BEFORE THE DISTRICT FORUM (UNDER CONSUMER PROTECTION ACT, 1986), MEDAK AT SANGAREDDY
Present:Sri P.V.Subrahmanayma, B.A.B.L., PRESIDENT
Smt. Meena Ramanathan, B.Com., Lady Member
Sri G. Sreenivas Rao,M.Sc.,B.Ed.,LL.B.,PGADR (NALSAR),
Male Member
Wednesday, the 5th day of January 2011
CC. No. 30 of 2010
Between:
Smt. P. Bhagya Lakshmi, W/o Late P. Kumar,
Aged about 38 years, Occ: House Wife,
R/o H.No. 428, Ghanpur Village,
Patancheru Mandal, Medak District. … Complainant
And
Met Life India Insurance company Ltd.,
Rep. by its General Manager
(claims Department),
O/o Brigade Seshamahal,
5, Vani Vilas Road, Basavanagudi,
Bangalore – 560 004. ….Opposite party
This case came up for final hearing before us on 29.12.2010 in the presence of Sri. M. Sudhakar, Advocate for complainant and Sri. G. Laxman Kumar, Advocate for opposite party, upon hearing arguments, on perusing the record and having stood over for consideration till this day, this Forum delivered the following
O R D E R
(Per Sri P.V. Subrahmanyam, President)
This complaint is filed Under Section 12 of The Consumer Protection Act, 1986 to direct the opposite party to pay the insurance policy amount of Rs.2,51,000/- and to pay compensation of Rs. 50,000/- to the complainant.
The averments in the complaint in brief are as follows:
1. The complainant is a resident of Ghanpur Village, Patancheru Mandal, Medak District. Her husband Late P. Kumar, while working as constable in Patancheru Police Station, obtained a policy bearing No. 1200900835032 dated 18.03.2009 for a total amount of Rs. 2,51,000/- with annual premium of Rs. 25,100/-. The policy was issued by the office of the opposite party at Bangalore. The policy commences from 18.03.2009 and it is upto 18.03.2029 which covers a period of 20 years. The complainant’s husband P. Kumar paid the premium amount. The policy was issued by the opposite party after completing all the prescribed formalities. While the things stood thus on 20-06-2009 the complainant’s husband was admitted in Yashoda Hospital due to sudden chest pain and he was declared dead by the doctors in the hospital on 21.06.2009 at 2:00 p.m. Immediately after death the complainant approached the opposite party company and submitted death certificate in the office of claims department at Begumpet, Hyderabad. There was neither response nor the policy amount was paid even after lapse of nine months. The complainant already received Rs. 66,840/- on 22.02.2010 in respect of LIC policy No. 643076892. She has also received Rs. 88,443/- on 22.02.2010 in respect of LIC policy No. 641661609. The above said two policies were obtained by her husband P. Kumar. The complainant got a legal notice dated 17.03.2010 issued to the opposite party through registered post acknowledgement due, demanding to pay the policy amount. The opposite party received the notice and sent a reply with false and baseless allegations without paying the policy amount. This forum has jurisdiction to entertain the complaint as the complainant is residing in Ghanpur, Patancheru Mandal, Medak District. Hence the complaint.
2. The claim is resisted by the opposite party by filing a counter which in brief is as follows:
The complaint is not maintainable. There is no consumer dispute as defined in The Consumer Protection Act as there is neither any unfair trade practice nor deficiency in service on the part of the opposite party. This forum has no territorial jurisdiction to entertain the complaint. The entire cause of action stated in the complaint is based on a Life Insurance Policy taken from the opposite party at Hyderabad. The opposite party has no branch at Medak. The policy holder / life assured P. Kumar who is complainant’s husband was admitted in Yashoda Hospital for a surgical operation of his left leg which had complaints of pain and non healing ulcer ie. varicose ulcer from 28.07.2008 to 01.08.2008. He was also suffering from diabetes mellitus for the past one year prior to his death. He had not disclosed about the said material facts in his application form dated 09.03.2009 which was submitted at the time taking the insurance policy. As the policy of life Insurance is a contract of utmost good faith, personal information like health and habits should be disclosed by the prospective life assured and such disclosure is very vital in a contract of life insurance because it is the bases for taking a decision by the insurance company whether to offer coverage or not and the premium payable. The policy holder fraudulently suppressed material facts as stated above and hence the opposite party is entitled to rescind the contract.
The complainant’s husband approached the opposite party at Hyderabad for issuance of Life insurance policy under the plan MET EASY and submitted application on 09.03.2009 setting out his personal details including health and habits. MET EASY plan being a “non medical plan” (no medical test would be done at the time of application). The insurance policy was issued on 18.03.2009 solely on the declaration made by the policy holder in his application. The annual premium was Rs.25,000/- for twenty years. The policy holder died on 21.06.2009 due to Cardiac respiratory arrest. It is revealed from the progress sheet dated 21.06.2009 issued by Yashoda Hospital, Hyderabad that he was suffering from diabetes for the past one year i.e. before issuing insurance policy. During the course of investigation at Yashoda Hospital it was found that the policy holder had undergone a surgery for varicose ulcer in left limb on 29.07.2008 which can be seen from discharge summary dated 01.08.2008. The claim of the complainant was repudiated vide letter dated 16.11.2009 clearly mentioning. the reasons. Opposite party paid Rs.1 9.404/- being the fund value which was available in the policy account and issued a cheque dated 13.11.2009 for the said amount infavour of the complainant as mandated in the terms and conditions of the policy. In the letter dated 09.03.2010 submitted by the complainant to the opposite party to reconsider the decision of repudiation has clearly mentioned by the complainant herself that the deceased life assured was known to have been suffering from diabetics. As material facts are suppressed by the life assured in his application form, the claim of the complainant was rightly repudiated. The opposite party sent a suitable reply for the legal notice issued on behalf of the complainant. The complaint is therefore liable to be dismissed with costs.
3. To substantiate the pleadings both parties have filed their evidence affidavits. Exs. A1 to A9 are marked on behalf of the complainant and Exs. B1 to B9 are marked on behalf of the opposite party. Written arguments filed on behalf of the complainant. A memo is filed on behalf of the opposite party to treat counter as its written arguments and oral arguments. Complainants advocate is heard. Perused the record.
4. The points for consideration are i). Whether this forum has territorial jurisdiction to entertain the complaint? If so
ii). Whether the complainant is entitled for the policy amount or not?
The case of the complainant is that her husband P. Kumar, while working as police constable in Patancheru police station, Medak District has obtained a life insurance policy from the opposite party on 18.03.2009 and on 20.06.2009 suddenly he developed chest pain and he was admitted in Yashoda Hospital, Hyderabad were he was declared dead in the next day i.e. on 21.06.2009 at 2:00 p.m. and immediately there after she claimed the insurance amount but the opposite party repudiated the claim on the ground that Yashoda Hospital reports disclosed that the policy holder had diabetes for the past one year prior to his death. The defence of the opposite party is two fold viz., i). this forum has no territorial jurisdiction because the opposite party is not located within the territorial jurisdiction of this forum nor there is any branch office of the opposite party within the territorial jurisdiction of the this forum and further no part of the cause of action has arisen within the territorial jurisdiction of this forum, because the complaint itself discloses that the policy was obtained in the office of the opposite party at Begumpet, Hyderabad. The second line of argument of the opposite party is that the deceased policy holder had diabetes by the time of taking the policy in question but he had not disclosed the same in his application for issuance of the policy, which amounts to suppression of material fact and hence the claim of the complainant is rightly repudiated. In view of the above contest let us now consider the objection for the jurisdiction of this forum, in the first instance and then if necessary to consider the second line of argument.
5. To decide the points at issue it is not necessary to refer the various documents marked by the parties. Therefore reference will be made only to those documents which are necessary.
6. Point No. (i):
The complainant has not stated either in the complaint or in her evidence affidavit or in written arguments to show that any part of cause of action has arisen within the territorial jurisdiction of this forum. However during arguments the learned counsel for the complainant has drawn our attention to Ex.A7, which is also available in the document of opposite party, Ex.B1 (Third sheet). It is first premium receipt dated 20.03.2009. In the policy details table, given in Ex. A7 the last but one column is “financial advisor name”. Against the same it is written “AXIS – Patancheru – Hyderabad”. It is argued by the learned counsel for the complainant that the first premium amount of Rs.25,100/- was paid at Patancheru which is within the territorial jurisdiction of this forum. The said fact is not denied by the opposite party either in the counter or in the evidence affidavit. On the other hand their own document Ex.B1 is in support of the contention of the learned counsel for the complainant. Clause (c) of Sub-Section 2 of Sec 11 of The Consumer Protection Act says that a complaint can be filed within the jurisdiction of the District forum if cause of action wholly or in part arises. In the instant case making payment of first premium in Patancheru Axis Bank constitutes part of cause of action. Because a part of cause of action has arisen within the territorial jurisdiction of this forum, this forum has jurisdiction to entertain this complaint. The contention of the opposite party that this forum as no territorial jurisdiction is therefore not correct.. The point is answered infavour of complainant.
7. Point No. 2:
According to the opposite party the investigation reports of Yashoda Hospital dated 21.06.2009 show that the complainant’s husband P. Kumar/ insured, had diabetes for the past one year i.e. from June 2008 and because Ex.B2 first sheet, which is application form for issue of Life Insurance Policy which was submitted in March 2009, is silent about the said disease, even though he was having the disease for about more than 9 months prior thereto, it amounts to suppression of material fact and hence the opposite party is entitled to rescind the contract and did so and rightly repudiated the claim of the complainant.
8. It is to be observed here that it is not the case of either the complainant or the opposite party that the deceased P. Kumar / insured was known diabetic from June 2008. Mentioning of diabetes to the complainant’s husband in the Yashoda Hospital reports dated 21.06.2009 does not automatically mean that the deceased knew that he was having diabetes before 21.06.2009, especially on date when he had submitted Ex.B2 application form for issuance of Life Insurance Policy. Suppression of material fact arises if such fact is voluntarily not disclosed ie. having knowledge of it. There is no evidence on record to show that the insured had knowledge that he was diabetic at any time prior to 21.06.2009 . Therefore not mentioning of diabetes in Ex.B2 by the insured does not amount to suppression of material fact and hence repudiation of claim of the complainant on that ground is illegal. It is therefore held that the complainant is entitled to the policy amount of Rs. 2,51,000/-. The point is answered in favour of the complainant.
9. In the result the complaint is allowed with costs. The opposite party is directed to pay to the complainant the policy amount of Rs. 2,51,000/- after deducting the amount of Rs.19,404/- (which was stated to have been paid by the opposite party towards fund value through cheque dated 13.11.2009) with interest at 9% p.a. from 21.06.2009, the date on which the insured died. The opposite party is further directed to pay to the complainant Rs.10,000/- towards compensation for the mental agony suffered by her due to illegal repudiation of her claim and to pay Rs. 5,000/- towards costs of this litigation. One month time is granted for payment of the above amounts.
Typed to dictation, corrected and pronounced by us in the open forum this 5th day of January, 2011.
Sd/- Sd/- Sd/-
PRESIDENT LADY MEMBER MALE MEMBER
Sd/-
PRESIDENT
Copy to
- The Complainant Copy delivered to the Complainant/
- The opp.parties Opp.Parties On _____________
- Spare copy Dis.No. /2011, dt.
