BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD
F.A.No. 639 OF 2014 AGAINST C.C.NO.200 OF 2012 DISTRICT CONSUMER FORUM WARANGAL
Between
- Shriram Life Insurance Company Limited
Regd. Off: 3-6-478, Anand Estates, 3rd floor
Liberty Road, Himayathnagar,
- Shriram Life Insurance Company Limited
Near Land Mark Hotel
Nakkalagutta Hanamkonda
Warangal City & Dist.
Rep by its Branch Manager
Appellants/opposite parties
AND
Pindipolu Annapurna W/o Sathaiah
Age 45 years, Occ: Household
R/o Rampur Village, Maripeda Mandal
Warangal District
Counsel for the Appellants M/s KRR Associates
Counsel for the Respondent M/s. A.Raghu Rama Aurava
QUORUM :
HON’BLE SRI JUSTICE B.N.RAO NALLA, PRESIDENT
&
SRI PATIL VITHAL RAO, MEMBER
MONDAY THE TWENTY THIRD DAY OF APRIL
TWO THOUSAND EIGHTEEN
Oral Order : (per Hon’ble Sri Justice B.N.Rao Nalla, Hon’ble President)
***
This is an appeal filed by the opposite parties aggrieved by the orders dated 22.08.2014 of the District Forum, Warangal made in C.C.No.200 of 2012 wherein it allowed the complaint directing the opposite parties to deposit in the District Forum a sum of Rs.1,00,000/- towards sum assured with interest @ 7.5% per annum from the date of filing of the complaint i.e., 10.04.2012 till the date of realization and Rs.5,000/- towards mental and costs.
2. For the sake of convenience, the parties are referred to as arrayed in the complaint.
3. The case of the complainant, in brief, is that the complainant is the mother of the deceased Pindipolu Rajesh who during his life time obtained Shri Plus Policy from the opposite party no.1 for a sum assured of Rs.1,00,000/- for which the complainant is the nominee. While so the said Pindipolu Rajesh died on 06.05.2009 due to ill health. After the death of her son, the complainant, as a nominee submitted the claim form along with all the required documents to the opposite party no.1 for grant of policy sum assured amount with profits. The complainant requested the opposite parties several times to settle the claim but the opposite party failed to settle the claim. Vexed with the attitude of the opposite parties the complainant got issued legal notice dated 21.07.2010 to the opposite party no.1. The opposite party no.1 issued letter dated 14.05.2011 to complainant stating that no claim is payable under the said policy and they treated the matter as closed. Further the policy was taken under Unit Linked Plan and the opposite party no.1 will release the payment of balance in the fund account under the policy amounting Rs.2,653/- to the complainant towards full and final settlement and required the complainant to submit the discharge voucher. The complainant again got issued legal notice dated 15.06.2011 to opposite party no.1 by enclosing the copies of the documents and requested to settle the claim for which there was no response from opposite parties. Hence, the complaint praying to direct the opposite parties to pay sum assured amount of Rs.1,00,000/- and the Fund value on the premium paid amount due under the Policy with interest @ 12% p.a. from the date of death of the deceased i.e., 06.05.2009 till its full realization to the complainant together with compensation of Rs.20,000/-.
4. The opposite party no.1 resisted the case contending that the after the death of the deceased, the nominee has intimated the company that her son i.e., the policy holder died on 05.05.2009 and immediately the company through its investigator has personally on 19.06.2009 handed over the concerned claim forms to the nominee and requested to submit them properly filled in claim forms along with relevant documents to process the death claim. Simultaneously the investigator conducted his preliminary enquiry into the death claim found that the life assured consumed sleeping pills and died and he is also smoker. The company has sent reminders dated 19.08.2009 and 19.09.2009 for submission of fill in claim forms and the company sent another letter dated 16.11.2009 requesting her to forward the filled claim form B, but there was no response from the nominee. Since the nominee has not cooperated with the process by submitting the required filled in claim forms due to which having no other option the company has finally closed the claim vide its closing letter dated 16.11.2009. Hence, the opposite party no.1 prayed for dismissal of the complaint.
5. Despite service of notice the opposite party no.2 did not appear before the District Forum and hence it was set exparte.
6. In proof of her case, the complainant filed her evidence affidavit and got marked Ex.A1 to A14. On behalf of opposite party no.1, the Asst.General Manager-cum-Authorized Signatory has filed his evidence affidavit and got marked Exs.B1 to B13.
7. The District Forum after considering the material available on record, allowed the complaint bearing CC No.200 of 2012 by orders dated 22.08.2014 as stated in paragraph No.1, supra.
8. Aggrieved by the said decision, the opposite party no.1 preferred the appeal contending that the Dist. Forum did not appreciate the facts in correct perspective. The opposite parties contended that deceased life assured has obtained the policy by suppressing the material facts such as he has not mentioned about his smoking habits. The proposal was accepted based on the answers, statements and declarations provided by the deceased life assured in the proposal form. Had the deceased life assured disclosed his habit if intake of Tobacco/smoking, the opposite parties would not have accepted risk on the life of life assured and would not have issued subject policy to him. The complainant despite issuing several letters and reminders failed to submit claim form B with duly filled in and therefore, the appellants/opposite parties were constrained to close the claim. Therefore, the complainants prayed to set-aside the order of the District forum and appeal be accepted.
9. Counsel for the appellant and Mr.C.M.Sridhar, Asst. Manager (Legal) of opposite party no.1 who also represents on behalf of the opposite party no.2 were present and were heard. Written arguments of the appellants/opposite parties and the respondent/complainant have been filed
10. The point that arises for consideration is whether the impugned orders as passed by the District Forum suffer from any error or irregularity or whether they are liable to be set aside, modified or interfered with, in any manner? To what relief?
Top of Form
11. The facts not in dispute are that the son of the complainant P.Rajesh during his life time obtained Shri Plus Policy No.LN0708009110912 dated 28.08.2008 from the opposite party no.1 by paying premium amount of Rs.10,000/- per year and the sum assured was Rs.1,00,000/-. While so on 06.05.2009 the life assured died and after his death the complainant being a nominee submitted claim form-A to the opposite party no.1. The disputed facts are that though the complainant stated to have been submitted duly filled Claim Form-B to the opposite party no.1 as requested by the opposite party no.1, the opposite party no.1 closed the claim for two reasons i.e., the complainant despite several letters and reminders failed to submit/fill the claim form-B and another reasons the opposite parties stated that in the proposal form the life assured suppressed the fact that he is a smoker and he died due to consuming of sleeping pills.
12. Now we will see the two reasons for which the opposite parties closed the claim. The first reason stated by the opposite party no.1 is that the deceased life assured has obtained the policy by suppressing the fact that though he is a smoker he did not mention the same in the proposal form.
14. At the outset we may state that the allegation that the complainant’s son was a smoker is not evidenced by any document. In the investigation report furnished by the Investigator it is mentioned that the deceased life assured married a girl without the knowledge of his parents and that over a period of time due to serious difference between them he visited his native place and consumed sleeping pills and died. It was also mentioned by the investigator that “He was a smoker”. The Insurance Company assumed that it was suppressed while submitting the proposal form and therefore the complainant was not entitled to any benefit. The fact remains that for every habit the assured need not give information to the Insurance Company. The Insurance Company did not allege any serious ailment against the assured. In Ex.B8 against the column cause of death it was mentioned due to fever and motions he died. Nowhere was it mentioned that the deceased life assured died due to consuming of sleeping pills. There is no postmortem report nor had any evidence that the deceased life assured died due to intake of sleeping pills. At any rate, no certificate from the doctor or authority was filed in order to show that the habit of smoking would lead to death and also that the deceased life assured had died due to consuming sleeping pills suppression of this information would entail the Insurance Company to close the claim. Since the Insurance Company alleges that the deceased was a smoker, we are of the opinion that non-mention of it, would not entail the complainant from claiming the amount.
15. The next reason, the opposite parties stated in their grounds of appeal that due to non- submission/filling of Claim Form-B the claim was closed as “ No Claim”. The complainant filed copy Ex.A13 which is CLAIM FORM “B” i.e., Medical Attendant’s Certificate which showed that it was already filled by the complainant attested by Dr.Y.Sapta Naga Kumar of Sashi General Hospital, Khammam. On the other hand the opposite parties filed Ex.B7 i.e., Claim Form “B” and contended that the complainant had not sent the said form by duly filling it. The complainant stated that on the request of the opposite parties, she submitted the Claim Form “B” after duly filling it and that even after receipt of the same they closed the claim as “No Claim”. Ex.B7, the Claim Form-B which is blank form by which the opposite parties want to show that the complainant submitted the said blank form to them for settling the claim. Had the complainant really not submitted the Claim Form “B” as was stated by the opposite parties, there is no occasion to the complainant to file the duly filled in Claim Form “B” before the District Forum which was marked as Ex.A13. As such adverse inference is drawn against the Insurance Company that the closure of the claim as “ No Claim” by the opposite parties is nothing but to avoid payment of the claim amount to the complainant.
16. Therefore, the District Forum after considering the facts in correct perspective allowed the complaint and we do not see any mis-appreciation of fact or law in this regard. We do not see any merits in the appeal. In the circumstances discussed supra, we answer the point no.10, supra in favour of the complainant and against the opposite parties.
In the result the appeal is dismissed confirming the order of the District Forum, Warangal passed in C.C.No.200 of 2012 dated 22.08.2014. There shall be no order as to costs. Time for compliance four weeks.
PRESIDENT MEMBER
23.04.2018
