BEFORE THE DISTRICT CONSUMERS FORUM: KURNOOL
Present: Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member, PRESIDENT (FAC)
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Wednesday the 16th day of January, 2013
C.C.No.162/2011
Complainants 2 to 5 are added L.Rs as per orders in I.A.80/2012 dated 17-09-2012 |
Between:
1. P.Lakshmi Devi, (Died)
W/o Late P.Pedda Ranganna,
2. P.Pandu Ranganna, S/o Late P.Lakshmi Devi at P.Ramalakshmi,
3. Pulikonda Rangaswamy, S/o Late P.Lakshmi Devi at P.Ramalakshmi.
4. B.Lakshmi Devi,D/o Late P.Lakshmi Devi at P.Ramalakshmi.
5. P.Muniswari,D/o Late P.Lakshmi Devi at P.Ramalakshmi.
All are resident of H.No.1-100, Gonegandla Post and Mandal - 518 463,
Kurnool District.
…..COMPALIANTs
-Vs-
1.The Branch Manager, Shriram Life Insurance Company Limited,
1/730, UTY Complex, First Floor, Near SBI, Park Road,Yemmiganur - 518 360, Kurnool District.
2.The Assistant General Manager,Shriram Life Insurance Company Limited,
No.3-6-478, III Floor, Anand Estates,Liberty Road, Himayat Nagar,
Hyderabad - 500 029.
...Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri M.Sivaji Rao, Advocate for complainant and opposite party No.1 called absent and Sri B.Venkata Ramana Reddy, Advocate for opposite party No.2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt.S.Nazeerunnisa, Lady Member)
C.C. No.162/2011
1. This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying:-
- To direct the opposite parties jointly and severally to pay the assured amount with interest @ 24% per annum;
- To grant a sum of Rs.25,000/- towards the compensation for causing mental agony and hardship;
- To grant the cost of this complaint;
- To grant such other relief or reliefs as the Honourable Forum deems fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as under:- The first complainant is the wife of insured and complainant 2 to 5 are the children of the deceased driver late Potta Pedda Ranganna. The complainants 2 to 5 are added as per the order in I.A.No.80/2012 after the death of 1st complainant. On 28-03-2008 P.Pedda Ranganna insured his life with the opposite parties under the policy bearing No.NP0808000490ZZ for assured amount of Rs.1,50,000/- with an annual premium amount of Rs.11,399/-, with its maturity date being 28-03-2023. The opposite parties issued the policy to the assured, the 1st complainant is the nominee under the policy. On 28-07-2009 the insured died due to heart attack. The 1st complainant being the nominee under the policy submitted the claim to opposite parties. The opposite parties repudiated the claim on 30-01-2010, on the false ground stating that the insured suppressed the material facts regarding Hypertension and smoking in the Proposal Form. There is deficiency of service on the part of the opposite parties in not Honouring the claim of the complainant. The opposite parties caused mental agony by repudiating the claim of the complainant. Hence the complaint.
3. Opposite party No.1 called absent and set exparte.
Opposite party No.2 filed written version stating that the complaint is not maintainable and it is liable to be dismissed. There is no cause of action to file the present complaint. The proposer concealed and suppressed misstated the material facts in the proposal form. The assured is in breach of a pious relationship uberrimafides between the insurer and the insured. On 14-09-2009 the 1st complainant had intimated the death of insured and submitted claim form to opposite parties. The opposite parties conducted an internal investigation. During the investigation the medical report given by Dr.K.Narasaram, Kurnool reveals that the life assured was suffering with Hypertension from past 8 years and also a smoker which was deliberately suppressed from opposite parties at the time of taking the policy. The contract shall be null and void. The repudiation of the claim by the opposite parties was legally valid. There is no deficiency of service on part of opposite parties. The complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to A5 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to B8 are marked and sworn affidavit of the opposite party No.2 is filed.
5. Both sides filed written arguments.
6. Now the points that arise for consideration are:
- Whether there is deficiency of service on the part of Opposite Parties?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINTS i and ii:- Admittedly late P.Pedda Ranganna, who is the husband of the first complainant and father of 2 to 5 complainants obtained insurance policy bearing No.NP0808000490ZZ in his name on 28-03-2008 which is marked as Ex.B3. The sum assured under the policy was Rs.1,50,000/- and annual premium of Rs.11,399/-. Ex.A2=Ex.B2 is the first premium receipt dated 28-03-2008. Ex.B1 is the Proposal Form dated 24-03-2008. The 1st complainant is the nominee under the said policy is not under dispute. The complainants 2 to 5 are the childrens of the insured are added as per I.A.No.80/2012 after the death of 1st complainant. It is the case of the complainants that the assured died on 28-07-2009 due to heart attack. Ex.A4 is the photo copy of the Death Certificate issued by Medical Officer, Primary Health Center, Gonegandla Mandal, dated 30-11-2009. Admittedly the 1st complainant submitted claim form to opposite party No.2, which is marked as Ex.B4. The said claim was repudiated by the opposite parties under Ex.A5=Ex.B8 dated 30-01-2010 on the ground that insured had suppressed the material facts regarding his health condition.
8. It is the case of opposite parties that the proposer must disclose all the material facts which are within his knowledge in the proposal form Ex.B1. In Ex.B1 it was mentioned by proposer that he was not suffering from any disease or ill health. After the receipt of death intimation the opposite parties conducted the investigation. The investigation report is marked as Ex.B6. Ex.B7 is the copy of Medical report given by Dr.K.Narasaram, Kurnool. During the investigation the Medical Report given by Dr.K.Narasaram, Kurnool reveals that the life assured was suffering with Hypertension for which he had consulted and treated from last 8 years and further revealed that he was a Smoker. The insured has suppressed the said material facts in the proposal form. So the complainants are not entitled for any benefits under the policy.
9. The learned counsel appearing for the complainant argued that the burden is on the opposite parties to prove that insured suppressed the material fact of his pre-existing disclose at the time of taking policy. In this case the opposite parties filed the prescription of Dr.K.Narasaram, Kurnool stating that the insured was known Hypertension patient since 8 years (Ex.B6) and he was treated by him, but the said doctor was not examined as witness. The opposite parties not filed at least affidavit of the said doctor who issued the prescription. Mere filing of medical prescription is not sufficient to prove his version that the insured had been suffering from Hypertension before taking the policy.
10. The learned counsel appearing for the complainant further contended that Hypertension or smoking are the normal problem of any person and they are not material diseases. To support his version he relied on decision reported in II (2008) CPJ 213, Life Insurance Corporation of India –Vs- Sushma Sharma where in it was held that concealment of every fact not gives right of repudiation of claim. Hypertension and diabetes not material diseases. He filed another decision reported in II (2012) CPJ 65 (NC), Life Insurance Corporation of India and Another –Vs- Sudesh. In the above case Insurance Company alleged that insured was chain smoker and a concealed the material fact, so repudiated the claim. The Honourable National Commission held that, suppression of information would have arisen only if there was evidence to show that insured had undergone hospitalization for any disease in near proximity of time when policy was obtained and had not chosen to disclose it. In the present case also the opposite party could not establish that the insured had undergone hospitalization for any disease prior to obtained the policy. There is deficiency of service on the part of opposite parties. The 1st complainant died during the pendency of complaint, as per order in I.A.No.80/2012 the complainants 2 to 5 are added as legal heirs of insured and 1st complainant. Taking into consideration on the facts and material placed on record, we are of opinion that the complainants 2 to 5 are entitled for assured amount of Rs.1,50,000/- with 9% interest on basis of equal shares among them.
11. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay assured amount of Rs.1,50,000/- to the complainants 2 to 5 with interest at 9% per annum from the date of the complaint i.e., on 13-12-2011 till the date of realization. Within one month from the date of the order along with costs of Rs.1,000/-.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 16th day of January, 2013.
Sd/- Sd/-
LADY MEMBER PRESIDENT (FAC)
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainants : Nil For the opposite parties : Nill
List of exhibits marked for the complainants:-
Ex.A1 Photo copy of Deposit Acknowledgement Receipt
dated 24-03-2008.
Ex.A2. Photo copy of First Premium Receipt No.0198442 for
Rs.11,399/- dated 26-03-2008.
Ex.A3 Photo copy of Deposit Acknowledgement Receipt
dated 23-03-2009.
Ex.A4 Photo copy of Death Certificate dated 30-11-2009.
Ex.A5 Photo copy of Letter dated 30-01-2010.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal for Insurance dated 24-03-2008.
Ex.B2 First Premium Receipt No.0198442 for Rs.11,399/-
dated 28-03-2008.
Ex.B3 Policy No.NP0808000490ZZ dated 31-03-2008.
Ex.B4 Letter from complainant to opposite party No.1.
Ex.B5 Death Certificate dated 31-07-2009.
Ex.B6 Investigation Report dated 05-11-2009.
Ex.B7 Photo copy of prescription dated 15-07-2009.
Ex.B8 Letter dated 30-01-2010.
Sd/- Sd/-
LADY MEMBER PRESIDENT (FAC)
// 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 :
