BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 8/2013.
THIS THE 13th DAY OF SEPTEMBER 2013.
P R E S E N T
1. Sri. Prakash Kumar B.A. LLB. PRESIDENT.
2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.
3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER.
*****
COMPLAINANT :- Sri. Jagadesh S/o. Basangouda Hosamani aged
32 Occ: Agri., R/o. Marlanahalli village, Tq. Gangavathi, Dit: Koppal.
//VERSUS//
OPPOSITE PARTY :- The Branch Manager,
Bajaj Alllianz Life Insurance Company Ltd., Near ICICI Bank Sindhanoor, Dist: Raichur.
Date of institution :- 24-01-2013.
Date of disposal :- 13-09-2013
Complainant represented by Sri. Prasanna Sharma, Advocate.
Respondent represented by Sri. Vishwanath Pattansetty, Advocate.
ORDER
By Sri. Prakash Kumar, President:-
The complaint is filed by the complainant against the Respondent U/sec. 12 of Consumer Protection Act 1986.
2. The complaint in brief is that, the father of the complainant Basangouda Hosamani had insured his life with the Respondent’s Insurance Company under Policy No. 0219919071 for Rs. 6,00,000/- in which the complainant has made as nominee. The premium amount payable is Rs. 44,040/-p.a. it was paid while obtaining the policy. The said Basangouda died on 27-11-2011. The complainant being the nominee under the policy made claim with the Respondent’s Insurance Company to pay the amount assured under the policy. However the Respondent instead of settling the claim by giving untenable reasons repudiated the claim. Therefore the complainant got issued legal notice to the Respondent calling upon him to settle the claim which was served and in spite of it the Respondent neither settled the claim nor replied to the notice. Hence the complaint seeking compensation as prayed for.
3. The Respondent filed written version stating that the allegations made in the complaint are not true. The averments made in the complaint Para No.3 to 15 are denied as false. The complaint is not maintainable either in law or on facts. The deceased life assured had not disclosed the previous ailments which he was suffering prior to making the proposal, which he was under an obligation to mention at the time of applying for the Insurance policy. Had he disclosed the same the company would not have insured the life assured or would have certainly called for more documents and medical tests. The breach of providing information by the assured entitles the insurer to avoid the contract of insurance so long as he can show that the non disclosure induced the making of the contract on the relevant terms. The claim of the complainant also stands repudiated on the ground that, the life assured had suppressed and under stated his age while availing the policy. The life assured had the knowledge that he had not shown proper age and pre existing disease at the time of making proposal to the Insurance Company. Therefore the life assured is guilty of suppression of material facts at the time of proposal for Insurance. The proposer who intends to take the Insurance policy has to fill in the material details in the proposal form among which the age, medical details have to be provided as per the Insurance Act. The policyholder and the company are bound by the terms and conditions of the policy. The Life Insurance policy issued to the life assured is based on the principles of “Uberimma Fidei” i.e, utmost good faith and accordingly the Insurance company rely on the declarations and statements made in the proposal form and issue the Insurance policy. The insured must disclose to the insurer all materials facts to the insurer’s appraisal of the risk, which are known or deemed to be known by the insured, but neither known nor deemed to be known by the insurer. Para-1 & 2 of the complaint does not require any explanations as it all matters of records. On receipt of the claim from the complainant the Respondent Insurance company made various investigations regarding cause of death of the policyholder which discloses that he was known DM,HTN and IHD patient and was regularly taking treatment at Sri Laxmi Nursing Home. The medical cause of death was Cardiac arrest secondary to sepsis, diabetes and IHD. The investigation reveled that the actual age of the deceased was 70 years at the time of death whereas in the proposal form it was mentioned as 54 years. Thus it is proved that the material facts pertaining to the actual age and previous ailments of the deceased life assured were suppressed while availing the policy. The actual age of the policyholder and pre existing disease was known to him prior to making the proposal for insurance policy and same was deliberately concealed by him during proposal of insurance. Therefore the Respondent Insurance Company rightly repudiated the claim of the complainant. Hence there was no deficiency in service on the part of the Respondent’s Insurance Company. Therefore the complaint is liable to be dismissed with cost in the interest of justice and equity.
5. Complainant to prove his case filed his affidavit which is marked as PW-1 and relied on ten documents which are marked as Ex.P-1 to Ex.P-10. The Respondents to prove their case filed their affidavit evidence which is marked as RW-1 & RW-2 and relied on thirty documents which are marked as Ex.R-1 to Ex.R-30.
6. Arguments heard on complainant’s side.
7. The points that arise for our consideration are:
1. Whether the complainant proved deficiency in service on the part of the Respondent against him.?
2. Whether the complainant is entitled for the reliefs prayed for.?
3. What order?
8. Our answer on the above points are as under:
(1) In the affirmative.
(2) Partly in the affirmative.
(3) As per final order:
REASONS
POINT NO.1 :-
9. The Respondent admitting the issuance of LIC Policy in favour of the deceased life assured Basangouda by his Insurance Company on the death of the said Basangouda repudiated the claim made by the complainant, he being the nominee under the said policy, on the ground of suppression of material facts by the deceased life assured with regard to his previous ailments and age while making proposal for Insurance policy. It is the case of the Respondent that, the deceased life assured was DM,HTN IHD patient and was regularly taking treatment at Sri Laxmi Nursing Home and the deceased was aged 75 years at the time of his death and in the proposal form he mentioned his age as 54 years.
10. As per the proposal form said to have been filled up by the deceased life assured which is marked Ex.R-1 the copy of which is marked as Ex.P-4, at col. No.14 pertaining to ailments, if any, the deceased life assured answered the questions were in the ‘negative’, indicating that the deceased life assured was not at all suffering from any disease and he was not treated any where for any such diseases. Like wise in the said proposal form at col. No.1 the date of birth of the deceased life assured was mentioned as 01-01-1957 and aged 54 years and proposal form was dt. 31-05-2011.
11. To substantiate the contention that the deceased life assured had suppressed about his previous ailments the Respondent has produced the death certificate issued by Sri Laxmi Nursing Home, Gangavathi marked as Ex.R-27and copy of report issued by Jayadeva Institute of Cardiology Bangalore which is marked as Ex.R-29. On the basis of the certificate Ex.R-16 the Respondent contended that the age of the deceased life assured 70 years and it shows that he was suffering from diabetes HTN-IHD which fact was not shown in the proposal form while making proposal for Insurance policy by the deceased life assured. However what we would like to opine is that the age mentioned in Ex.R-16 as 70 years cannot be accepted as gospel truth with regard to the age of the deceased life assured because it is not an authenticated document regarding the age of the deceased life assured. To prove the correct age of the deceased life assured the Insurance company must produce some authenticated documents like school certificate, birth certificate or other reliable and authenticated documents. The PAN Card pertaining to deceased life assured the copy of which is marked as Ex.R-4 which is produced by the Respondent shows date of birth of deceased life assured as on 01-01-1957 which is as per the date of birth shown in the proposal form. This shows that the contention of the Respondent that the deceased life assured had suppressed his age while making proposal for Insurance policy is found baseless and therefore has to fail. Now coming to the allegations of suppression of previous ailments by the deceased life assured Ex.R-16 does not disclose since when the deceased life assured was suffering from DM,HTN IHD. It does not reveal that the deceased life assured was suffering from said disease prior to making proposal for Insurance policy. Therefore the said document Ex.R-16 is of no use for the Respondent. In proving the allegation of suppression of previous ailments by the deceased life assured the coronary angiogram report given by Jayadeva Institute of Cardiology Bangalore the copy of which is marked as Ex.R-29 dt. 01-02-06 shows the age of the patient Basangouda as 68 years. As per the PAN Card, copy of which is produced by the Respondent and marked as Ex.R-12 shows that the date of birth of deceased life assured as on 01-01-1957. Therefore in the year 2006 when Ex.R-29 was issued the deceased life assured must be aged 49 years. So Ex.R-29 as belonging to deceased life assured is doubtful because in it the age of Basangouda is shown as 68 years. It does not disclose the full identity of the patient. Therefore it cannot be concluded that the said certificate pertains to deceased life assured Basangouda. So on the basis of the said document it cannot be concluded that the said certificate pertains to the deceased life assured and as per it he had undergone coronary angiogram at Jayadeva Institute of Cardiology, Bangalore and he had suppressed the said fact while making proposal for Insurance policy with the Respondent’s Insurance Company. Besides this the said document Ex.R-29 is not legible and clear therefore it cannot be relied to conclude that it pertains to the deceased life assured. Further the said document is not supported with the evidence of the doctor who issued the certificate or who allegedly treated the patient Basangouda. Therefore practically there is no reliable evidence produced by the Respondent to prove suppression of previous ailments by the deceased life assured while making proposal for Insurance policy with the Respondent’s Insurance Company. Therefore repudiation of the claim made by the complainant to pay the amount assured under the policy amounts to deficiency in service on the part of the Respondent’s Insurance Company. Accordingly this point is answered in the affirmative.
POINT NO.2:-
12. As the complainant has proved deficiency in service on the part of the Respondent’s Insurance Company and that the repudiation made by the Insurance Company to pay the amount assured under the policy being found baseless, the complainant is entitled for the amount assured under the policy along with interest and cost of the proceedings which shall be as per final order. Accordingly, we answer this point partly in affirmative.
POINT NO.3:-
13. As per order below:
ORDER
The complaint filed by the complainant is partly allowed with cost.
The complainant is entitled to recover sum of Rs.6,00,000/- from Respondent.
The complainant is also entitled to recover interest at the rate of 6% p.a. on total sum of Rs.6,00,000/- from the date of the complaint till realization of the full amount.
The complainant is also entitled to recover sum of Rs.1,000/- towards cost of the proceedings from the Respondent.
Respondent is given one month time from the date of this order for making payment of the above said amount.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 13-09-2013)
Smt.Pratibha Rani Hiremath Sri. Gururaj Sri. Prakash Kumar
Member. Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur. District Consumer Forum Raichur.
