THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Sri.Y.Reddappa Reddy, M.A., L.L.M., President,
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Monday the 23rd day of March, 2015
C.C.No.05/2013
Between:
E.Bharathi,
W/o Late E.Chandranna,
Aged about 34 Years,
H.No.7-479-10-2,
Tarakarama Nagar,
Dhone Town-518 222,
Kurnool District. …Complainant
-Vs-
1. Shriram Life Insurance Company Limited,
Represented by its Branch Manager,
1-780, 1st Floor, Park Road,
Yemmiganur-518 360,
Kurnool District.
2. Shriram Life Insurance Company Limited,
Represented by its Assistant General Manager,
Regd. and Administration Office 3-6-478,
Anand Estate, 3rd Floor,
Liberty Road, Himayath Nagar,
Hyderabad-500 016. …OPPOSITE PARTIES
This complaint is coming on this day for orders in the presence of Sri.S.Siva Rama Krishan Prasad, Advocate for complainant and Sri.S.V.Krishna Reddy, Advocate for opposite party No.1 and opposite party No.2 called absent and set exparte and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member,)
C.C. No.05/2013
1. This complaint is filed under section 12 of Consumer Protection Act, 1986 praying:-
(a)To direct the opposite parties to pay a sum of Rs.3,00,000/- and vested bonus on policy bearing No.NP081100050509.
(b)To direct the opposite parties to pay a sum of Rs.50,000/- on policy bearing No.LS081100096841.
(c)To award interest on the amount liable to be paid by the opposite parties under policy bearing Nos.NP081100050509 and LN081100096841 at the rate of 18% per annum.
(d)To cost of the complainant.
(e)To such other relief or reliefs as the Honourable Forum deems fit and proper under the circumstance of the case.
2. The facts of the complainant in brief is as under:- The complainant is the wife of E.Chandranna. The Late.E.Chandranna during his life time had taken two policies “Sri Raksha” and “Shriram Ujjwal Life (SP)” bearing Nos.NP081100050509 and LN081100096841 from opposite party No.2 through opposite party No.1 for assured sum of Rs.1,00,000/- for an annual premium of Rs.10,833/-, and a sum of Rs.125/- is collected for accident rider and Rs.150/- is collected under FIB (Family Investment Benefit) under the FIB rider Additional a sum of Rs.1,00,000/- is payable by the opposite parties. The policy under Shriram Ujjwal Life (SP) bearing No.LN081100096841. The complainant paid single premium of Rs.35,000/- and it was invested in to the Stock Market as per the agreement of opposite parties with its date of commencement of policy is from 04.11.2011 the insured sustained injuries to his right foot accidentally in the month of April, 2012 and was consulted to Dr.P.Sreenivasulu at Vamsi Diabetic, Endocrine and Maternity Center at Kurnool and got admitted in Viswabharathi Super Speciality Hospital for treatment and undergone surgery on 24.04.2012. During the course of treatment, he developed actue myocardial infection consequently respiratory system was failed, and insured died on 24.04.2012 at 10.45 A.M. The complainant being the wife and nominee under two policies submitted claim form to the opposite parties. The opposite parties repudiated the claim on 28.06.2012 and 10.12.2012, on the ground that the deceased/insured had not disclosed the pre-health ailment of diabetic in the proposal form, which ought to have disclosed. The opposite parties did not supplied the terms and conditions of the policy to the insured and the form were filled up by the agent C.Kesava, either the agent or opposite parties not informed the terms and conditions of the policy. So question of suppressing of material information does not arise. The insured never suffered with diabetic as alleged by the opposite parties before obtained the policies. There is deficiency of service on the part of opposite parties by non-settling her claims and caused mental agony to the complainant. Hence this complaint.
3. Opposite party No.1 filed written version stating that the complaint is not maintainable either in law or on facts. It is admitted that the opposite parties issued two policies “SRHRI RAKSHA” and “SHRIRAM UJJWAL LIFE (SP)” bearing Nos.NP081100050509 and LN081100096841. The said policies commenced on 24.04.2011 for a term of 15 years with sum assured amount of Rs.1,00,000/- (Rupees one lakh only) and Rs.50,000/- (Rupees Fifty Thousand only) the complainant is the wife/nominee to receive the death benefits under the policies. It is submitted that at the time of taking policy, the insured suppressed the material facts with regard to his health conditions in the proposal form. On 21.05.2012 the complainant informed that policy holder died on 24.04.2012 the opposite parties appointed investigator and it was found that the deceased was suffering from diabetics since more than four years. The investigation report and medical report revealed that the cause of death of the deceased was due to existing disease. The contract of insurance is based on the principle of “UBERRIMAFIDE”. But the insured/deceased had provided incorrect details and took the policies and deliberately suppressed the material facts in Proposal Form, the claim under the policy is void and not enforceable in law. The opposite parties rightly repudiated the claim of the complainant on 28.06.2012. There is no deficiency of service on the part of opposite parties. Hence the complaint is liable to be dismissed.
Opposite party No.2 called absent and set exparte.
4. On behalf of the complainant filed Ex.A1 and Ex.A2 are marked and sworn affidavit of complainant is filed. On behalf of opposite parties filed Ex.B1 to Ex.B4 are marked and sworn affidavit of opposite party No.1 is filed.
5. Complainant and opposite party No.1 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 the insured/deceased obtained two policies under the name of “SRHRI RAKSHA” and “SHRIRAM UJJWAL LIFE (SP)” bearing Nos.NP081100050509 and LN081100096841. The said policies commenced on 24.04.2011 and 04.11.2011 for a sum assured amount of Rs.1,00,000/- and Rs.50,000/- with its annual premium of Rs.10,833/- in first policy and Rs.35,000/-. Single premium as per the agreement of opposite parties in 2nd policy. Ex.B3 is the proposal form under policy bearing No.NP081100050509. The complainant is the nominee under both the policies. This policy also covers accidental benefits and FIB assuring additional sum of Rs.1,00,000/- under each head as shown in the policy. It is the case of the complainant that the opposite parties collected a sum of Rs.125/- for accidental rider and sum of Rs.150/- is collected under FIB (Family Investment Benefit) in the first policy in the second policy the insured paid Rs.35,000/- single premium amount and the opposite parties was invested the said amount in stock market since the policy itself is called as “ULIP Policy”. After satisfying the health conditions of insured the opposite parties issued above two policies. The insured sustained injuries to his right foot accidentally and consulted with Dr.P.Sreenivasulu and on 23.04.2012 got admitted in Viswa Bharathi Hospital, Kurnool for treatment. On 24.03.2012 the insured under gone surgery and during the course of treatment he died due to actue myocardial infection and respiratory system was failed.
The complainant being the wife and nominee informed the same to opposite parties and submitted claim form. The opposite parties repudiated the claim on 28.06.2012 under policy bearing No.NP081100050509 and on 10.12.2012 under the policy bearing No.LN081100096841, on the ground that the deceased life assured was suffering from the Diabetics mellitus since 4½ years and he suppressed the material facts in the proposal form. The repudiation letters in two policies are marked as Ex.A1 and Ex.A2. It is further case of the complainant that the agent C.Keshave filled up the proposal form. Neither the agent nor the opposite parties supplied the terms and conditions of the policy. There is no question of suppression of material facts. The insured never suffered diabetics as alleged by the opposite parties.
It is a case of opposite party No.1 that the opposite parties appointed investigator, after enquiry it was found that the insured suffered from diabetics also from cancer since more than four years and cause of death of deceased life assured was due to the existing diseased. A copy of medical reports is marked as Ex.B2 along with letter dated 03.04.2013, Ex.B1 is the investigation report dated 16.06.2012. Ex.B3 is the Proposal Form No.112611000128 dated 26.04.2011. Ex.B4=Ex.A1 is the repudiation Letter dated 28.06.2012. The deceased/insured suppressed the material facts that the deceased was suffering from cancer before taking the policy.
The learned counsel appearing for the opposite party No.1 contended that the insured violated the terms and conditions of the policy. The contract has now become void, unenforceable and not legally binding on opposite parties. Therefore the opposite parties are not liable to pay any amount towards death benefits under the policies.
The learned counsel appearing for the complainant argued that the opposite parties did not choose to file an affidavit of its agent to prove that the deceased/insured given a false statement in order to get the benefits of the above referred policies. He relied on decision reported in I (2009) CPR (NC) Page 162 where in it was held that at para 4 and 5 of the evidence of the insurance company agent is best piece of evidence to prove the contents. He further argued that in order to prove pre-existing deceased except the opposite parties filed Ex.B1 and Ex.B2 there is no other evidence except in Ex.B2. At the time of admission in hospital, it is mentioned in admission card that the deceased life assured suffered from diabetes since 4½ years. The opposite parties did not examine the doctor who issued Ex.B2. To support his version we relied decision of National Commission in Revision Petition No.2615/2011 and 2616/2011 Life Insurance Corporation of India -Vs- Smt.Priya Sharma, the Honourable National Commission held that the onus to prove is on the Insurance Company to prove the pre-existing disease of insured, not examined any doctor to prove this fact, repudiated not justified.
In decision II (2004) CPJ Page 452 Life Insurance Corporation of India -Vs- Sudhajain Delhi State Commission held that maladies like diabetes hypertensions being normal wear and tear of life, cannot be termed as concealment of pre-existing disease. It can be detectable by basic test. In the present case on hand also the deceased/insured alleged to be suffered from diabetics prior to obtained the policies.
There is no dispute with regard to issuance of policies bearing Nos.NP081100050509 and LN081100096841 in favour of the insured and the complainant is the nominee under the policy. The insured died on 24.04.2012 the complainant submitted the claim form to opposite parties and the opposite parties repudiated the claim of the complainant but the policies under Ex.A1 dated 28.06.2012 and Ex.A2 dated 10.12.2012, on the ground that the deceased/insured suppressed the material facts in regard to his health conditions in the proposal form Ex.B3. During the investigation, it was found that the deceased/insured was suffering from diabetics since 4½ years and also suffered from cancer before taking the policy. The opposite party No.1 filed investigation report Ex.B1 and medical report (Ex.B2) dated 21.04.2012 to 24.04.2012. But the opposite parties did not choose to examine the doctor who issued Ex.B2, even did not filed either any affidavit of a doctor or investigator or agent to prove their version. The deceased/insured died on 24.04.2012 and the cause of death is mentioned as Myocardial problem. In the present case on hand the burden is on the opposite parties to prove that the insured suffered from the alleged diseases prior to obtaining the policies. Mere filing of medical reports are not sufficient, filing of document is different from prove the same without the examine the concerned doctor or any affidavit of a doctor any affidavit of agent, we could not come to conclusion that the deceased/insured suppressed the material facts with regard to his health condition. Therefore the opposite parties could not establish that the deceased/insured suppressed the alleged diseases, obtained the above policies and violated the terms and conditions of the policy. We consider all the material available on record and in the light of above decisions found that there is deficiency of service on the part of opposite parties and the complainant suffered mental agony.
8. POINT No.iii:- The complainant prayed for a sum of Rs.3,00,000/- with vested bonus in policy bearing No.NP081100050509 and a sum of Rs.50,000/- in policy bearing No.LN081100096841 and with interest at 18% per annum. We persued the all material placed on record. It is not a case of accidental death so the complainant is not entitled for accidental benefits. Hence the complainant is entitled for an assured amount of Rs.1,00,000/- in policy bearing No.NP081100050509 and as the policy further an assured for additional a sum of Rs.1,00,000/- as FIB and the opposite parties collected Rs.150/- as FIB (Family Investment Benefits) rider. Therefore she is further entitled for a sum of Rs.1,00,000/-. The complainant further entitled assured a sum of Rs.50,000/- in policy bearing No.LN081100096841 and Rs.5,000/- towards mental agony.
9. In the result, the complaint is partly allowed directing the opposite parties jointly and severally liable to pay a sum of Rs.2,50,000/- (Rupees two lakhs fifty thousand only) with interest at 9% per annum from the date of complaint i.e., on 17.01.2013 till the date of realization under the above two policies bearing Nos.NP081100050509 and LN081100096841 and further direct to pay compensation of Rs.5,000/- towards mental agony and Rs.1,000/- as costs of the case. Time for compliance is one month from the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 23rd day of March, 2015.
Sd/- Sd/-
LADY MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant:- Nil For the opposite parties:- Nil
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Repudiation Letter dated 28.06.2012.
Ex.A2 Photo copy of Repudiation Letter dated 10.12.2012.
List of exhibits marked for the opposite parties:-
Ex.B1 Investigation Report dated 16.06.2012.
Ex.B2 Letter dated 03.04.2013 along with Medical Reports.
Ex.B3 Proposal Form No.112611000128 dated 26.04.2011.
Ex.B4 Repudiation Letter dated 28.06.2012.
Sd/- Sd/-
LADY MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//
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