BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD
FA NO.256 OF 2016 AGAINST CC NO.139 OF 2014
ON THE FILE OF DISTRICT FORUM, RANGA REDDY
Between:
1) Shriram Life Insurance Company Limited,
having its Regd. Office at H.No.3-6-478,
Anand Estates, III-Floor, Liberty Road,
Himayathnagar, Hyderabad – 500 029.
Rep. by its Manager.
2) Shriram Life Insurance Company Limited,
having its office at 5th Floor,
Ramky Selenium, Plot No.31 & 32,
Beside Andhra Bank Training Centre,
Financial District, Gachibowli,
Ranga Reddy district – 500 032.
…Appellants/Opposite parties
And
B.Lakshmi Tulasi W/o late B.Bhoga Rao,
Aged about 32 years, Occ: Housewife,
R/o D.No.12-88, Madiwada Center,
Akiveedu, West Godavari district – 534 235.
…Respondent/Complainant
Counsel for the Appellants : Sri Mohd. Abdul Samad
Counsel for the Respondent : Sri V.Appa Rao
Coram :
Hon’ble Sri Justice B.N.Rao Nalla … President
and
Sri Patil Vithal Rao … Member
Tuesday, the Twenty First day of March
Two thousand Seventeen
Oral Order : (per Hon’ble Sri Justice B.N.Rao Nalla, Hon’ble President)
***
This is an appeal filed by the Opposite parties aggrieved by the orders of District Consumer Forum, Rangareddy dated 23.04.2015 made in CC No.139 of 2014 in allowing the complaint and directing the Opposite parties to pay an amount of Rs.7,90,000/- with interest @ 9% p.a. from the date of complaint i.e., 03.06.2014 till date of realization and to pay costs of Rs.5,000/- granting time of one month.
2) For the sake of convenience, the parties are referred to as arrayed in the complaint.
3) The case of the complainant, in brief, is that her husband B.Bhoga Rao during his life time obtained two policies bearing No.NP111200041877 for an assured sum of Rs.7,40,000/- and another policy No.NP1112000115748 for an assured sum of Rs.50,000/- showing her as nominee. To her misfortune, the policy holder died on 14.01.2013 due to cardiac arrest while moving to hospital. After death of her husband, she approached the Ops with a request to make payment of the policy benefits. To her shock and surprise, the Ops sent a letter dated 30.04.2013 repudiating the claim on the premise that the policy holder was suffering with HIV (+) virus since two and half years and undergoing treatment at various hospitals which he failed to disclose at the time of obtaining policies.
4) In fact, the deceased life assured did not suffer with HIV+ virus and she is not aware of who the Dr.M.V.Rama Krishna is. However, her enquiries revealed that Dr.M.V.Rama Krishna is a R.M.P. and not competent to issue any certificate. Only to evade payment of claim amount, the Ops have taken such false pleas. On her approaching the Claims Review Committee at Gachibowli of the Ops, there was no response. Complainant got issued a notice on 27.11.2013 to which a reply dated 03.12.2013 was given by the Ops with false pleas. Hence, the complaint praying to direct the Ops to pay Rs.7,90,000/- with interest and Rs.1,00,000/- towards compensation for negligence and deficiency of service together with costs of the complaint.
5) Opposite parties filed their written version resisting the claim on the premise that complainant is not a consumer within the meaning of the Act and there is no deficiency of service on their part and hence liable to be dismissed. They admitted as to taking of two policies in question. At the time of filling the proposal form, the life assured had not disclosed his pre-health ailment of HIV as the same is evident from the form-B given by Dr.M.V.Rama Krishna, Sri Sai First Aid Clinic, Eluru that the life assured was suffering from the said disease since April 2011.
6) The insurance policies are contracts governed by the principle of “uberrimae fidei”. It was the primary duty of the proposer to disclose everything about his health condition, pre-existing disease, habits, etc., which he failed to and thereby violated the terms and conditions of the policies, as such, the contract has now become void, unenforceable and not legally binding on the Ops. Hence, prayed to dismiss the complaint with exemplary costs.
7) During the course of enquiry before the District Forum, in order to prove their case, the Complainant filed her evidence affidavit and Exs.A1 to A15; on behalf of the Opposite parties they got filed the evidence affidavit of one Mr.E.Sridhar their Assistant General Manager and Ex.B1 and B2.
8) The District Forum after considering the material available on record, allowed the complaint bearing CC No.139/2014 by orders dated 23.04.2015, as stated, supra, at paragraph no.1.
9) Aggrieved by the above orders, the Appellants/Opposite parties preferred this appeal contending that the forum below (a) erred in considering the fact that basing on the declarations made in the proposal form, the policies were issued; (b) erred in considering the form-B dated 29.04.2013 issued by Dr.M.V.Rama Krishna of Sri Sai First Aid Clinic, Eluru and on plain reading of the same, it reveals that the deceased was a patient of NACO+ since 2½ years and since then he was under treatment in A.R.T.Centre, Tadepalligudem; (c) erred in considering the fact that the life assured has fraudulently suppressed the material facts with regard his medical history and hence repudiation is proper; (d) failed to consider the fact that the life insurance policies are contracts governed by the principles of ‘uberrimae fidei’ and the proposer is expected to furnish all material information. Hence, prayed to allow the appeal and set aside the orders of the forum below.
10) The point that arises for consideration is whether the impugned orders as passed by the District Forum suffer from any error or irregularity or whether they are liable to be set aside, modified or interfered with, in any manner? To what relief ?
11) It is not in dispute that the Respondent is the wife of the deceased life assured and further that the deceased life assured had obtained two policies from the Appellants insurance company for the assured sum thereof. The date of death of the deceased life assured is also not disputed. The only dispute is that the deceased life assured obtained the above two policies by suppressing the material fact of having taken treatment for HIV+. To prove the same, the Appellants relied on form-B stated to have been issued by one Dr.M.V.Rama Krishna of Sri Sai First Aid Clinic, Eluru. Except the sole document, no piece of evidence is brought on record by the Appellants to prove their contention. On other hand, to disprove the said contention, Ex.A13 is brought on record by the Respondent.
12) A perusal of Ex.A13 goes to show that the form-B is not issued by the alleged doctor and none of the officials of the Appellants visited him seeking the particulars of the deceased life assured. Except making bald and vague assertions, the Appellants failed to file any piece of paper to prove their contentions. In such a circumstance, no credence can be given to Ex.B1 document. The Appellants failed to file the affidavit of the issuing doctor so as to fortify their contention, which they failed to do so.
13) There is no evidence to prove that the deceased life assured had suffered with any pre-existing disease much less the HIV+ virus or that he had undergone treatment at A.R.T. Center, Tadepalligudem. Nothing prevented the Appellants from producing the records to the effect that the deceased life assured was treated at A.R.T. Center, Tadepalligudem. Having failed to take any steps, the Appellants cannot now turn round and state that there is suppression of fact. Without any cogent evidence, the act of the Appellants in withholding the monies payable to the nominee amounts to sheer negligence and deficiency of service.
14) It became a routine manner to the insurance companies to take specious plea of suppression of fact when it comes to payment of claims. For that matter, the erstwhile State Consumer Disputes Redressal Commission of Andhra Pradesh while deciding the matter in FA No.1000 of 2013, in the matter of LIC of India & anr Vs. Pasupuleti Bhagya Laxmi & anr, decided on 14.08.2014, had observed as follows:
“……A close scrutiny of the proposal form would reveal even the columns were filled up by the agent and simply obtained the signatures of the proposer on ‘x’ marks. It is manifest that the proposal was routed through the agent of the LIC. If we may say so, the agents are playing fraud on LIC as well as gullible consumers with false assurances. When the policy was issued by the insurance company with utmost good faith, the same yardstick has to be applied while settling the claims also. The LIC ought to have made thorough enquiry, investigation or necessary medical health check-ups before issuance of policy irrespective of the amount involved. Without doing so, when they have issued the policy, now they cannot turn round and contend that they need not pay any amount as there was suppression of material information with regard to his health”.
Without bringing on record any piece of evidence, the Appellants are estopped from making such false and flimsy plea of suppression of material facts which is not sustainable in the eyes of law. The principle of uberrimae fidei (utmost good faith, literally meaning most abundant faith) is equally applicable to both sides and in this regard, we may state the decision rendered by the Hon’ble Apex Court reported in AIR 2000 Supreme Court 1014 in the matter of M/s Modern Insulators Ltd., Appellant Vs. Oriental Insurance Co., Ltd., Respondent, decided on 22.02.2000, wherein it is observed as follows:
“…….The insured has a duty to disclose and similarly it is the duty of Insurance Company and its agents to disclose all material facts in their knowledge since obligation of good faith applies to both equally……”
It appears, in order to evade payment of the claim amount, such a flimsy and untenable plea is taken. In this regard, we may state that the Hon’ble National Consumer Disputes Redressal Commission, New Delhi in the matter of Abdul Latheef and others Vs. The Life Insurance Corporation of India in RP No.2370/2012 had observed as follows:
“It will be unfortunate, if the insurance companies try to repudiate genuine death claims on such technical and flimsy grounds. Most of the innocent insured will be victims and the beneficiaries will be deprived of the fruits of life insurance.”
“It is unfortunate that on one hand the LIC raises the voice of “Utmost good faith” but, in contrast, the faith will be lost while not settling the genuine claims for some or other reasons. It is the exploitation of the policy holders. The consumers are literally under fear or dilemma that, whether, after death, the beneficiaries ever certainly get any fruits from the LIC…..”
For the aforesaid reasons, we do not find any infirmities or irregularities in the well-considered orders of the forum below. Accordingly, we answer the point framed for consideration at paragraph No.10, supra, against the Appellant and in favour of the Respondents.
15) In the result, the appeal fails and is accordingly dismissed with costs of Rs.5,000/-. Time for compliance : four weeks.
PRESIDENT MEMBER
Dated 21.03.2017
