BEFORE THE DISTRICT CONSUMER FORUM : WARANGAL

Present:     Sri D. Chiranjeevi Babu,

                                                President.

                                                Sri N.J. Mohan Rao,

                                                Member

                                               And

Smt. V.J. Praveena,

                                                Member.

 Friday, the 30^th day of May, 2008.

CONSUMER COMPLAINT NO. 30/2007

Between:

P. Venkayamma, W/o late Peddanna,

R/o Kamalapuram (V)

Mangapet (M),

Warangal District.

                      … Complainant

AND

Life Insurance Corporation,

Divisional Office,

Warangal.

Rep. by Sr.Divisional Manager.

… Opposite Party

Counsel for the Complainant      : Sri. G. Vidyasagar Reddy, Advocate

Counsel for the Opposite Party    : Sri Md. Valiuddin,  Advocate.

This complaint coming for final hearing before this Forum, the Forum pronounced the following Order.

                                                 ORDER

Sri D. Chiranjeevi Babu, President.

This is a complaint filed by the complainant P. Venkayamma against the Opposite party under section 12 of Consumer Protection Act, 1986 for a direction to pay an amount of Rs.10,00,000/-.

          The brief averments contained in the complaint filed by the complainant are as follows:

          The complainant is the wife of P.Peddanna (Herein after referred to as the deceased).  The deceased during his life time took Jeevan Anand Insurance Policy No.686886518 for the sum assured Rs.10,00,000/- and mode of payment as stipulated in the bond is yearly.  The deceased was fall ill and he was admitted in Life Line Hospital, Warangal on 30-11-2004 and died on 7-12-04 due to Cardiorespiratory arrest.   Immediately after the death of the deceased the complainant submitted claim form to release the amounts under 5 policies.  The opposite party cleared all the policy amounts except withholding and repudiating the claim under Policy No.686886518.  The complainant made an application to Zonal Manager, Hyderabad.  The said office through Opposite party rejected the claim.   The complainant further moved an application to Zonal Claims Review Committee for which it was intimated that decision is pending.   Hence, the complainant field this complaint before this Forum.

          Opposite party filed the Written Version contending in brief as follows:

          It is true that the deceased had taken the policy No.686886518 for the sum assured 10,00,000/- and the nominee is Smt.P.Venkayamma.  The deceased suppressed the particulars of his ill health and got his policy with an intention to defraud the Opposite party and subsequently died on 7-12-04 within 10months from the date of taking policy.   Hence, there is no any deficiency of service on the part of the opposite party.  Hence, the complaint filed by the complainant may be dismissed.

          The complainant in support of her claim, filed her Affidavit in the form of chief examination and also marked Exs.A-1 to A-7.  On behalf of Opposite party one V. Bhaskar filed his Affidavit in the form of chief examination and also marked Exs.B-1 to B-7.

Now the point for consideration whether the complainant is entitled to get an amount of Rs.10,00,000/- with profit and other benefits.

After arguments of both side counsels, our reasons are like this:

The complainant filed this case praying to direct the Opposite party to pay Rs.10,00,000/- with interest.  The deceased P.Peddanna died on 7-12-2004 due to Cardio Respiratory Arrest.  The complainant is the wife of the said Peddanna and nominee.  The life assured taken 5 policies out of which 4 policies were settled.  The claim of Policy No.686886518 for the sum assured Rs.10,00,000/- was not settled and repudiated the same on the ground that suppression of material facts in the proposal form.   The complainant made application to Zonal Manager, South Central Zonal Office, Hyderabad, but they have rejected the claim under letter dated 15-02-2006.

After arguments of both side counsels our reasons are like this:

It is the duty of the life assured that he has to give correct information in the proposal form.  Without giving correct information with regard to the diseases on the proposal form certainly after the death his nominees are not entitled to get the insurance premium.  In this case already the deceased P.Peddanna had taken 5 insurance policies and almost all 4 insurance policies were settled but this policy in his proposal form he has not given the material facts of this case i.e, he suppressed the material facts. This policy was issued on 22-02-2004 with date of commencement 28-4-2003 under Jeevan Anand Plan with premium payment period of 16 years with yearly mode of payment of premium. The policy No.is 686886518 the sum assured 10,00,000/- table and term 149-16, date of risk 4-2-2004 the nominee is P.Venkayamma i.e., the complainant herein. The deceased died on 7-12-2004 and requested for settlement of claim under 5 policies and already another 4 policies were settled.  The life assured had been suffering from Hyper tension and diabetic mellitus at the time of taking policy No.686886518 and the life assured without disclosing particulars of his ill health and consequences there of got his policy with an intention to defraud the Opposite party and subsequently died on 7-12-2004 within 10 months from the date of taking policy.

It is an admitted fact that he had admitted in Jaya Hospital, Hanamkonda and records of the said hospital with medicare No.6595 dated 2-12-2002 reveal that Late P.Peddanna was suffering from Hyper tension and Diabetes earlier to the date of taking policy. It is evidenced on Ex.B-2 i.e., Peddanna case sheet it clearly goes to show that the late Peddanna was suffering from Hypertension and diabetis prior to the date of taking the policy.  It is clear that the life insurance contract is a contract of utmost good faith and there is a bounden duty on the part of the proposer to disclose all material facts about his or her health and also should not conceal material facts such as accident, operations and serious diseases etc., he/she suffered or suffering. The life assured answered the following points in negative in the proposal form dated 31-3-2003 which clearly indicate that he had suppressed the particulars of his ill health thereby inducing opposite party to issue the policy without calling for special reports required for assessing the risk where extra hazard is found.  And further prior to the taking policy in the proposal form the insurance authorities asked the question :  Are you suffering from or have you ever suffered from Diabetes,tuberculosis, High Blood Pressure, Low blood pressure, Cancer Epilepsy, Hernia, Hydrocele, Leprosy or any other disease? For this he stated “No” and another question What has been your usual state of health Answer is “Good”. 

          This clearly goes to show that the life assured suppressed the material information about his health and defrauded the Opposite party Corporation.  When he defrauded the opposite party corporation certainly the life insurance corporation i.e, Opposite party is not liable to pay the policy amount to the complainant because Ex.B-2 clearly goes to show the diseases of late Peddanna. 

          The counsel for complainant cited citation in AIR 1993 Orissa 103

Life Insurance Corporation of India                    … Petitioner

                    Vs

Narmada Agarwalla & others                          … Respondents

Confidential report of doctors at the time of taking policy and approved by Corporation not disclosing that deceased was suffering from diabetes – Deceased not guilty of withholding material fact – Repudiation of policy, not proper.

          The facts of this case and facts of the present case are different.  So this judgment is not applicable for the present case.

The counsel for complainant cited another judgment

                in AIR 2000   Delhi 63

Smt.Krishna Wanti                                               … Appellant

             Vs

Life Insurance Corporation of India                      … Respondent

Death of insured on account of heart failure – Evidence of doctor not sufficient to establish that the insured had history of heart disease – Respondent corporation have no case for not honoring their commitment under the insurance policies.  

          This judgment is also not applicable to the case of the complainant.    

The counsel for complainant cited another judgment  in AIR 1991 Supreme Court 392

Life Insurance Corporation of India                             ..  Appellant

         Vs

Smt. G.M. Channabasemma                                         … Respondent

Allegation of insured being guilty of making false representations and suppressing material facts – Burden of proof – It is on corporation.

          This judgment is not applicable to the present case. This applicable to the opposite party because the policy was issued by Opposite party it is true.  The Life insurance corporation of India proved their case by way of filing Ex.B-2.

          For the foregoing reasons given by us, we are of the opinion that the complainant husband defrauded the opposite party because of his self interest without disclosing the material facts ie., about his ill health, so the insurance company is not liable to pay anything to the complainant.  Hence, we answered this point accordingly in favour of opposite party against the complainant.

Point NO.2 : To what relief:-  The first point is decided in favour of opposite party against the complainant, this point is also decided in favour of opposite party against the complainant.

          In the result there are no merits in the complaint filed by the complainant and accordingly the same is dismissed, but without costs.

(Dictated to the Stenographer, Transcribed by her, corrected and pronounced by us in the open Forum, today, the 30^th day of May, 2008).

                                                    Sd/-                     Sd/-             Sd/-

                                                Member                 Member       President,

                                                     District Consumer Forum, Warangal.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

On behalf of Complainant                          On behalf of Opposite Party

Affidavit of complainant filed                          Affidavit of O.P. filed.

EXHIBITS MARKED

On behalf of complainant

1. Ex.A-1 Letter by O.P. to complainant, dt.27-6-05.
2. Ex.A-2 Letter by O.P. to complainant, dt.15-2-06.
3. Ex.A-3 Letter by Insurance Ombudsman to complainant, dt.1-2-06.
4. Ex.A-4 Policy.
5. Ex.A-5 xerox copy of Special Bio chemical tests. 
6. Ex.A-6 Report on X-Ray of chest.
7. Ex.A-7 Admission card issued by Life Line hospitals.

On behalf of Opposite party.

1. Ex.B-1 Repudiation letter dt.30-3-05.
2. Ex.B-2 Certified copy of patient case sheet of Jaya Hospital.
3. Ex.B-3 Claim form dt.12-1-06 issued by Life Line Hospital, hanamkonda.
4. Ex.B-4 Policy bond, dt.22-2-04.
5. Ex.B-5 Proposal form for insurance, dt.31-12-03.
6. Ex.b-6 letter of opposite party,dt.15-2-06.
7. Ex.B-7 Admission record of Life Line Hospital.

                                                              Sd/-

                                                          President.