Telangana

Mahbubnagar

CC/11/40

N. Ashok Kumar S/o Tuljaram - Complainant(s)

Versus

The Branch Manager, Reliance Life Insurance Corporation Ltd, and Another - Opp.Party(s)

Sri P. Amba Shankar,

09 Feb 2012

ORDER

BEFORE THE DISTRICT CONSUMER FORUM AT MAHABUBNAGAR

   Thursday, the 9^th day of February, 2012 

                                                                  Present:- Sri P. Sridhara Rao, B.Sc., LL.B., President

                Sri A. Veerupakshi, B.A., LL.B., Member     

                    Smt. D. Nirmala, B.Com., LL.B., Member        

C.C.NO. 40  Of   2011

 

Between:-

N. Ashok Kumar S/o Tuljaram, age 61 years, Occ: Retd. Govt. Employee, R/o H.No.16-108, Lingojikota village, Makthal Mandal, Mahabubnagar District.  

                                                               … Complainant

And

1. The Branch Manager, Reliance Life Insurance Corporation Ltd.,                 

    1-5-107/4, New Town, Opp: I.B., Mahabubnagar.

2. The Manager, Reliance Life Insurance Corporation Ltd., Reliance Hose

    No.6, 6^th floor, Haddows Road, Tamil Nadu, 600 006.                 

   … Opposite Parties

 This C.C. coming on before us for final hearing on 7-2-2012 in the presence of Sri P. Amba Shankar, Advocate, Mahabubnagar on behalf of the complainant and Sri M. Chennaiah Goud, Advocate, Mahabubnagar for the opposite parties and the matter having stood over for consideration till this day, this Forum made the following:   

                                                                                                           O R D E R

 (Sri P. Sridhara Rao, President)

1.  This is a complaint filed by the complainant under section 12 of Consumer Protection Act, 1986 seeking a direction to the opposite parties to pay sum of Rs.5,00,000/- being the insurance amount with interest @ 18% p.a. from the date of death of the policy holder i.e., 14-9-2010 till the date of realization, Rs.1,00,000/- towards compensation for mental agony besides costs of the complaint. 

2. The averments of the complaint in brief are that:- The complainant is the husband of late Smt. Sangeetha. During her life time the said Smt. Sangeetha had taken Reliance Life Insurance Policy bearing No.16601233 for Rs.5,00,000/- nominating the complainant as her nominee. The plan and term of the policy is Reliance Super Invest Assurance plus Basic Plan (with yearly premium of Rs.50,000/- and the date of commencement of the policy is on 23-3-2010).  After completion of all formalities by the wife of the complainant as required, the opposite parties issued the above said policy certificate on 23-3-2010 for Rs.5,00,000/- as assured amount to the wife of the complainant. While the matter stood thus, on 13-9-2010 due to ill health the complainant joined his wife/policy holder in Yashoda Hospital at Secunderabad for treatment and the doctors diagnosed Encephalopathy Pancytopenia with Thrombocytopenia. After diagnosing the problem by the doctors they started treatment to her and while undergoing treatment in the hospital she was died on 14-9-2010.  On account of the death of the deceased, as a nominee, the complainant is entitled to get Rs.5,00,000/- in terms of the insurance policy.  So, the complainant promptly intimated about the death of his wife to the opposite parties and preferred a claim for the amount covered by the policy along with relevant documents on 28-9-2010.  When the said claim was unsettled for a quite sufficient long period, the complainant sent a letter to the opposite parties demanding for payment of the claim amount.  Then the opposite parties sent a reply with false allegations on 19-1-2011 stating that the claim of the complainant is repudiated just for evading the payment of sum assured.  Such acts on the part of the opposite parties amounts to deficiency in service and unfair trade practice on their part.  Due to the unfair trade practice and defective services of the opposite parties the complainant has been put to pain and agony and so the complainant is entitled to claim for compensation.  Thus the present complaint is filed for the aforesaid relief.

3. The opposite parties filed their counter contending that the complainant himself rather falsely submitted the claim on the ground that only on 30-8-2010 the life assured fell down in bathroom with no injuries and when she contacted local hospitals it had been diagnosed TIA and treated on OP basis and sent home and later on 9-9-2010 due to feeling of some uneasiness she was given four units of PRP and referred to Yashoda Hospital at Secunderabad for medical treatment wherein she was admitted on 13-9-2010 and expired on 14-9-2010 on account of Encephalopathy, Pancytopenia with Thrombocytopenia.  It is further stated that on receipt of the claim statement the opposite parties got thoroughly investigated the matter by their authorized investigator who in turn submitted a report dated 8-11-2010 stating that the life assured had been suffering from Rheumatoid Arthritis but the insured concealed the said material fact willfully in her proposal form and obtained the policy by playing fraud with the opposite parties just to cause wrongful gain to the nominee and wrongful loss to the opposite parties and therefore the opposite parties are justified in repudiating the claim made by the complainant and as such there is no deficiency of service and unfair trade practice on their part and further the opposite parties as a goodwill gesture have refunded the fund balance of Rs.34,699.53Ps., as on the date of the death under the said policy vide cheque bearing No.033813, dt.20-1-2011 being the full and final settlement of the captioned policy and thus the complaint is liable to be dismissed with heavy costs.       

4. Thereupon the complainant in support of his claim filed his affidavit evidence and got marked Exs.A-1 to A-5. On the other hand, the opposite parties in support of their contentions filed their affidavit evidence and got marked Exs.B-1 to B-4.

  5.  The points for determination now are: 

1. Whether there is any deficiency and unfair trade practice on the part of the opposite parties in rendering service to the complainant as alleged?

    (ii)  Whether the complainant is entitled for the relief sought for by him?          

    (iii)  To what effect? 

6. The undisputed facts in the case are that the complainant is the husband of late Smt. Sangeetha who during her life time insured her life nominating the complainant as her nominee and the opposite parties accordingly issued the policy in question on 23-3-2010 to an assured sum of Rs.5,00,000/-.  It is also an admitted fact that the insured Smt. Sangeetha died on  14-9-2010 while undergoing treatment in Yashoda Hospital at Secunderabad and the cause of her death was due to Encephalopathy, Pancytopenia with Thrombocytopenia.    

7. Point Nos.1 and 2:- The learned standing counsel for the opposite parties contended that much earlier to her taking the policy the insured   Smt. Sangeetha was suffering from Rheumatoid Arthritis since July, 2009 and though the information relating to her hospitalization and treatment was specifically sought in the proposal form but it was suppressed by the assured and therefore the insurance company was justified in repudiating the claim due to suppression of relevant information relating to the health of the assured which had material bearing on the risk to be assumed by the insurance company and therefore the complainant is not entitled for the relief sought for by him.

8. On the other hand, the learned counsel for the complainant while relying upon two decisions reported in 1) IV (2011) CPJ 6 (SC) (P. Vankat Naidu Vs. Life Insurance Corporation of India & Another) and 2) IV (2011) CPJ 663 (NC) (LIC of India & Others Vs. Surekha Rameshrao Mankar) contended that the opposite parties did not produce any tangible evidence to prove that the deceased Smt. Sangeetha withheld information about her such hospitalization and treatment, and that the alleged disease as contended by the opposite parties was in no way related to her cause of death and therefore the opposite parties are not justified in repudiating the claim on the ground that the deceased suppressed information relating to her illness as such the complainant is entitled to the relief sought for by him.   

9. So the only question that has to be seen now in the matter is whether the opposite parties are justified in repudiating the claim made by the complainant on the ground that the deceased suppressed information relating to her health in the proposal form submitted by her? 

10. To consider the said aspect the opposite parties relied upon Exs.B-1 to B-4 and among them Ex.B-1 is the copy of medical record said to have been issued by KIMS while Exs.B-2 and B-3 are the copies of some other medical records said to have been issued by Aditya Hospital.  Ex.B-4 is the copy of the proposal form said to have been submitted by the deceased   Smt. Sangeetha to the opposite parties for obtaining the policy in question.  The opposite parties in support of their contentions except relying upon the medical records Exs.B-1 to B-3 did not produce the affidavit evidence of any of the doctors of the concerned hospitals to prove its contentions.  Further, there is no evidence produced by the opposite parties to show that the deceased died due to the alleged pre existing disease.  As stated above, as per the counter and the affidavit evidence filed by the opposite parties, it is the contention of the opposite parties that on receipt of the claim statement they appointed Zubair & Co. investigators to investigate into the claim of the complainant and authorized the said investigator to collect all the relevant documents pertaining to the case from the hospital, police authorities and government department etc., and that the matter was thoroughly investigated by the said investigator and they submitted their report dated 8-11-2010 revealing that the life assured had been suffering from Rheumatoid Arthritis since July, 2009 well prior to the issuance of the policy and the life assured had died due to the complications of the same.  The opposite parties except taking such a contention did not produce any affidavit evidence of such investigator and also not filed any such report dated 8-11-2010 in order to establish their contention. Therefore, in the absence of any such oral or documentary evidence, the contention of the opposite parties that the assured had been suffering from Rheumatoid Arthritis since July, 2009 well prior to the issuance of the policy and the life assured had died due to the complications of the same is not tenable and acceptable. As per Ex.A-4 medical record the cause of death of the deceased/insured was due to Encephalopathy, Pancytopenia with Thrombocytopenia.  According to Ex.A-5 certificate dated 12-8-2011 said to have been issued by one Dr. B. Subhash, Rheumatoid Arthritis is not a condition which leads to death of a patient and Rheumatoid Arthritis will not cause to Thrombocytopenia or Encephalopathy on its own.  In view of the said unchallenged medical certificate Ex.A-5 it can clearly be said that the opposite parties are not justified in repudiating the claim on the ground that the insured has concealed the said material facts in the proposal form relating to her health condition.  In the decision relied upon by the learned counsel for the complainant reported in IV (2011) CPJ 663 (NC) it is held that “Normally while filling up an insurance proposal form, it is not expected that the insuree has to also state all incidents of viral infections from which he may have suffered since these are frequent, common place and curable”.     As stated above, the opposite parties did not produce any tangible evidence to prove that the deceased had withheld information about her health condition while submitting her proposal form for obtaining policy from the opposite parties.  Under the said circumstances and for the reasons stated above, we hold that the opposite parties are not justified in repudiating the claim by making a wild guess work that the deceased had suppressed the facts relating to her illness and such act on the part of the opposite parties in repudiating the claim on such flimsy ground amounts to deficiency of service and unfair trade practice on their part.  In other words, it can clearly be said that the complainant has established his claim against the opposite parties on the ground of deficiency of service and unfair trade practice, as such we hold that the complainant is entitled for the policy amount along with some interest and some reasonable compensation and costs of the complaint. Both the opposite parties are jointly and severally liable to comply the same.     

11. At this juncture, it is the contention of the opposite parties that as a goodwill gesture they have refunded the fund balance of Rs.34,699-53Ps., as on the date of the death under the said policy vide cheque bearing No.033813, dt.20-1-2011 being the full and final settlement of the captioned policy. It is no doubt true that they have mentioned the said fact in their counter and as well as affidavit evidence. If any such positive proof is produced in that regard by the opposite parties, the opposite parties are entitled to deduct the said amount at the time of making payment if any to the complainant in compliance of the present order. According to the contention of the opposite parties the said cheque was enclosed to their repudiation letter dated 19-1-2011 sent to the complainant.  Ex.A-3 is the copy of such letter which clearly goes to show that the opposite parties have informed the complainant that their branch officials will personally hand over the cheque to the complainant. But the opposite parties absolutely did not produce any oral or documentary evidence to show that they have delivered such cheque to the complainant.  Therefore, in the absence of any such material placed on record by the opposite parties, we find that the opposite parties are not entitled for deduction of any amount while complying the present order.  Both the points are answered accordingly in favour of the complainant and against the opposite parties.   

12. Point No.3:- In the result, the complaint is allowed in part directing the opposite parties jointly and severally to pay to the complainant a sum of Rs.5,00,000/- towards the policy amount along with interest @ 9% p.a. from the date of the death claim made by the complainant on 28-9-2010 till the date of its realization besides a sum of Rs.5,000/- towards compensation and Rs.500/- towards costs of the complaint within one month from the date of the present order.

         Typed to dictation, corrected and pronounced by us in the open Forum on this the 9^th day of February, 2012.    

 

      I agree                                I agree                                                                 

    MEMBER                             MEMBER                              PRESIDENT            

 

  Appendix of evidence

      List of Witness examined

On behalf of Complainant:                          On behalf of Opposite Parties:   

- Nil -                                                                     - Nil -                                       

List of documents marked:-

On behalf of Complainant:-    

Ex.A-1: Copy of Policy Schedule, dt.23.3.2010.

Ex.A-2: Copy of Letter, dt.25.10.2010.

Ex.A-3: Copy of Repudiation Letter, dt.19.1.2011.

Ex.A-4: Copy of Medical Report.

Ex.A-5: Medical Certificate, dt.12.8.2011.  

On behalf of OPs:                  

Ex.B-1: Photostat copy of Out Patient Card, dt.20.4.2009.

Ex.B-2: Photostat copy of Out Patient Card, dt.11.7.2009.

Ex.B-3: Photostat copy of Out Patient Card.

Ex.B-4: Photostat copy of Proposal Form, dt.18.3.2010.                                                                                                               

                                                                       

                                                                        PRESIDENT                                

Copy to:-

1. Sri P. Amba Shankar, Advocate, Mahabubnagar on behalf of the complainant.

2. Sri M. Chennaiah Goud, Advocate, Mahabubnagar for the opposite parties.