Andhra Pradesh

Anantapur

106

Sri Ambati Nagaraju - Complainant(s)

Versus

The Branch Manager and one another - Opp.Party(s)

Sri Sreenath Reddy

13 Jun 2008

ORDER


District Consumer Forum Anantapur
District Consumer Forum Anantapur
consumer case(CC) No. 106

Sri Ambati Nagaraju
...........Appellant(s)

Vs.

The Branch Manager and one another
...........Respondent(s)


BEFORE:
1. Smt.S.Lalitha 2. Sri S.Chinnaiah

Complainant(s)/Appellant(s):
1. Sri Ambati Nagaraju

OppositeParty/Respondent(s):
1. The Branch Manager and one another

OppositeParty/Respondent(s):
1. Sri Sreenath Reddy

OppositeParty/Respondent(s):




ORDER

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DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTAPUR

 

PRESENT:- Sri S.Chinnaiah, B.A., B.L., President

 

      Smt.S.Lalitha, M.A., M.L., Lady Member

                                   

Friday, the 13th day of June,2008

 

C.C.No.106/2007

 

Between:

 

            Ambati Nagaraju

           S/o A.Rangaiah

           D.No.10-506

           Dharmavaram town,

           Anantapur District.                                                ….    Complainant

 

Vs.

 

 

         1. The Branch Manager,

             Life Insurance Corporation of India,

             Dharmavaram Town,

             Anantapur District.

 

         2. The Divisional Manager,

              Life Insurance Corporation of India,

              Kadapa.                                                              ….   Opposite Parties

 

 

This case coming on this day for final hearing before us in the presence of Sri K.Sreenatha Reddy, advocate for the complainant and Sri V.Krishna Sharma, Advocate for the  opposite parties 1 & 2 and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:

                                   

           

ORDER

(Per Smt.S.Lalitha, Lady Member)

 

 

1.         This is a complaint filed under section 12 of Consumer Protection Act, 1986 by the complainant to direct the opposite parties to pay the Insurance amount of Rs.1,00,000/- with interest and costs of the complaint.

2.         The contents of the complaint in brief are that the complainant is resident of Dharmavaram.  His wife by name Ambati Sreedevi has taken life insurance policy with the opposite parties through their agent by name S.S.Gupta, who is having valid licence.  The said Sreedevi has been paying installment premium amount i.e. Rs.12,615/- for a year.  After due enquiry, the opposite parties have confirmed the policy of Ambati Sreedevi and she was allotted Policy No.653814846 dt.08-09-2005.  The complainant is the nominee of the deceased Ambati Sreedevi and She died on 12-09-2005.  After her death, when the complainant approached the opposite party No.2, he has rejected claim amount alleging that the deceased Ambati Sreedevi has given false statement regarding to her health, even-though she has given correct statement for evading the payment.  On the other hand, the opposite party No.2 sent a letter to the complainant on 27-12-2006 with false allegations and he stated in his letter send objections to the Zonal office.  The complainant has sent a suitable reply to the Zonal Manager, LIC of India, Hyderabad on 17-02-2007.  The family doctor of Ambati Sreedevi has also sent a letter to the Zonal Manager, LIC of India, Hyderabad regarding to the health of Ambati Sreedevi with correct facts on             10-02-2007.  Even-though, the complainant has sent suitable reply to the Zonal Manager, LIC of India, Hyderabad, the opposite parties did not pay the insurance covered amount.   After death of Sreedevi, the complainant handed over the original policy to the opposite parties.  Inspite of several requests made by the complainant, the opposite parties did not pay the amount.  Thus, the case of the complainant.

3.         The opposite parties 1 & 2 filed a written statement contending that it is a fact that the deceased Ambati Sreedevi submitted proposal for a policy of Rs.1,00,000/-  with payment yearly premium and that a sum of Rs.12,615/- was paid to the 1st opposite party. The said Sreedevi opted the date of commencement of risk from 08-09-2005 onwards and submitted a proposal dt.27-08-2005.  The said proposal is sent for approval and the same was intimated to her through a letter dt.16-09-2005.  The proposal was accepted on 21-09-2005 and policy No.653814846 was allotted to her.  After accepting the proposal on 21-09-2005, a letter was received from the complainant, who is nominee of late Sreedevi on 11-11-2005 stating that his wife Sreedevi died on 12-09-2005.   It is further stated that as seen from the  records i.e. proposal form, the declarant submitted a proposal form with false information i.e. regarding her health and answered the questions stating that she was not suffering with any ailment including Hypertension  and she never consulted any doctor. By seeing the records, it is clear that the proposer gave false declaration before the authorities suppressing the material fact i.e. regarding health and basing on the declaration and proposal on good faith the insurance company accepted the same on 21-09-2005.  It is further stated that the enquiries by the insurance authorities reveal that she was a chronic patient and was suffering with Hypertension i.e. 180/90 for the last more than three years before her death and was taking treatment for the same regularly.    It is also learnt that she fell ill and was taken treatment more than 10 days at Bangalore also before her death.  The doctor, who treated also gave an sworn affidavit attested by the Notary Public dt.20-10-2006 and Medical Attendant Certificate etc.,  Thus, it is very clear that in order to obtain policy, the proposer alongwith the present complaint gave false information by suppressing the material fact regarding the health condition of late Ambati Sreedevi.  It is submitted that the contract of insurance must be in good faith and any party violates the same the contract can not be enforced.  It is further stated that there is no concluded contract at all in the present case as the proposer died on 12-09-2005 and the proposal was accepted on 21-09-2005               i.e. after death of the said Sreedevi.  The nominee, who is the present complainant also willfully, suppressed the death intimation and after obtaining the policy intentionally he gave a letter to the opposite party on 10-11-2005.  Had the opposite party came to know about the sudden demise of Ambati Sreedevi, the proposal ought not to be accepted.  As there was no concluded contract , the opposite party is absolutely not liable to pay any compensation.  It is also submitted the first premium was adjusted on 27-09-2005 i.e. after her death only.  In view of unconcluded contract between the proposer and the insurance company as on the date of her death, it is deemed to that there is no valid contract and the alleged policy was not subsisting and the basic requirements are not fulfilled before the death of the proposer.  As there is no correct information regarding the health condition of proposer, the alleged policy is not enforceable.  It is further stated that as seen from the records, though the date of risk was dt.08-09-2005 and the proposer died on 12-09-2005 i.e. her death is within four days from the date of risk, which is a very early one, hence the opposite party conducted enquiry and reveals that there was suppression of material facts regarding health and the same is intended to get wrongful gain.  In view of the suppression of material fact and unconcluded contract between the proposer and the insurance company as on the date of death, the nominee i.e. present complainant herein will not get any amount and the insurance company  is absolutely not liable to pay any amount.  The opposite party also made it clear to the complainant by their letter dt.27-12-2006 i.e. the date of repudiation.  After examining all the records, the claim is repudiated on valid grounds and the repudiation letter is also served on the complainant.  Though the complainant sent a requisition to the higher officials i.e. Zonal Office, the repudiation by the opposite parties was confirmed.  As the repudiation is under valid grounds, there is absolutely no deficiency of service on the part of the opposite parties.  Hence, the present complaint is absolutely not maintainable. It is stated that the proposer was a chronic patient and was suffering with high B.P. since 2002 onwards and the cause of death is also mentioned that heart failure due to fall in B.P.  Thus, the B.P. leads to the death of the proposer.  The records also clearly show that she was a regular patient with heavy over-weight and continuously using medicines for her ill-health.  The allegation in the complaint that after satisfying the health condition and the reports of the Panel Doctor etc., only the opposite parties issued policy is absolutely false.  It is further stated that letter                              dt.10-02-2007 said to be given by Dr.J.Sudharshan Gupta is obtained in order to suit their claim and the contents in the said letter are all not correct and the complainant is put to strict proof of the same by examining the concerned person as required under law.  According to the last para of the declaration of the proposal form, the deceased life assured is bound to reveal the details of her ill-health if any between the date of the proposal.  The relevant para is as follows:

            “ And I further agree that if after the date of submission of the proposal but before the issue of the first premium receipt (i) any change in my occupation or any adverse circumstances connected with my financial position or the general health of myself or that of any members of my family, occurs or (ii) if a proposal for assurance or an application for revival of a policy on my life made  to any office of the Corporation has been withdrawn or dropped deferred or accepted at an increased premium or subject to a lien or on terms other than as proposed I shall forthwith intimate the same to the corporation in writing to reconsider the terms of acceptance of assurance.  Any omission on my part to do so shall render this assurance invalid and all moneys which shall have been paid in respect thereof shall stand forfeited to the corporation.”  It is submitted that the deceased life assured has not revealed of her ill-health between the date of proposal and the date of completion of the policy by the opposite parties and hence nothing is payable by the opposite parties under the policy.  It is further submitted that as the contract is not concluded the opposite party would not have been ready to settle the claim as the deceased life assured has not suppressed about her ill-health and the claim is not a bonafide claim.  But since the deceased life assured had suppressed about ill-health at the time of proposal, the claim is not treated as a bonafide claim and the same is repudiated as per rules.  The claim of the complainant for a sum of Rs.1,00,000/- with costs and interest is highly excessive and the complainant is absolutely not entitled for the same or any portion thereof.  It is submitted that in view of most early death, suppression of material fact and unconcluded contract, the present complaint is liable to be dismissed with exemplary costs. 

4.         Heard arguments on both side.

5.         The point that arises for consideration herein is:

            Whether the complainant has proved the deficiency of service on the part

           of the opposite parties ?

 

6.        Ex.A1 to A4 and Ex.B1 to B8 are marked for the complainant and the opposite parties. 

Ex.A1 is the repudiation letter dt.27-12-2006 issued by the 2nd opposite party to the complainant.  Ex.A2 is Xerox copy of Insurance Policy bearing No.653814846 issued by the 2nd opposite party and the proposal form.  Ex.A3 is letter dt.10-02-2007 of Dr.J.Sudarshan Gupta addressed to the Zonal Manager, LIC of India, Hyderabad.  Ex.A4 is the letter dt.17-02-2007 of the complainant addressed to the Zonal Manager, LIC of India, Hyderabad. Ex.B1 is the Xerox copy of the proposal form of late Ambati Sreedevi submitted to the opposite parties.  Ex.B2 is the letter dt.16-09-2005 of the 1st opposite party addressed to late A.Sreedevi.  Ex.B3 is the letter dt.10-11-2005 of the complainant addressed to the 1st opposite party. Ex.B4 is the Medical Attendant’s Certificate                dt.25-06-2006.  Ex.B5 is the letter dt.13-09-2006 of Vasavi Nursing Home, Dharmavaram addressed to the 1st opposite party.   Ex.B6 is the questionnaire of the opposite parties submitted by Dr.J.Sudarshan Guptha to the 1st opposite party. Ex.B7 is the letter dt.13-09-2006 of B.Tirupal Chetty addressed to the                     1st opposite party. Ex.B8 is the repudiation letter dt.27-12-2006 issued by the 2nd opposite party to the complainant.

7.         We have gone through the contents of the complaint, written version filed by the opposite parties, documents filed on either side, affidavits of both parties, written arguments and the material available on record.

8.   POINT:-   Before entering into the merits and demerits of the case, it is beneficial to discuss the arguments advanced on both sides.

9.  The learned counsel appearing for the complainant urged that the complainant is the husband of deceased Ambati Sreedevi, who had taken life insurance policy with the opposite parties through its agent.  His next contention is that the said insured had taken insurance policy of yearly premium and accordingly she paid Rs.12,615/- towards premium.   His next contention is that after due enquiry the opposite parties have confirmed the policy of the deceased Sreedevi and was allotted Policy No.653814846 dt.08-09-2005.  His further contention is that the complainant is the husband and nominee of the deceased.  The insured Sreedevi died on 12-09-2005 and after her death, when the complainant approached the 2nd opposite party claiming the amount of insurance relating to his wife, but his claim was rejected on the ground that the deceased has given false statement regarding to her health condition.  While rejecting the claim amount, the 2nd opposite party has sent a letter to the complainant on              27-12-2006 with false allegations and that the complainant has sent suitable reply to the Zonal Manager, Life Insurance Corporation of India, Hyderabad on              17-02-2007.  His further contention is that the family doctor of the deceased has also sent a letter to the Zonal Manager, Life Insurance Corporation of India, Hyderabad regarding health condition of the deceased with correct facts on               10-02-2007.  His next contention is that the reply given by the complainant and the letter sent by the family doctor of the deceased will reveal the correct facts.  But the opposite parties have repudiated the claim in order to escape from paying the claim amount relating to the deceased.

10.       On the other hand, the learned counsel appearing for the opposite parties vehemently contended that Ambati Sreedevi submitted a proposal dt.27-08-2005 and she opted the date of commencement of risk from 08-09-2005 onwards for a sum of Rs.1,00,000/- and the premium is payable yearly.  His next contention is that the said proposal form was sent to the Higher Authorities for approval and the premium amount paid by the deceased Sreedevi is kept under suspense account.  After receiving information from higher officials to the Branch Office, Dharmavaram, a regular policy was issued and the proposal was accepted on  21-09-2005 after adjusting the first premium amount on 27-09-2005.  His further contention is that the complainant, who is the husband of the deceased, is nominee of the deceased.  His further contention is that the Branch Office, Dharmavaram received a letter from the complainant on 11-11-2005 intimating that his wife died on 12-09-2005.  His further contention is that the complainant sent a letter intimating the death of his wife on 11-11-2005 though she died on                  12-09-2005 after receiving the policy from the Branch Office.  His further contention is that only in order to get wrongful gain delayed the intimation of the death of his wife wantonly.  His further contention is that had the opposite parties came to know about the sudden demise of the deceased Sreedevi, the policy proposal ought not to be accepted on 21-09-2005.  His further contention is that considering the facts of the present case, there is no concluded contract at all as the proposer died on 12-09-2005 and the proposal was accepted on 21-09-2005 i.e. after death of the proposer.  His further submission is that as there was no concluded contract, the opposite parties are absolutely not liable to pay compensation.  The date of commencement of risk is not the criteria, but the date of acceptance of the policy proposal is important.  His further contention is that in the present case, the death of the deceased Sreedevi is very early one.  Hence, the opposite parties conducted enquiry and during the enquiry it is revealed that there is also suppression of material facts with regard to her health.  His next contention is that as seen from the records, the proposer was suffering with hypertension and she was consulted with local doctors since 2002 onwards and she was also taken treatment at Bangalore for her ill-health.  His further contention is that she was treated by local doctors for her ill-health.  Cause of death is heart failure due to failure in B.P. and thus B.P. leads to death of the proposer.  His further contention is that after satisfying the reports of the Panel Doctors only, the Life Insurance Corporation accepted and letter dt.10-02-2007 of Dr.J.Sudharshan Guptha is obtained in order to suit their claim, after repudiating the claim.  His further contention is that unless the proposer reveals her health condition even the Panel Doctors could not detect the condition of the person.  As seen from the proposal form, it clearly reveals that the proposer suppressed the material facts regarding her health condition.

11.       The learned counsel in support of his contention relied on the decisions reported in (1)   1998(5) SCALE page 584 & 1998(7) SCC 348 (2) A.P.State Commission, Hyderabad  in O.P.No.101/96  order dt.01-09-1998  (3)   1995(3) C.P.R. 62 and (4) 1993 C.P.J. 146 (NC).

            The learned counsel appearing for the opposite parties contending that the deceased has concealed her health condition at the time of submitting the proposal form and relied on the decisions reported in (1) 1993(2) C.P.J. page 146 (2) 1995(2) C.P.J. page 62 (3) 1986-94 N.C.  & S.C. Consumer Cases page 1178 (4) 1986-95 Consumer page 1387 and Civil Appeal No.5322/2007 of Hon’ble Supreme Court of India.

12.       After going through the rival contentions, we have to necessarily accept the contention of the opposite parties.

13.       The complainant Ambati Nagaraju is the husband of deceased Ambati Sreedevi.  During the life time of Sreedevi, she has submitted a proposal form to the opposite parties on 27-08-2005   opting the date of commencement of risk from 08-09-2005 onwards for a sum of Rs.1,00,000/- and the premium was payable yearly and that she paid Rs.12,615/-.  Ex.A2 is the insurance policy with proposal form bearing No.653814846 dt.08-09-2005 for Rs.1,00,000/-  and yearly premium of Rs.12,615/-.  The said Sreedevi died on 12-09-2005.  As seen under Ex.A2, the complainant, who is husband of the deceased, is shown as nominee.  On 10-11-2005 the complainant informed the opposite parties that his wife Sreedevi died on 12-09-2005 due to fall in B.P. suddenly under Ex.B3.  Thus, the complainant, who is the husband of the deceased intimated the death of his wife on 10-11-2005 though she died on 12-09-2005 after receiving the policy under Ex.A2 from the Branch Office, Dharmavaram. Now, it is the staunch contention of the opposite parties is that only in order to get wrongful gain, the complainant has delayed the death intimation of his wife and waited till receiving the policy bond under Ex.A2.  At this juncture, it is pertinent to note that and it can be stated that if at all, had the opposite parties had an opportunity to know about the sudden demise of the deceased Sreedevi, the policy proposal ought not to be accepted on 21-09-2005.  Ex.B1 is the proposal form filed by the opposite parties.  Ex.A2 is the policy bond filed alongwith proposal form of Ex.B1.  It is also pertinent to note that under Ex.B2 the opposite parties have issued a letter dt.16-09-2005 addressed to Ambati Sreedevi stating that the opposite parties have acknowledged the remittance of Rs.12,615/- through her agent.  In the said letter, they have also stated that her proposal has been sent by them to their higher office for underwriting decision and that they shall revert to her soon in the matter.  It is to be noted that by the time they have addressed a letter intimating the fact of sending proposal to their higher authorities’ dt.16-09-2005, the said proposer was already expired on 12-09-2005.  As seen from the records the fact of death was not intimated to the opposite parties by the complainant. It is also relevant to note that the proposal was accepted on 21-09-2005 and as such the policy was also issued adjusting the amount of Rs.12,615/-, which was kept under suspense account by which time the proposer Sreedevi was expired.  Hence, as seen from the facts of the present case, there is no concluded contract at all as the proposer died on 12-09-2005 and the proposal was accepted on               21-09-2005 i.e. after death of the proposer.  Thus, by the date of death of the deceased, the policy was not in force.

14.       At this juncture, it is relevant to go through the decisions relied on by the opposite parties:

            1998(5) SCALE 584 & 1998(7) SCC 348 their lordships have observed that “ It is the date on which the policy had been issued and not the date on which risk under the policy had commenced by way of allowing dated back. “

            In a decision reported in A.P.State Commission, Hyderabad in O.P.No.101/96 order dt.01-09-1998 “ mere receipt and retention of premium until the death of the applicant or the mere preparation of the policy document is not acceptance. “

            In a decision reported in 1995(3) C.P.R. page 62, National Commission, New Delhi  their lordships have held that “ before submitting age proof the deceased died in accident – unconcluded contract – mere receipt and retention of premium until after the death of the applicant is not acceptance of contract. “

            In a decision reported in 1993(2) C.P.J. page 146 (NC) their lordships have held that “proposer dies before the acceptance of the proposal – No concluded contract of Insurance. “

            After going through the above said decisions, the same are amply applicable to the facts of the present case, for the reason that the deceased in the present case submitted a proposal for policy of Rs.1,00,000/-.  The proposal was submitted on 27-08-2005 with yearly premium payment of Rs.12,615/- and she paid on 08-09-2005 opting the date of commencement of risk on 08-09-2005.  The proposal was accepted on 21-09-2005 and policy was issued.  The husband of the deceased intimated the death of Sreedevi on 10-11-2005 to the opposite parties though she died on 12-09-2005 even before accepting the proposal.    Hence, as seen from the facts, there is no concluded contract at all in the present case as the proposer died on 12-09-2005 and the proposal was accepted on              21-09-2005 i.e. after death of proposer.

15.       In order to show the death of Sreedevi very early, after commencement of risk i.e. 08-09-2005 and that she died on 12-09-2005 due to hypertension and she was consulted with local doctors since 2002 onwards and she had also taken treatment at Bangalore for her ill-health, filed Ex.B4 Medical Attendant Certificate issued by Dr.J.Sudarshan Gupta dt.25-06-2006.  A perusal of Ex.B4 reveals that the deceased Ambati Sreedevi was under the treatment of Dr.J.Sudarshan Guptha, Dharmavaram since 5 years.  It is also stated that the treatment was given for common seasonal problems and hypertension.  She died due to cardiac failure on 12-09-2005.  The symptoms of illness were giddiness and that she died due to sudden illness.  However, Ex.B4 shows that Dr.J.Sudarshan Guptha was medical attendant of the deceased since 5 years prior to her death.  Above all, the said Dr.J.Sudarshan Guptha also issued a letter to the Manager, LIC office, Dharmavaram dt.13-09-2006 under Ex.B5 stating that the health condition of the deceased was that chronic B.P. patient and  T.B.P. recording 150/90.  She was regularly taking medicines.  She was under his treatment for the last 3 years.  She died in her house on 12-09-2005 due to fall in B.P. and due to cardiac arrest.  At this juncture, it is also profitable to go through Ex.B6 questionnaire issued by Dr.J.Sudarshan Guptha.  As seen from Ex.B6 questionnaire, he has stated that Ambati Sreedevi was under his treatment for the last 3 years prior to her death.  He gave treatment to her for B.P. and she was also suffering with mild hypertension.  The opposite parties have also filed Ex.B7 letter given by one B.Tirupal Chetty dt.13-09-2006 stating the health condition of deceased Ambati Sreedevi. It is stated in Ex.B7 that the deceased Ambatri Sreedevi was aged about 60 years by the date of 13-09-2006.  It is further mentioned that she was suffering with B.P. since 2 years and that she underwent treatment with Dr.S.V.K.Prasad Reddy, Dharmavaram and also she had taken treatment with Dr.J.Sudarshan Guptha.  10 days prior to her death, she was suffering with serious ill-health and she took treatment at Bangalore and she died on                12-09-2005.  She also went to America 3 times as her daughter was staying there.  There is nothing on record that B.Tirupal Chetty gave Ex.B7 letter stating health condition of deceased Ambati Sreedevi is in enemical terms with the complainant.   Hence, there are no grounds to disbelieve Ex.B7.   On the other hand, the contents under Ex.B7 are amply corroborating regarding health condition of the deceased that Ex.B4, B5 and B6 issued by Dr.J.Sudarshan Guptha under whom the deceased underwent treatment. 

16.       Above all, it is also relevant to go through Ex.A3 letter addressed by Dr.J.Sudarshan Guptha dt.10-02-2007 to the Zonal Manager, LIC of India, Hyderabad stating the health condition of the deceased Sreedevi.  Under Ex.A3 the same doctor, who issued Ex.B4,B5 & B6 regarding the health condition of the deceased stated that the deceased was suffering with fever, cough, cold and check up of B.P. and her B.P. was generally 145/85, during periodical check up, which is quite normal for the age of 59 years old.  He never prescribed any medicine for her hypertension as assured by the office.  Letter under Ex.A3 given by Dr.J.Sudarshan Guptha, who gave health condition of the deceased Sreedevi under Ex.B4, B5 and B6 is quite different.  It is not in dispute that he was Medical Attendant of deceased Ambati Sreedevi and that he gave different version under Ex.B4 to B6.  Hence, the documents filed by the opposite parties go to show that the deceased Ambati Sreedevi was suffering with hypertension prior to her death and that she underwent treatment with Dr.J.Sudarshan Guptha since 3 years.  The opposite parties have rightly repudiated the claim of the complainant for the death of his wife.  Legal proceedings adduced by the opposite parties certainly go to show that the deceased suppressed material facts while submitting the proposal form.   As seen from the proposal form under Ex.B1, it clearly reveals that the deceased Sreedevi suppressed the material facts regarding her health. 

17.        The counsel appearing for the opposite parties contended that while submitting the proposal form, the deceased Ambati Sreedevi suppressed the material facts regarding her health and relied on the decisions reported in 11(1995) C.P.J. 62 (National Consumer Disputes Redressal Commission, New Delhi) .  In the above decision their lordships have held that “ non-disclosure of history of hypertension in the proposal – claim repudiated – it does not amount to deficiency in service.”

            In a decision reported in 1178(NS) National Commission & SC on Consumer Cases, 1986-94, National Commission, New Delhi.  In the above decision, their lordships have held that “Consumer Protection Act, 1986 –section 2(1)(g) – deficiency in service – insurer had repudiated its liability on the ground that the insured had made incorrect statement – once it is found that insurer had considered all the relevant facts and circumstances, it can not be said that there is any deficiency in service. “

            In a decision reported in 1986-95 Consumer 1387 (NS), their lordships have held that “ the policy of insurance is a policy of utmost good faith – while filling up proposal form an agent acts as an agent of the insured for whose benefit the insurance is to be obtained. “

            The opposite parties have also relied on the decision reported Supreme Court of India, Civil Appeal No.5322/2007 (arising out of SLP© No.23951/2005).  In the above said decision, their lordships have held that “ the contracts of insurance including the contracts of life assurance are contracts uberrima fieds and every fact of materiality must be disclosed other-wise there is good ground for rescission.  And this duty to disclose continues up-to the conclusion of the contract and covers any material alteration in the character of the risk, which may take place between proposal and acceptance. “

            After going through the above said decisions, we are of the opinion that the same are amply applicable to the facts of the present case on the ground that the deceased suppressed material facts regarding her health while submitting the proposal form.  It is be noted that the cause of death of the deceased is heart failure due to fall in B.P. and that she was under the medical care of Dr.J.Sudarshan Guptha since 3 years prior to her death.

18.       Now the contention of the complainant is that the deceased furnished correct information in the proposal form for assurance.  His next contention is that the opposite parties are the masters of the deceased verified it and on finding it correct had accepted insurance of life of the deceased.  His next contention is with bad motive and intention to avoid the insurance amount on the death of the deceased Sreedevi through, the policy under Ex.A1 and Ex.B8, which are one and the same repudiation letters stating that the deceased had not furnished correct information in the proposal form regarding her health .  His next contention is that the deceased was insured her life with the opposite parties with good intention and broad mentality to help her legal heirs during sudden demise of the insured.  His next contention is that the deceased died due to sudden                        ill-health, which was not expected.  His last contention is that the opposite parties ignoring the natural justice creating troubles to the family of the deceased have repudiated the claim.  The complainant in support of his contention filed Ex.A3 letter issued by Dr.J.Sudarshan Gupta.  After going through relevant documents regarding health condition of the deceased, Ex.A3 is in no way improve the case of the complainant, for the reason that it is already held that the same Doctor, who issued Ex.A3 stated that the deceased was under his treatment since 3 years prior to her death and that she was suffering with chronic hypertension.  The complainant also filed Ex.A4 letter addressed by him to the Zonal Manager, LIC of India, Hyderabad stating that the repudiation of the claim is not justified as the deceased Sreedevi never suffered from hypertension.               

 

19.      After going through Ex.B4 Medical Attendant Certificate and Ex.B5 letter given by Dr.J.Sudarshan Guptha, who was giving treatment to the deceased and Ex.B6 questionnaire and Ex.B7 letter given by Dr.J.Sudarshan Guptha stating the health condition of the deceased Sreedevi that she was suffering with hypertension.  The contention of the complainant can not be taken into consideration.  Ex.A4 letter addressed by the complainant to the Zonal Manager, LIC of India, Hyderabad stating that his wife never suffered from hypertension falls to the ground.   Hence, the contention of the complainant is not convincing.  We are satisfied that the opposite parties have rightly repudiated the claim of the complainant under Ex.A1 & B8 letter dt.27-12-2006 and as such there is no deficiency of service committed by the opposite parties.

 

20.       In this view of the matter, there is no substance in this complaint and is therefore liable to be dismissed.  There is no order as to costs.

 

21.       In the result, the complaint is dismissed without costs.

Dictated to the Steno, transcribed by him, corrected and pronounced by us in open Forum, this the 13th day of June, 2008.

 

 

 

                     Sd/-                                                                              Sd/-                                                                   

              LADY MEMBER                                                   PRESIDENT

DISTRICT CONSUMER FORUM,                     DISTRICT CONSUMER FORUM,

                ANANTAPUR                                                    ANANTAPUR

 

 

APPENDIX OF EVIDENCE

 

WITNESSES EXAMINED FOR

 

 

COMPLAINANT:   NIL                                                      OPPOSITE PARTIES: NIL

 

 

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT

 

 

Ex.A1 -  Original Repudiation letter dt.27-12-2006 issued by the 2nd opposite

               party to the complainant.

 

Ex.A2 -  Xerox copy of Insurance Policy bearing No.653814846 issued by the

              2nd opposite party and the proposal form.

 

Ex.A3 – Letter of Dr.J.Sudarshan Gupta addressed to the Zonal Manager, LIC

              of India, Hyderabad dt.10-02-2007. 

 

Ex.A4 - Letter dt.17-02-2007 of the complainant addressed to the Zonal

             Manager, LIC of India, Hyderabad.

 

            EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES

Ex.B1 - Xerox copy of the proposal form of late Ambati Sreedevi submitted to the

            opposite parties. 

 

Ex.B2  -Letter dt.16-09-2005 of the 1st opposite party addressed to late

            A.Sreedevi. 

 

Ex.B3 - Letter dt.10-11-2005 of the complainant addressed to the 1st opposite

             party.

 

Ex.B4 - Medical Attendant’s Certificate dt.25-06-2006. 

Ex.B5 - Letter dt.13-09-2006 of Vasavi Nursing Home, Dharmavaram addressed

             to the 1st opposite party.

 

Ex.B6 - Questionnaire of the opposite parties submitted by Dr.J.Sudarshan

              Guptha  to the 1st opposite party.

 

Ex.B7 -   Letter dt.13-09-2006 of B.Tirupal Chetty addressed to the 1st opposite

               party.

 

Ex.B8 -  Repudiation letter dt.27-12-2006 issued by the 2nd opposite party to the

              complainant.

 

 

 

 

                          Sd/-                                                                   Sd/-

                LADY MEMBER                                                  PRESIDENT

DISTRICT CONSUMER FORUM,                     DISTRICT CONSUMER FORUM,

                  ANANTAPUR                                                    ANANTAPUR

 

 

Typed by JPNN

 

 

  

 

 




......................Smt.S.Lalitha
......................Sri S.Chinnaiah