT DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM ANANTAPUR ANANTAPUR APPENDIX OF EVIDENCE WITNESSES EXAMINED ON BEHALF OF THE COMPLAINANT: ON BEHALF OF THE OPPOISITE PARTIES -NIL - - NIL EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT Ex.A1 – Xerox copy of Insurance Policy No.00765464 relating to deceased N.Samanthakamani issued by the opposite parties. Ex.A2 – Xerox copy of First Premium Receipt issued by the opposite parties in favour of deceased N.Samanthakamani. Ex.A3 - Xerox copy of Certificate from Medical Attendant/Family Doctor relating to deceased N.Samanthakamani. Ex.A4 - Xerox copy of Death Claim Form submitted by the complainant to the opposite parties. Ex.A5 - Xerox copy of Last Medical Attendant’s Certificate relating to N.Samanthakamani issued by the Medical Attendant. Ex.A6 - Xerox copy of the Death Certificate issued by the Medical Officer, PHC,Nallacheruvu, Anantapur District. Ex.A7 - Xerox copy of the repudiation letter dt.03-06-2008 sent by the 1st opposite party to the Complainant. Ex.A8 - Xerox copy of the letter dt.10-07-2008 sent by the 1st opposite party to the complainant. EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES Ex.B1 - Xerox copy of the proposal form for unit linked policy submitted by the deceased N.Samanthakamani to the opposite parties Ex.B2 - Xerox copy of Insurance Policy No.00765464 relating to deceased N.Samanthakamani isued by the opposite parties. Ex.B3 - Xerox copy of Death Claim Information Form relating to deceased N.Samanthakamani. Ex.B4 - Xerox copy of Case Summary and Discharge Card relating to deceased N.Samanthakamahi issued by the St.John’s Medical College Hospital, Bangalore. Ex.B5 - Xerox copy of Medical Examination Report relating to deceased N.Samanthakamani. Ex.B6 - Xerox copy of repudiation letter dt.03-06-2008 sent by the 1st opposite party to the complainant. Ex.A7 - Xerox copy of the letter dt.10-07-2008 sent by the 1st opposite party to the complainant. Sd/- Sd/- LADY MEMBER PRESIDENT DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM ANANTAPUR ANANTAPUR Typed by JPNN
......................Sri. C.Thyagaraja Naidu | | 
