BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
F.A.No.389/2012 against C.C.No.69/2011 District Forum-I, VISAKHAPATNAM.
Between
- Managing Director
Bajaj Allianz Life Insurance Co. Ltd.,
GE Plaza, Airport Road, Yerawada,
PUNE, Maharashtra-411006.
- Branch Manager,
Bajaj Allianz Life Insurance Co. Ltd.,
47-10-20, Dwaraka Plaza, II floor,
Dwarakanagar,
Visakhapatnam-530 016. …Appellants/
opposite parties
And
Smt.Munagavalasa Seshirekha W/o.late Rama
Rao, Hindu, aged 49 years, R/o.D.No.44-38-4,
Srinivasanagar, Akkayyapalem,
Visakhapatnam. Respondent/
Complainant.
Counsel for the Appellants : Sri G.Anand Kumar
Counsel for the Respondents: Mr.M.R.K.Chakravarthi
QUORUM: SMT.M.SHREESHA, HON’BLE Incharge President
AND
SRI S.BHUJANGA RAO, HON’BLE MEMBER.
FRIDAY, THE TWENTY SIXTH DAY OF APRIL,
TWO THOUSAND THIRTEEN
Order (Per Smt.M.Shreesha, Hon’ble Incharge President)
***
Aggrieved by the order of C.C.No.69/2011 on the file of District Forum-I, Visakhapatnam, the opposite parties preferred this appeal.
The brief facts as set out in the complaint are that the complainant is the wife of Mr.Rama Rao, who is an employee in East Coast Railways Visakhapatnam and obtained Bajaj Allianz Fortune Plus policy from opposite parties for Rs.1,25,000/- for a term of 15 years and the annual premium of Rs.25,000/- was paid on 21-2-2009. The complainant submitted that her husband was hale and healthy but died on 08-1-2010 as inpatient in Seven Hills hospital after suffering for a period of one month and after rituals, the complainant informed her husband’s death to opposite party No.2 on 13-4-2010 and submitted her claim. The complainant submitted that opposite party No.2 repudiated the claim on the ground of non-disclosure of facts and thereby the complainant approached the Claims Review Committee challenging the repudiation. The complainant submitted that if the deceased had critical illness, the opposite parties would have rejected the proposal prior to commencement of risk coverage and the information furnished in the proposal was correct and submitted that the action of the opposite parties in repudiating the claim amounts to deficiency in service. Hence the complaint for a direction to the opposite parties to pay the policy amount of Rs.1,25,000/- together with compensation of Rs.50,000/-.
Opposite party No.2 filed counter admitting the issuance of policy and submitted that on the base of facts mentioned in the proposal form only the policy will be issued and if the true facts known to the company, they would not have accepted and issued the policy. Opposite party No.2 submitted that the policy was issued based on principles of “uberimma Fides’ i.e. utmost good faith and the deceased inspite of his knowledge of pre existing disease did not disclose the same. The deceased had critical illness of diabetic mellitus since more than 10 years and also having high blood pressure for more than 5 years and his health deteriorated gradually and he expired in Seven Hills hospital due to the said diseases. Opposite party No.1 submitted that for 13 specific questions in the proposal form as to the health condition, the life assured specifically mentioned ‘no’ and this establishes that he suppressed material facts and justified their repudiation and submitted that there is no deficiency in service and prayed for dismissal of the complaint.
Based on the evidence adduced i.e. Exs.A1 to 10 and B1 to B7 and the pleadings put forward, the District Forum allowed the complaint directing opposite parties 1 and 2 to pay the policy amount of Rs.1,25,000/- to the complainant with interest at 9% p.a. from 05-5-2010 till the date of payment together with compensation of Rs.20,000/- with interest at 9% p.a. from the date of order till the date of payment and costs of Rs.5,000/-.
Aggrieved by the said order, the opposite parties preferred this appeal.
The learned counsel for the appellant filed written arguments.
The facts not in dispute are that the complainant’s husband had taken Bajaj Allianz Fortune Plus policy evidenced under Ex.A1 for a sum assured of Rs.1,25,000/- for a period of 15 years. The policy commenced from 21-2-2009. While so, on 08-1-2010, the complainant’s husband expired and the same was intimated to the second appellant on 13-4-2010 a claim was made which the appellants repudiated vide letter dated 05-5-2010 on the ground that the insured suppressed material facts. The complainant submits that her husband was hale and healthy and that the repudiation is unjustified. A representation was also made to the Claims Review Committee for reconsideration of the claim but there was no reply.
It is the case of the appellants/opposite parties that Ex.B1 is the proposal form which discloses that the life assured suppressed diabetis and Hypertension which he was suffering for more than 10 years. The life assured expired in Seven Hills hospital and relied on Ex.B5, investigation report dated 27-4-2010. The learned counsel for the appellant also relied on Ex.B3 which is the medical record of Seven Hills hospital which reveal that the complainant’s husband had diabetes mellitus, Hypertension, ulceration with fever and decreased urine output. It does not state that the life assured was suffering from diabetes and Hypertension for the last 10 years. The learned counsel drew our attention to Ex.B4, which is a certificate from the family doctor in which he stated that the complainant’s husband had Diabetes Mellitus and Hypertension and the date of first consultation was on 13-12-2009 and only routine investigations were conducted and even this certificate does not state the duration since when the life assured was suffering from diabetes and hypertension. Ex.B7 is the repudiation letter dated 18-10-2010 and the appellants have repudiated the policy on the ground that the life assured suppressed Diabetes Mellitus and Hypertension which he was suffering for the last 10 years.
The learned counsel for the appellants relied on several decisions of National commission and Supreme Court and drew our attention to the decisions reported in Chackochan v. LIC of India reported in Civil Appeal No.5322/07 dated 20-11-2007 wherein it was held that the insurer is justified in repudiating a claim wherever there is suppression of material facts.
In Sealark V. United India Insurance co. Ltd., reported in Civil Appeal No.803/08 dated 30-1-2008 wherein it was held when there is suppression of fact, acceptance of the policy by the insurance company would not be binding upon it.
In Satwant Kaur Sandhu v. New India Assurance Co. Ltd., reported in Civil Appeal No.2776/02 dated 10-7-2009 wherein it was held by the apex court that the hospital records recording the past history of illness should be relied upon.
A brief perusal of the record and Exs.B3 and B4 as per Section 45 of the Insurance Act do not establish that the life assured wilfully and wantonly suppressed Diabetes Mellitus and Hypertension prior to issuance of the policy. The proposal form is dated 28-7-2008 and Exs.B3 and B4 are dated 17-12-2009 and 26-4-2010 which are subsequent to the issuance of the policy and subsequent to the date of proposal, therefore, the burden of proof shifts to the appellants to justify their repudiation which in the instant case, they failed to establish as they did not file the hospital record specifically mentioning that the deceased had Diabetes Mellitus and Hypertension for the last 10 years and this led to the death of the deceased and the life assured had wilfully and wantonly suppressed his health condition which was material for suppression prior to the issuance of the policy. Hence we do not see any reasons to interfere with the well considered order of the District Forum so far as deficiency in service is concerned. However, we observe that the District Forum has awarded interest at 9% p.a. and also compensation of Rs.20,000/- since interest is awarded by way of damages, the compensation amount of Rs.20,000/- is set aside to meet the ends of justice.
In the result this appeal is allowed in part and the order of the District Forum is set aside with respect to compensation only while confirming the rest of the order of District Forum. Time for compliance four weeks.
INCHARGE PRESIDENT.
MEMBER.
JM Dt.26-4-2013.
