Date of filing: 13.5.2014.
Date of disposal:18.11.2014.
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM - II:
VIJAYAWADA, KRISHNA DISTRICT
Present: SMT N. TRIPURA SUNDARI, B. COM., B. L., PRESIDENT (FAC)
SRI S.SREERAM, B.COM., B.A., B.L., MEMBER
TUESDAY, THE 18TH DAY OF NOVEMBER, 2014.
C.C.No.113 of 2014
Between:
Mullapudi Raj Kumar, S/o Raju, Hindu, Agricultural Coolie, House No.2-42/A, Jakkulanekkalam Village, Gannvarm Mandal, Krishna District. Andhra Pradesh.
. … Complainant.
AND
1. The Branch Manager, M/s Birla Sun Life Insurance Co., Ltd., Near Kazana Jewelleries, K.P. Towers, Benz Circle, M.G.Road, Vijayawada – 520 010, Andhra Pradesh.
2. The Managing Director, M/s Birla Sun Life Insurance Co., Ltd., One India Bulls Centre, 841, Senapati Bapat Marg, Mumbai – 400 013, Maharashtra State.
3. The Authorized Signatory, M/s Birla Sun Life Insurance Co., Ltd., 6th Floor, Kasar Wadavali, Ghodbunder Road, Thane – 400 601, Maharashtra State.
. … Opposite Parties.
This complaint coming on before the Forum for final hearing on 12.11.2014, in the presence of Sri K.Satyannarayana Rao, Advocate for complainant and Sri P.Raghu Kumar, Advocate for opposite parties and upon perusing the material available on record, this Forum delivers the following:
O R D E R
(Delivered by Hon’ble President (FAC) Smt N. Tripura Sundari)
This complaint is filed under Section 12 of the Consumer Protection Act, 1986.
The averments of the complaint are in brief:
1. The complainant’s mother obtained insurance policy ‘Vision’ from the opposite parties on 14.1.2012 vide policy No.005323977 for a period of 21 years covering 100 years. The sum assured is Rs.1,11,000/- and the annual premium is Rs.6,454.65ps. The complainant’s mother paid the first premium on 14.1.2012. The complainant is the nominee under the said policy. While so on 23.2.2012 the mother of the complainant died due to sudden acute respiratory problem. The complainant informed the said fact to the 1st opposite party and submitted all necessary documents for settlement of the claim. On receipt of the said claim papers the opposite party repudiated the claim of the complainant on the ground that the insured suppressed the material facts with regard to her health at the time of applying for the policy. Under the said circumstances the complainant got issued a legal notice demanding the opposite parties to settle the claim. The opposite parties received the said notice and issued a reply with all false allegations which amounts to deficiency in service. Hence the complainant is constrained to file this complaint against the opposite parties praying the Forum to direct the opposite parties to pay an amount of Rs.1,11,000/- along with interest at the rate of 24% per annum from the date of death of the insured till realization to pay Rs.30,000/- for mental agony and to pay costs.
2. The version of the opposite parties is in brief:
The opposite parties denied all the allegations of the complaint and submitted that the claim of the complainant was repudiated as per the terms and conditions of the policy on the ground of suppression of material facts in the proposal form. The life assured is suppressed her past medical history. The life assured was admitted in Praveen Cardiac Centre, Vijayawada on 16.3.2007 and was diagnosed with Atypical chest plain NYHA class II & lower respiratory tract infection. The life assured after taking treatment discharged from the hospital on 18.3.2007. The opposite parties replied to the legal notice of the complainant vide its letter dated 3.7.2013. The opposite parties investigate each and every claim received by it and releases the claim amount of genuine claims and reject the false claims. In the present case the claim of the complainant was found to be false. Therefore the opposite parties reject the claim on the ground of concealment of material facts in the proposal form. Therefore there is no deficiency in service on the part of the opposite parties and prayed to dismiss the complaint with costs.
3. On behalf of the complainant he gave his affidavit and got marked Ex.A.1 to Ex.A.11. On behalf of the opposite parties Ms Harshita Dere Authorized Representative gave her affidavit and got marked Ex.B.1 to Ex.B.7.
4. Heard and perused.
5. Now the points that arise for consideration in this complaint are:
1. whether there is any deficiency in service on the part of the opposite parties in
repudiating the claim of the complainant?
2. If so is the complainant entitled for any relief?
3. To what relief the complainant is entitled?
POINTS 1 AND 2:
6. It is not a disputed fact that the mother of the complainant obtained ‘vision’ policy No.005323977 on 14.1.1012 from the opposite parties by paying first premium, the complainant is the nominee under the said policy. The policy holder died on 23.2.2012. After the death of the insured the complainant made a claim under Ex.A.3 and submitted all necessary documents for settlement of the claim. On receiving the claim form the opposite parties repudiated the claim of the complainant on the ground that the insured suppressed the material facts with regard to her health at the time of applying for the policy. Under these circumstances the complainant got issued a legal notice Ex.A.8 dated 15.2.2013 demanding the opposite parties to pay the claim amount of Rs.1,11,000/- and to pay compensation of Rs.30,000/- for mental agony along with interest at 24% per annum from the date of death of the deceased/life assured. The opposite parties gave a reply notice Ex.A.9 dated 3.7.2013 informing that the deceased/life assured got policy on 14.1.2012 on the basis of information provided in the application form Ex.B.1 duly filled and signed with declaration that she understand and agreed that all statements and answers made in the application (proposal for insurance) provided in connection with this application are true and complete to the best of her knowledge and belief and she had not made any statement to the agent, medical examiner or any other person associated with BSLI which in any way modifies the statement and answers in this application and she hereby declared that the contents of the application for insurance have been fully explained to her and she has fully understood the significance of the proposed contract of insurance. The said claim was duly examined by opposite parties and on the basis of the documents evidenced, repudiated the same on the ground of non disclosure of past medical history at the time of applying for the said policy. The policy has been obtained fraudulently by suppressing material facts. The contract of insurance based on utmost good faith i.e., principle of uberrimae fidaes. The life assured had suppressed material facts that she was suffering from Atypical chest pain NYHA class II and lower respiratory tract infection prior to the policy issuance and she had underwent various tests and treatment for the same prior to her application for insurance. If the insured had disclosed the correct and true medical facts to the opposite parties the opposite parties would not have issued policy at all. Ex.B.4, Ex.B.5 and Ex.B.7 shows the said facts that the insured underwent treatment for the above said medical problems regarding her health and she was joined in Praveen Cardiac Hospital on 16.3.2007 and discharged on 18.3.2007. We noted in Ex.B.1 proposal form, for all questions of para 14 she answered as ‘no’. Then the opposite parties repudiated the claim of the complainant. As per the terms and conditions of the policy the parties to the contract are bound by them. The deceased/life assured obtained the policy on 14.1.2012 and died on 23.2.2012 within a short period of 40 days from obtaining the policy. On the ground that the complainant suppressed the facts about her previous medical history, the opposite parties repudiate the claim of the complainant. Therefore we hold that there is no deficiency in service on the part of the opposite parties in repudiating the claim of the complainant. Hence the complainant is not entitled any relief as he prayed. Accordingly these points are answered.
POINT No.3:-
8. In the result, the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected by me and pronounced by us in the open Forum, this the 18th day of November, 2014.
PRESIDENT(FAC) MEMBER
Appendix of evidence
Witnesses examined
For the complainant: For the opposite parties:
P.W.1 M.Raj Kumar D.W.1 Harshita Dere,
Complainant, Authorized Representative
(by affidavit) of the opposite parties
(by affidavit)
Documents marked
On behalf of the complainant:
Ex.A1 13.01.2012 Photocopy of application form
Ex.A.2 14.01.2012 Photocopy of First Premium Receipt.
Ex.A.3 24.05.2012 Photocopy of Death claim intimation form.
Ex.A.4 . . Photocopy of Claimants statement.
Ex.A.5 26.05.2012 Photocopy of Declaration issued by the complainant about his father.
Ex.A.6 29.12.2012 Photocopy of Death certificate.
Ex.A.7 26.04.2012 Photocopy of Medical Certificate issued by Sri Sai Hospital, Vijayawada.
Ex.A.8 15.02.2013 Office copy of legal notice.
Ex.A.9 03.07.2013 Photocopy of reply notice.
Ex.A.10 . . Photocopy of identity card issued by the Election Commission.
Ex.A.11 15.02.2013 Photocopy of household card.
On behalf of the opposite parties:
Ex.B.1 13.01.2012 Photocopy of application form
Ex.B.2 . . Photocopy of Claimants statement.
Ex.B.3 24.04.2012 Photocopy of death certificate.
Ex.B.4 . . Photocopy of discharge summary.
Ex.B.5 18.03.2007 Photocopy of Echo Cardiographic Report issued by Praveen Cardiac Centre, Vijayawada.
Ex.B.6 25.06.2012 Photocopy of letter from the 2nd opposite party to the complainant.
Ex.B.7 17.03.2007 Photocopy of Haemogram report issued by Chetan Diagnostic Centre, Vijayawada.
PRESIDENT(FAC)
