BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD 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 2nd 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