BEFORE THE DISTRICT FORUM: KURNOOL
                          Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
                                                        And
                                 Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
                                                        And
                                    Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
                                        Wednesday the 18th day of April, 2012
                                                   C.C.No.90/2011

Between:

M.Vikram Raju,
S/o M.Deva Raju,
H.No.8-99, BVR Colony,
Karivena Village – 518 422,
Atmakur Mandal,
Kurnool District.                           …COMPLAINANT
   
                                                  -Vs- 

1. M/s Birla Sun Life Insurance Company Limited,
 Represented by its Authorised Signatory,
 D.No.40-301-10,
 Bangarupeta, R.S. Raod,
 Kurnool – 518 002.

2. M/s Birla Sun Life Insurance Company Limited,
 Represented by its Managing Director,
 One Indiabulls Centre, Tower 1,
 15th & 16th Floor,  Jpiter Mill Compound,
 841 Senapati Bapat Marg.,
 Elphinstone Road,
 Mumbai – 400 013.                                ...OPPOSITE PARTIES

This complaint is coming on this day for orders in the presence of Sri M.Sivaji Rao, Advocate for complainant and opposite party No.1 as called absent and Sri M.D.V.Jogaiah Sarma, Advocate for opposite party No.2 and upon perusing the material papers on record, the Forum made the following.
                                    
                                                  ORDER
                                 (As per Sri. T.Sundara Ramaiah, President)
                                             C.C. No. 90/2011

1. This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying to direct the opposite parties:-

(a) To pay the assured  amount of Rs.2,38,000/- with other benefits on the policy with interest @ 24% per annum;

(b) To pay a sum of Rs.50,000/- towards the compensation for causing mental agony and hardship;

(c) To pay the costs of the complaint;
                            And
(d) To pass any such order or orders that are deem to be fit and proper in the circumstances of the case.

2.    The case of the complainant in brief is as under:- The deceased life assured obtained one Dream Endowment Fund coverage policy from opposite party No.1.  The sum assured under the policy is Rs.2,38,000/- with other benefits.  The premium per year is Rs.9,932/-.  The complainant is the son of the life assured.  The complainant is the nomine under the policy.  On 14-04-2010 the assured M.Deva Raju died due to Sudden Heart Attack.  The complainant being the nominee of the deceased submitted claim to opposite parties.  The investigator of opposite parties came to the complainant and obtained his signature in a white paper stating that they would settle the claim.  On 15-10-2010 the opposite parties repudiated the claim on the ground that the deceased over stated his income in the proposal form.  The deceased disclosed the entire information correctly at the time of taking the policy.  The deceased was cultivating lands of M.Saramma, Father Johnson and CH.Venkateswarlu on lease and getting minimum income of Rs.1,40,000/- per year.  There was no suppression of material information.  The insured was also doing contract works.  The opposite parties negligently repudiated the claim on flimsy ground.  Hence the complaint.

3. Opposite party No.1 set exparte.

 Opposite party No.2 filed counter stating that the complaint is not maintainable.  The complainant in the proposal form mis-stated the material facts pertaining to his occupation he also mis-sated the material facts regarding his health conditions.  The life assured signed the application after reading and understanding the contents.  In the application the insured himself stated to be land lord and owner.  He declared his income to be Rs.1,40,000/- per annum. In the claim statements it is stated by the complainant that the life assured was a farmer.  The insured died 26 days after the application for insurance.  After the death of the insured   the opposite party investigated the matter and found that the insured provided false and incorrect information regarding his income occupation and medical condition to the opposite parties.  The insured gave false information about his occupation and income.  The investigation reveals that the life assured was a labourer and earning of Rs.50/- per day.   The Thasildar, Atmakur gave income certificate stating that the annual income of the insured was Rs.18,000/-.  The deceased also concealed the information regarding his health condition.  The deceased suppressed the material facts about his income and medical information.  The deceased over stated his annual income with an intention to got insurance coverage.  The deceased also concealed his fast medical history in the proposal form.  The opposite parties rightly repudiated the claim of the complainant.  The complainant has not approached the forum with clean hands.  The complaint is liable to be dismissed.  

 4. On behalf of the complainant Ex.A1 to A8 are marked and sworn affidavit of the complainant, and third party affidavits of Smt.M.Saramma, Father Sri. Johnson and Sri CH.Venkateswarlu are filed.  On behalf of the opposite party No.2 Ex.B1 to B5 are marked and sworn affidavit of opposite party No.2 is filed. 

5. Both sides filed written arguments.

6. Now the points that arise for consideration are:

 i. Whether there is deficiency of service on the part of Opposite Parties?

 ii. Whether the complainant is entitled for the reliefs as prayed for?

 iii. To what relief?

7. POINTS i and ii:- Admittedly the opposite parties issued Ex.A1 policy in favour of M.Deva Raju father of the complainant.  The period of the policy is from 20-03-2010 to 20-03-2040.  The sum assured under the policy is Rs.2,38,000/-. The yearly premium is Rs.9,932.50Ps.  The complainant is the nominee under Ex.A1 policy.  It is the case of the complainant that his father M.Deva Raju died on 14-04-2010 due to Heart Attack and later he submitted the claim to the opposite parties.  The complainant in his sworn affidavit clearly stated that his father died on 14-04-2010.  The complainant also filed Ex.A3 death certificate issued by Panchayat Secretary Karivena Grama Panchayat stating that M.Deva Raju died on 14-04-2010.

8. Admittedly the complainant who is the nominee under the policy submitted the claim to the opposite parties after the death of the insured.  The opposite parties repudiated the claim of the complainant through its letter dated 15-10-2010 stating that the life assured over stated his income in the proposal form fraudulently and that there are no liable to pay the benefits under the policy to the complainant.  In the affidavit filed by opposite party No.2 it is stated that the insured in the application Ex.B1 over stated his annual income as Rs.1,40,000/- and also made a false statement that he was a land lord and farmer.  It is the contention of the opposite parties that their investigation revealed that the insured was a labourer, that he was earning Rs.50/- per day and that the Thasildar issued the income certificate stating that the income of the deceased was Rs.18,000/- per year.   The opposite parties did not choose to file the affidavit of the Thasildar who issued the certificate.  Mere filing of the photo copy of the certificate is not sufficient.  The said certificate is not marked on behalf of the opposite parties.  It is further case of the opposite parties that the investigator recorded the statement of the complainant and that the complainant stated before the investigator that his father as labourer was earning Rs.50/- per day.  The complainant in his sworn affidavit clearly stated that his father was a farmer and getting more than Rs.1,40,000/- per annum.  The opposite parties also filed statement CH.Venkateswarlu said to have been recorded by the investigator.  In the said statement it is mentioned that the deceased was attending labour works.  But the said CH.Venkateswarlu gave affidavit in favour of the complainant stating that the deceased was cultivating lands on lease and getting income of Rs.1,40,000/- per year and that the investigator deputed by the opposite party obtained his signatures on empty papers.  In light of the affidavit evidence of the complainant and CH.Venkateswarlu the contention of the opposite party that the deceased was attending labour Works and earning Rs.50/- per day cannot be believed. 

9. The complainant to show that the deceased was earning more than Rs.1,40,000/- per year relied on Exs.A5, Ex.A6 and Ex.A8.  As already stated it is the case of the complainant that the deceased was cultivating lands of M.Saramma, Father Johnson and CH.Venkateswarlu.  Ex.A5 and Ex.A6 are the copies of Adangals.  The entries in Ex.A5 and Ex.A6 go to show that the deceased was cultivating the lands of M.Saramma, Father Johnson prior to his death and raising commercial crops in the said lands.  CH.Venkateswarlu also in his affidavit evidence stated that the deceased was cultivating his land on lease.   Ex.A8 is photo copy of Pattadar Pass Book of Chilakal Chinna Venkateswarlu.  Merely because the deceased stated in the proposal form that he is a Land lord, the claim of the complainant cannot be rejected.   The deceased in his proposal form clearly stated that he was a farmer.  In the claim form in Ex.B2 also it is mentioned that the deceased was a farmer.  No doubt the contract of insurance is based on good faith.  The insured has to disclose material facts in the proposal form.  The opposite parties filed to establish that the annual income of deceased was only Rs.18,000/-.  There is sufficient evidence on record to show that the deceased was cultivating the lands of other on lease and raising commercial crop in the said lands.  In a decision reported in III (2010) CPJ 1 it is held that it is the duty of the insurance company to verify income of the applicant.   No doubt in the proposal form the insured stated that his annual income was Rs.1,40,000/-.  There is no evidence that the opposite parties verified the income of the insured before issuing the policy Ex.A1.  Now it is not open to the opposite parties to repudiate the claim of the complainant on the ground that the insured overstated his income in the proposal form. 

10. It is also the case of the opposite parties that the deceased suppressed the material facts regarding his health condition in the proposal form.  It is further case of the opposite parties that the deceased was suffering from Asthma, Chest Pain and Hipper Tension before he applied for the policy and the same was not mentioned in the application form Ex.B1.   In Ex.B1 no doubt there is no mention that the deceased was suffering from Asthma, Chest Pain and Hipper Tension.  According to the opposite parties the deceased prior to Ex.B1 took treatment from Dr.S.Venkataramana, Civil Assistant Surgeon, Atmakur and Dr.A.Sarada.  The opposite parties did not choose to file the affidavits of the said Doctors to establish that the deceased was suffering from Asthma, Chest Pain and Hipper Tension before he applied for the policy.  In a decision reported in IV (2007) CPJ 163 it is held that no substantial evidence supported by affidavit of doctor, who treated deceased, filed on record - Fraudulent suppression of material facts not proved – Insurance Company liable to pay policy amount along with interest.  In the present case also no medical evidence is placed by the opposite parties to show that the deceased was suffering from Asthma, Chest Pain and Hipper Tension before he applied for the policy.  The opposite parties are not justified in repudiating the claim of the complainant.  There is deficiency of service on the part of opposite parties.     
                            
11. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay the assured amount along with benefits if any to the complainant within two months from the date of order along with costs of Rs.500/-.

    Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 18th day of April, 2012.

             Sd/-                           Sd/-                      Sd/-
MALE MEMBER             PRESIDENT     LADY MEMBER

                               APPENDIX OF EVIDENCE
                                    Witnesses Examined

For the complainant : Nil        For the opposite parties : Nill

List of exhibits marked for the complainant:-

Ex.A1  Photo copy of Policy No.003970792 dated 20-03-2010.

Ex.A2  Photo copy of Benefit Information of Birla Sun Life Insurance.

Ex.A3  Death Certificate issued by Panchayat Secretary  Karivena Village, Atmakur Mandal, Kurnool District dated 13-05-2010.                            

Ex.A4  Photo copy of Repudiation Letter dated 15-10-2010.

Ex.A5  Adangal of Sy.No.217/1 and 215/1 Fasali 1420 issued by Village Revenue Officer, Karivena Village, Atmakur Mandal, Kurnool District.

Ex.A6  Adangal of Sy.No.316 issued by Fasali 1420 issued by Village Revenue Officer, Karivena Village, Atmakur  Mandal,Kurnool District.

Ex.A7  Photo copy of Empty paper with Signatures.

Ex.A8  Photo copy of Pattadar Pass Book of Chilakal Chinna Venkateswarlu.

List of exhibits marked for the opposite parties:-

Ex.B1  Photo copy of Proposal Form issued by opposite party No.2.

Ex.B2  Photo copy of Claimants Statements of Metla Deva Raju.

Ex.B3  Photo copy of Letter of complainant dated 06-10-2010.

Ex.B4  Photo copy of statement of Ch.Venkateswarlu along with Tranlation Letter dated 06-10-2010.

Ex.B5  Photo copy of Letter by opposite party No.2 to complainant dated 15-10-2010.

    Sd/-       Sd/-                Sd/-
MALE MEMBER                  PRESIDENT     LADY MEMBER

              // Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//

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