F.A.No.625/2011 against C.C.No.104/2009,  Dist.Forum,  Kadapa, Y.S.R.Dist.    

Between:

1.The Divisional Manager,

    Bajaj Allianz Life Insurance Company Ltd.,

    Dwaraka Towers, 7 Roads,

    Kadapa Post & City.

2. The Regional Manager,

    Bajaj Allianz Life Insurance Company Limited,

    Plot No.18-1-5-2  B 2^nd Floor,

    Opp: to SBI, K.T. Road,

    Tirupathi.

3.The Managing Director,

   Bajaj Allianz Life Insurance Company Limited,

   Head Office at GE Plaza,

   Airport road, Yerawada,

   Pune-411 006.                                                           … Appellants/

                                                                             Opp.parties

 Appellants are rep. by

State Operation Manager Smt.K.Aruna.

         And

Sri Ramireddy Chinna Obula Reddy,

S/o.Gangi Reddy,

R/o.Yerragudipadu Village & Post,

Kamalapuram Mandal ,

Kadapa Dist.                                                         … Respondent/

                                                                              Complainant

Counsel for the appellants     :   Mr.Srinivas Karra

Counsel for the Respondent   :    Mr.J.Seshagiri Rao      

QUORUM:SMT.M.SHREESHA,HON’BLE INCHARGE PRESIDENT,

AND

SRI S.BHUJANGA RAO, HON’BLE MEMBER

TUESDAY, THE TWENTY SIXTH   DAY OF MARCH,

TWO THOUSAND THIRTEEN.

Oral Order:  (per Sri S.Bhujanga Rao, Hon’ble Member)

                                                ****

                This appeal is directed against the order dt.28.10.2010 of the District Forum, Kadapa,  Y.S.R.Dist. made in C.C.No.104/2009.

        The appellants are the opposite parties and the respondent is the complainant in C.C.No.104/2009.   For the sake of convenience the parties are  described as arrayed in the complaint.

        The case of the complainant as set out in the  complaint  in  brief is as follows:

 The complainant’s mother  namely Ramireddy  Parvathamma   obtained insurance policy bearing no.85513736,  from the  insurance company of opposite party (in short  the Insurance Company),  by  figuring the complainant  as nominee  to the said policy.  The insurance company  issued policy  on payment of premium amount of Rs.30,000/-.  As per the  insurance certificate, the date of risk started from 4.2.2008, the sum assured under the above policy is Rs.1,50,000/-. As per the terms of the above policy, if the insured died during the policy period,  insurance company shall pay the sum  assured   or  the amount  paid by the  insured, whichever  is   higher,  along with the bonus, to the  nominee   of the policy.

        While so,  unfortunately the complainant’s mother  died on 30.3.2008,  due to heart attack and hyper tension.  At the time of taking  the policy, the mother of the complainant was hale and hearty  and the agent of the opposite party insurance company had observed  the health condition of the complainant’s mother, through the opposite party insurance company’s doctor and after verifying  the health condition of the complainant’s mother only, the opposite parties have satisfied and allowed the complainant’s mother to take the policy, by taking premium amount form her.   Prior to taking of the policy,  there is no  heart problem  to the complainant’s mother.     

        After  the death of his mother, the complainant  has made claim with the opposite party insurance company, for the sum assured, through the agent of  the insurance company and the complainant has submitted all the required  documents. As the complainant’s mother  does not have family doctor, the complainant could not submit the certificate  to the insurance company. As the complainant expressed his inability  to  get the certificate,  the agent of the insurance company has taken the complainant to  Prabhu Clinic, Yerraguntla  and there he took certificate  from  the doctor and submitted the same through the complainant. After receipt of the medical certificate from the complainant, the opposite party   repudiated the  claim with an observation that the life assured  Ramireddy Parvathamma  had a  history of high blood pressure since six months and was under the treatment for the same and the same was deliberately concealed  in the proposal form. With that observation, opposite parties have repudiated the claim of the  complainant through a letter  dt.1.12.2008. Hence  the complainant filed the complaint seeking direction to the opposite parties to pay  the assured sum of Rs.1,50,000/-  under the said policy to the complainant with interest @ 18% p.a. from the date of death of the complaint’s mother i.e.30.3.2008,  till realization and to direct opposite parties to pay Rs.50,000/- to the  complainant towards mental agony and  inconvenience caused to the complainant along with costs of Rs.2000/-

        Resisting the complaint, the opposite parties filed counter/written version contending that the complainant has made a false claim on the ground that the deceased life assured  namely  Ramireddy Parvathamma   died on account of heart attack  and hypertension on 30.3.2008 and that he is entitled for  the benefits of the policy taken in the name of the deceased. These opposite parties further contended    that  they  revealed that the deceased was already suffering from hyper tension since  6  months prior to taking of the policy. The deceased life assured, even though, was aware  that she was suffering from hypertension, did not disclose  the same  in the proposal  and thus tried to gain out  of insurance contract,  which  is illegal and  unjustified. Thus the policy was taken  suppressing the material particulars.

        The death of the deceased was due to previous  complications and  adverse health conditions  arose due to hypertension which is the primary cause of  her death.  Thus, the life assured suppressing her  previous health condition, obtained the  policy. Therefore, the claim of the complainant was rightly repudiated and hence there are  no merits in this complaint  and the complaint is liable to be dismissed with costs.

        During the course of enquiry, before the District Forum,  in order to prove his  case, the complainant filed his evidence affidavit  and got   marked Exs.A1 to A5  and as against that evidence, the opposite parties   got marked  Exs.B1 to B3 . 

        Upon hearing the counsel for both the parties and on consideration of material on record, the District Forum allowed the complaint, directing the opposite parties 1 to 3 jointly and severally to pay  Rs.1,50,000/-, the sum   assured  including bonus with interest at 9% p.a.  from the date of death of the mother   of the complainant  till realization to the complainant. Opposite parties are also directed to pay a sum of Rs.10,000/- to the complainant towards mental agony and also to pay Rs.2000/- towards costs of the complaint.

        Aggrieved by the said order, the opposite parties preferred the above appeal urging that the order of the District Forum is contrary to law, weight of evidence and probabilities of the case. That the District Forum failed to see that the insurance policy issued is   held to be contract based on the principle ‘Ubberima Fadie’ i.e. in good faith  and any amount of suppression of fact vitiates the  policy and hence there is no deficiency in service on the part of the opposite parties. That the District Forum  ought  to have considered the evidence adduced by the opposite party in support of its decision  to repudiate the claim. Hence the repudiation of the claim  by the opposite party company is based on evidence available on record and hence there is no deficiency in service on the part of the opposite party insurance company.  The appeal therefore may be allowed and impugned order of the District Forum may be set aside.   

        We heard the counsel for both  parties and perused the entire material on record. 

        Now the point for consideration is whether the impugned order of the District Forum is vitiated for misappreciation of fact or law?

        The complainant’s mother late Ramireddy Parvathamma  had obtained policy bearing no.85513736  from the opposite party insurance company for  an assured sum of Rs.1,50,000/-. The policy will be in force from 4.2.2008 to 4.2.2018. After payment of premium of Rs.30,000/-  to the opposite parties,  Policy Bond  was issued  to the complainant’s mother late Ramireddy Parvathamma. Thereafter, the complainant’s  mother died on 30.3.2008  due to  heart attack and hypertension. After the death of his mother, the complainant submitted a claim,  as nominee under the policy, to the opposite parties,  for the sum assured  under the policy.  All these facts are not in dispute  and they are also proved by  Exs.A1,A2 and A3 and B1 and B2. The opposite party insurance company has not denied its liability  to pay the assured sum,  if the insured dies during the policy  in force. 

        The contention of the opposite party insurance company  is that  they  have  repudiated the claim of the complainant on the ground that the deceased i.e. the mother of the complainant was  suffering from hypertension since six months prior to taking of  policy, that the deceased life assured  even though  was aware that she was suffering from hypertension, did not disclose the same in the proposal form and  thus tried to gain out of insurance contract. Thus the deceased has obtained the policy  suppressing the material particulars, contrary to the terms and conditions of the policy. Therefore the insurance company is not liable to pay any amount, under the policy to the complainant.

        The opposite party relied on Ex. B3 photostat copy of the Medical Certificate dt.10.6.2008  issued by Dr.Prasannanath, Prabhu Clinic, Erraguntla.  The complainant denied the genuineness of Ex.B3 and contended that his mother was hale  and  hearty,  at the time of taking  of the policy and she never suffered from hyper tension and took treatment  for the alleged disease,  much less, from Dr.Prasannanath, Prabhu Clinic, Erraguntla.    The opposite parties have not filed  affidavit of the doctor, who issued Ex.B3 certificate and they  did not choose to obtain the record maintained by the  said doctor, regarding the treatment given to the deceased.  Further, in Ex.A4 certificate dt.9.8.2008  issued  by the same doctor  he did not mention that he treated  the deceased for hyper tension,  since six months prior to the date of her death. Under these circumstances, the  insurance company ought to have  adduced reliable and convincing evidence to show that Dr.Prasannanath treated the deceased for hyper tension for a period of 6 months prior to her death. Under these circumstances, we are of the considered view that the opposite party insurance company failed to prove that the deceased insured was suffering from pre existing disease, the burden of proof which, is on the insurance company. The repudiation of the claim of the complainant without any  reliable material in proof  of the  fact that the deceased assured was suffering from pre existing disease is liable to be  rejected.  In view of the above facts and circumstances, we do not  find any grounds, much less, valid grounds to interfere with the order of the District Forum. Therefore  the appeal fails.

        In the result, appeal is dismissed confirming  the order of the District Forum.  In view of the facts and circumstances of the case, there shall be no order as to costs.

                                                           INCHARGE PRESIDENT

MEMBER

Pm*                                                          Dt. 26.3.2013