Andhra Pradesh

Nellore

CC/55/2013

Smt K.Kousalya - Complainant(s)

Versus

The Branch in charge AviavaLife insurance Coltd - Opp.Party(s)

S.Ankaiah

03 Jun 2015

ORDER

Date of Filing     :18-04-2013

                                                                                                Date of Disposal:03-06-2015

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM:NELLORE

Wednesday, this the  3^rd day of  June, 2015

 

          PRESENT: Sri P.V. Krishna Murthy, B.A., B.L., President

                             Sri M. Subbarayudu Naidu, Member.

 

C.C.No.55/2013

 

K.Kousalya, W/o.Late Ravindra Babu,

Age 40 years,  R/o.16-3-1779,

Near Naga Saibaba Mandir,

2^nd street, Harinadapuram, Nellore Town,

S.P.S.R.Nellore District.                                                                    ..… Complainant        

 

                                                                           Vs.

 

The Branch in charge, Aviava Life Insurance Company Limited, 1st Floor, Santhi Plaza, D.No.59-14-2A, Gayatri Nagar, Near BEHZ Circle, Vijayawada-520008, Andhra Pradesh.                                                                              ..…Opposite party

                                                              .  

            This complaint coming on 18-05-2015 before us for hearing in the presence of                Sri S.Ankaiah, advocate for the complainant and Sri E.V.Rami Reddy, advocate for the opposite party  and having stood over for consideration till this day and this Forum made the following:

 

ORDER

(ORDER BY  Sri P.V. KRISHNA MURTHY, PRESIDENT)

 

The brief averments of the  complaint in brief are as follows:

 

            The husband of the complainant obtained an insurance policy from the opposite party for Rs.3,50,000/- for a term of ten years.  The complainant is shown as  the nominee in the policy.  The insured  paid premium.  He  died on 27-08-2012.  The policy was inforce on the date of his death.  The complainant filed the claim with documents.   The opposite party repudiated the claim in an illegal manner.  The same is a deficiency of service.  Hence, the complaint for the payment of the sum assured with interest, costs and damages.

 

            2.         The opposite party filed the counter stating in brief as follows:

 

              The complaint is not maintainable.  The allegations made in the complaint are not correct.  The complainant is not a  consumer.  The deceased  suppressed  earlier disease while taking  policy.  The deceased   took treatment in Bollineni Super Speciality Hospital for  heart disease prior to the policy but suppressed the same.  There is no cause of action for the claim.  The repudiation was on the correct lines.  The assured died soon after  obtaining the policy  There is no deficiency of service.  Hence, the complaint may be dismissed.

 

            3.         Now the point for consideration is “whether  the opposite party committed a deficiency  of service?”

 

            4.         The complainant filed her affidavit and  marked Exs.A1 to A5.  On behalf of the opposite party, the investigator filed his affidavit and marked Exs.B1 to B6.

 

 5.  POINT No.:   The complainant alleged deficiency of service by the opposite party in rejecting  an insurance  claim.  The husband of the complainant obtained an insurance policy from the opposite party.  The settled law is, that  a policy of insurance is a contract of utmost good faith.  The  insured  shall not suppressed any material  fact while entering into the contract of insurance with the insurer.  The insurer,   the opposite party repudiated  the claim under Ex.B6 (also Ex.A2) on the ground that the insured suppressed a previous ailment while entering into the insurance contract.  The deceased  entered into a policy of insurance on 23-11-2011 with the opposite party.  Ex.B1 is a copy of the policy bearing the date 18-11-2011.  As contended by the opposite party, the insured denied to have  suffered from high  blood pressure,  angina, heart attack,  and stroke  or any other  disorder  of heart,  in para-6 of Ex.B1. 

 

6.         The complainant averred that the diseased died on 27-08-2012.  The cause of  death was not mentioned for the reasons known to the complainant.  The complainant  has not pleaded any illness leading  to the death.  The opposite party got the matter investigated.  The opposite party filed the previous medical record of the deceased, which was  marked as Ex.B4.  Ex.B4 is the medical record of Bollineni Super Speciality Hospital, Nellore regarding the disease (life assured, G. Ravindra  Babu, the husband of the  complainant).   In the  medical record, the deceased was  known  to suffer from old CAD.  CAD means Coronary Artenary Disease (Dorlands pocket medical  dictionary, page-132).  The word coronary refers to the arteries of the heart.  Under Ex.B4, the deceased was admitted on 23-12-2009 and was discharged on                 29-12-2009.  The medical treatments underwent  by the  diseased was prior  to the date of the insurance contract under Ex.B1.  The deceased has denied the same in Ex.B1, for reasons best known to him.  The contention of the  opposite party that the diseased suppressed an existing heart ailment on the  date of the policy has to be accepted.  The deceased suppressed the above material fact, which was  within his knowledge.  The deceased  ought not to have done so.  The deceased violated  the primary principle of  an insurance contract.  The opposite party  was right in repudiating the claim and thus has  done no deficiency of service.  The repudiation of the claim was within the ambit of  law.  The complainant failed to establish the averred deficiency of service.  The complainant is not entitled   to  the sum assured and other benefits claimed.  The point  is held   against the complainant

 

7.  IN THE RESULT,  the complaint is  dismissed, but without costs.

 

            Dictated to Stenographer, transcribed by her corrected  and pronounced by us in the open  Forum, this the  3^rd day of   June, 2015.

 

                 Sd/-                                                                                                   Sd/-

           MEMBER                                                                                       PRESIDENT

 

                                                APPENDIX OF EVIDENCE

 

Witnesses Examined for the complainant

 

P.W.1  -

27-01-2014

Smt.K.Kousalya, W/o.Late G. Ravindra Babu, Nellore (Chief Affidavit filed)

 

Witnesses Examined for the opposite party

 

R.W.1  -

14-02-2014

Affidavit  filed by  Sri PSS Praskash, acting on behalf of  Stellar Insurance Management Services Pvt. Ltd., Corporation, Hyderabad-500029.

 

                             EXHIBITS MARKED FOR THE COMPLAINANT

 

Ex.A1  -	24-11-2011	Photocopy of  Schedule in policy No.NHP0019293 issued by opposite party.
Ex.A2  -	18-12-2012	Letter from opposite party to the complainant.
Ex.A3  -	11-02-2013	Photocopy of legal notice from complainant’s advocate to the  opposite party.
Ex.A4  -	-	One registered post receipt addressed  to the opposite party.
Ex.A5  -	-	Served postal acknowledgement sent by the complainant’s advocate to the opposite party.

 

                         EXHIBITS MARKED FOR THE OPPOSITE PARTY

 

Ex.B1  -	18-11-2011	Photocopy of  proposal form in favour of  complainant’s husband issued by the opposite party.
Ex.B2  -	-	Photocopies of  Schedule,  Important point about  Aviva Health Plus and Befit Illustration details (two pages) issued by the opposite party.
Ex.B3  -	11-10-2012	Photocopy of  Additional Document Letter (ADL) issued by opposite party to the complainant.
Ex.B4  -	-	Photocopy of Medical Record in favour of complainant’s husband issued by Bollineni Superspeciality Hospital, Nellore.
Ex.B5  -	05-11-2012	Photocopy of  Investigation Report issued by M/s.Stellar  Insurance Management Services Private Limited.
Ex.B6  -	18-12-2012	Photocopy of  letter from opposite party to the complainant.

                                                                                                                                 Id/-

 

                                                                                                                         PRESIDENT

 

Copies to:

 

1.	Sri S. Ankaiah, Advocate, D.No.16/1967-1, Srinivasa Agraharam, Nellore-524 002.
2.	Sri E.V.Rami Reddy, Advocate, 1st floor, Raju Bhavan, Beside District Court,                   Nellore-524 001.

 

Date when free copy was issued: