BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
And
Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Friday the 25th day of March, 2011
C.C.No 145/10
Between:
Smt.R.Nirmala, W/o. Sri R. Gundu Rao,
H.No.11-543, Brahmin Street, Adoni - 518 301, Kurnool District.
…Complainant
-Vs-
- The Branch Manager, Shriram Life Insurance Company Limited,
Door No.20/451, Nakathe Buildings, 1st Floor,Opp. II Town Policy Station, Main Road, Adoni - 518 301, Kurnool District.
- The Assistant General Manager,Shriram Life Insurance Company Limited,
D.No.3-6-378, 3rd Floor, Anand Estates,Liberty Road, Himayathnagar, Hyderabad-500 029.
…Opposite Parties
This complaint is coming on this day for orders in the presence of Sri J.Lakshminarayana, Advocate for complainant, and Sri B.V.Ramana Reddy, Advocate for opposite parties 1 and 2 upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No. 145/10
1. This complaint is filed under section 12 of C. P. Act, 1986 praying:-
- To direct opposite parties to pay a sum of Rs.2,50,000/- (Rs. Two Lakhs fifty thousand) i.e., the sum assured with interest at 12% p.a. from the date of death of the insured i.e., on 12-10-2009 to till the date of realization of the claim amount;
And
- To award cost of the present complaint;
And
(c) For such other relief or reliefs as the Hon’ble Forum deem fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as under:- The complainant is the mother of the deceased Rampuram Raghavendra Rao. The deceased during his life time insured his life with opposite parties. The opposite parties issued insurance policy bearing No.LNo.80800142769. The complainant is the nominee under the said policy R.Raghavendra Rao died on 12-10-2009 due to Tubercular Meningitis. The complainant informed about the death her son to the opposite parties. The opposite parties sent an investigator by name G.Rama Murthy. The investigator handed over claim Forms to the complainant. The complainant submitted the claim Forms A and C to the opposite parties. Opposite party No.2 requested the complainant to get the B Form filled up by the Doctor who treated the insured. The complainant issued notices to the Medical Officer Command Hospital, Pune for issuance of Form B duly filled by the Medical Attendant. The opposite parties did not settle the claim of the complainant on the ground that Form B was not duly filled up by the Medical Attendant. Hence the complaint.
3. Opposite party No.2 filed written version and it was adopted by opposite party No.1. It is stated in the written version of opposite party No.2 that the complaint is not maintainable. The complainant is not a Consumer under Section 2 (1) (d) of the Consumer Protection Act. After receiving the intimation about the death of the insured the opposite party appointed investigator. The investigator handed over the claim Forms to the complainant. The complainant submitted the claim Forms A and C claim Form B was sent in blank. The investigator came to know that the insured was suffering with Tubercular Meningitis and Multi Drug Resistance TB since long time and died due to the said illness only. The investigator came to know that the deceased was admitted in St.Mary’s Hospital Bellary in the month of October, 2009 and from there he was shifted to Southern Command Hospital, Pune on 06-10-2009 and died on 12-10-2009 due to the illness. The opposite parties closed the claim of the complainant on 08-07-2010, as the complainant failed to submit filled in claim Form B. After filing the present complaint the complainant submitted filled in claim Form B to the opposite party. It is mentioned in claim Form B that the deceased was suffering from the ailments since last 11 years before his death. It is also mentioned that the deceased observed the illness in August, 1998 (i.e.) before taking the policy from the opposite parties. The deceased did not disclose that he was suffering from the diseases at the time of taking the policy. He voluntarily suppressed the material facts regarding to his health. The contract of insurance has become void. The deceased violated the conditions of the policy. The complainant is not entitled to any relief.
4. On behalf of the complainant Ex.A1and A14 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to B15 are marked and sworn affidavit of second opposite party is filed.
5. Both sides filed written arguments.
6. The points that arise for consideration are:
- Whether there is deficiency of service on the part of the Opposite Parties?
- Whether the complainant is entitled to the reliefs as prayed for?
(c) To what relief?
7. Points 1 & 2:- Admittedly Rampuram Raghavendra Rao obtained the insurance policy Ex.A1 from the opposite parties. The complainant is the nominee under the said policy. The insured R.Raghavendra Rao died on 12-10-2009 at the command Hospital Pune due to Tubercular Meningitis. Ex.A3 is the death certificate issued by Command Hospital Pune. It is also admitted that the complainant who is the mother of the deceased informed the opposite parties about the death of her son R.Raghavendra Rao on 12-10-2009. The policy issued in the name of R.Raghavendra Rao Commenced on 21-08-2008. The term of policy is 15 years. The insured paid single premium amount of Rs.50,000/- to the opposite party.
8. The opposite parties closed the claim of the complainant on 08-07-2010 on the ground that the complainant failed to submit the filled in claim Form B. Admittedly the opposite parties appointed the investigator. The investigator came to know that the deceased died due to Tubercular Meningitis and Multi Drug Resistance TB. Subsequent to the filing of the complaint the complainant obtained filled in claim Form B Ex.A13 issued by Command Hospital Pune. A copy of Ex.A13 issued to opposite parties is marked as Ex.B15. According to the opposite parties the deceased was suffering from the ailments since 11 years, that the deceased intentionally not disclosed the same at the time of taking the policy that the deceased violated the conditions of the policy and that the opposite parties are not liable to pay any amount to the complainant who is the nominee under the policy. The opposite parties mainly relied on recital in Ex.A13 (Ex.B15). In Ex.A13 claim Form B filled in by the Medical Attendant Command Hospital Pune it is mentioned that the insured died due to the disease of Tubercular Meningitis as primary cause of death and Multi Drug Resistance Tuberculosis as secondary cause of death. It is also mentioned in Colum No.5 of Ex.A13 that the deceased had been suffering from the above disease since 11 years before his death. It is also mentioned in Colum No.5 of Ex.A13 that the deceased first observed the symptoms of illness in 1998. Admittedly the policy was taken by the deceased on 21-08-2008. There is no material on record to show that the deceased took treatment in any Hospital before the date of the commencement of the policy i.e. 21-08-2008. On what basis the Medical Attendant who filled up Ex.A13 came to know that the deceased observed the illness in 1998 is not know. It is submitted by the learned counsel appearing for the complainant that the burden is on the insurer that the insured suppressed the material fact fraudulently at the time of submitting the proposal. Ex.B1 is the proposal Form submitted by the deceased. It is mentioned in the proposal Form dated 23-08-2008 that he deceased was not suffering from the diseases mentioned there in. Merely because the insured died of Tubercular Meningitis it cannot be presumed that the deceased had knowledge about the said disease at the time of making the proposal Ex.B1 dated 23-07-2008. No Medical evidence is placed on record to show that the deceased had knowledge that he was suffering from Tubercular Meningitis by the date of the proposal Ex.B1. There is also no clear mention in Ex.A13 that the deceased had knowledge that he was suffering from Tubercular Meningitis by the date of the commencement of the policy Ex.A1. The burden is on the insurer to establish that the deceased had knowledge that he was suffering from Tubercular Meningitis by the date of the proposal for the policy. Admittedly the deceased took treatment in the year 2009, in Command Hospital Pune. The opposite parties failed to establish that the deceased had knowledge that he was suffering from Tubercular Meningitis by the date of the proposal. Therefore the contention of the opposite parties that the company is not liable to pay the assured amount to the complainant cannot be accepted. The opposite parties failed to establish that the deceased suppressed the material fact knowing that he was suffering from Tubercular Meningitis. The insurer ought to have settled the claim of the complainant after receiving Ex.B15 claim Form B issued by Command Hospital Pune. There is abnormal delay in settling the claim of the complainant by the opposite parties. There is deficiency of service on the part of the opposite parties. The complainant who is a nominee under the policy is entitled to the assured amount.
10. In result, the complaint is partly allowed directing the opposite parties jointly and severally to pay assured amount of Rs.2,50,000/- to the complainant with interest at 9% from the date of the complaint i.e. 03-08-2010 till the date of payment along with costs of Rs.500/-.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 25th day of March, 2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nill
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Shriram Life Insurance Company Limited Policy No.LNo.80800142769, dated 21-08-2008.
Ex.A2 Photo copy of Death Certificate issued by Registrar of Births and Deaths, Pune dated 28-10-2009.
Ex.A3 Medical Certificate of Death issued by Command Hospital (SC), Pune dated 12-10-2009.
Ex.A4 Photo copy of Statement of R.Gundu Rao recorded by investigator dated 22-01-2010.
Ex.A5 Photo copy of Claimants Statement Form-A.
Ex.A6 Letter dated 20-03-2010 issued by opposite party No.2 to the complainant.
Ex.A7 Letter dated 12-04-2010 of complainant to
opposite party No.2.
Ex.A8 Office copy of legal notice dated 11-05-2010.
Ex.A9 Office copy of legal notice dated 22-05-2010.
Ex.A10 Office copy of legal notice dated 19-06-2010.
Ex.A11 Reply notice dated 02-07-2010.
Ex.A12 Office copy of legal notice dated 26-07-2010.
Ex.A13 Photo copy of Claim Form-B issued by Command Hospital, Pune, dated 23-08-2010.
Ex.A14 Office copy of legal notice dated 17-09-2010.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal form of R.Rghavendra Rao.
Ex.B2 Shriram Life Insurance Company Limited Policy No. LNo.80800142769, dated 21-08-2008.
Ex.B3 First premium receipt.
Ex.B4 Death intimation letter dated 14-12-2009.
Ex.B5 Photo copy of death certificate of R.Raghvendra Rao.
Ex.B6 Letter addressed to Insurance Investigator.
Ex.B7 Reminder Letter dated 10-02-2010
Ex.B8 Claimants Statement Form-A
Ex.B9 Photo copy of Medical attendance certificate,
Claim From-B.
Ex.B10 Certificate of Identity and Burial or cremation,
Claim Form-C.
Ex.B11 Office copy of letter dated 20-03-2010.
Ex.B12 Investigation report on Death Claim dated 25-01-2010.
Ex.B13 Office copy of letter dated 08-07-2010.
Ex.B14 Office copy of legal notice dated 17-09-2010.
Ex.B15 Photo copy of Medical attendance certificate,
Claim From-B, dated 23-08-2010.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
