This C.C. is coming on before us for final hearing in the presence of Sri.J.Venkateswarlu, Advocate for complainant and of Sri.K.Jagan Mohan Rao, Advocate for opposite parties; upon perusing the material papers on record and upon hearing the arguments, this Forum passed the following order;
ORDER
(Per Sri R.Kiran Kumar, Member)
This Complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the husband of the complainant, Shaik Babu, during his lifetime, obtained insurance policy for a sum assured Rs.75,000/- vide policy bearing No.687051227 on 7-2-2005. In the said policy, he appointed his wife i.e. complainant No.1 herein as nominee, subsequently during the period from May 2008 to February-2009, the husband of the complainant unable to pay the premium amount. On 19-2-2009 the husband of the complainant paid the entire premium amount and the policy was revived. The complainant further submitted that at the time of taking policy and also at time of revival, the panel doctors of opposite parties had check up the health condition of her husband. That in the last week of April, 2009 due to ill health the husband of the complainant admitted in Mamatha General Hosptial, Khammam and after discharge from the hospital. On 8-5-2009 he died at his residence due to sudden heart attack. That after death of the husband of complainant, the complainant intimated the same to the opposite party branch office at Khammam. The authorities of opposite parties in turn came and found death of the husband of the complainant and thereafter the complainant submitted all the relevant documents requesting to settle the death claim of her husband. In Last week of April, 2010 to the surprise the complainant was served a letter from the opposite parties vide letter dt.30-4-2010 and in the contents of that letter, so many allegations were made against the husband of the complainant. While sending the letter the opposite party alleged that her husband was suffering from weekness of upper limb before the date of revival and he did not disclose the same in his personal statement and also alleged that he made deliberate misstatement about his health and that the said policy is declared as void, and also informed the complainant that if any objection she may be advised to send representation to opposite party No.1. The complainant further submitted that aggrieved by the said decision of opposite party No.2, the complainant made application to the opposite party No.1 for reconsideration of the claim vide requisition, dt.10-7-2010. The complainant further submitted that since from the date of death of her husband she made many rounds to opposite party No.2 and 3 and made representations to them, but all her efforts are in vain. Since the opposite parties failed to settle the claim of the complainant and having seen the attitude of opposite parties, the complainant lost hope that the opposite parties will settle the claim of the complainant without the approaching the forum. Hence, filed this complaint.
On behalf of the complainant, the following documents were filed and marked as Exs.A.1 to A.4.
Ex.A.1 - Photocopy of Death certificate, dt.6-6-2009
Ex.A.2 - Photocopy of Letter, dt.31-3-2010 addressed by opposite parties
Ex.A.3 - Photocopy of Premium Receipt No.1212771, dt.30-6-2005
Ex.A.4 - Photocopy of Letter addressed by complainant to
opposite party No.2 along with postal receipt.
On receipt of notice, opposite parties corporation appeared through their counsel and filed counter. In their counter, opposite parties submitted that the opposite party No.2 is competent authority and necessary party to take a decision and the repudiation of the claim under any life insurance policy serviced by the Warangal Division of the opposite party corporation, as such it is not necessary to implead opposite party No.1 i.e. zonal manager of opposite parties corporation as party to this complaint and also submitted that the above policy had lapsed for non payment of 4 quarterly premiums for the period from 5/2008 to 2/2009, which was got revived on 19-2-2009 by the said life assured by submitting personal statement regarding health, dt.19-2-2009 duly executed by him and witnessed by outsider not connected with the opposite parties corporation and also submitted that the revival of policy is treated in life insurance under writing as denovo i.e. a fresh proposal and the policy holder is required to furnish all correct replies to the questions contained in the personal statement regarding health, which is basis of the revival of the policy and also as per the intimation received by the opposite party corporation the aforesaid life assured died on 8-5-2009 and since the death occurred within three months of the revival of the said policy, treating the same as early claim by revival. The investigation was caused into the bonafides for the said claim so as to decide on its admissibility and also submitted that the life assured had replied to the questions related to question No.2 and 4 all the personal statement regarding health, dt.19-2-2009 while getting revival of the lapsed policy.
question No.2(A): Have you ever suffered from any illness/ diseases requiring
treatment for a week or more? No
Question No.2(B): Did you ever have any operation, accident, or injury? No
Question No.2(C): Did you ever undergo ECG, X-ray, screening, Blood,
Urine or stool examination? No
And further submitted that replies given by the deceased/ life assured to the questions of the personal statement regarding health, stating that he was in sound health condition from the date of signing the personal statement regarding health i.e. on 19-2-2009 and that he had not undergone any diagnostic tests or operation, accident or injury was all wrong. The opposite party further submitted that during the course of investigation it is came to the light that while getting the lapsed policy revived, the deceased/ life assured had suppressed material facts related to hyper tension for the last 5 to 6 months, and the treatment for the same he had at Mamatha General Hospital, Khammam under IP No.4/0960/09, DT.11-4-2009. Also submitted that the averments made by the complainant in para No.2 of the complaint that the doctors of opposite party No.3 had check up health condition of the husband of the complainant is false and baseless and there was no medical examination conducted at the time of revival. To support their case the opposite party submitted that the personal statement regarding health submitted by the deceased/ life assured and the computer generated revival review slip, dt.19-2-2009 and also submitted that the averments made by the complainant in para No.4 of the complainant that the opposite party No.3 corporation had postponing the settlement. The settlement of the death claim on one pretext or the other is false and baseless and to support their case the opposite party corporation submitted the case sheet/ discharge summary of Mamatha General Hospital, Khammam along with the certificate of hospital treatment signed by Dr.P.Asadharan, M.S., M.Ch., Neuro, who is the consultant Neuro of the said hospital. The opposite party corporation further submitted that in view of the direct, positive and cogent evidence in the form of case sheet/ discharge summary of the Mamatha General Hospital and the certificate of hospital treatment by Dr.P.Asadharan, it is submitted that there is no deficiency of service as alleged by the complainant and also submitted that the complainant had preferred appeal against the decision of opposite party No.2 to the Zonal manager claims review committee at Hyderabad on which Hon’ble Justice T.N.C. Ranga Rajan, retired High Court Judge is a member has perused and upheld decision of opposite party No.2. As such prayed to dismiss the complaint.
On behalf of the following documents were filed and marked as Exs.B.1 to B.4.
Ex.B.1 - Personal statement regarding health of Shaik Babu
Ex.B.2 - Ordinary revival quotation, dt.19-2-2009
Ex.B.3 - Discharge/ death summary of Sk.Babu issued by Mamatha
General Hospital, Khammam.
Ex.B.4 - certificate of hospital treatment.
Both parties filed their written arguments. Upon perusing the material papers on record and upon hearing the arguments, now the point that arose for consideration is,
Whether the assured had suppressed the material facts pertaining to his health at the time of revival of policy, consequently the complainant is entitled for the claim amount under the policy?
Point:
In this case the husband of the complainant during his lifetime obtained insurance policy bearing No.687051227 from opposite party No.1 and shown the name of complainant No.1 as nominee . During the period from 5/2008 to 2/2009 the husband of the complainant unable to pay the premium amount. On 19/2/2009 the husband of the complainant approached the opposite party No.3 branch office, Khammam and paid the entire premium amount and the policy was revived on the same day. That in the last week of April, 2009 due to ill heatlh the husband of the complainat admitted in Mamatha General Hospital, Khammam and he was discharged. Subsequently on 8-5-2009 the husband of the complainant died at his residence due to heart attack. Immediately after death of her husband, the complainant No.1 intimated the same to opposite party No.3 and submitted all the relevant documents requesting to settle the death claim of her husband. But the opposite parties made investigation on the death of the insured as the claim is very early. On investigation the opposite party came to know that the deceased/ life assured had intentionally suppressed the material facts about his health that he has suffering from weakness of upper limb from the date of revival and he did not disclose the same in his personal statement, which is directly effect the issuance of policy on his life, as such they repudiated the claim of the complainant, for that the complainant approached the Forum.
It is an undisputed fact that the husband of the complainant died on 8-5-2009, while he had taken policy on 7-2-2005 and the same was revived on 19-2-2009. After revival of the policy within three months from the date of revival the husband of the complainant died. By virtue of insurance act, since the death was within three months from the date of revival, the opposite party insurance corporation made investigation. During the course of investigation the opposite party corporation came to know that the husband of the complainant joined in Mamatha General Hospitl, Khammam in the last week of April, 2009 for treatment and to support their case the opposite party corporation filed Exs.B.3 and B.4 patient record issued by the said hospital, the record shows that the deceased was taken treatment in the said hospital.
In the revival application submitted by the deceased on 19-2-2009 he had answered the questions particularly for four questions
question No.2(A): Have you ever suffered from any illness/ diseases requiring
treatment for a week or more? No
Question No.2(B): Did you ever have any operation, accident, or injury? No
Question No.2(C): Did you ever undergo ECG, X-ray, screening, Blood,
Urine or stool examination? No
Question No.4: Are you in sound health at present Yes
From the above there is no reason to doubt about the medical record furnished by the opposite party corporation. The complainant did not file any evidence to disprove the case of opposite parties. In fact when the assured had taken treatment in Mamatha General Hospital, Khammam, it cannot be said that he was hale and healthy at the time of revival of the policy. The facts remains that the insured had suppressed the material facts regarding his health. He took treatment before the date of revival of insurance policy, evidenced from Ex.B.3 and B.4. Since the suppression of material, repudiation of claim according to us was justified.
In the result, the complaint is dismissed. There is no order as to costs.
Dictated to steno, transcribed by her, corrected and pronounced by us in the open forum, on this 11th day of June, 2012.
PRESIDENT MEMBER
DISTRICT CONSUMER FORUM,
KHAMMAM
APPENDIX OF EVIDENCE
Witnesses examined for complainant:- None
Witnesses examined for opposite parties:- None
Exhibits marked for Complainant:
Ex.A.1 - Photocopy of Death certificate, dt.6-6-2009
Ex.A.2 - Photocopy of Letter, dt.31-3-2010 addressed by opposite parties
Ex.A.3 - Photocopy of Premium Receipt No.1212771, dt.30-6-2005
Ex.A.4 - Photocopy of Letter addressed by complainant to
opposite party No.2 along with postal receipt.
Exhibits marked for opposite parties:-
Ex.B.1 - Personal statement regarding health of Shaik Babu
Ex.B.2 - Ordinary revival quotation, dt.19-2-2009
Ex.B.3 - Discharge/ death summary of Sk.Babu issued by Mamatha
General Hospital, Khammam.
Ex.B.4 - certificate of hospital treatment.
PRESIDENT MEMBER
DISTRICT CONSUMER FORUM,
KHAMMAM
