Complaint filed on: 17-01-2011
Disposed on: 05-05-2011
BEFORE THE BANGALORE IV ADDITIONAL DISTRICT
CONSUMER DISPUTES REDRESSAL FORUM,
BANGALORE URBAN DISTRICT, NO.8, SAHAKARA BHAVAN, CUNNINGHAM ROAD, BANGALORE – 560 052
C.C.No.105/2011
DATED THIS THE 5th MAY 2011
PRESENT
SRI.D.KRISHNAPPA., PRESIDENT
SMT.ANITA SHIVAKUMAR.K., MEMBER
Complainant: -
Smt.Kannagi Ravi
W/o. late M.K.Ravi,
Aged about 40 years,
Residing at no.273 P, 1st ‘B’ Cross,
HMT layout, Mathikere,
Bangalore-54
V/s
Opposite parties: -
1. SBI Life Insurance Co, Ltd,
Central Processing Centre,
Kapas Bhavan, Plot no.3A,
Sector, No.10, CBD Belapur,
Navi Mumbai-14
Reptd by its Managing Director,
2. Head – Claims,
SBI Life Insurance Co. Ltd,
Central Processing Centre,
Kapas Bhavan, Plot no.3A,
Sector No.10, CBD Belapur,
Navi Mumbai – 14
3. The Federal Bank Ltd,
No.20, 18th Main Road, 108-B,
Bus Station, Ganganagar,
RT Nagar, Bangalore – 32
Reptd by its branch manager
O R D E R
SRI. D.KRISHNAPPA., PRESIDENT.,
Brief facts of the complaint filed by the complainant against the OPs are, that she is the widow of late M.K.Ravi, who died on 28-8-2009. She had purchased a flat No.501, 5th floor with undivided share of the plot over which flats were built. That she purchased the flats under registered sale deed dated 12-12-2007 for a total consideration of Rs.18,00,000=00 and she alongwith her husband had availed a loan of Rs.15,74,546=00 which was inclusive of insurance premium from OP No.3 the Federal Bank. The loan was repayable in 180 installments at Rs.17,406=00 per each EMI. That her husband had paid Rs.74,546=00 towards insurance premium by becoming a member of Home Loan Group Insurance Scheme floated by the first OP, on 12-12-2007. Thus her husband was covered under the Group Insurance Scheme called Super Suraksha Policy for Rs.15,00,000=00. Thus the risk covers under the policy in question was to the tune of Rs.14,32,305=00 equalent to the outstanding loan amount. Thus, the policy coverage is in respect of the loan payable by the deceased and not on account of his death. Thus the death of her husband, the housing loan obtained from OP no.3 stands discharged with the policy amount payable by Ops no.1 and 2. That her husband died due to suspected organ phosphrous Ingestion on 28-4-2009 at Christian Medical College, Vellore who was admitted there on 24-4-2009 with history of Poisson, when the claim was made to Ops no.1 and 2, they repudiated the claim vide repudiation letter 30-10-2009, on the ground that the deceased had filed proposal form furnishing false good health declaration. The complainant therefore attributing deficiency to Ops 1 and 2 in not honouring her claim for discharging outstanding housing loan of Rs.15,00,000/- has prayed for a direction to Ops no.1 and 2 to pay Rs.15,00,000=00 with interest at 24% per annum and to award compensation of Rs.3,00,000=00 towards suffering.
2. OPs have appeared through their advocate and filed version. Ops No.1 and 2 in their common version admitting that the husband of the complainant was a member of Group Insurance Scheme introduced for the benefits of the borrowers of the housing loan from OP No.3 to had issued a policy have contended that Ombudsman of Hyderabad a quasi judicial body has also heard the grievance of the complainant and passed an award agreeing with the ground of repudiation of claim and therefore stated that the complaint is hit by section 11 CPC under the principle of resjudicata and the complaint is not maintainable. These Ops have further contended that contract of insurance is one entered into with utmost good faith and the proponent is duty bound to disclose everything concerning his health, habits and other related matters. That the husband of the complainant while filling up the proposal form for availing Housing Loan Group Insurance Scheme filled up the proposal form declaring that he was and had not suffered with any illness, and obtained the policy by suppression the true facts that he was suffering from diabetic mellitus and psychiatric illness at the time, when he made good health declaration. That the deceased had knowledge of his suffering from diabetic mellitus and psychiatric illness, but despite that given false information and they by referring to case sheets of the deceased maintained in Colombia Asia Hospital, Hebbal for his treatment from 2-2-2007 to 6-2-2007 have also referred to a certificate given by Dr.S.N.Patil of Sumathi Nursing Home and certificate of Dr.Sudha Jasmine of Christine Medical College, Vellore and have contended that the deceased died because of psychiatric illness, he was suffering resulting in suicide and justifying repudiation of the claim of the complainant have prayed for dismissal of the complaint.
3. The third OP has filed version by contending that, he has been impleaded in this complaint as a formal party and he by referring to the Group Insurance Policy issued by the first OP in favour of the deceased denied his personal knowledge about the contents of para-4 of the complaint and stated that repudiation of the claim of the complainant by Ops No.1 and 2 is unjust and stated that as on 11-3-2011 deceased Ravi is liable to pay Rs.15,08,874=00 and has prayed for dismissal of the complaint against him.
4. In the course of enquiry into the complaint, the complainant and the OPs have filed their affidavit evidence reproducing what they have stated in their respective complaint and version. The complainant alongwith the complaint has produced a copy of sale deed of the flats purchased by them, copy of loan sanction order, copy of certificate of insurance, copy of bankers certificate, copy of death certificate and copies of certain correspondences, she made with the Ops. OPs No.1 and 2 have produced a copy of Super Suraksha Group Master Policy, copy of terms and conditions of the policy, a copy of proposal form submitted by deceased, copy of investigation report of pyramid associates, copies of medical check up of the deceased with M.V.Diabetes Clinic Centre Bangalore and copies of Columbia Asia Hospital records with copies of some correspondences. Counsel for the complainant has filed written arguments. We have heard the counsel for the OPs and perused the records.
5. On the above contentions following points for determination arise.
1) Whether the complainant proves that OPs No.1 and 2 have caused deficiency in their service by repudiating her claim for dischargel of housing loan from out of Group Insurance Scheme amount on account of the death of her husband M.K.Ravi?
2) To what reliefs, the complainant is entitled to?
6. Our findings are as under:
Point no.1: In the Negative
Point no.2: See the final Order
REASONS
7. Answer on Point No.1: As stated by the complainant herself, her late husband availed housing loan of Rs.15,74,546=00 which is said to be inclusive of insurance premium amount of Rs.74,546=00 from OP No.3 which had Group Insurance benefit Scheme in which her husband was a member paid one time insurance premium which conferred benefits on the borrowers, that in the event of death of the insured, the housing loan borrower in the middle the sum assured which is equivalent to the outstanding loan amount including interest, as per the original EMI schedule will be paid by the insurer to the advancing bank discharging liability of the borrowers. These facts are not disputed by the Ops. The complainant has further stated that her husband M.K.Ravi died of suspected organ phosphorous ingestion on 28-4-2009 in Christian Medical College, Vellore, which is also not dispute. Ops no.1 and 2 who are contesting, Ops have stated that the deceased as on the date of death was due of Rs.14,37,305=00 to the 3rd OP which advanced loan. But the complainant has claimed that Ops no.1 and 2 are liable to pay Rs.15,00,000=00 together with interest and claimed for awarding that amount besides awarding compensation. If the complaint is allowed, the amount outstanding towards the housing loan with OP no.3 has to be discharged by OP no.1 and 2 as per the terms and conditions of the policy. But the Ops no.1 and 2 have repudiated the claim of the complainant to pay the insurance amount, on the ground the deceased had given a false good health declaration at the time of submission of enrollment under SBI Home Loan Insurance Scheme and the Ops have in this regard referred to the condition of the policy and medical records pertaining to the deceased issued by M.V.Diabetes Clinic, Vyalikaval, Bangalore and Columbia Asia Hospital, Hebbal, Bangalore and Health declaration made by deceased in the proposed policy.
8. As per the discharge certificate issued by the Christian Medical College, Vellore the husband of the complainant stated to have died due to Organophosphorous Ingestion, it is further stated in that certificate that Mr.Ravi, husband of the complainant who was admitted to that hospital with a alleged history of Organophosphorous poisoning had respiratory failure type-II was admitted to ICU as his health deteriorated died on 28-4-2009. Thus it is not in dispute that the husband of the complainant died due to Organophosphorous poisoning. None of the parties to this complaint have produced any documents or made submission regarding the cause for this Organophosphorous Ingestion. But the material placed before this forum i.e. the records of Columbia Asia Hospital and Christian Medical College, Vellore disclose that the husband of the complainant died a suicidal death.
9. The counsel for the Ops no.1 and 2 invited our attention to the medical records of the deceased maintained in M.V.Diabetes Clinic, Bangalore and submitted that the deceased was suffering from diabetic mellitus even during Sept.2007, he had poor Glycemic Control over past 2 – 3 months and was poorly managed. Ops no.1 and 2 have also invited our attention to medical records of Columbia Asia Hospital, Hebbal, Bangalore, wherein it disclose that the deceased was admitted to that hospital on 2-2-2007 and was in patient till 6-2-2007 and he was discharged on that day. The deceased at the time of admission to that hospital stated to had given history which is reproduced here as under:
“44 years old married Indian is admitted with delusions, paranoia, agitation and depression family reports that problems have been on and off, but patient has never been diagnosed or treated in the past patient had recently been injured in Kanykumari and is also complaining of headaches”.
10. Further in the said discharge summary, primary diagnosis is shown as “Bipolar Disorder type-I most recent episode depressed”.
11. Case sheets of the deceased maintained in Columbia Asia Hospital on 3-2-2007, further discloses that attention and concentration of the patient were poor, insight and judgement were also poor and it is further recorded that suicide precautions were explained to the family of the deceased and the family indicated of having understood the advice by the doctor and attendants of the deceased agreed to implement the advice given by the doctor. This noting of the hospital un-erroringly shown that the deceased was poor in concentration was also poor in insight, judgement and suicide precautions were given to family member. The complainant has not denied the correctness of the entries made by attending doctor in Colombia Asia Hospital and also not denied in her husband having had undergone treatment as inpatient between 2-2-2007 to 6-2-2007. As per the copy of the proposal form produced by the Ops, the husband of the complainant when filled up medical questionnaire regarding good health declaration as against the column, whether he had been ever treated or told that he has diabetes or raised blood sugar, high blood pressure, heart attack, chest pain, he has answered in the negative. Further as against column, whether the deceased had any diseases like psychiatric disorder, mental or nervous disorder, he has answered in the negative and thereby stated as if he was not having any such disease or problem as on 12-12-2007 on which date he filled proposal form for becoming member of Group Insurance under the Housing Loan Scheme. The deceased has further declared that he was in sound health did not have any physical defects or deformity he had not been hospitalized for any critical illness for the last three years. Under the definition of critical illness as defined in the proposal form mental illness is also included. The husband of the complainant, who had taken treatment for diabetes mellitus, bipolar disorder type-I with episode of depression and had psychological and nervous problems give a good health declaration on 12-12-2007 by suppressing the fact of his ailment and treatment he underwent. Thus considering the fact that the deceased has died due to poisoning substance found in his body. Hence, in the absence of any material or contention that he was poisoned by external force the only legal inference that could be drawn in the case is that the deceased committed suicide, because of his mental disorderliness. The deceased manifestly found to had obtained Group Insurance under Super Suraksha Plan by suppressing fact of his bad health. Therefore the doctrine of utmost good faith is breached and that the complainant in our view is not entitled for the benefits of the insurance policy. Section 11 C.P.C. is not applicable here as the ombudsman is not a court.
12. The learned counsel appearing for the complainant further argued that the insurance is taken on the loan amount and not on the basis of health or good health of the insured. But we find difficult to accepted that argument, because benefit of insurance under Super Suraksha Scheme is extended to borrower on his becoming a member of that scheme who was possessing good health and within prescribed age limit and on such declaration of good health by him. Otherwise, any borrower even with serious ailment knowing that he may not live long can suppress the same and he can avail huge loan from the bank, become a member of Super Suraksha Scheme and if dies within the short span of time, then the insurance company cannot be burdened with that heavy liability of repay the huge loan. As stated above contract of insurance is entered into in good faith wherein both parties are excepted to be honest in disclosing. That is why the insurer at the stage of issuing policy do not subject the proponent to strict medical check up but accept good health declaration given by the proponent. Considering all the aspects of the matter, we are of the view that the husband of the complainant by suppressing his vital disease became member of Super Suraksha Scheme and that resulted in breach of good faith. Hence the Ops have rightly repudiated the claim, which in our view do not amounts to deficiency in their service. With the result, the complaint is liable to be dismissed and pass the following order:
ORDER
Complaint is dismissed. Parties to bear their own costs.
Dictated to the Stenographer, Got it transcribed and corrected, Pronounced on the Open Forum on this 5th May 2011.
Member President
