BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION:HYDERABAD
F.A.No.816/2005 against C.D.No.51/2003, District Forum, Cuddapah.
Between:
N.Venkatasubba Reddy,
S/o.late N.Narayana Reddy,
Aged about 38 years, Hindu,
R/o.Mamillapalle village,
C.K.Dinne Mandal, Cuddapah District. ... Appellant/
Complainant
And
Life Insurance Corporation of India,
Rep. by its Senior Divisional Manager,
Divisional office, Arts College road,
Cuddapah , Cuddapah District. .... Respondent/
Opp.party
CORAM:THE HON’BLE JUSTICE SRI D.APPA RAO, PRESIDENT,
SMT.M.SHREESHA, HON’BLE MEMBER
AND
SRI G.BHOOPATHI REDDY, HON’BLE MEMBER.
TUESDAY, THE TWELFTH DAY OF FEBRUARY,
TWO THOUSAND EIGHT.
ORAL ORDER: (Per Sri G.Bhoopathi Reddy, Hon’ble Member)
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This is an appeal filed by the appellant/complainant under Section 15 of Consumer Protection Act,1986 against the order of dismissal passed by the District Forum, Cuddapah in C.D.No.51/2003 dt.8th October 2004.
The appellant herein is the complainant before the District Forum. He filed a complaint under Section 12 of C.P.Act ,1986 to direct the opp.party to pay policy amount along with interest @ 18% p.a. from 31.5.98 till the date of realisation and Rs.20,000/- towards deficiency of service and Rs.1000/- towards costs of the complaint
The case of the complainant is that his father Nagireddy Narayana Reddy had taken insurance policy bearing no.652030178 from the opp.party corporation. The date of commencement of policy is 28.8.1997 and the sum assured is Rs.50,000/- . The said policy was issued under the salary savings scheme and the premia will be paid directly by the employer of the policy holder. The complainant is the nominee under the said policy. The complainant submits that his father was hale and healthy and panel doctor of the corporation also examined him, and thereafter policy was issued. The policy holder died on 31.5.98 during the validity of the policy. When he made claim before the insurance company, it has repudiated the claim on 15.4.1999 on the ground that the policy holder suppressed the material particulars regarding his health. He was suffering from diabetes and ulcer in leg prior to six months of taking of the policy in question. The repudiation of the policy is illegal .. Alleging deficiency in service, the complainant approached the District Forum to direct the opp.party to pay the policy amount of Rs.50,000/- with 18% interest from 31.5.98 till realisation, to pay Rs.20,000/- towards compensation and to pay Rs.1000/- towards costs.
The opp.party filed counter alleging that the insured has suppressed about his health condition. The statement made by the deceased life assured was taken as true statement and policy was issued. . In view of the suppression of ill health of the life assured in his proposal ,the claim was repudiated by the opposite party There is no deficiency in service on its part The complaint is barred by limitation. It prayed for dismissal of the complaint.
During the pendency of the proceedings before the Dist.Forum ,the opposite party filed a memo stating that the complainant has already filed I.A.No.124 /01 in C.D.S.R.No.806/2001 and the said case was rejected , and the said order became final . Fresh complaint in C.D.NO.51/2003 is barred by resjudicata.
In support of the complainant’s claim he filed evidence affidavit and documents Exs.A1 to A4. Opp.party also filed evidence affidavit and documents Exs.B1 to B3. The District Forum based on the evidence adduced and pleadings dismissed the complaint.
Aggrieved by the said order the complainant has filed this appeal contending that it is not barred by resjudicata . The CD.SR. NO.806/2001 was not dismissed on merits therefore the question of resjudicata does not arise. The complaint is filed within the limitation .The District Forum has not properly appreciated the evidence on record. There is no evidence to show that the insured has suppressed the previous ailment regarding his health. Repudiation of claim of the complainant by the opp.party is illegal. Therefore he prayed that order of District Forum be set aside.
The points that arise for determination are:
- Whether the complaint is barred by limitation ?
- Whether the principle of resjudicata applies ?
- Whether there is deficiency in service on the part of the
Insurance company?
Point no.1: There is no dispute that a policy was taken and the policy holder died on 31.5.1998. The claim was repudiated on 15.4.99. An appeal was filed before the Zonal Manager of Life Insurance Corporation . The said appeal was rejected on 26.9.2001. Thereupon the complainant has filed the complaint before the District Forum on 13.3.2003 within two years . Therefore .the complaint filed is within limitation.
Point no.2 : The respondent now contends that the case is hit by the principle of resjudicata . The opp.party has not taken this plea in the counter. A memo was filed before the District Forum and on the basis of the said memo, the finding was given without knowing the proceedings in I.A.No.124/2001 in C.D.Sr.No.806/2001 . The opposite party has not filed orders passed in I.A.NO.124/2001 in C.D.S.R.No.806/2001. The District Forum went wrong in stating that the principle of resjudicata applies . The respondent has not filed the order copy before the District Forum or at appellate stage before this Commission. . Therefore finding given by the District Forum is not sustainable.
Point no.3 . The claim made by the appellant/nominee was rejected on the ground that the deceased suppressed the ailment . The respondent contended that the deceased was suffering with diabetes and ulcer in leg prior to six months of taking of the policy, and he has suppressed this information before taking the policy he suppressed ailment in the proposal form. The burden lies on the respondent to prove that prior to six months of taking the policy , the deceased was suffering with diabetes and ulcer . The respondent has not examined any medical officer nor filed any hospital record to show that the insured was suffering with previous ailments. On the other hand insurance company panel doctor has examined the insured and certified that his health condition was good. Thereafter only the policy was issued. The insured has not suppressed any previous ailments . Repudiation of the claim by the insurance company stating that the complainant’s father suppressed about the previous ailments is not sustainable. Repudiation of the claim of the complainant by the insurance company is illegal. The complainant being a nominee under the policy he is entitled to the policy amount. The order of District Forum is set aside.
In the result appeal is partly allowed. The respondent/ opp.party is directed to pay the insured policy amount of Rs.50,000/- to the complainant with 9% interest from the date of filing of the complaint till realisation together with costs of Rs.1000/- . Order shall be complied within six weeks from the date of the order.
PRESIDENT LADY MEMBER MALE MEMBER
Dt.12.2.2008
Pm*
