O R D E R
(By Sri A. Radha Krishna, President on behalf of the Bench)
1. The 1st complainant the wife, the 2nd complainant the minor son, the 3rd complainant the mother of the deceased Venkata Giri filed this case for an award in their favour for a sum of Rs. 4,99,437/- being the amounts due under the insurance policy is obtained by the deceased from the opposite parties.
2 The version of the complainants is that the deceased Bhajana Venkata Giri obtained two insurance policies from the 2nd opposite party at Kakinada. The 1st opposite party is a Divisional Manager stationed at Visakhapatnam. One policy is for a sum of Rs. 82,500/- and another is for Rs. 2,50,000/-. The maturity date of 1st policy is 23.09.2021 and 2nd policy maturity date is 20.03.2012. It is under the scheme named “Shri Plus”. According to them in the event of the death of the insured the opposite party has to pay sum insured and the unit value to the nominee under the respective policies. The deceased was paying premiums regularly and without fail. The deceased died on 17.09.2007 at Global Hospital, Hyderabad. On account of the death of deceased the sum assured under the above two policies became payable. Immediately after the death of deceased the 1st complainant had given the death intimation to the opposite parties and requested to pay the assured amount. She also sent the original policies to the opposite parties but the opposite parties repudiated the claim on the ground the deceased was having some pre existing health problems and suppressed the factum and as such on the ground they repudiated the claim. According to complainants the repudiation grounds are not substantiable under law. The deceased did not furnish false information and it is only after medical examination, relevant medical tests by the opposite party they issued the policies.
3 As the opposite parties repudiated the claim the complainants issued a notice to the opposite parties for which a reply was given with untenable grounds. Thus complaining deficiency of service on the part of the opposite parties in not paying assured amounts the complainants approached this Forum for redressal of their grievance.
4 The 1st and 2nd opposite party filed their written version interalia contending the complainant is not a consumer as defined under the Act. There is no such existing 2nd opposite party as described in the complaint and they have no branch at Kakinada. For the convenient and effective service to its customers, they have got a collection centre at Kakinada located in the office of Shriram Chits Pvt. Ltd. at Kakinada. Thus according to them this Forum has no jurisdiction to entertain the complaint. They admit factum of policy is obtained by the deceased. Further according to them immediately after the receipt of death intimation the head office of the 1st opposite party sent claim forms to her for processing the claim. The head office of 1st opposite party conducted regular investigation and upon such investigation and medical records of Global Hospital it was revealed that the deceased was known case of Bronchial Asthma since last 15 years and he was also having habit of smoking and drinking which were not revealed by him at the time of taking above said two polices. Since he suppressed material facts they repudiated the claim. Thus according to them as the deceased suppressed material facts with regard to health they repudiated the claim of the complainants and they issued a suitable reply to the notice sent by the complainants. Thus they sought dismissal of the complaint.
5 Now the points for determination are:
- Whether this Forum has jurisdiction to entertain the complaint?
- If so, whether there is any deficiency of service on the part of the opposite parties in repudiating the claim of the complainants?
- Whether the complainants are entitled for the amounts sought by them in the complaint?
6. Point No.1: To substantiate the contentions of the complainants the 3rd complainant furnished her proof affidavit and exhibited 8 documents. Ex.A1 is Photostat copy of policy, so also Ex.A2, Ex.A3 is xerox copy of death summary given by Global Hospital, Hyderabad, Ex.A4 is the letter addressed by the opposite party, Ex.A5 is covering letter, so also Ex.A6, EX.A7 is office copy of notice issued to the opposite party and acknowledgment of the same, Ex.A8 is reply by the opposite party.
7. As against this evidence the opposite party examined its Assistant General Manager and they exhibited 7 documents which are original policies Ex.B1 and Ex.B3 and first premium receipts Ex.B2 and Ex.B4, original proposal forms Ex.B5 and Ex.B6 and Xerox copy of medical records Ex.B7.
8. The contention raised by the opposite party is that this Forum lacks jurisdiction to entertain the complaint as they have no branch office at Kakinada at all and the 1st opposite party is located at Visakhapatnam and as such this Forum has no jurisdiction to entertain the complaint.
9 It is no doubt the 1st opposite party stationed at Visakhapatnam and as per complaint the complainant has shown the branch office at Kakinada represented by its Manager. The opposite party disputes the existence of any such branch. But even according to them they have collection center located in the office at Kakinada. Thus when once they collected amount at their office at Kakinada by operating collection center, part of cause of action arose at Kakinada. As such the contention of the opposite party the Forum at Kakinada has no jurisdiction is untenable. Thus this point is answered against the opposite party.
10 Point No.2: There is no dispute about the deceased obtaining two policies from the opposite party. The bone of contention of the opposite party in repudiating the claim is that the deceased suppressed the material facts at the time of taking policy. Though in the reply notice the opposite parties disputed pre medical checkup of the deceased at their instance, infact their own letters under Ex.A5 and A6 would contradict the said version. These letters would indicate the medical checkup arranged by them at their expenses for mutual beneficial in monitoring the health standards of deceased and thus sought his co-operation when their medical examiner visited him.
11 That apart Ex.A3 which is the death summary issued by Global Hospital, Hyderabad where the deceased expired would indicate that he was admitted in their hospital with severe Malaria and the cause of death was severe malaria with multi organ failure. As seen from the version of the opposite party the deceased suppressed the factum of his Bronchial Asthma for last 15 years and also he is having habit of smoking and drinking. Here the case of death as revealed by Ex.A3 has nothing to do with the alleged non disclosure of the illness referred in the written version. Even in Ex.B7 medical records the deceased was having habit of smoking and consuming alcohol occasionally. Thus in these circumstance when the deceased died of malaria with multiple organ failure he cannot be faulted with for non disclosure of Bronchial Asthma which cause was advanced by the opposite party for repudiating the claim. Thus in these circumstances it can not be said that the deceased suppressed material facts and as such the claim of the complainants can be repudiated on the said ground. Hence under these circumstances the repudiation of claim by the opposite parties is unjust and unlawful. Thus clearly there is deficiency of service on the part of the opposite parties in repudiating the claim of the claimants. Hence this point is answered in favour of the complainants.
12. Point No.3: In the result, the opposite parties are directed to pay Rs.4,99,437/- [rupees four lakhs ninety nine thousand four hundred and thirty seven only] within one month from the date of this order. Otherwise, the said amount shall carry interest @9% from the date of this order till realization. All the three complainants are entitled to this amount in equal shares. The 2nd claimant is being minor as such his share of amount shall be invested in any Nationalized Bank still he attains majority.
Dictation taken by the Steno, transcribed by her, corrected and pronounced by us, in open Forum, this the 03rd day of February, 2015.
Sd/- xxxx Sd/- xxxxxxx
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For complainants :
PW1: Smt. Bhajana Satyavani [3rd complainant ]
For opposite parties:
RW1: Sri E.Sridhar, Assistant General Manager, Shriram Life Insurance Co. Ltd.
DOCUMENTS MARKED
For complainants:-
Ex.A1 23.09.2006 Photostat copy of policy LN110600075207
Ex.A2 Photostat copy of policy LN110700015706
Ex.A3 Xerox copy of death summary given by Global Hospital, Hyderabad
Ex.A4 Photostat copy of letter addressed by the opposite party
Ex.A5 Photostat copy of covering letter addressed by the opposite party
Ex.A6 Photostat copy of covering letter addressed by the opposite party
EX.A7 Office copy of notice issued to the opposite party and acknowledgment
Ex.A8 Reply given by the opposite party.
For opposite parties:-
Ex.B1 23.09.2006 Original policy No. LN110600075207
Ex.B2 12.09.2006 Original first premium receipt No. 0052788
Ex.B3 Original policy No. LN110700015706
Ex.B4 20.02.2007 Original first premium receipt No. 0097249
Ex.B5 Original proposal form No.124207000008
Ex.B6 Original proposal form No. 124206000058
Ex.B7 Xerox copy of medical records
Sd/- xxxx Sd/- xxxxxxx
MEMBER PRESIDENT
