Karnataka

Kolar

CC/29/2015

Sr.Srinivasa.B - Complainant(s)

Versus

Reliance General Insurance Company - Opp.Party(s)

Sri.B.Kumar

15 May 2017

ORDER

Date of Filing: 11/08/2015

Date of Order: 15/05/2017

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, D.C. OFFICE PREMISES, KOLAR.

 

Dated: 15^th DAY OF MAY 2017

PRESENT

SMT. PRATHIBHA.R.K., BAL LLM, PRESIDENT

SMT. A.C. LALITHA, BAL., LLB           ……  LADY MEMBER

CONSUMER COMPLAINT NO :: 29 OF 2015

Sri.Srinivasa.B @ Srinivasappa,

S/o. Changalarayappa,

Aged About 33 Years,

R/at: House No.80, Majara

Upparahalli, Byatanuru, Mulbagal

Taluk, Kolar District.

(Rep. by Sri.G.N. Narayanaswamy, Advocate)                      ….  Complainant.

 

- V/s -

M/s. Reliance Life Insurance

Company Limited,

Sri.Lakshmi Srinivasa Complex,

M.G.Road, Kolar.

(Rep. by Sri.V.K.Prashanth, Advocate)                  …. Opposite Party.

-: ORDER:-

 

BY SMT. PRATHIBHA.R.K, PRESIDENT

01.   The complainant has preferred this complaint as envisaged Under Section 12 of the Consumer Protection Act, 1986 against the OP-Insurance Company seeking directions against the OP to pay Rs.10,49,667/- under policy bearing No.51641203, dated: 22.07.2014 and Rs.6,17,000/- under policy bearing No.5764975, dated: 16.07.2014 towards the assured amount on account of the death of Smt. Narayanamma wife of complainant and also to direct the OP to pay Rs.2,50,000/- each towards loss of estate and Rs.2,50,000/- towards damages along with litigation expenses.

02.   The facts in brief:-

(a)    It is contention of the complainant that, the complainant is an agriculturist and his parents Sri.Changalarayappa and Smt. Narayanamma were owning properties at Palamner and also in Mulbagal.  The complainant’s father had 3 acres of agricultural land in Byrakur Village, Mulbagal, and complainant’s mother was possessing 5 acres and 4 cents of land among which 4 acres are cultivable land at Jangapalli Village, Gandarajpalli, Gangavaram Mandal, Palamner Taluk, Andhra Pradesh.  The annual agricultural income of the complainant’s parents is Rs.20,33,933/- and Rs.7,61,619/- for the years 2013-2014 and 2012-2013 respectively. 

 

(b)    The complainant further submits that, during the life time of Late Smt. Narayanamma, she had obtained Guaranteed Money Back Policy of insurance bearing No.51641203  for a sum assured of Rs.10,49,667/- from the OP.  Smt. Narayanamma during the subsistence of the previous policy has obtained another Guaranteed Money Back Policy bearing No.51649754 on 16.07.2014 for a period of 20 years from OP.  A sum of Rs.36,223.76 was to be paid half yearly.  The above 02 policies complainant is the nominee.  The OP had accepted the proposal submitted by the mother of the complainant and have issued insurance policy. 

 

(c)    Further complainant submitted that, on 19.08.2014 Smt. Narayanamma, mother of the complainant, complained about chest pain and immediately she was taken to Dr.K.Kadirappa, a Civil Surgeon at Srinivasa Nursing Home, M.B.T. Road, Palamner, Chittor District, Andhra Pradesh.  After examination Dr. K.Kadirappa referred her to higher hospital as she was suffering from Myocardial Infraction.  As per the advice of Dr. K.Kadirappa, complainant tried to shift Smt.Narayanamma through 108 Ambulance to R.L. Jalappa Hospital, Kolar, but while on the way near Mulbagal Smt. Narayanamma lost her breath.  Immediately complainant rushed to Manohara Sai Gowda Memorial Hospital, Mulbagal, where the doctor declared her death and the cause of death may be massive heart attack. 

 

(d)    Further contention of the complainant is that, claim was submitted to the OP towards above said policies, but the OP has repudiated the same through letter dated: 04.07.2015. 

 

(e)    The complainant further contention is that, in spite of several approaches and requests made by the father of the complainant Sri.Changalarayappa, the OP instead of settling the claims, repudiated the claims, holding Smt. Narayanamma died on account of breast cancer.  The father of the complainant could not withstand this attitude of the OP and due to stress and strain given by the OP he died on 29.04.2015. 

 

(f)     Further complainant’s submission is that, due to the demise of both father and mother complainant became an orphan and was thrown to the street.  The complainant submitted that, One Smt. Narayanamma, W/o. Narayanappa, residing at Upparahalli, Mustur Post, who belongs to same village has visited Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011.  The OP by referring to the above document has repudiated the claim of the complainant.  So contending, the complainant has filed this complaint seeking the above set-out reliefs against the OP.

 

(g)    Along with the complaint the complainant has filed following copies of documents:-

(i) Copy of the ROR issued by Mee Seva, AP.

(ii) Copy of the Pass-book issued by the Government Office of AP.

(iii) Certificate issued by Deepthi.A.V., Chartered Accountant.

(iv) Policy documents issued by the OP with policy schedule and terms and conditions.

(v) Claim Form-B of Reliance Life Insurance issued by Dr.K.Kadirappa, Palamner, Chittoor District.

(vi) Certificate dated: 10.10.2014 issued by Dr.Doddabadre Gowda, Manohara Sai Gowda Memorial Hospital, Mulbagal.

(vii) Death certificate dated: 17.10.2014 of Smt. Narayanamma.

(vii) Repudiation letter dated: 04.07.2015 issued by the OP.

(viii) Death certificate of Sri.B.Chengalrayappa

(ix) Document pertaining to issuance of policy and First Premium Receipt issued by Bajaj Allianz Life Insurance Company with policy acceptance proforma.

(x) Personal Protect Policy issued by ICICI Lombard General Insurance Company.

(xi) Patient’s ID Card and Election card of Narayanamma, W/o. Narayanappa.

 

03.   In response to the notice issued from this Forum, counsel for OP appeared and filed his version by resisting the claim of the complainant in toto.

 

(a)    The OP submitted that, the complainant has arrayed the Reliance Life Insurance Company as a party, but the reliance General Insurance Company having a separate legal entity than of the Reliance Life Insurance Company Limited which is a life insurance company engaged in the business of providing life insurance.  This insurance company is duly incorporated under the provisions of the Companies Act, 1956 having its registered office at 9^th and 10^th floor, building No.2, R-Tech Park, Nirlon Compound, Next to Hub Mall, Behind 1-Flex Building, Goregaon (East), Mumbai.  The instant complaint is false, malicious, incorrect and malafide and is nothing but an abuse of the process of the law and the same has been filed just to avail undue advantage. 

 

(b)    The OP submission is that, after perusal of documents collected during the investigation it came to knowledge of this OP that, DLA was suffering from Breast Cancer since 2011 and was treated at Kidwai Medical Institute of Oncology prior to issuance of the said policy and she died due to the same.  It was further learnt that, the DLA had taken policies from HDFC Life Insurance Company prior to issuance of said policy for total assured sum of Rs.4.25 lacks and the said fact was also not disclosed to this OP at the time of issuance of said policy.  The DLA was admitted at Kidwai Medical Institute of Oncology on 15.03.2011 with the hospital code 3534/11 for the treatment of Breast Cancer.  Therefore on the basis of the aforesaid facts this OP has declined the death claim under the policy on the ground of non-disclosure of past insurance coverage details with multiple insurance companies.  There is no negligence or deficiency in service on the part of this OP and this OP in terms of the provision of Section 45 of the Insurance Act, 1938 has rightfully repudiated the death claim on the ground of suppression of material facts and on providing of wrong information as stated in the repudiation letter and thus the present complaint is liable to be dismissed. 

 

(c)    Further OP submitted that, the DLA had passed away within short period of signing of the proposal form and issuance of policy which itself shows reasonable doubt over the correctness of the materials made in the proposal forum.  Further OP by relying following citations has submitted that, the very fact of early claim is a good corroborative evidence to prove misrepresentation, material non-disclosure or contemplation of death:-

(i) III (2003) CPJ 172 (NC),

(ii) I (2009) 2012 (NC)

(iii) II (2008) CPJ 156,

(iv) III(2008) CPJ 226,

(v) Appeal No.242 OF 2006.

 

(d)    Furthermore OP submission is that, Smt. Narayanamma has submitted the duly signed proposal forms dated: 27.05.2014 bearing Nos.D8691009 and D7936783 for “Reliance Guaranteed Money Back Plan” each by giving all relevant details and information in the prescribed form, for an assured sum of Rs.10,49,667/- and Rs.6,17,000/- under the base plan in the proposal form.  Based on the information provided in the Proposal form including the income declared by the DLA after receipt of initial premium amount, this OP has issued the policy bearing Nos.51641203 and 51649754 to the DLA on 12.05.2014.  At page 3 of the proposal Smt. Narayanamma had given declaration that, she had made complete, true and accurate disclosure of all the facts and in page-2 of the proposal form the DLA replied in negative to question Nos.31 and 33 and did not disclose about the disease of Breast cancer she was suffering since 2011.  The DLA also did not disclose the detail of the policy already having with HDFC Life Insurance Company. 

 

(e)    Furthermore the OP has submitted that, in the policy it also contains a section “Life style questions and personal metical history of the life to be assured” at Page-3 of the proposal form pertaining to the medical details wherein it is answered in the negative by DLA.  Thus in-spite of knowing well the terms and conditions of the policy the DLA has answered in the negative regarding her health.  The DLA had also agreed under the agreement therein that, if any untrue statement be contained in the proposal form, the policy contract shall be null and void and the moneys which have paid thereof shall forfeited to OP.  This OP has received death claim intimation dated: 07.11.2014 from the complainant stating that deceased passed away on 19.08.2014.  After receipt of the death claim an investigation was conducted from the investigation agency for evaluation of claim.  While going through all the documents procured by the investigation agency, this OP came to know that, DLA had suppressed that, she is suffering from Breast Cancer since 2011 and was admitted at Kidwai Medical Institute of Oncology on 15.03.2011 i.e., prior to signing of the proposal form and she died due to the same.  From the medical treatment record it is very much clear that, the DLA was suffering from above mentioned disease at the time of signing of the proposal form.  Based on the information regarding illness of the DLA the OP repudiated the claim of the complainant on the ground of suppression of facts at the time of making the proposal and the same was intimated to the complainant vide letter dated: 13.01.2015.  As per section 45 of Insurance Act, 1938 suppression of material facts is liable to be rescinded.  As per the Indian Contract Act, 1872 consent to an agreement is caused by fraud or misrepresentation, the agreement is a contract voidable at the option of the party whose consent was so caused.  As per Section 17 & 18 of the Indian Contract Act, 1872, the definition for “Fraud” and “Misrepresentation” are detailed at page 11 & 12 of the version. 

 

(f)     The OP further submitted below mentioned citations:-

(i) (1996) 6 SCC 428

(ii) (2000) 2 SCC 734

(iii) RP 2130 of 2007 dated: 31.07.2012 passed by the District Consumer Fora,

(iv) RP 3794-3796 OF 2007, dated: 17.04.2012,

(v) III (2006) CPJ 32.

(vi) I (2008) CPJ 144

 

(g)    So contending, the OP has prayed for dismissal of the complaint with exemplary  costs.

                                

04.   On 29.11.2016 counsel for complainant has filed affidavit evidence by way of examination-in-chief.  On 30.12.2016 counsel for OP submitted interrogatories and on 01.02.2017 counsel appearing for complainant has filed reply to the interrogatories.  On 14.03.2017 counsel appearing for the OP has filed affidavit evidence on behalf of OP. 

 

05.   On 14.03.2017 counsel appearing for OP filed written arguments and on 04.04.2017 counsel appearing for complainant has filed complainant’s written arguments.  After hearing oral arguments on both sides case is posted for orders. 

 

06.   Therefore the points that do arise for our consideration in this case are:-

 (A) Whether the complainant has proved  

     deficiency in service on the part of the 

      OP?

 (B) Whether the complainant is entitled for the reliefs sought for in the complaint?

(C)   What order?

 

07.   Findings of this District Forum on the above stated points are:-

POINT (A) & (B):- In the Negative

POINT (C):-  As per the final order

for the following:-

 

 

 

REASONS

POINTS (A) & (B):-

09.   It is an admitted fact that, the complainant’s mother Smt. Narayanamma during her lifetime had obtained 02 insurance policies bearing Nos. 51641203 dated: 22.07.2014 for an assured sum of Rs.10,49,667/- and policy bearing No.51649754 dated: 16.07.2014 for an assured sum of Rs.6,17,000/- from the OP.  The complainant’s mother Smt. Narayanamma W/o. Changalarayappa paid Rs.46,390.50 and Rs.36,223.76 towards above said policies for half yearly premium. 

 

10.   The complainant submitted that, on 19.08.2014 Smt. Narayanamma complained about chest pain, immediately she was taken to Dr.K.Kadirappa, Civil Surgeon at Srinivasa Nursing Home, Palamner, Chittor District, Andhra Pradesh.  The doctor diagnosed Myocardial Infraction and referred to go any higher hospital.  Hence complainant taken deceased Narayanamma in 108 Ambulance to R.L. Jalappa Hospital, Kolar, On the way to R.L. Jalappa Hospital, near Mulbagal Smt. Narayanamma lost her breath and doctor of Manohara Sai Gowda Memorial Hospital, Mulbagal, declared cause of death may be massive heart attack.  After the death of complainant’s mother, complainant submitted claim application to OP.  But the OP has repudiated the claim on 04.07.2015.

 

11.   Further submission of the complainant is that, one Smt. Narayanamma, W/o. Narayanappa, who is also residing in the same village i.e., Upparahalli, Mustur Post, has visited the Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011.  The OP by referring to the above documents has refused to settle the claim of the complainant. 

 

12.   Per contra, the OP submits that, the DLA was suffering from Breast Cancer since 2011 and she was taken treatment at Kidwai Medical Institute of Oncology prior to issuance of the said policies and she died due to the same.  OP further submitted that, on the basis of non-disclosure of pre-existing disease the OP had repudiated the death claims of the complainant. 

 

13.   In the instant case the main allegation of the complainant is that, the OP had repudiated the claims of the complainant by falsely referring the case of another person Smt. Narayanamma, W/o Sri.Narayanappa who is also residing in the same village and was suffering from “Breast Cancer”.    

 

14.   Admittedly the DLA (deceased life assured) had obtained insurance policy on 22.07.2014 and 16.07.2014.  On perusal of the Case Summary Sheet issued by the Kidwai Institute of Oncology, Bangalore, dated: 15.03.2011 it is mentioned as,

“Patient name Smt. Narayanamma and Sri.Changalarayappa is the husband and Sri.Srinivas is the attender’s name and relation column it is clearly mentioned as Son.” 

 

The contention raised by the complainant that, another person who is residing in the same village was suffering from Breast Cancer and by referring the said case the OP has wrongly come to the conclusion that complainant’s mother is suffering from Breast Cancer is unbelievable.  Further the burden of proof will always lies on the complainant to prove his case by producing cogent evidence.  But here the complainant has failed to produce any cogent evidence.  Hence we come to the conclusion that, the DLA is suffering from cancer before taking policy and the same was suppressed at the time of submitting of proposal forms.  Further at the time of submission of proposal forms the deceased life assured has answered the question Nos.31 and 33 as “No”.  The deceased life assured is well aware of the diseases and she undergone operation and answered the above questions in the negative which amounts to suppression of material facts and it violates the terms and conditions of the policy.

 

15.   In view of the above facts and circumstances, it is clear that, Smt. Narayanamma, W/o. Changalarayappa, was suffering from Breast Cancer before taking the above said policies in question.  And by suppressing the illness of “breast cancer” she had since from 2011 falsely obtained the policies.  Hence we came to the conclusion that, there is no deficiency in service on the part of the OP. Accordingly we answered to the issue Nos. (A) & (B) in the negative. 

 

POINT (C):

16.   We proceed to pass the following:-

ORDER

01.   The complaint filed by the complainant is hereby dismissed.  No orders as to costs.

 

02.   Send a copy of this order to both parties free of cost

 

(Dictated to the Stenographer in the Open Forum, transcribed by him, corrected and then pronounced by us on this 15^th DAY OF MAY 2017)

 

                                                      

 

LADY MEMBER                                    PRESIDENT