BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Sri.Y.Reddappa Reddy, M.A., L.L.M., President,
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Friday the 19th day of December, 2014
C.C.No.71/2014
Between:
Smt.B.Shoba,
W/o Late Boya Anand Kumar,
Hindu, Aged about 20 Years, House Wife,
H.No.6-46, Madapuram Village,
Amakatadu Post,
Krishnagiri Mandal-518225,
Kurnool District. …Complainant
-Vs-
1. The Branch Manager,
Bajaj Allianz Life Insurance Company Limited
D.No.40/581/A, 2nd Floor,
S.V. Complex
Kurnool District-518 004.
2. Bajaj Allianz Life Insurance Company Limited,
Represented by its Chief Operating Officer,
G.E. Plaza, Airport Road,
Yerawada, Pune-411006,
Maharastra State. …OPPOSITE PARTIEs
This complaint is coming on this day for orders in the presence of Sri.B.Gopala Krishnudu, Advocate for complainant and Sri.Y.Jaya Raju, Advocate for opposite party No.1 and opposite party No.2 called absent and set exparte and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member,)
C.C. No.71/2014
1. This complaint is filed under section 11 and 12 of Consumer Protection Act, 1986 praying:-
(a)To direct the opposite parties to pay Rs.2,36,805/- with benefits which are covered under the policy bearing No.0194353067 and damages for mental agony of Rs.10,000/- to the complainant.
(b)To grant interest at 24% per annum from the date of death of the insured.
(c)To pay the costs of this complaint.
(d)To grant any such other relief or reliefs as the Honourable Forum may deem fit in the circumstances of the case.
2. The facts of the complaint is in brief as follows:- The complainant is the wife of Late Boya Anand Kumar. On 14-12-2010 Boya Anand Kumar insured his life with the opposite parties under the policy bearing No.0194353067 for Rs.2,36,805/- with an annual premium amount of Rs.9,775/- with its maturity date being 14-12-2035. The complainant is the nominee under the policy. On 21-08-2011 the insured died due to ill health. The complainant who is the nominee under the policy submitted the claim to opposite parties. The opposite parties repudiated the claim of the complainant on 01-04-2012 stating that the insured suppressed the material facts regarding his health condition in the proposal form. The allegations of opposite parties are baseless. There is a deficiency of service on the part of opposite parties and caused mental agony by delaying the settlement of claim of the complainant. Hence the complaint.
3. Opposite party No.1 filed written version stating that the complaint is not maintainable either in law or on facts of the case. It is admitted that the opposite parties issued policy bearing No.0914353067for an assured sum of Rs.2,00,000/- and the complainant is the nominee under the said policy. It is also admitted that the complainant submitted claim form to opposite parties and the opposite parties repudiated the claim on 01-04-2012 for non-discloser of material facts. It is submitted that after enquiry and investigation, it was found that the deceased was already diagnosed for nephritic syndrome, and admitted in Government General Hospital, Kurnool on 18-08-2010 and availed benefit under Arogyasree scheme and he was treated as in-patient with IP.No.54168. The deceased suppressed the material facts in regard to his age and occupation also. Though he was at the age of 25 years and occupation as Agriculturist, he was wrongly mentioned as sales marketing in PLC Universal and his age was 22 Years at the time of taking policy. The opposite parties refunded the amount of Rs.7,525/- under the said policy being the accrued maturity value and credited the same to the account of complainant lying in Oriental Bank of Commerce. The opposite parties rightly repudiated the claim of the complainant. There is no deficiency on the part of opposite parties. Hence the complaint is liable to be dismissed.
Opposite party No.2 called absent and set exparte.
4. On behalf of the complainant Ex.A1 to Ex.A3 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite party No.1 Ex.B1 to Ex.B8 are marked and sworn affidavit of opposite party No.1 is filed.
5. Complainant and opposite party No.1 are filed Written Arguments.
6. Now the points that arise for consideration are:
- Whether there is deficiency of service on the part of opposite parties?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINTS I and ii:- Admittedly the insured Boya Anand Kumar took the policy from opposite party No.2 through opposite No.1 under Ex.B1 bearing No.0194353067 for an assured sum of Rs.2,00,000/- on the annual premium of Rs.9,775/- dated 15-12-2010. Ex.B2 is Proposal Form dated 01-12-2012. The deceased insured died on 21-08-2011. Ex.A1 = Ex.B7 is the death Certificate issued by Registrar of Births and Deaths, Kurnool Municipal Corporation, Kurnool District, dated 01-11-2011. Admittedly the complainant submitted claim form to opposite parties. Ex.A3 is the Receipt of Death Claim issued by opposite party dated 29-11-2011. The said claim was repudiated by opposite parties under Ex.A2 dated 01-04-2012, on the ground that the insured suppressed the material facts regarding his health, age, and occupation, at the time of taking policy.
8. The complainant in her sworn affidavit stated that the allegation made against the insured are baseless, after all formalities were completed, the opposite parties issued policy in favour of insured deceased. The learned counsel appearing for the complainant submitted in written arguments that after due enquiry and medical examination of the deceased insured, the opposite parties issued policy in favour of insured and further submitted that so as to prove the version of opposite parties they produced Ex.B5 and Ex.B6 said to have obtained from Government General Hospital, Kurnool, but they are Xerox copies so the authenticity of Ex.B5 and Ex.B6 is doubtful and not trust worthy.
9. The opposite party No.1 in his sworn affidavit stated that the opposite parties conducted investigation and appointed investigator to enquire about the cause of death of insured. During the investigation it was disclose that the decease insured was already diagnosed for nephritic syndrome, admitted in Government General Hospital, Kurnool dated 18-08-2010 even prior to submitting the policy and availed benefit under Arogyasree scheme. He was treated as in-patient with IP.No.54168. The investigation report dated 18-08-2010 is marked as Ex.B8, Voter ID of insured is marked as Ex.B3 and photo copy of Discharge Summary Card is marked as Ex.B4=Ex.B5 and Case Sheet is marked as Ex.B6 dated 01-12-2010. After investigation it was reveal that the deceased concealed the material facts regarding his health, age and occupation. As per the terms and condition No.10, condition No.20 and condition No.34 of insurance policy, the suppression of facts will result in disentitlement of the policy amount in case of death of the insured.
10. There is no dispute with regard to issuance of policy in favour of deceased insured, the complainant is nominee under the said policy, she made a claim to opposite parties and opposite parties repudiated the claim, on the grounds that the deceased insured suppressed the material facts in regard to his health, age, and occupation. At the time of taking policy the deceased insured submitted his school leaving certificate to prove his age, according to the school certificate, the date of birth is mentioned on 01-07-1989, the insured age was 21 years at the time of obtaining policy. The opposite parties accepted it and well aware of the fact regarding his age and issued policy. Now the opposite party No.1 wants to contradict by producing voter ID of insured Ex.B3 where in, the date of birth of insured is mentioned as 1986. The certificate issued by Registrar of Births and Deaths is the more authenticate certificate to prove the age of person but opposite party No.1 did not produced it. Voter ID is not an authentic document to prove the correct age of person. Except Ex.B3 there is no other material on record to show that the Life Assured was 25 years at the time of taking policy. Ex.B3 cannot taken in to consideration without any supportive evidence to prove the said fact. The burden lies on the opposite parties to establish that the deceased suppressed the alleged material facts regarding his health, age and occupation. There is no material on record to prove that the deceased insured was an agriculturalist. The opposite parties produced Ex.B4 photo copy of Discharge Summary Card issued by Government General Hospital, Kurnool dated 18-08-2010. The photo copy of progress report case sheet regarding the admission of deceased insured Government General Hospital, Kurnool (Ex.B6) dated 01-12-2010 also filed. The said Ex.B4, Ex.B5 and Ex.B6 are Xerox copies without any attestation of any doctor, who issued the same. In that discharge summary (Ex.B4=Ex.B5) the date of discharge is not mentioned, the signatures of doctor and patient are not shown, and the age of patient is mentioned as 16 years. To establish the authenticity of Ex.B4 to Ex.B6 the opposite party No.1 did not take steps to examine the doctor, who issued the same and treated the deceased/insured. Mere filing medical certificates without examine a doctor is not prove the said facts. In decision reported in IV (2012) CPJ Page 646 (NC) LIC -Vs- Priya Sharma, Honourable National Commission held that the onus to prove is on the Insurance Company to prove the existing pre disease of insured, not examined any doctor to prove this fact, repudiation not justified.
III (2011) CPJ Page 118 (NC) it was held that medical certificate produced by petitioner not proved on record production of documents is different from proof of same.
11. In the present case on hand the burden is on the opposite parties to prove the alleged suppression of material facts by insured by evidence. The photo copy of Ex.B4=Ex.B5=Ex.B7 are filed, but the opposite parties did not examine either a doctor or file an affidavit of the doctor, who treated the patient, without filing any affidavit of a doctor or examine on their behalf, we could not come into conclusion that he had been suffered from the alleged disease and had been taken treatment. The cause of death is not mentioned in Ex.A1 Death Certificate. The opposite parties could not establish that the deceased insured suppressed the material facts regarding his health, age and occupation at the time of taking policy. We found deficiency of service on the part of opposite parties. Hence the complainant is entitled for an assured amount of Rs.2,00,000/- under the said policy
12. POINT No.iii:- The complainant claimed for Rs.2,36,805/- with benefits but the said claimed amount is the guaranteed maturity value with benefits which shall be payable at maturity date provided all regular premiums had been paid. In instant case the complainant is entitled as a nominee for an assured amount of Rs.2,00,000/- which is payable on the date of the insured.
13. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay an assured sum Rs.2,00,000/- with interest at 9% per annum from the date of complaint i.e., on 03-03-2014 to the date of payment and Rs.1,000/- as costs of the case. The time for compliance is one month from the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 19th day of December, 2014.
Sd/- Sd/-
LADY MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties : Nil
List of exhibits marked for the complainant:-
Ex.A1 Death Certificate issued by Registrar of Birth and Deaths,
Kurnool Municipal Corporation, Kurnool
Ex.A2 Letter addressed by opposite party to the complainant
dated 01-04-2012.
Ex.A3 Receipt of Death Claim dated 29-11-2011 issued by
opposite party.
List of exhibits marked for the opposite parties:-
Ex.B1 Policy bearing No.0194353067
Ex.B2 Proposal Form dated 01-12-2012
Ex.B3 Photo copy of Voter Identity Card.
Ex.B4 Photo copy of Discharge Summary Card issued by Government
General Hospital, Kurnool dated 18-08-2010.
Ex.B5 Photo copy of Discharge Summary Card issued by Government
General Hospital, Kurnool dated 18-08-2010.
Ex.B6 Photo copy of Case Sheet.
Ex.B7 Photo copy of Death Certificate issued by Registrar of Birth and
Deaths, Kurnool Municipal Corporation, Kurnool
Ex.B8 Photo copy of Investigation Report.
Sd/- Sd/-
LADY MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties :
Copy was made ready on :
Copy was dispatched on :
