BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD

F.A.No.40 OF 2011 AGAINST C.C.NO.52  OF 2010 DISTRICT FORUM ANANTHAPUR

Between:

Smt J.Nagaratna W/o late J.Bayanna Gowd
D.No.22-216, Kuruba Street, Old Town,
Anantapur, Anantapur Dist.

                                                        Appellant/complainant

                A N D

The Branch Manager,
Shriram Life Insurance Co.Ltd.,
Subash Road, Anantapur

                                                        Respondent/opposite party

Counsel for the Appellant                      M/s I.Venkata Prasad

Counsel for the Respondent                   M/s K.R.R.Associates

          QUORUM:   SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER

                                                AND

SRI THOTA ASHOK KUMAR, HON’BLE MEMBER

TUESDAY THE ELEVANTH DAY OF SEPTEMBER

                                TWO THOUSAND TWELVE

Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)

                                        ***

1.             The unsuccessful complainant has filed the appeal contending that the District Forum has not considered her claim, in correct perspective and that it had committed a grave error in not considering ExB7, the letter dated 21.01.2010 sent by the zonal office of the respondent-insurance company to its claim department.

2.             The facts leading to the filing of the appeal are that the appellant’s husband obtained Life Insurance Policy bearing no. LN080800077792 dated 24.04.2008 with the risk commencing from 24.04.2008 for a sum assured amount of `1.5 lakh. He paid premium of `20,000/- and was examined by the panel doctor of the respondent-insurance company before the proposal submitted by him was accepted .He died on 10-11-2009. After the death of her husband, the appellant filed claim with the respondent -insurance company. The appellant got issued notice dated 5-03-2010 with request to pay the sum assured.

3.             The respondent resisted the claim contending that the appellant’s husband had knowledge of his ill-health and suppressed his health history. The respondent conducted investigation which revealed that the insured was a known case of bronchial asthma since his childhood, having history of Old Koch’s Cor Pulmonale. He suppressed the pre-existing disease in the proposal form dated 31.03.2008.Had he informed the respondent-insurance company about his health history, the respondent would not have issued the insurance policy. The respondent collected the medical records of the insured from the NIMS and Pavani Multi Speciality Hospital, Hyderabad.

4.             The  appellant  has filed her affidavit and the documents, Exs.A1 to A9.  On behalf of the respondent, its Assistant General Manager, E.Sridhar and its Assistant Manager, B.Venugopal Rao  had filed his affidavit and the documents,ExB1 to B9. 

5.             The District Forum has dismissed the complaint on the premise that the appellant’s husband  suppressed his previous ailments such as asthma, Old Koch’s disease and Cor pulonale etc.,

6.             The learned counsel for the respondent- insurance company has filed written arguments.

7.             The points for consideration are:

1)           Whether the appellant’s husband has suppressed any material fact at the time of submitting the proposal?

2)           To what relief?

8.             POINTS NO.1:  The respondent-insurance company issued life insurance policy in favour of the appellant’s husband on 24-4-2008 for the sum assured of one lakh and fifty thousand rupees.  The insurance policy commenced from 24-4-2008. The insurance policy was issued for a period of 15 years on payment of premium of Rs.20,000/-. The appellant’s husband died on 10.11.2009 due to ill-health.

The appellant’s claim was repudiated on the premise that her husband suppressed his health history at the time of submitting the proposal form on 31.03.2008. The learned counsel for the appellant would contend that the deceased had not suppressed his health condition and the panel doctor of the respondent had examined him before the proposal was accepted by the respondent-insurance company. He has submitted that the District Forum had not considered the documents filed by the appellant and the document,ExB7 filed by the respondent which would support the claim of the appellant.

The learned counsel for the respondent-insurance company has contended  that  the respondent got investigated the claim by G.Ram Murthy who collected the medical records of the insured from the NIMS and Pavani Multi Speciality Hospital, Hyderabad which establish that the deceased is a known case of Brochnial Ashthma and had the history of Old Koch’s , cur Pulmonale(pulmonary heart disease –damage to the right ventricle of the heart as a response to resistance of high blood pressure in the lungs) and the deceased did not disclose the pre-existing disease in the proposal and they came into light after the claim was got investigated by the respondent-insurance company. He has relied upon the following decisions:

I .”LIC of India vs N.P.Nagarathna”     2012(2) CPR 214(NC).

2.”United India Insurance Company Ltd vs Milap Telecom” 2012(1)CPR 114   (NC).

The learned counsel for the appellant has contended that the District Forum has not considered the evidence on record and blindly came to the conclusion that the insured suppressed his health condition at the time of submitting the application for revival of the insurance policy. He has taken us through the enquiry report of the assistant manager of the respondent-insurance company and the medical attendant’s certificate issued by the Assistant Professor , Government General Hospital, Anathapur  in support of his contention that the repudiation of the claim  is not justified.

The respondent repudiated the claim on the premise that the insured suppressed from ill health at the time of obtaining the insurance policy. Thus, the respondent had to establish that the insured was suffering from pre-existing disease and he died due to such disease. The pre-existing diseases according to the respondent, that the deceased suffered are, bronchial asthma and Koch’ disease and cor. Pulmonale.

Before issuing the insurance policy, the respondent addressed letter dated 24.04.2008 to the appellant’s husband that he has to undergo medical checkup by their authorized medical examiner. The letter reads as under:

“We are pleased to inform you that your proposal dated 31.03.2008 for life insurance has been accepted by us based on the information furnished by ou in the proposal.  We appreciate your wise decision to provide security to your family through Shriram Life Insurance.  We assure you of our best services at all times to give you maximum customer satisfaction. 

Our Authorized Medical Examiner will be calling on you during the course of next few days to do a  medical check-up.

As the medical check-up will be conducted at our expense and will be mutually beneficial in monitoring your health standards, please extend your cooperation when our Medical Examiner visits you.

        As against what was stated in the aforementioned letter, the assistant general manager of the respondent-insurance company has stated that no medical examination of the appellant’s husband was conducted before issuing the insurance policy. The letter and the statement of the assistant general manager of the respondent-insurance company were not considered by the District Forum.

In all fairness the respondent had placed on record the enquiry report of its assistant manager. The claim enquiry report indicates that the insured was suffering from Ashtma for about one year and he was treated in the NIMS and at a hospital at Anathapur from where he was referred to a hospital at Bangalore. At column no.18 of the report, the health condition of the insured is mentioned as “normal”.  The learned counsel for the appellant has submitted that the district Forum has not considered the document whereby  the correct conclusion was not arrived at.

In order to arrive at conclusion that the insured had suppressed material fact in regard to his health, all the documents placed on record and the statements of the witnesses have to be considered.  Whether the insured was suffering from asthma since his childhood and whether he suffered from tuberculosis etc., are not considered by the District Forum. The respondent had not submitted the discharge sheet from the NIMS or any other hospital. The medical record of Pavani Multi Speciality hospital or the pathological reports of the insured does not support in any manner the case of the respondent as all these documents would show that the deceased was suffering from the disease after the insurance policy was issued.

        It is not proper for a Court or Tribunal not exercising jurisdiction vested in it. The District Forum has not exercised its jurisdiction vested in it by its failure to consider the evidence placed on record. No order can be passed without assessing evidence on record. Findings of the District Forum should be based on all relevant issues of the case vis-à-vis the contention and arguments of the parties, absence thereof would result in miscarriage of justice. The order passed without considering the documents placed on record is not sustainable.

The Hon’ble Supreme Court held  in “State of Orissa vs  Dhaniram Luhai”  (2004) 5 SCC 568 that” The hallmark of a judgment/order and exercise of judicial power by a judicial forum is to disclose the reasons for its decision and giving of reasons has been always insisted upon as one of the fundamentals of sound administration justice –delivery system, to make known that there had been proper and due application of mind to the issue before the Court and also as an essential requisite of principles of natural justice”.

The Supreme Court held in “United India Insurance Company and others vs Roshan Lal Oil Mills Ltd and others” (2000)10 SCC19 that non-consideration of documentary evidence would result in serious miscarriage of justice and vitiates the order or judgement passed by the Forum or Court.

 We are of the considered opinion that the matter need be remitted back to the District Forum giving opportunity to the appellant to proceed with her claim basing on the evidence placed on record and to be adduced if any,.     The District Forum shall not be carried away by the observations made by this Commission in this regard.    It has to come to the conclusion independently,   uninfluenced by any observations made by us in the order. 

        In the result the appeal is allowed setting aside the order passed by the District Forum. The matter is remanded back to the District Forum. The District Forum is directed to dispose of the matter as per law after issuing notice and giving opportunity to both sides to lead evidence.       In the circumstances,  there shall be no order as to costs. 

                                                                                MEMBER

                                                                                MEMBER

                                                                            Dt.11.09.2012

KMK*