BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
And
Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Tuesday the 15th day of March, 2011
C.C.No 118/10
Between:
D.Peeramma, W/o.Dudekula Khasim,
R/o. H.No.30-341, Noonepalli, Nandyal Village and Mandal,
Kurnool District.
…Complainant
-Vs-
- Shriram Life Insurance Company Limited,Rep. by its Branch Manager,
U-con plaza, Park Road, Kurnool-518 001.
2. Shriram Life Insurance Company Limited,Rep. by its Division Incharge,
Divisional Office, D.No.10-3-206 M/4,II floor, Opp. Krishna Reddy Hospital, D.B.R. Cardia Hospital, Upstairs, Reddy and Reddy Colony,
Tirupathi-517 501.
3. Shriram Life Insurance Company Limited,Rep. by its Assistant General Manager,
D.No.3-6-478, III floor Anand Estates, Liberty Road, Himayat Nagar,
Hyderabad-500 029.
…Opposite Parties
This complaint is coming on this day for orders in the presence of Sri M.L.Srinivasa Reddy, Advocate, for complainant, and opposite party No.1 set exparte and Sri S.V.Krishna Reddy Advocate for opposite parties 2 and 3 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No. 118/10
1. This complaint is filed under section 12 of C. P. Act, 1986 praying:-
- To direct the opposite parties to pay assured sum of Rs.75,000/- with all benefits and interest at 18% p.a. from the date of death of the insured;
- To award compensation of Rs.15,000/- for causing mental agony and inconvenience suffered by the complainant at the deficient conduct of the opposite parties;
And
- To cost of Rs.9,000/- ;
And
(d) To grant such other reliefs as the Hon’ble Forum may deem fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as under:- The complainant’s husband Late D.Khasim took insurance policy bearing No.LN080900116645 from opposite party No.2 though opposite party No.1 for Rs.75,000/-. Complainant is the nominee under the said policy. The complainant’s husband died on 29-10-2009 due to breathlessness. After the death of D.Khasim the complainant submitted the claim to the opposite parties. The claim of the complainant was repudiated by opposite party No.3 on 20-03-2010, on the ground that the age of deceased as per the Pension Card was 65 years by the date of the proposal. The insured was born in the year 1959. The same is shown in the Voter Identity Card issued by Election Commission of India. Satisfying the same opposite party No.2 issued policy. The old age Pension Scheme is a beneficiary Scheme. The age of the deceased mentioned in the Pension Card is not correct. Repudiation of the claim by the opposite parties is not correct. There is negligence of the opposite parties in paying the assured amount. Hence the complaint.
3. The opposite party No.1 set exparte. Opposite party No.3 filed written version stating that the complaint is not maintainable. The complainant’s husband has taken a policy from the opposite parties. The term of the policy is 15 years commencing from 15-09-2009. After the death of the insured the complainant submitted the claim form to the opposite parties in the last week of February, 2010. The company conducted enquiry through investigator by name G.Rama Murthy. The investigator revealed that the policy holder was 65 years old in December, 2008. The insured availed Old Age Monthly Pension of Rs.200/- under Government of Andhra Pradesh Pension Plan for Senior Citizens. The insured was having habit of drinking alcohol and he undergone eye surgery at Aravinda Hospital, Madyrai on 11-08-2008. The deceased suppressed the material facts with regard to his actual age and health in the proposal form. Contract of insurance in between the complainant and the opposite parties has become void. The opposite parties rightly repudiated the claim of the complainant. The complainant is not entitled to the reliefs as prayed for. The complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1and A2 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to B13 are marked and sworn affidavit of opposite party No.3 is filed.
5. Both sides filed written arguments.
6. The points that arise for consideration are:
- Whether there is deficiency of service on the part of the Opposite Parties?
- Whether the complainant is entitled to the reliefs as prayed for?
(c) To what relief?
7. POINT No.1 & 2:- Admittedly the complainant’s husband D.Khasim took insurance policy Ex.B3 bearing No.LN080900116645 from opposite party No.2. The term of the said policy is 15 years commencing from 15-09-2009. Admittedly the complainant is the nominee under the said policy. It is the case of the complainant that her husband died on 29-10-2009 in Government Hospital, Nandyal due to breathlessness. Ex.B5 is the Death Certificate of D.Khasim issued by Registrar of Births and Deaths, Nandyal Municipality, Nandyal. In Ex.B5 there is a clear mention that D.Khasim husband of the complainant died on 29-10-2009. Admittedly after the death of the D.Khasim, the complainant submitted the claim form to the opposite parties and the claim of the complainant was repudiated under Ex.A1 stating that the deceased disclosed his age wrongly as 50 years by the date of proposal even though he was 65 years old by that date.
8. Ex.B2 is the proposal form dated 05-09-2009 where in the age of the deceased is mentioned as 50 years basing on the Voter Identity Card submitted by the deceased. The opposite parties issued Ex.B3 policy in favour of the deceased admitting the age of the deceased as 50 years by the date of the proposal. The complainant filed Ex.A2 copy of the Voter Identity Card where in it is mentioned that the deceased was born in the year 1959. As per Ex.A2 the age of the deceased was 50 years by the date of the proposal. The opposite parties filed EX.B9 copy of the Old Age Pension Card of the deceased wherein the age of the deceased is mentioned as 65 years by 2009. As seen from Ex.B9 it is very clear that the deceased received Old Age Pension from December, 2009. Basing on the age of the deceased mentioned in Ex.B9 the opposite parties repudiated the claim of the complainant stating that the deceased suppressed the material fact regarding his age. Admittedly there is no school record showing the correct age of the deceased. The deceased is not show educated and advanced. Admittedly the Old Age Pension Scheme is a beneficiary scheme provided to the Senior Citizen who are below poverty line. The deceased might have given his age as 65 years in order to have benefit under Old Age Pension Scheme. The insurance company cannot repudiate the claim of the complainant basing on the age of the deceased mentioned in Ex.B9 Old Age Pension Card. The opposite parties admitted the age of the deceased as 50 years basing on the age of the deceased mentioned in the Voter Identity Card. Now it is not open to the opposite parties to repudiate the claim of the complainant on the ground that the deceased suppressed his correct age at the time of making proposal.
9. It is also the case of the opposite parties that the deceased also gave false information regarding his health conditions on the date of proposal. Ex.B10 is the discharge summery issued by Aravind Eye Hospital. As seen from Ex.10 it is very clear that the deceased has under gone operation to his right eye in the month of August, 2008. It is not the case of the opposite parties that the insured died due to eye operation that was conducted in the year 2008. It is stated by the complainant in her sworn affidavit that her husband died due to “heart attack”. The opposite parties failed to establish that the insured suppressed the material particulars regarding his age and health fraudulently. Mere in accuracy on falsity said in respect of sum recitals in the proposal is not sufficient to repudiate the claim. The insurance company should establish that the insured suppressed material fact fraudulently knowing that at the time of making the statement that it is false. It is not established by opposite parties that the cause of the death of the insured is an account of suppressed health information. The repudiation of the claim of the complainant is not justified. There is deficiency of service on the part of the opposite parties.
10. In result, the complaint is partly allowed directing the opposite parties jointly and severally to pay assured amount of Rs.75,000/- with all other benefits within 3 months from the date of order along with cost of Rs.500/-.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 15th day of March, 2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nill
List of exhibits marked for the complainant:-
Ex.A1 Repudiation letter dated 20-03-2010 received by the complainant from opposite party No.3.
Ex.A2 Photo copy of Identity card NO.YFSO 110577 Election commission of India.
List of exhibits marked for the opposite parties:-
Ex.B1 Broacher of Shri Plus Policy.
Ex.B2 Proposal form.
Ex.B3 Policy documents (which contains first premium receipt & policy schedule & terms and conditions of policy).
Ex.B4 Death intimation letter dated 07-12-2009
Ex.B5 Photo Copy of death certificate.
Ex.B6 Letter dated 30-12-2009 of complainant.
Ex.B7 Office copy of reminder letter dated 10-02-2010.
Ex.B8 Investigation of report on death claim dated 06-01-2010.
Ex.B9 Photo copy of Old age pension card of deceased life assured of Dudekula Kashim.
Ex.B10 Photo copy of the Discharge Summary of the Aravind Eye Hospital, Maduri.
Ex.B11 Voluntary statement letter dated 30-12-2009 of complainant.
Ex.B12 Voluntary statement letter dated 30-12-2009 of Mr.P.Balavant.
Ex.B13 Office copy of repudiation letter dated 20-03-2010
along with postal receipt.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
