BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION
AT HYDERABAD.
F.A. 381/2009 against C.C. 66/2009, Dist. Forum-III, Hyderabad.
Between:
Shujauddin Ahmed Jeddy
S/o. Late I. A. Jeddy
Age: 45 years, Pvt. Service
R/o. 3-5-826, III Floor
Hyderguda,
Hyderabad-500 029. *** Appellant/
Complainant.
And
S. B. I. Life Insurance Company Ltd.
Rep. by its Manager
6th Floor, United India Towers Building
Basheerbagh X Roads, Hydeguda
Opp. Police Commissionrate’s Office
Hyderabad-500 029. *** Respondent/O.P.
Counsel for the Appellant M/s. Nisarrudin Ahmed Jeddy
Counsel for the Respondent: M/s. G. Srinivasa Rao.
CORAM:
HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.
&
SMT. M.SHREESHA, MEMBER.
MONDAY, THE TWENTY SECOND DAY OF NOVEMBER TWO THOUSAND TEN
ORAL ORDER: (Per Hon’ble Sri Justice D. Appa Rao, President.)
***
1) Appellant is unsuccessful complainant.
2) The case of the complainant in brief is that he had taken a policy in the name his younger brother Zaheer Ahmed Jeddy on 8.5.2006 and paid the premium regularly up to 8.5.2007. He had taken yet another policy in the name of his younger brother Zaheer Ahmed Jeddy called Horizon-II Pension Option-I policy. While so his brother Zaheer Ahmed Jeddy developed depression and was unable to come out despite treatment. He went out for walk and never returned. On a report the police registered a case in Crime No. 249/2007 on 15.10.2007. Later they found his dead body in Hussainsagar lake. He submitted his claim along with death certificate etc. However, the respondent insurance company sent a cheque for Rs. 12,298/- and repudiated the entire claim on the ground that he was suffering from depression even prior to commencement of the policy. Assailing the said repudiation he filed the complaint to pay an amount of Rs. 1,20,000/- less Rs. 11,860/- and settle Horizon-II policy as per rules less Rs. 12,298/- together with compensation and costs.
3) The insurance company resisted the case. While admitting issuance of policy it alleged that the deceased was suffering from mental disorder since 2000 and took treatment from Asha Hospital, Institute of Medical Psychology & Counselling & Psychotherpay which fact was suppressed and therefore the policy was void ab initio. Under Horizon-II pure pension- option-I policy was issued on 8.5.2006. He died on 15.10.2007. Fund value of Rs. 12,298/- as on the date of death was paid as per the terms of the policy. Relying on the proposal form it had issued the policy when it was mentioned that he was not suffering from any mental disorder. After the death an enquiry was conducted which disclosed that he was taking treatment from Asha Hospital, Institute of Medical Psychology & Counselling & Psychotherpay since 2000. He underwent treatment from 4.2.2006 to 9.2.2006 and advised to take medicine by Dr. K. Chandrasekhar. In the proposal form dt. 3.5.2006 he declared that the answers given in the proposal form were true and correct and furnishing of any false information policy would be void. Since he has suppressed the above material fact, an amount of Rs. 11,680/- was refunded being policy investment value. The complainant was not entitled for remaining amount. The amount was paid towards full and final settlement of the claims. Therefore it prayed for dismissal of the complaint with costs.
4) The complainant in proof of his case filed his affidavit evidence and got Exs. A1 to A12 marked while the insurance company filed the affidavit evidence of its Head-Legal and got Exs. B1 to B10 marked.
5) The Dist. Forum after considering the evidence placed on record opined that there was suppression of material fact of his mental condition and that he was suffering from Schizophrenia, and therefore dismissed the complaint.
6) Aggrieved by the said decision, the complainant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. The Dist. Forum ought not to have relied that he was suffering from Schizophrinia which neither exists in dictionary nor existed in entire medical texts, and basing on such certificate the claim could not have been disallowed. Exs. B3 to B7 are unauthenticated record. It ought not to have relied. There was no suppression of any ailment much less mental illness at the time of submitting his proposal, and therefore prayed that the complaint be allowed.
7) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
8) It is an undisputed fact that the brother of the complainant by name Zaheer Ahmed Jeddy had taken two policies 1) H Horizon policy No. 18006546807 for Rs. 1,20,000/- commencing from 8.5.2006 and 2) Horizon-II Fixed Term policy No. 27005448209 commencing from 21.3.2007. He died on 15.10.2007. The police after investigation vide Ex. A2 opined that “he was suffering from ‘Schizophrenia’ and undergoing treatment and he might have committed suicide.” His dead body was found in Hussainsagar lake, and the doctor who conducted the post-mortem examination opined that his death was due to ‘asphyxia as a result of drowning. The police found that no foul play could be suspected in the incident. When the complainant submitted the claim he being the nominee, the insurance company had issued a cheque for Rs. 12,298/- settling the claim in respect of Horizon-II Fixed Term policy No. 27005448209. In regard to Horizon policy No. 18006546807 it had repudiated the claim under Ex. A6 dt. 12.12.2008 alleging that the deceased was under medication for depression since 2000, and was hospitalized for the same prior to the date of commencement of the policy, and that he has suppressed the information for question No. 8(ii):
During the last 10 years, have you undergone or been recommended to undergo, hospitalization, an operation or any investigation or test?
He answered ‘No’.
Finding that “as per the record available with us late Zaheer Jeddy was under medication for depression since 2000, and was hospitalized for the same prior to the date of commencement of the policy.” Thus the assured had concealed the material information, and therefore the claim was repudiated. However, an amount of Rs. 11,680/- was refunded towards investment value as per policy conditions. The complainant therefore prays to settle and pay balance of amount in regard to the above said policies. The complainant alleges that his brother has passed SSC vide Ex. A12 certificate. Assuming that he was suffering from mental depression and he committed suicide, by virtue of clause-18 the insurance company was liable to pay the amount. Clause-18 reads as follows :
18. Suicide:
If the life assured, whether sane or insane, commits suicide within one year from the date of issue of the policy, the policy shall be void. In such event, the fund value, prevalent on the first working day following the date the intimation has been received by the company shall be paid to the beneficiary refunded, and all benefits under the policy will cease.
If the suicide intimation is received by the company before 3.00 p.m. of any day – the closing NAV of the same day will apply for the calculation of the fund value and
If the suicide intimation is received by the company after 3.00 p.m. of any day – the closing NAV of the next day will apply for the calculation of the fund value.
He therefore contends that the insurance company has issued a policy for an insane person, and the argument that the insured had suppressed his ailment had no relevancy. He committed suicide one year after the commencement of the first policy, and therefore he was entitled to the amount. The insurance company relying on question No. 8 in the proposal form contends that the assured had not mentioned factum of his ailment. From the above, the moot question is whether the assured is sane or insane, the insurance company having agreed to terms of the policy cannot abdicates itself to pay the amount covered under the policy even to the person lumbering under depression like Schizophrenia however subject to its revealing in the proposal.
9) It is not in dispute that the deceased Jeddy was suffering from depression and other mental ailments had been under treatment in Asha Institute of Medical Psychology & Counselling & Psychotherapy that was from 4.2.2006 to 9.2.2006 and again from 6.5.2006 to 17.5.2006. Ex. B3 shows that he was under treatment from 27.7.2006 followed by further treatment in the very same hospital during, and subsequent to taking of the policy vide Ex. B7. It may be stated that the deceased had committed suicide and his body was surfaced in Hussainsagar lake and the police while filing the final report u/s 174 Cr.P.C. under Ex. A2 mentioned that “the deceased was suffering with schizophmia and undergoing treatment and he might have committed suicide. Obviously the S.I. of police did not verify the spelling of ‘Schizophrenia’ and from this the learned counsel for the complainant submits that there is no such disease, and therefore the Dist. Forum ought not to have relied on the said report in order to state that the complainant was not entitled to the amount.
10) In P.C. Chacko & anr Chairman, Life Insurance Corporation of India reported in III (2008) CPJ 78 (SC) the Supreme Court held:
“The purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law.”
11) Coming to the facts there is no embargo on the insurance company to issue insurance policy to mentally challenged person vide terms and conditions mentioned. If the insurance company is satisfied with his physical condition, may undertake to issue insurance policy. If he commits suicide the insurance company also agreed to pay the policy amount however subject to disclosure of facts by the assured. When the facts were suppressed for apparent reasons while accepting policy, amount need not be paid if such ailment was not revealed. Then he may not be entitled to the benefit as per clause 13 of the policy. Since admittedly the assured had suppressed his ailment, a material fact irrespective of the fact whether the insurance policy could be given to a mentally challenged person even covers the death by suicide he would not be entitled to such relief. The insurance company had paid the amount that it was liable under the policy even to a mentally challenged person. The complainant is not entitled to any more amount than what was settled by the insurance company. The Dist. Forum has rightly up-held the repudiation. There are no merits in the appeal.
12) In the result the appeal is dismissed. No costs.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
Dt. 22. 11. 2010.
*pnr
“UP LOAD – O.K.”
