BEFORE THE DISTRICT CONSUMER FORUM AT NALGONDA
PRESENT: SRI D.SINGARA CHARY, B.A., LL.B.,
PRESIDENT.
SMT.CH.A.LATHA KUMARI, M.A.,M.Sc.,LL.M.,
FEMALE MEMBER.
. . .
THURSDAY, THE THIRTIETH DAY OF JANUARY, 2014
CONSUMER COMPLAINT No. 71 OF 2013
Date of filing: 29-10-2013
Date of Disposal: 30-01-2014
Between:
- Govinda Venkata Ramana W/o Late Venkata Narsu,
Age: 37 years, Occ: Household,
- Govinda Srinivas S/o Late Venkata Narsu, Age: 19 years,
Occ: Agriculture,
Both are R/o Kalvapalli Village of Miryalguda Mandal,
Nalgonda District.
…COMPLAINANTS.
AND
S.B.I. Life Insurance Co.Ltd., Branch Office, Near: Gandhi
Statue, Sagar Road, Miryalguda Town, Nalgonda District,
Represented by its Manager.
…OPPOSITE PARTY.
This complaint coming on before us for final hearing on this day, in the presence of Sri Ch.Nagaraju, Advocate for the Complainants, and Sri G.Jawaharlal, Advocate for the Opposite Party, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:
ORDER OF THE FORUM DELIVERED
BY SRI D.SINGARA CHARY, PRESIDENT
1. The Complainants No.1 and 2 have filed this complaint U/S 12 of the Consumer Protection Act, 1986 to direct the Opposite Party to pay a sum of Rs.7,40,000/- with interest and costs.
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2. The facts of the case as disclosed from the complaint are as follows:
The Complainant No.1 is the wife and the Complainant No.2 is the son of late Govinda Venkata Narsu. The said Venkata Narsu obtained two insurance policies from the Opposite Party vide Policy No.3501852203 for Rs.1,50,000/- under Ex.B-3 and Policy bearing No.14042381204 for Rs.2,00,000/- under Ex.B-4. The deceased nominated the Complainant No.2 as his nominee therein. As per the terms and conditions of the policies, if the life assured dies during the period of existence of policy, the Opposite Party will pay the sum assured and bonus. During the existence of the policy, on 07-12-2012 the deceased died of heart attack in his house at Kalvapally. After his death, the Complainant No.2 applied for benefits of the policies, but the Opposite Party denied the payment on one ground or the other. The Complainants made so many trips around the Opposite Party and ultimately, the Opposite Party repudiated the claims under Exs.A-1 and A-2 dated 28-01-2013 on the ground that the deceased had suppressed his health problems while taking the policies. The deceased was hale and healthy and he never suffered any diseases and had collapsed on account of the heart attack. Hence the complaint.
3. The Opposite Party filed a lengthy written version and the sum and substance thereof is as follows:
There is no deficiency of service on the part of the Opposite Party. After the death of the deceased, the Opposite Party appointed
an investigator and as per the investigation report Ex.B-5, the
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deceased was suffering from tuberculosis of grade-III, but he suppressed the same in the proposal forms Exs.B-1 and B-2. Had the deceased disclosed that he was suffering from tuberculosis, the Opposite Party would have estimated the risk and taken suitable decision before issuing the policies. Both the policies are non medical and they were issued just on the health declarations signed by the deceased in the proposal forms. The repudiation is justified since there was suppression of material fact. The Opposite Party ultimately prayed for the dismissal of the complaint.
4. The parties filed their respective proof affidavits. The Complainants marked Exs.A-1 to A-4 and the Opposite Party marked Exs.B-1 to B-7.
5. The point for consideration is:
Whether the repudiation made by the Opposite Parties
is justified?
6. POINT:
The Opposite Party did not deny the issuance of the policies Exs.B-3 for a sum of Rs.1,50,000/- and Ex.B-4 for a sum of Rs.2,00,000/-. It is however pleaded that the deceased had suppressed the factum of his having undergone treatment for tuberculosis in the proposal forms Exs.B-1 and B-2. The deceased, vide question No.25, answered all the sub-questions in such a way that he had never suffered any diseases nor undergone any tests.
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7. When the Opposite Party admitted the issuance of the policies Exs.B-3 and B-4 and when he repudiated the policies on the ground of suppression of ill health, it is for him to establish the grounds justifying the repudiation. It is to be seen as to whether the Opposite Party had discharged his obligation to prove that the deceased had suppressed his ailments.
8. The Opposite Party relies on Exs.B-5 and B-6 the Investigation Report and the Lab Report respectively. Ex.B-6 consists of two pages. The first page is Laboratory Form, where under the deceased was advised to undergo some tests. In the second page, the result of the test is mentioned by the lab, wherein it was stated that the disease was assessed for 3rd grade positive. According to the Opposite Party, this is the indication that the deceased was suffering from third grade tuberculosis. Basing on Ex.B-6, the investigator submitted Ex.B-5 his report. The investigator did not collect any certificates from the doctors who are said to have treated the deceased even though he mention the names of the doctors under whom the deceased was said to have undergone the treatment. Page No.3 of Ex.B-5 investigation report shows that the deceased underwent treatment in Government Hospital (place of the hospital is not mentioned) under Dr.Narsimha Rao, in Vaishnavi Hospital, Kalvapally under Dr.Prasad, in Madhu Hospital, Kalvapally under Dr.Madhusudhan Reddy and in Venkateshwara Hospital under Dr.Srinivas. All these hospitals were said to have been located at Kalvapally, Miryalguda. The report also shows the contact numbers of the doctors. It is mentioned in
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summary under the names of the doctor that no record was available with the respective hospitals relating to the deceased. The investigator also did not collect any certificates from any of the doctors indicating that the deceased had undergone treatment for tuberculosis under any of them. In Page No.3, it is also mentioned that the deceased underwent treatment under Krishna, R.M.P.Doctor, Miryalguda and that Krishna verbally informed the investigator that he knew the life assured since many years and used to consult him for minor ailments and that the said doctor also confirmed that the life assured was taken treatment for tuberculosis. If that is the case, the investigator should have obtained a certificate and the Opposite Party should have examined the said doctor. It is also mentioned in page No.3 of Ex.B-5 that the deceased underwent treatment in Kalpana Clinic under Dr.Sudhakar, but the said Dr.Sudhakar informed the investigator that he does not aware any person with the name of the deceased. Thus, there is absolutely no material to justify the investigator to mention in his report Ex.B-5 that the deceased had undergone treatment for tuberculosis either before or after the deceased taking the policies Exs.B-3 and B-4. Consequently, the Opposite Party is with no material to establish his plea that the deceased had undergone the treatment for tuberculosis before he signed the proposal forms Exs.B-1 and B-2 and that he suppressed the same in the proposal form. Thus, the repudiation is totally unjustified.
9. Though the Opposite Party cited so many decisions in the written version and during the course of arguments, they relate to suppression of material facts. The said decisions become relevant only after the
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Opposite Party establishes that the deceased was suffering from serious ailments of tuberculosis and that he had suppressed the same in the proposal forms Exs.B-1 and B-2. Since it was held that the deceased had not undergone any treatment for tuberculosis, much less his suffering the diseases, there is no need to consider the said decisions.
10. It is to be seen as to what relief is to be granted. Even though the Complainants claimed a sum of Rs.7,40,000/-, the policies Exs.B-3 and B-4 show that the sum assured there under alone is payable with bonus. Therefore, the Complainants are entitled to receive the basic sum vested with bonus, i.e. total sum of Rs.3,50,000/-.
In the result, the complaint is allowed and the Opposite Party is directed to deposit in this Forum, a sum of Rs.1,50,000/- (Rupees One lakh and Fifty thousand only) under the Policy Ex.B-3 and a sum of Rs.2,00,000/- (Rupees Two lakhs only) under the policy Ex.B-4 with vested bonus, if any, thereon with interest at the rate of 9% p.a. from the date of the complaint till realization and a sum of Rs.5,000/- (Rupees Five thousand only) towards deficiency of services and Rs.2,000/- (Rupees Two thousand only) towards costs within one month from today.
Dictated to Steno-Typist, transcribed by him, corrected and pronounced by us in the open Forum on this 30th day of January, 2014.
FEMALE MEMBER PRESIDENT
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APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For Complainants: For Opposite Party:
Affidavit of the Complainant No.2. Sri Dhanya K.P., Deputy
Manager-Legal of SBI Life
Insurance Company Limited,
filed his affidavit on behalf of
the Opposite Party.
EXHIBITS MARKED
For Complainants:
Ex.A-1 Dt.28-01-2013 Repudiation Letter of Policy No.3501852203.
Ex.A-2 Dt.28-01-2013 Repudiation Letter of Policy No.14042381204
Ex.A-3 Dt. Attested copy of the PAN Card of the
deceased life assured.
Ex.A-4 Dt.12-06-2008 Attested copy of Election I.D.Card of the
deceased life assured.
For Opposite Party:
Ex.B-1 Dt.28-04-2011 Attested copy of Proposal Form.
Ex.B-2 Dt.28-04-2011 Attested copy of Proposal Form.
Ex.B-3 Dt.03-08-2011 Attested copy of Policy No.14042381 204.
Ex.B-4 Dt.14-02-2012 Attested copy of Policy No.35018532203.
Ex.B-5 Dt.17-01-2013 Attested copy of SBI Life Claims
Investigation Report.
Ex.B-6 Dt.16-04-2011 Attested copy of Laboratory Form for
Sputum Examination, issued by National
Tuberculosis Control Programme.
Ex.B-7 Dt.28-01-2013 Attested copy of Repudiation Letters.
PRESIDENT
DISTRICT CONSUMER FORUM
NALGONDA
TO
1). Sri Ch.Nagaraju,
Advocate for the Complainants.
2). Sri G.Jawaharlal,
Advocate for the Opposite Party.
