Date of filing: 24-01-2014.
Date of disposal: 25-08-2014.
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
Friday, the 22nd day of August, 2014
C.C.No.36 of 2014
Between:
Sama Sridevi, D/o Chinni Rama Rao, Hindu, Aged about 43 years, R/o.D.No.39-1-90/B; Labbipeta, Mahatma Gandhi Road, Vijayawada - 520 010.
... Complainant
And
1. The Branch Manager, Reliance Life Insurance Co., Ltd., D.No.40-1-21/1-3, Surya Towers, III Floor, M.G. Road, Vijayawada – 520 002.
2. The CEO, Reliance Life Insurance Co., Ltd., H – Block, 1st Floor, Dhirubai Ambani Knowledge City, Navi Mumbai, Maharashtra – 400710.
. … Opposite Parties.
This complaint is coming before for final hearing on 7-8-2014 in the presence of Sri T. Siva Rama Reddy, advocate for complainant, Sri Ch. Suresh Kumar, advocate for opposite parties, and having stood over for consideration till this day, the Forum doth order the following:
ORDER:
(Delivered by Hon’ble Member Sri S. Sreeram)
This is a complaint filed by the complainant under Sec.12 of Consumer Protection Act against the opposite parties 1 and 2 directing them to make payment of claim amount of Rs.7,50,000/- with subsequent interest at 18% p.a., to pay compensation of Rs.20,000/- towards mental agony, for costs and other reliefs.
1. The brief averments of the complaint are as follows:
The father of the complainant being induced by the representations made by the executives of opposite parties 1 and 2 obtained a policy by name “Reliance Super gold years plan” vide policy No.14263450, dt.16.4.2009 with an annual premium of Rs.15,000/- for a period of 13 years and the sum assured is Rs.7,50,000/- and that the father of the complainant nominated his daughter i.e. complainant as his nominee and since the date of the policy, the father of the complainant paid the premiums till 2013. While so, the father of the complainant expired on 24-4-2013 due to chest pain at his house at Thammavaram, Korisapadu, Prakasam District and the complainant being the nominee approached the 1st opposite party for settlement of claim after producing necessary documents. But the complainant noticed that Rs.51,202-23 ps was credited to her account. The opposite parties 1 and 2 contrary to the terms of policy repudiated the claim in part, which is nothing but deficiency in service. The complainant got issued a legal notice dt.18-11-2013 to the opposite parties with a demand to pay entire death benefit covered under the policy. The opposite parties though received notice failed to pay the amount. Hence, the complaint.
2. After registering the complaint, notices were sent to the opposite parties. The opposite parties 1 and 2 while admitting the issuance of policy to the father of complainant on 16-4-2009 and death of life assured, denied the rest of the allegations and contended that there is no deficiency of service on their part and that the father of complainant has committed default in payment of premiums resulting which the policy was lapsed and that again he applied for reinstatement of policy and submitted renewal premium and declaration of good health on 22-3-2013 mentioning that he was not suffered from any major ailments. The opposite parties 1 and 2 further contended that the life assured was hospitalized on 5-3-2013 and was diagnosed for CAD/TVD/Cardiomyopathy and that he also underwent angiogram on 7-3-2013 and the life assured suppressed the said fact and obtained renewal policy and as such the complainant is not entitled for any benefit under the policy and prayed to dismiss the complaint.
3. The complainant filed her chief affidavit reiterating the material averments of the complaint and got marked Ex.A1 to A10 on her behalf. The authorized signatory of opposite parties filed chief affidavit and got marked Ex.B1 to B6.
4. Heard both sides and perused the record.
5. Now the points that stood for consideration are
- Whether there is any deficiency of service on the part of opposite parties in repudiating the claim of complainant?
- If so, to what relief?
Point No.1:
6. The undisputed facts in this case are that the father of complainant by name Chinni Ramarao obtained policy under the name and style of “Reliance Super Golden Years plan” from the opposite parties 1 and 2 vide policy No.14263450 on 16-4-2009. As seen from Ex.A1 letter dt.16.4.2009, Ex.A2 receipt for payment of 1st premium, Ex.A3 is statement of account, Ex.A4 Benefit illustration, Ex.A5 policy schedule and Ex.A6 Policy document discloses that the father of complainant took the afore said policy with an annual premium of Rs.15,000/- for a period of 13 years and the sum assured is Rs.7,50,000/-. The opposite parties are not disputing the above said facts. Further there is no dispute with regard to death of life assured on 24-4-2013, which is evident from Ex.A7. According to the complainant her father paid the premiums till 2013 and later expired on 24-4-2013 and that she being the nominee of life assured approached the opposite parties for settlement of claim, but they repudiated part of claim and only paid some amount. As such she got issued legal notice under Ex.A8 (Ex.A9 are postal receipts) to the opposite parties and the same was returned under Ex.A10.
7. In this regard, the contention of the opposite parties is that the father of complainant committed default in payment of premium amounts and consequently the policy was lapsed and thereafter he again applied for reinstatement of policy and submitted renewal premium and declaration of good health on 22.3.2013 and that he mentioned that he was not suffered from any major ailments by suppressing the fact that he was diagnosed for chest pain and underwent angiogram.
8. Perusal of record discloses that, though the complainant stated that her father paid the premiums up to 2013, she has not filed the receipts before this Forum. She filed the only first premium receipt dt.19.4.2009 under Ex.A2. As per the version of opposite parties, the life assured committed default in payment of premium and as such the policy was lapsed. The non filing of premium receipts gives strength to the version of opposite parties that the policy was lapsed. Further as seen from Ex.B1 proposal form dt.31.3.2009, the life assured has mentioned that he was not suffering from any medical ailments and basing on the said statement, the policy was issued. As per the version of the opposite parties, the life assured applied for reinstatement of policy by submitting the renewal premium and accordingly they renewed the policy upon the declaration of state of health form given by life assured under Ex.B3. Perusal of Ex.B3 discloses that the life assured gave answers regarding his health as follows:
- Are you now in good health and entirely free … Yes
- …….
- Have you had or been advised to undergo hospital Treatment or surgery in the last one year No
Ex.B3 declaration was given by the life assured on 22.3.2013 and he has expired on 24-4-2013 as seen from Ex.A7 death certificate. As the life assured expired within two years of the renewal of policy, the insurance company has every right to investigate into the matter as per Sec.45 of Insurance Act. According to opposite parties, the life assured joined in Usha Cardiac Center Ltd., New Delhi on 5-3-2013 for CAD/TVD and was discharged on 8-3-2013 and that he was also underwent Angiogram on 7-3-2013. Ex.B4 and B5 Discharge summary issued by Usha Cardia Center discloses the said fact. Admittedly the life assured gave declaration on 22.3.2013 after getting treatment from the hospital. But he has not disclosed the said fact in the declaration and suppressed the same. If the life assured mentioned the said facts, the opposite parties would not have renewed the policy of life assured. The life assured is under a solemn obligation to disclose the true and full information sought in the declaration and non disclosure of facts as to his illness in the declaration though he was suffering from certain diseases at relevant point of time amounts to suppression of material facts. Any inaccurate answer to the said questions will entitle the insurer to repudiate the liability under policy. In the present case also, the life assured has not disclosed the true and correct state of facts regarding his treatment at Usha Cardiac Center in the declaration though the same is within his knowledge and it seems that the life assured with a malafide and malicious intention suppressed the said fact.
9. In the result, the complaint is partly allowed and the opposite parties 1 and 2 are jointly and severally directed to pay Rs.5,000/- to the complainant with interest at 9% p.a. from the date of application till realization. The opposite parties 1 and 2 are also directed to pay compensation of Rs.1,000/- besides costs at Rs.500/-. Time for compliance is one month. The other claims of complainant are hereby dismissed.
Typewritten by Steno N. Hazarathaiah, corrected by me and pronounced by us in the open Forum, this the 22nd day of August, 2014.
PRESIDENT (FAC) MEMBER
Appendix of evidence
Witnesses examined
For the complainant: -None- For the opposite party: -None-
Documents marked
On behalf of the complainant:
Ex.A1 16.04.2009 Original copy of letter issued by OP to complainant.
Ex.A2 Original copy of first premium receipt.
Ex.A3 Original copy of statement of account.
Ex.A4 Original copy of benefit illustration for reliance super golden year plan.
Ex.A5 Original copy of policy schedule.
Ex.A6 Original copy of policy document.
Ex.A7 Photocopy of death certificate.
Ex.A8 18.11.2013 Photocopy of legal notice got issued by complainant to OPs.
Ex.A9 Postal receipts.
Ex.A10 Returned postal cover and postal acknowledgement.
On behalf of the opposite parties:
Ex.B1 Photocopy of common proposal form for LI – Linked plan.
Ex.B2 Photocopy of policy document.
Ex.B3 Photocopy of declaration of state health form.
Ex.B4 Photocopy of claim form –A of OPs.
Ex.B5 08.03.2013 Photocopy of discharge report.
Ex.B6 12.07.2013 Photocopy of letter issued by OP to complainant.
PRESIDENT (FAC).
