This C.C. is coming before us for final hearing, in the presence of Sri. K. Satya-narayana, Advocate for Complainant and in the presence of Sri. G. Harender Reddy, Advocate for opposite party; upon perusing the material papers on record; upon hearing the arguments 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(A) of the Consumer Protection Act, 1986. The brief facts of the complaint are that the paternal Uncle of the complainant had obtained Shri Plus Insurance Policy from the opposite party vide policy bearing No.LN100600117448, for a period of one year on payment of Rs.20,000/- towards premium. The sum assured under the policy is @Rs.2,00,000/-. After thorough verification only, the opposite party had issued the policy. Unfortunately, on 14-12-2007, the policyholder had died due to fever and jaundice. The complainant being the nominee informed the same to the opposite party through an application by furnishing required information regarding the death of the deceased. Though, he received a letter from the opposite party by stating that the insured has pre- existing decease and not disclosed the same at the time of policy and as such the claim is not payable. The complainant further submitted that, it is the duty of the insurance company to verify the health condition of the insured prior to issuance of policy and the opposite party cannot escape from their liability to pay the claim amount. Therefore, the complainant got issued legal notice dated 06-09-2008 as nominee for payment of death benefits for which, the opposite party issued reply notice dated 18-09-2008 by denying the payments under the policy, it amounts to deficiency of service and prayed to direct the opposite party to pay assured amount of Rs.2,00,000/-under the policy bearing No.LN100600117448 and to pay Rs.10,000/- towards damages and costs.
2. Along with the complaint, the complainant filed his affidavit and also filed the following documents, which were marked as Exhibits.
Ex.A1:- Office copy of legal notice, dated 06-09-2008.
Ex.A2:- Reply notice dated 18-09-2008.
Ex.A3:- Photocopy of premium receipt.
Ex.A4:- Photocopy of Policy.
Ex.A5:- Photocopy of Claimant’s statement.
3. On receipt of notice, the opposite party appeared through its counsel and filed counter by denying the averments made in the complaint.
4. In the counter, the opposite party admitted the issuance of policy bearing No.LN100600117448, in the name of the paternal uncle of the complainant for a sum of Rs.2,00,000/- and also submitted that they issued the policy, basing on the information provided in the proposal form and immediately after receipt of death information, sent the claim forms A, B,C and E to the complainant along with a letter dated 03-03-2008 by requesting to submit the claim forms with required documents for processing the claim, but the complainant failed to do so within stipulated time. Again it addressed another reminder on 25-03-2008 and constrained to close the claim as no claim vide letter dated 10-04-2008, but after receipt of letter dated 10-04-2008, the complainant had submitted the claim forms in the last week of June, 2008 with blank claim form ‘B’. The opposite party further submitted that it conducted the regular investigation, as it is an early Claim. During the course of investigation, the complainant and his brother threatened the investigators for seeking any information and upon enquiries it is understood that the deceased/policyholder has smoking and liquor drinking habits from past several years, which were not disclosed at the time of proposal and the policyholder had deliberately suppressed the material facts regarding the health condition and habits. Therefore, rightly repudiated the claim of the complainant and informed the same through the letter dated 14-08-2008 and as such there is no deficiency on its part and prayed to dismiss the compliant.
5. Along with the counter, the opposite party filed the following documents, which were marked as Exhibits.
Ex.B1:- Original Proposal Form.
Ex.B2:- Original policy, which is the original of Ex.A4.
Ex.B3:- Original premium receipt, which is the original of Ex.A3.
Ex.B4:- Letter dated 11.02.2008, addressed by the complainant.
Ex.B5:- Letter dated 03.03.2008 addressed by the opposite party.
Ex.B6:- Unfilled Claim Form ‘B’ (Medical Attendant’s Certificate)
Ex.B7:- Investigator’s report, dated 31-07-2008.
Ex.B8:- Letter dated 14.08.2008, addressed by the opposite party.
Ex.B9:- Office copy of legal notice, dated 06.09.2008.
Ex.B10:- Reply notice dated 18.09.2008.
6. The learned counsel for the opposite party relied two decisions of the apex court, delivered in Oriental Insurance Co. Ltd., Vs Muni Mahesh Patel and in P.C.Chacko & Another Vs Chairman, Life Insurance Corporation Of India & Others, but the facts consisting in these decisions are not similar to the present case on hand and in the instant case, the opposite party failed to furnish any proof regarding the suppression of material facts apart from investigation report.
7. In view of the above submissions, now the point that arose for consideration is,
Whether the complainant is entitled to the relief as prayed for?
As seen from the above averments, there is no dispute regarding the issuance of Shri Plus Insurance policy, bearing No.LN100600117448 in the name of the deceased/policyholder by receiving the premium amount through the collection center of opposite party at Khammam, the only dispute is with regard to the concealment of material facts relating to the health condition of the deceased/policyholder prior to obtaining the policy and with regard to the same, the opposite party taken a plea that the deceased/policyholder was having smoking and alcohol drinking habits from the past several years prior to proposal form and which were not disclosed in the questionnaire No.25 of the proposal form, which is against the principal of “Uberrima Fide” , as such the opposite party repudiated the claim through a letter dated 14.08.2008, which is evidenced under Ex.B8 and in support of its contention the opposite party relied Ex.B4 and B7. Ex.B4, is the letter dated 11.02.2008, addressed by the complainant, being the nominee, by requesting the opposite party to pay insured amount under the policy as his paternal father was suddenly died due to fever and jaundice. Ex.B7, is the investigator’s report, conducted by a private investigator, deputed by the opposite party, which is having no legal sanctity in the eye of law and moreover, nothing was elicited from Ex.B.7 and the investigator did not grab any single piece of evidence against the complainant either from the neighbors of the complainant or by filing any hospital record. Moreover the opposite party also failed to file any reliable evidence except Ex.B4 & B7 and as such we are of the opinion, in the absence of any material evidence regarding the suppression of material facts at the time of obtaining the policy, we cannot come to a conclusion in favour of the opposite party and as such the point is answered accordingly in favour of the complainant by holding that the complainant is entitled to the relief as nominee under the policy by re-submitting the Claim Form ‘B’, if it is necessary.
8. In the result, the complaint is allowed, directing the opposite party to pay an amount of Rs.2,00,000/- under the policy bearing No.LN100600117448, together with interest @9% per annum from the date of repudiation i.e. 14.08.2008 till the date of realization and accrued benefits if any. Further directed to pay an amount of Rs.1000/- towards costs.
Typed my dictation, corrected and pronounced by us in the open forum on this 8th day of August, 2010.
PRESIDENT MEMBER MEMBER
DISTRICT CONSUMERS 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, dated 06-09-2008.
Ex.A2:- Reply notice dated 18-09-2008.
Ex.A3:- Photocopy of premium receipt.
Ex.A4:- Photocopy of Policy.
Ex.A5:- Photocopy of Claimant’s statement.
Exhibits marked for opposite parties:-
Ex.B1:- Original Proposal Form.
Ex.B2:- Original policy, which is the original of Ex.A4.
Ex.B3:- Original premium receipt, which is the original of Ex.A3.
Ex.B4:- Letter dated 11.02.2008, addressed by the complainant.
Ex.B5:- Letter dated 03.03.2008 addressed by the opposite party.
Ex.B6:- Unfilled Claim Form ‘B’ (Medical Attendant’s Certificate)
Ex.B7:- Investigator’s report, dated 31-07-2008.
Ex.B8:- Letter dated 14.08.2008, addressed by the opposite party.
Ex.B9:- Office copy of legal notice, dated 06.09.2008.
Ex.B10:- Reply notice dated 18.09.2008.
PRESIDENT MEMBER MEMBER
DISTRICT CONSUMERS FORUM, KHAMMAM
