This C.C. is coming on before us for final hearing in the presence of Sri. K.Koteswara Rao, Advocate for complainant and of Sri.G.Sita Rama Rao, Advocate of Opposite parties; upon perusing the material papers on record; upon hearing the arguments and having stood over for consideration this forum passed the following:
ORDER
(Per Sri R. Kiran Kumar, Member)
This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the husband of complainant had obtained insurance policy No.12263059, dt.21-7-2008 for Rs.5,00,000/-, from opposite party No.2 through opposite party No.1, by mentioning the name of his wife/complainant as nominee, the annual premium is for Rs.50,000/-, term of policy is 15 years. The complainant further submitted that on 10-6-2009 her husband had suffered with fever with vomiting and motions due to sun stroke and died on the same day. Immediately the complainant informed the same to the opposite parties. On 8-8-2009 the complainant submitted the claim form and enclosing the relevant documents with a request to settle the claim. The complainant also submitted that in the month of October, 2009 when she personally approached the opposite party No.2 and requested to settle the death claim of her husband, on that she was informed the claim was settled and they obtained signatures on blank, printed and stamped papers and issued a cheque for Rs.37,514-04 and she was shocked and asked about the issuing of cheque for Rs.37,514-04ps. instead of Rs.5,00,000/-. The opposite parties in issuing a cheque for Rs.37,514-04 ps instead of Rs.5,00,000/-, there is sheer and gross negligence on the part of opposite parties and also there is deficiency of service. As such the complainant approached the forum for redressal.
In support of her complaint, the complainant herself filed affidavit and filed the following documents, the same have been marked as Exs.A.1 to A.11.
Ex.A1 :- Photocopy of Proposal Form (Annexure-II)
Ex.A2:- Receipt No.WC0001360253, dt.21-07-2008 issued by Opposite
party No.2.
Ex.A3:- Photocopy of Policy Schedule.
Ex.A4:- Photocopy of Letter dt.22-07-2008 addressed by
opposite party No.2.
Ex.A5:- Scheme of opposite parties under benefit illustration
for Reliance Automatic Investment Plan (Regular).
Ex.A6:- Photocopy of first Premium Receipt.
Ex.A7:- Photocopy of Death Certificate of Sk.Janimiya.
Ex.A8:- Photocopy of Claim Form-A & B.
Ex.A9:- Photocopy of letter dt.08-08-2009.
Ex.A10:- Photocopy of Household card.
Ex.A11:- Photocopy of A/C Payee cheque No.204409, dt.10.09.2009.
3. On receipt of the notice, the opposite parties appeared thorough their counsel and filed counter by denying the contents of the complaint and submitted para-wise reply. The opposite parties further submitted that the contract of Insurance in this complaint is void abinitio as the deceased/ policyholder had suppressed material facts regarding his health condition, as the deceased/ policyholder was hospitalized just three months before proposing for the said life insurance policy during the month of March 2008 and was diagnosed for Pancreatitis and also deceased/policyholder was advised by the Doctor to reduce alcohol consumption, but the same was not disclosed by the deceased at the time of filling-up the proposal-form and on this ground, they are entitled to rescind the contract as per Section- 45 of Insurance Contract Act, 1938 and also submitted that in the proposal form filled by the deceased/policyholder answered to Question No.29 & 32, he is in good health and that he did not receive any treatment for any disease, symptoms of illness. And the opposite parties further submitted that since one of the most important and basic principals of Insurance is ubbermai fides i.e. utmost good faith and in this case the deceased/ policyholder had suppressed material facts about his health condition. Hence the opposite parties taken plea that they rightly repudiated the claim of the complainant on the ground of non-disclosure of material facts as per Sec.45 of Insurance Act 1938. And the opposite parties admitted the payment made to the complainant to the extent that the complainant has been paid the fund value amount of Rs.37,514.04ps/-.
5. On behalf of the opposite parties, Dr.C.Bharavi, Gastro-entrologist examined as R.W.1 and marked Exs.B.1 to B.4.
Ex.B1:- Attested copy of Discharge Summary.
Ex.B2:- Attested copy of Proposal Form.
Ex.B3:- Attested copy of Letter dt.10.09.2009.
Ex.B4:- Attested copy of Payment Advice (Annexure IV).
6. To support her complaint, the complainant herself filed Chief Affidavit and also filed written arguments.
7. Upon perusing the material papers on record, now the points that arose for consideration are,
- Whether the assured had suppressed the material facts pertaining to his health in the proposal form, consequently the complainant is entitled for the claim amount covered under the Policy?
- To What relief?
Point No.1:-
In this the case, the husband of the complainant had obtained life insurance policy No.12263059, dt.21-7-2008 for Rs.5,00,000/- from opposite parties by mentioning the name of his wife/complainant as nominee, he died on 10-06-2009. As per the terms and conditions of the policy, the complainant submitted claim form along with all the relevant documents. But the opposite parties obtained the signatures of complainant on blank printed form and issued a cheque for Rs.37,514.04ps/- for which she was shocked and asked about the issuing of cheque instead of cheque for Rs.5,00,000/-, as such the complainant approached the forum for redressal.
It is an undisputed fact that the husband of the complainant died on 10-06-2009 while he had taken policy on 21-07-2008. On receipt of death information, the investigation was carried on by the opposite parties wherein it came to light that the husband of the complainant admitted in Janatha Super Specialty Hospital, Khammam on 22-03-2008 with a complaint of abdominal pain and discharged from the hospital on24-03-2008. The opposite parties filed Ex.B1, Discharge Summary issued by said hospital. The record shows that the deceased was taken treatment related to Pancriatitis. In the proposal for Insurance Ex.B2, signed by the deceased/policy holder on 21-07-2008, he had answered the questions particularly Q.No.29 & 32.
Q.No.29: Do you suffer from any medical ailments E.g.diabitis, Hi-B.P., Cancer, Respiratory disease (including Asthama) Kidney or Liver disease, stroke, any blood disorder, heart problems, Hepatitis ‘B’ or ‘C’ , Tuberculosis, Psychiatric disorder, depression, HIV/Aids or a related infection?
Ans: No.
Q.No.32: Have you suffered from Drug or Alcohol addiction or been advised by a doctor to reduce your alcohol/tobacco consumption ?
Ans: No.
The complainant in her written arguments denied the contention of opposite parties and had taken a plea that “the policy of insurance was issued without any certification by the panel doctors while filling up of the proposal form, the deceased have mentioned the true facts in respect of his health condition and he was not disclosed about the disease of pancriatitis alleged to have suffered and therefore the repudiation of claim by the opposite parties is unjust, arbitrary and illegal”.
To support their contention the opposite parties examined Dr.C.Bharavi, Gastroentrologist, Janatha Super Specialty Hospital, Khammam as R.W.1.
The opposite parties filed written arguments with the following citations:
1) 2010 (2) An.W.R.wherin the Hon’ble Gowhathi High Court, between the Sakitombi Devi and Zonal Manager, L.I.C. of India, wherein their lordships held that
Insurance Act, 1938, Section 45 – Repudiation of claim by the Life Insurance Corporation of India – Writ Petition filed by widow of assured – Husband of petitioner obtained policy on 15-03-1994 for a sum of Rs.1,00,000- - policy lapsed and revived on 4-12-1995 – Policy holder died on17-12-1995 when the widow of policy holder claimed the amount, Insurance company repudiated the claim on the ground that assured at the time of filling the proposal form and subsequently at the time of revival suppressed fact that he was suffering from peptic ulcer syndrome for which he was taking treatment for one to two years prior to his death – Held : Doctor who treated the husband of petitioner during his life time had stated that the assured was under his medical supervision for one to two years prior to his death for suffering from peptic ulcer syndrome – Assured suppressed material facts – LIC justified in repudiating the claim – What petition devoid of merit and therefore dismissed.
2) IV (2008) CPJ 196 (NC) the Hon’ble National Commission, between the Kulwanth Singh and United India Insurance Company Limited, wherein their lordships held that
Consumer Protection Act, 1986 – Section 21 (b) – Insurance – Non-disclosure of pre-existing disease – Claim repudiated by insurer – Complaint allowed by Forum with direction to pay amount under policy - Order set aside in appeal – Hence revision – History in discharge summary wrongly recorded not proved – Plea of non-disclosure of pre-existing disease at time of purchase of policy, not specifically dealt with by Commission – Petitioner can not take advantage of failure to deal with above plea in revision – Order of state commission upheld.
3) II (2009) CPJ 55 wherein Hon’ble A.P. State Commission between Chalamani Narasa Reddy and New India Assurance Co. Ltd., wherein their lordships held that
C.P. Act 1986 – Sec. 15 – Insurance – Suppression of material facts – Insured had chest pain before taking of policy – ECG taken 7 days prior to submission of proposal form suppressed, wherein inducible myocardial ischemia mentioned – Insured having diabetes and angina, could not have taken specific insurance policy for hospitalization charges for said ailments suppression of material facts proved – Repudiation of claim justified.
From the above, there is no reason to doubt the medical record furnished by the opposite parties. The complainant did not adduce any evidence to prove her case. In fact, when the assured had taken treatment from Janatha Super Specialty Hospital, Khammam and was advised by the Doctor to reduce alcohol consumption, but the same was not disclosed at the time of taking policy. The fact remains that insured had suppressed material facts regarding his health and also he was hospitalized just three months before the date of proposal for insurance, which is evident from Ex.B1. Since the suppression of material, the payment of fund value of Rs.37,514.04ps/- was justified and the point is answered accordingly.
Point No.2:-
In the result, the complaint is dismissed. No order as to cots.
Dictated to steno, transcribed by her, corrected and pronounced by us in the open forum, on this 5th day of January 2012.
President Member
District Consumer Forum,
Khammam
APPENDIX OF EVIDENCE
Witnesses examined for complainant:- None
Witnesses examined for opposite parties:- None
Exhibits marked for Complainant:-
Ex.A1:- Office copy of legal notice dated15-03-2010.
Ex.A2:- Postal Acknowledgement Card.
Ex.A3:- Death Certificate.
Ex.A4:- Colour photo.
Ex.A5:- Original Gas connection certificate issued by opposite party.
Ex.A6:- Domestic Gas Customer Card issued by opposite party.
Ex.A7:- Identity Cards (Nos.2) of the Complainant and hisMother.
Exhibits marked for opposite parties:-
Ex.B1:- Office copy of the Reply Notice, dt.13-04-2011.
Ex.B2:- Receipt issued by Professional Couriers, dt.13-04-2011
President Member
District Consumer Forum,
Khammam
