BEFORE THE DISTRICT CONSUMER FORUM : MEDAK AT SANGAREDDY

PRESENT: Sri Patil Vithal Rao, B.Sc., LL.B.,President

Smt. Meena Ramanathan, B.Com., Lady Member

Sri G.Sreenivas Rao, M.Sc., B.Ed.,LL.B.,PGADR (NALSAR),Member

Thursday, the 28^th day of February, 2013

CC. No. 08 of 2012

Between:

Mangali Sathaiah,

S/o Thukaram, Aged: Major,  

Occ: Barber, R/o Tigul Village, Mandal Jagdevpur,

Dist. Medak.                                                                            ……Complainant                       

                   And

1. The Asst. General Manager,

Shriram Life Insurance Company Ltd.,

# 3-6-478, Anand Estates, III Floor,

Liberty Road, Himayath Nagar,

Hyderabad – 500 029.

2.       Branch Manager,

Shriram Life Insurance Company Ltd.,

H.No. 9-3-1/1 & 2, III floor,  Medak Road,

Mahadev Complex, Siddipet.                                ……Opposite parties

This case came up for final hearing before us on 19.02.2013 in the presence of Sri G. Chandrakanth, Advocate for complainant and Sri G. Venkat Ramulu, advocate for opposite parties No. 1 & 2 and heard the arguments of both sides, on perusing the record and having stood over for consideration till this day, this Forum delivered the following:

O R D E R

(Per Se Sri Patil Vithal Rao, President)

1.                The complainant, who is husband of one deceased Mangali Narsamma, approached this Forum by way of the present complaint under Section 12 of the Consumer Protection Act, 1986, claiming Rs. 2,00,000/- towards insurance policy amount with bonus and other benefits thereon, Rs. 25,000/- towards compensation, Rs. 20,000/- towards damages and also costs of the litigation against the opposite parties. His contention, in brief, is that his wife late Mangali Narsamma took insurance policy from opposite party No. 2 on 12.07.2008 for a sum of Rs. 2 lakhs and paid annual premiums as per the agreed terms and conditions and unfortunately died on 22.07.2011. The further contention of the complainant is that when he made a claim for the policy amount on 12.08.2011 as nominee of the deceased, the opposite parties repudiated the same but however offerred only a sum of Rs. 33,242.39p towards full and final settlement. The complainant did not agree for the same and has come up with the present complaint.

2.              The opposite party No. 1 filed the counter on behalf of himself and also on behalf of opposite party No. 2 and resisted the claim on the grounds, inter-alia, that at the time of obtaining the policy, the deceased with held material information about her aliments of Asthma and Diabetes for which she was already under treatment. The opposite parties have further alleged that on internal investigation by the insurance company it was revealed that the deceased was suffering with the above said deceases since 2007 and ultimately died on account of Lungs problem. For the said reason, as per opposite parties, the claim was repudiated in view of the agreed terms and conditions of the insurance policy. Therefore they prayed to dismiss the complaint with costs.

3.              The complainant has filed his evidence affidavit as PW. 1 and relied on the documents under Ex. A1 to A4 to substantiate his claim. The opposite parties have examined three witnesses including opposite party No. 1 as RW. 1 to RW. 3 and marked Ex. B1 to B9, in defence. Ex.X1 to X5 are marked during the evidence of the physician, RW. 3.

4.                Heard the oral arguments and perused the written arguments submitted for the parties to the case.

5.           Now the point for consideration is that whether there is any deficiency of service on the part of the opposite parties for granting reliefs in favour of the complainant as prayed for?

Point:

6.         It is not in dispute that the deceased Mangali Narsamma took insurance policy for herself under Unit linked SHRI PLUS plan on 28.07.2008 for a sum of Rs. 2,00,000/- with annual premium of Rs. 20,000/- each for a period of 15 years and the policy was commenced on 28.07.2008. Ex. B1 is the proposal form for the policy and Ex. A4 is the policy. Ex. B2 is a receipt dated. 27.08.2008 towards payment of first premium. Subsequently the insurance company sent a notice to the deceased on 03.06.2010 for payment of the premium amount. The deceased died on 22.07.2011. Ex. B4 is the death certificate issued by village grampanchayat. The complainant, being husband and nominee of the deceased, intimated about the same to the opposite party No. 2 while submitting his claim for the policy amount and the benefits thereon on 12.08.2011, vide Ex. B3. When the opposite parties repudiated the claim by the letter Ex. B9 on 30.09.2011 by offering a sum of Rs. 33,242.39p towards full and final settlement, the complainant got issued a legal notice vide Ex. A3, by rejecting the said offer, on 16.12.2011. The opposite party No. 1 sent reply to it on 22.12.2011 and reiterated repudiation of the claim.  Ex. A2 is said reply notice. The report of an investigator under Ex. B5 of the insurance company is made basis for the repudiation. As per the said report the deceased died of lung cancer. Exs. B6 to B8 and X1 to X5 are copies of medical papers evidencing the fact of aliments for which the deceased was taking treatment for the period from 18.09.2007 to 22.07.2011. She was treated by the physicians, RW. 2 & RW. 3. All these facts are not in dispute.

7.               The only controversy involved in the matter is alleged suppression of fact on the part of the deceased with regard to her alleged life threatening aliments. Exs. B6 to B8 and X1 to X5 are the star documents in this regard. Ex. B7 consists of copies of two medical prescriptions issued by the chest physician, RW. 2 on 03.08.2007 and 18.09.2007. After initial treatment by him to the deceased for Asthma, he referred her to the General physician, RW.3. All these documents show that the deceased was suffering with Asthma and Diabetese.  RW. 2 & RW.3 have deposed about the treatment given by them to her, basing on the above said documents. As per evidence of RW. 3, a patch in the X-ray film was found on a lung of the deceased which was suggestive of lung’s infection or Neo plasm i.e. Lung cancer. RW. 3 has expressed his inability about exact cause for the said patch for want of pathological report. Both these doctors, RW. 2 & RW. 3, have clearly opined that the aliments i.e. Asthma & Diabetese being suffered by the deceased were normal problems and that a patient could not have died because of them only. RW. 3 has also deposed that the diabetes of the deceased was under control with his medicines. Ex. B6 & X1 to X5 are his medical prescriptions. Ex. B8 is a copy of discharge summary issued by Yashoda Hospital, Somajiguda, Hyderabad which shows that at the time of admission in the hospital on 27.12.2011 she was diagnosed with CARCINOMA RIGHT LUNG WITH BILATERAL LUNG METASTASIS. During the course of her treatment, her health deteriorated and she was discharged on 22.07.2011 and she died on the same day. As per the investigation report dated. 22.09.2011 under Ex. B5 she died of lungs cancer and savere complications of diabetese. Be that as it may, as per the above noted medical evidence, she was not suffering with any life threatening disease at the time of taking insurance policy but affecting of cancer was a subsequent event. It is pertinent to note from the proposal form, Ex. B1, that the deceased was an illiterate lady hailing from a family of farmer with village background. Further, the proposal form was not only filled up by one P. Laxminarayana, Agent of the insurance company, but also attested by him as a witness. On this document there is also his recommendation to the effect that the life proposed for insurance of the deceased was insurable. The recommendation was evidently based on verification of all the facts by him as given by the insured and as noted in the proposal form, Ex. B1. His recommendation was accepted by the insurance company in issuing the policy. Therefore the company is liable for the acts of it’s agent. The Hon’ble Kerala State Consumer Disputes Redressal Commission held that the Principal is responsible for the act of the agent and liable to pay compensation to the complainant. This case was reported in, I (2013) CPJ 94, between:  “SICILY THOMAS And ICICI PRUDENTIAL LIFE INSURANCE CO.LTD”, I (2013) CPJ 94.     

                   It is also significant to notice that the insurance company has failed to get examined the insured medically before issuing policy for the reason best know to it. In “LIC of India vs. Ranjana Anil Rao Dhandole”, 1 (2013) CPJ 20B [NC] [CN] the complaint was filed claiming insurance policy benefits on death of insured by the nominee and that the claim was repudiated by the LIC on the ground of suppression of pre existing disease by the insured. In this case the insured was fully examined by panel doctor of LIC and Cancer was cropped up subsequent to obtaining the policy. As the LIC failed to prove that the repudiating of claim was correct, the complaint was allowed against it. By applying the ratio laid down in these two decisions, and inview of the above discussed facts and circumstances of the case we have no hesitation to hold that the insured was not suffering with any life threatening disease and did not suppress any material information, at the time of obtaining the insurance policy and that as such the repudiation of claim on the part of the insurance company is illegal. It is also to be seen that the company did not repudiate whole claim but offered part payment of Rs. 33,242.31p only.

No doubt the learned counsel for the opposite parties has in his written arguments cited three decisions reported in, 2011 (2) SCJ 500, 2011 (4) CPR (NC) and 2012 (1) CPR 48 (NC), but did not furnish the actual texts of them for perusal. Therefore we are unable to consider them.

8.             In view of the aforesaid discussion we hold that the complainant has established the deficiency of service on the part of the insurance company and as such the opposite parties are liable to pay the sum assured of Rs. 2,00,000/- with bonus and other benefits on it to the complainant, as a nominee of the insured i.e. his wife. He is also entitled for a reasonable compensation of Rs. 20,000/- and costs of Rs.5,000/- to meet the ends of justice. The point is answered accordingly in favour of the complainant.

9.                  In the result, the complaint is allowed directing the opposite parties to pay a sum of Rs. 2,00,000/- towards policy amount with bonus and other benefits on it and compensation of Rs. 20,000/- with costs of Rs. 5,000/- to the complainant. Time for compliance: one month.    

                  Dictated to Stenographer, after correction the orders pronounced by us in the open court this the 28^th day of February, 2013.

         Sd/-                                 Sd/-                                       Sd/-           

      MALE MEMBER     LADY MEMBER                    PRESIDENT

APPENDIX OF EVIDENCE

                                 WITNESS EXAMINED

For the complainant:                                            For the opposite parties:-

DOCUMENTS MARKED

For the complainant:                                            For the opposite parties:-

          Sd/-                                        Sd/-                                         Sd/-

MALE MEMBER                      LADY MEMBER                     PRESIDENT      

Copy to

1)   The Complainant

2)   The Opp.Parties

3)   Spare copy