BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 13/11.
THIS THE 8th DAY OF AUGUST 2011.
P R E S E N T
1. Sri. Pampapathi B.sc.B.Lib. LLB PRESIDENT.
2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.
3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER.
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COMPLAINANT :- Basavaraj S/o. Laxmana, Age: 38 years, Occ:
Business, R/o. Natraj Stores, Opp: Shet
Petrol Bunk, Maski, Lingasugur, Dist: Raichur.
//VERSUS//
OPPOSITE PARTY :- 1. The Branch Manager, Shriram Life Insurance
Company Ltd., Branch Sindhanoor Dist: Raichur.
2. The Assistant General Manager, Shriram Life
Insurance Company Ltd., Reg. Office 3-6-476, 3rd floor, Anand Estate Liberty Road, Himayath Nagar, Hyderabad- 500029. (AP)
CLAIM : For to direct the opposite to pay an assured
sum of Rs. 5,00,000/- towards mental harassment and deficiency in service with cost of Rs. 10,000/- other reliefs as deems fit to the circumstances of this case.
Date of institution :- 21-02-11.
Notice served :- 26-02-11.
Date of disposal :- 08-08-11.
Complainant represented by Sri. T.M. Swamy, Advocate.
Opposite No.1 Exparte.
Opposite No-2 represented by Sri. Yadavendra Katti, Advocate.
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This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.
JUDGEMENT
By Sri. Pampapathi President:-
This is a complaint filed by complainant Basavaraj against the opposite Nos. 1 & 2 Sriram Life Insurance Company Ltd., U/sec. 12 of Consumer Protection Act for to direct the opposite to pay an assured sum of Rs. 5,00,000/- under the policy of deceased Smt. Sita with death benefits, to pay a sum of Rs. 50,000/- towards mental harassment and deficiency in service and Rs. 10,000/- with cost and other reliefs as deems fit to the circumstances of this case.
2. The brief facts of the complainant’s case are that, Opposite No-1 Branch Office of Opposite No-2 situated at Sindhanoor. The complainant is the son and nominee. His mother Sita subscribed the policy by name SHRI PLUS for assured sum of Rs. 5,00,000/-, regular premiums under the said policy paid to opposites. The mother of the complainant expired on 16-04-10 in Maski village. The death was intimated to opposite Nos. 1 & 2, thereafter claim petition filed by the complainant for to make the payment of assured sum with death benefits as per the terms and conditions of the policy, but opposites illegally and on untenable grounds repudiated his claim on 28-10-10. As such, he filed this complaint for the reliefs as prayed in it.
3. Opposite No-1 Branch Office of Opposite No-2 placed Ex-parte. Opposite No-2 Main Office, situated at Hyderabad appeared in this case through its Advocate, filed its written version by admitting the fact that, deceased Sita subscribed SHRI PLUS policy for assured sum of Rs. 5,00,000/- for a term of (15) years. The said Sita was having past history of hypertensive, she took treatment for four years with one Dr. Basavalingappa Divater of Maski. She is suffering from common cold of hypertension. This fact was not disclosed by deceased, at the time of filing her proposal form. After her death investigation was done by the insurance company through investigator and noticed pre existing decease. Hence suppression of pre existing decease by Sita is a violation of terms and conditions of the insurance policy. Hence it repudiated the claim of complainant. There is no deficiency in service on its part. This Forum has no territorial jurisdiction to try the subject matter of this complaint. Accordingly, it prayed for to dismiss the complaint among other grounds.
4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that:
1. Whether the complainant is the son and nominee holder under Life Insurance Policy subscribed by Sita by name SHRI PLUS bearing Policy No. LN050900021378 for assured sum of Rs. 5,00,000/- for a period of (15) years. Further he proves that, his mother Sita died on 16-04-10, thereafter, he being the nominee holder under the said policy filed claim petition with all relevant records before the opposites, but opposites repudiated his claim on ill-legal and untenable grounds by showing their negligence in settling his claim and thereby opposite Nos. 1 & 2 found guilty under deficiency in their services.?
2. Whether complainant is entitled for the reliefs as prayed in his complaint.?
3. What order?
5. Our findings on the above points are as under:-
(1) In the affirmative
(2) As discussed in the body of this judgement and as noted in the final order.
(3) In-view of the findings on Point Nos. 1 & 2, we proceed
to pass the final order for the following :
REASONS
POINT NO.1 :-
6. To prove the facts involved in these two points, affidavit-evidence of the complainant was filed, he was noted as PW-1. The documents Ex.P-1 to Ex.P-4 are marked. On the other hand, affidavit-evidence of Assistant General Manager of Opposite No-2 was field, he was noted as RW-1. Documents Ex.R-1 to Ex.R-9 are marked.
7. Some of the undisputed facts between the parties in this case are:-
1. Complainant is the son and nominee holder under LIC policy issued by Opposite No-2 for assured sum of Rs. 5,00,000/- subscribed to his mother Sita for a term of (15) years, commencing from 28-12-09.
2. It is undisputed fact that, policyholder Smt. Sita died on 16-04-10 when the policy was inforce.
3. Further, it is undisputed fact that, death of insured and claim form with all necessary records submitted by this complainant before opposites for to settle the claim under the said policy, with death benefits.
4. It is further undisputed fact that, opposite No-2 repudiated the claim of complainant on the ground of suppression of material facts regarding ill-health of deceased Sita at the time of submitting her proposal form.
8. In the light of these undisputed facts, it is very much clear that, opposite insurance company repudiated the claim of complainant only on the ground that, deceased Sita suppressed the material facts regarding her ill-health while filing her proposal form and thereby it is a breach of the terms and conditions of the policy. Therefore there was no deficiency in its service in repudiating his claim.
9. The complaint denied all such contentions of the opposite.
10. It is now settled principles of the law that to prove the material suppression regarding ill health of insured in her proposal form is on the opposite insurance company. In this regard we have referred and followed the principles of the rulings (1) Mithoolal Nayak V/s. LIC AIR 1962 SC 814 and (2) LIC of India V/s. Kulwant Kumari 2009 CTJ 833 (NCDRC).
11. In view of the observations made by the their lordships of the Hon’ble Supreme Court, we have to see how as to whether the Opposite No-2 proved the fact of material suppression of the ill-health of Sita while filing her proposal form and the Opposite Insurance Company has justified in repudiating the claim of complainant.
12. The material records for opposite to prove this fact is Ex.R-9. It is a repudiation letter, in the said letter it appears that, opposite insurance company relied on the report of one Dr. Basavarajappa to come to conclusion that, deceased Sita was suffering with hypertension from past four years and she took treatment from him.
13. In support of such reliance by the opposites, it relied on the following documents:
1) Medical Attendance Certificate Ex.R-8 issued by Dr. Basavalingappa Divatar.
2) Indoor Patient case sheet Ex.R-5 issued by same doctor.
3) Certificate Ex.R-8(1) issued by one Dr. Nagangouda.B.Patil.
4) Attendance Certificate Ex.R-8(2) issued by Dr. Basavarajappa.
14. In support of these documents there is a pleading by the opposites in Para-8 of written version it is stated as Sita was suffering from hypertensive, she was taken treatment for past four years and common cold of hypertension.
15. At the most we can say from the above records that, Sita was hypertensive since four years of her death.
16. Whether hypertension is a decease causes instantaneous death or whether the same decease is incurable or whether it may indirectly cause death. By common experience, we can say that, hypertension is not causing instantaneous death, it is controllable, it has got a better treatment, it is not a threat to life if it is in control. When such being the medical theory, we are not agreeing with the contention of the opposite insurance company to hold that, such nature of decease is a danger or threat to life of insured. Apart from it, opposite insurance company has to prove the fact that, insured intentionally. Suppressed such decease only with an intention to get monetary benefit out of such suppression from this insurance policy. Mere not stating the names of general deceases or otherwise not disclosing such common disorders of the human body in the proposal form is not a suppression of material facts by the insured. We have to heard the principles of the rulings relied by the complainant (1) II 2007 CPJ 452 (DSCDRC), (2) I 2006 CPJ 494 (DSCDRC), (3) III 2007 CPJ 278 (APSCDRC), (4) IV 2007 CPJ 244 (APSCDRD) and (5) 2010 CJ 58 (Chandi SCDRD). We are of the view that, on going through the entire facts of the case of Opposite No-2, it not proved fact that, deceased Sita suppressed the material facts regarding her ill-health in her proposal form with an intention to get monetary benefit out of it. Cold or hypertension or not deceases required to be disclosed in the proposal form as those are common disorders in daily life of everyone accordingly the ground taken for repudiation by the opposite insurance company is not proper. Hence there is a deficiency in service on its part.
17. Another ground urged in the written version of opposite No-2 is that, this Forum has no territorial jurisdiction to try the subject matter of this complaint on the ground that, opposite No-2 head office is situated in Hyderabad.
18. Keeping in view of such contentions of opposite No-2, we have gone through the entire facts and records of this case of parties. Admittedly Opposite No-1 is the Branch Office of Opposite No-2 situated at Sindhanoor within the territorial jurisdiction of this Forum. Further we have noticed from the entire facts and circumstances of this case with records that, the entire papers including proposal form, death intimation, claim petition were forwarded to opposite No-2 through opposite No-1 Branch office at Sindhanoor only and the Opposite No-1 not come forwarded in support of Opposite No-2 by saying that, the Branch office at Sindhanoor has no role in getting proposal form of Sita, death intimation and claim form submitted by this complainant. As such, we are of the view that, there is no merit in this contention of Opposite No-2, accordingly we have opined that, this Forum has territorial jurisdiction to try the subject matter of this complaint.
19. As regards to reliefs are concerned, it is undisputed fact that, Smt. Sita died on 16-04-10 while insurance policy was inforce. Admittedly the assured sum under the policy is of Rs. 5,00,000/- with death benefit, as such the complainant is entitled for Rs. 5,00,000/- under the said policy due to death of her mother Sita with other death benefits as contemplated under the terms and conditions of the policy.
20. A lumpsum amount of Rs. 3,000/- is granted to the complainant towards deficiency in service on the part of opposites.
21. Another lumpsum amount of Rs. 3,000/- is granted to the complainant towards cost of this litigation, as such the complainant is entitled to get an amount of Rs. 5,06,000/- with death benefits from opposite Nos. 1 & 2 jointly and severally from the date of this complaint till realization of the full amount. Accordingly we answered Point No- 2.
POINT NO.3:-
22. In view of our findings on Point Nos-1 & 2, we proceed to pass the following order:
ORDER
The complaint filed by the complainant is partly allowed with cost.
The complainant is entitled to recover a total amount of Rs. 5,06,000/- from opposite Nos. 1 & 2 jointly and severally.
Opposites have been granted one month time to comply the above order from the date of this judgment.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 08-08-11)
Smt.Pratibha Rani Hiremath, Sri. Gururaj Sri. Pampapathi,
Member. Member. President,
Dist.Forum-Raichur. Dist-Forum-Raichur Dist-Forum-Raichur.
