This C.C. is coming on before us for hearing; in the presence of Sri. Chinnala Shreenivasa Rao and Sri. Kurapati Sekhar Raju, Advocates for complainant; and of Sri. Karnekanti Sridhar, Advocate for Opposite parties No.1 & 2; upon perusing the material papers on record; upon hearing and having stood over for consideration, this Forum passed the following:-

O  R  D  E  R

(Per Smt. V. Vijaya Rekha, Member)

This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. 

2.      The brief facts as mentioned in the complaint are that the wife of complainant had obtained Reliance Life Insurance Policy during her life time from the opposite parties vide policy No.19566702, dt. 10-12-2011 for a term of 16 years.  As per said policy, the opposite parties will be liable to pay an insurance amount of Rs.1,12,500/- along with vested bonus in the event of death prior to completion of maturity period.  After receipt of relevant documents and requisite premium amount of Rs.9,972=73 paisa, the opposite parties issued policy under Reliance Cash Flow Plan.  The second premium was also paid on 18-01-2013.  Unfortunately, on 08-11-2013 the wife of complainant / life assured was died due to failure of both kidneys, being the nominee, intimated the death and submitted claim form along with necessary documents, in turn, the opposite parties addressed a letter dt. 18-08-2014  by stating that the life assured was suffering from diabetes mellitus since 10 years and such all the premiums will be forfeited.  The complainant further submitted that the opposite parties issued policy after conducting thorough medical examinations and after verification of documents, submitted by the complainant.  Further he also alleged that the opposite parties raised the objections in order to avoid payment of assured amounts, having no other go, filed the present complaint by praying to direct the opposite parties to pay policy amount of Rs.1,12,500/- together with vested bonus and additional benefits and also prayed to direct to pay Rs.25,000/- towards damages and costs.

3.      In support of his case, the complainant filed affidavit and exhibits                 A-1 to A-6.

4.      After receipt of notice, the opposite parties filed counter by admitting the issuance of policy bearing No.19566702 in the name of wife of complainant after submission of proposal form along with required documents and also admitted that they received death intimation from the complainant / nominee. As the death was occurred prior to maturity of policy, conducted an investigation under the provisions of clause 8(3) of IRDA Regulations – 2002.  The investigation report reveals that the life assured suppressed material facts relating to past medical history that she was suffering from diabetes mellitus since 10 years and having hyper tension for the last 5 years prior to signing of proposal form.  She answered the question numbers 28 and 30 in negative in the proposal form regarding to her past medical history, if she had given correct answers relating to her health, the opposite parties would not have been issued the said policy to the life assured.  The life assured obtained the policy by withholding the material information with malafide intention.  Therefore, repudiated the claim on the ground of non-disclosure of material information with respect of past medical history of life assured.  The repudiation was duly conveyed vide letter dt. 18-08-2014.  Therefore, prayed to dismiss the complaint with costs as there was no deficiency of service on their part.

          In support of their case the opposite parties filed exhibits B-1 to B-10.  The Chief Manager of opposite parties filed Chief Affidavit by reiterating the same averments as mentioned in the counter.

6.      The complainant filed written arguments with the same averments as mentioned in the complaint and referred the judgments of Hon’ble Apex Court in Biman Krishna Bose V/s. United India Insurance Company and others, III (2001) CPJ 10 (SC), Smt. Parmjeet Kaur V/s. LIC of India and others in Appeal No.1299/2008 and LIC of India V/s. Anuradha (2004) 10 (SCC) 131.  The opposite parties filed a memo by mentioning that to treat the averments of their written version as written arguments.  The opposite parties also referred the judgments of Hon’ble Apex Court in Ravneet Singh Bagga V/s. KLM Royal Dutch Airlines (2001) I (SCC) 66, Satwant Kaur Sandhu V/s. New India Assurance Company Limited and also referred the judgment of National Commission in LIC of India V/s. Kusum Patro.    

7.      In view of above circumstances, now the point that arose for consideration is,

Whether the complainant is entitled to the relief as prayed for?

Point:-       

According to the aforesaid averments and the material on record, it is an admitted fact that the wife of complainant had obtained Reliance Cash Flow Life Insurance policy bearing No. 19566702 from the opposite party No.1 through opposite party No.2 on 10-12-2011 and also an admitted fact that the policy was in existence at the time of death of policy holder.  The only dispute is with regard to the concealment of material facts relating to her health at the time of signing of proposal form.  It is the case of the complainant that the opposite parties issued policy after conducting thorough medical investigations prior to issuance of policy.  Though, repudiated the claim only to avoid their liability in payment of assured amounts under policy.  On the other hand the opposite parties contended that the policy was taken by withholding the material facts regarding the past medical history of policy holder.  In support of their contentions both the parties filed exhibits A-1 to A-6 and B-1 to B-10.  As per said policy, the term of policy is 16 years and the maturity date of policy is 10-10-2027, for which, the policy holder has to pay yearly premiums during the life time till maturity.  The liability of insurer will be take place in the event of death of the life assured prior to completion of maturity period.  In the instance case, the policy holder was died on 08-01-2013 due to failure of both kidneys.  On a perusal of record, it was noticed that during her life time, the policy holder had paid 2 yearly premiums, while paying the second premium, the policy was revived on 18-01-2013, thereafter, she was died after revival of 9 months of policy, evidenced under exhibit A-3.  It is the contention of the opposite parties that the life assured was died before maturity of policy, therefore, conducted and as such an investigation was conducted, which reveals that the life assured suppressed material information regarding to her health at the time of proposal, Basing on the discharge record, issued by NIMS Hospital, Hyderabad, marked under exhibit B-7, the opposite parties denied their liability by sending repudiation letter.  As per discharge record consisting of 24 pages, marked on behalf of opposite parties, written by a doctor, speaks that the life assured was suffering from diabetes mellitus type–II for 10 years and hyper tension for last 5 years. Having observed the thumb impression of the policy holder on the proposal form, it is clear that the policy holder was an illiterate woman.  Except filing of discharge summary the opposite parties failed to place any corroborative evidence to prove that the life assured was suffering from any previous ailment either before joining or revival of policy.  Without placing any cogent reason or reliable documentary / medical evidence the repudiation is very serious matter basing on only oral statements of an illiterate lady.  Without filing any supporting evidence or affidavit of doctor, concerned, who recorded the statements of the deceased are not sufficient to come to the conclusion that the deceased suffering from DM-Type-II since 10 years and HTN for last 5 years.  In this regard we relied upon the judgment of National Commission in LIC and another V/s. Chawali Devi  I (2016) CPJ 456 (NC).

As per recent studies, Hyper Tension and Diabetes Mellitus-type-2 are the life style disorders but not the diseases, the same was expressed by the Hon’ble National Commission in Satish Chander Madan V/s. Bajaj Allianz General Life Insurance Company Ltd., I (2016) CPJ 613 (NC) wherein, the Hon’ble National Commission opined that the “Hyper Tension is a common ailment and it can be controlled by medication…. repudiation is not justified”.  With regard to the other objection for rejection of claim relating to Diabetes Mellitus is concerned, we have relied upon another judgment of the Hon’ble National Commission in ICICI Prudential Life Insurance company ltd., V/s.  Veena Sharma and another IV (2014) CPJ 580 (NC), wherein, the Hon’ble National Commission clearly stated that the onus to prove the contention of suppression was on the insurance company that the policy holder was suffering from pre-existing disease and had knowingly failed to disclose the same.  Further it is also opined that mere production of discharge card is not enough without filing credible evidence and dismissed the Revision Petition filed by the insurer by alleging the suppression of health information regarding the Diabetes Mellitus.  In the present case on hand, the claim form-B marked on behalf of opposite parties, speaks that the life assured suffered from renal problem prior to 6 months of death.  In the absence of any corroborative / credible evidence regarding the past medical history of the deceased / policy holder we cannot come to the conclusion that the policy holder was deliberately suppressed the material information regarding to her past medical history for obtaining policy.  Therefore, the objections raised by the opposite parties for repudiation of claim cannot be acceptable.  

In the light of above judgments and in view of above discussion the contentions of opposite parties would not be justifiable.  Therefore, the point is answered accordingly in favour of the complainant.         

8.      In the result, the complaint is allowed in part, directing the opposite parties to pay Rs.1,12,500/- (Rupees One Lakh Twelve Thousand Five Hundred only) to the complainant under Reliance Cash Flow policy bearing No. 19566702 along with vested bonus and the additional benefits if any together with interest @9% Per annum from the date of repudiation i.e. dt.18-08-2014 till realization.  Further directed to pay Rs.1,000/- towards costs.   

           Typed to dictation, corrected and pronounced by us in the open Forum, on this the  10^th day of January, 2017.

                                                FAC President              Member      

                                           District Consumer Forum, Khammam

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant                                                    For Opposite party  

       None                                                                          None

DOCUMENTS MARKED:-

For Complainant                                                    For Opposite party

FAC President              Member

     District Consumer Forum, Khammam.