Date of Filing: 08-04-2010
Date of Disposal: 27-06-2014
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTHAPURAMU
PRESENT: - Sri S.Niranjan Babu, B.A., B.L., President (FAC).
Smt.M.Sreelatha, B.A., B.L., Lady Member.
Friday, the 27th day of June, 2014
C.C.NO.52/2010
Between:
Smt.J.Nagaratna
W/o Late J.Bayanna Gowd
D.No.22-216, Kuruba Street
Old Town,
Anantapur. …. Complainant
Vs.
The Branch Manager
Shriram Life Insurance Company Ltd.,
Subash Road
Anantapur . …Opposite party.
This case coming on this day for final hearing before us in the presence of Sri S.Abdul Rasool & Sri G.Umapathi, advocates for the complainant and Sri N.R.K.Mohan and Sri A. Suresh Kumar, advocates for the opposite party and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:
O R D E R
Smt.M.Sreelatha, Lady Member: - This complaint has been filed by the complainant under section 12 of Consumer Protection Act, 1986 against the opposite party to direct him to pay the assured sum of Rs.1,50,000/- under Insurance Policy, Rs.50,000/- towards mental agony with interest @ 24%p.a. from January, 2010 till the date of realization with costs of the complaint.
2. This matter was remanded by the Hon’ble A.P.State Commission on 25-09-2012 with a direction to give an opportunity to the appellant to proceed with her claim basing on the evidence placed on record and to adduce if any and also directed to give opportunity to the opposite party.
3. The brief facts are that: – The husband of the complainant J.Bayanna Gowd (herein after referred to as deceased), who worked as L.F.L. Head Master, M.P.P. School, Rachepalli Village, Singanamala Mandal insured his life with the opposite party for a sum of Rs.1,50,000/- for the term of 15 years on payment of annual installments of Rs.20,000/- p.a. Accordingly, a proposal was made on 31-03-2008 by receiving the installment premium of Rs.20,000/-. At the time of obtaining the policy, the deceased was hale and healthy and not suffering with any disease or disorder and on medical examination made by the medical examiner of the opposite party recommended to receive policy in favour of the deceased. Accordingly, the opposite party got issued policy bearing No.LN080800077792 dt.24-04-2008 and the risk of the life of the deceased starts from 24-04-2008. While so, on 10-11-2009 the deceased died due to ill health and the same was informed to the opposite party and requested them to pay the policy amount to the complainant. Since the complainant being nominee of the deceased, the complainant made claim and presented all original records such as policy and other required documents in the month of January, 2010 by claiming assured amount of Rs.1,50,000/-. But the opposite party did not pay the amount to the complainant as assured in the policy. The complainant issued legal notice dt.05-03-2010 by claiming the assured amount under the policy and the same was served on the opposite party on 06-03-2010. But the opposite party never paid the assured amount of Rs.1,50,000/-. The complainant having no other go has filed this complaint against the opposite party to direct him to pay the assured sum of Rs.1,50,000/- under Insurance Policy, Rs.50,000/- towards mental agony with interest @ 24%p.a. from January, 2010 till the date of realization with costs of the complaint.
4. The opposite party filed counter and contended that basing on the information provided by the life assured the company has accepted to cover the risk on the life of assured and thereby issued the subject policy in all good faith. The information given by the life assured taken into consideration bonafidely by the opposite party company believing the same are true and correct. But the policyholder intentionally had suppressed his health history having knowledge about the same. Thus the complaint is liable to be dismissed. It is contended that in the month of November, 2009 the complainant under the above policy has intimated to the company that her husband i.e. deceased died on 10-11-2009 due to respiratory problem. Immediately on 19-01-2010 this opposite party through their official has personally handed over the concerned claim forms to the nominee and requested her to submit the properly filled claim forms at the earliest for processing the claim. The nominee has submitted the claim forms in the month of February, 2010. In this intervening period, the company has conducted its regular investigation into the matter through its official by name B.Venugopal Rao. During the investigation, the company has collected medical records of Nizam’s Institute of Medical Sciences, Hyderabad and lab reports of Pavani Multi Specialty Hospital, Anantapur. On perusal of the medical records and also lab reports, it is understood that the deceased life assured was known case of Bronchial Asthma since childhood, having history of Old Koch’s (Tuberculosis), Cor Pulmonale (pulmonary heart disease is damage to the right ventricle of the heart as a response to resistance or high blood pressure in the lungs). These pre-existing ailments were not disclosed by the life assured in proposal form dt.31-03-2008. All the above pre-existing ailments of the assured were come into light only after investigation conducted by the said Investigator. All the above material facts, which influence the decision of the company in accepting the risk on the life of assured, were intentionally not disclosed y the deceased in the proposal for insurance. Had the company been correctly informed regarding the pre-health problems, the above policy would not have issued. Hence, for non-disclosure of the above material facts, the company has rightly repudiated the claim vide their repudiation letter dt.12-02-2010. Thus, all these things clearly establish that there is no deficiency of service on the part of the opposite party. This opposite party denied the other averments mentioned in the complaint and contended that the complaint filed by the complainant is liable to be dismissed with costs.
5. On considering the above pleadings, the following points that arise for consideration are:
1. Whether there is any deficiency of service on the part of the opposite
party?
2. Whether the complainant is entitled the claim of compensation?
3. To what relief?
6. To prove the case of the complainant, the evidence on affidavit of the complainant has been filed as PW1 and marked Exs.A1 to A11 documents. On behalf of the opposite party, the evidence on affidavit of the opposite party and his witnesses have been filed as RW1 & RW2 and marked Exs.B1 to B9 documents.
7. Heard both sides.
8. POINT NO.1 – The counsel for the complainant argued that the complainant is entitled compensation as claimed as the husband of the complainant has insured his life with the opposite party for a sum of Rs.1,50,000/- and paid premium of Rs.20,000/- on 24-04-2008. The opposite party issued policy after thorough examination from Medical Authorized Examiner. The complainant stated that the husband of the complainant by name Bayanna Gowd, who worked as L.F.L., Head Master, M.P.P.School, Rachepalli Village. The counsel for the complainant submitted that the husband of the complainant was hale and healthy and not suffering with any disease or disorder and medical examiner of the opposite party recommended to receive policy in favour of J.Bayanna Gowd. Hence the opposite party got issued policy bearing No.LN080800077792 dt.24-04-2008. The husband of the complainant by name Bayanna Gowd died on 10-11-2009 due to ill-health. Immediately the complainant being nominee of the policyholder requested the opposite party to pay policy amount after submitting all original records in the month of January, 2010 but the opposite party did not pay the amount. Then the complainant got issued legal notice on 05-03-2010 by claiming the insured amount and same was served on the opposite party but the opposite party never paid the amount. Hence the complainant is constrained to approach this Forum. The counsel for the complainant also argued that as per the directions of the Hon’ble A.P.State Commission, he examined the complainant as PW1 and also marked Ex.B10, which is Service Book of late J.Bayanna Gowd shows that the said Bayanna Gowd was not suffered with any ailments prior to his death. The complainant also filed Certificate (Ex.A11) issued by the Mandal Educational Officer stating that the above said Bayanna Gowd was not availed any medical leave during his service. Hence, the complainant is entitled the claim.
9. The counsel for the opposite party argued that it is an admitted fact that the opposite party has issued policy to one Bayanna Gowd after accepting proposal filled by the above said Bayanna Gowd. The counsel for the opposite party argued that the above said Bayanna Gowd has suppressed the facts at the time of filling the proposal form that from his childhood he suffered with Bronchial Asthma and also Old Koch’s (Tuberculosis). The counsel for the opposite party argued that subsequent documents i.e. service register filed by the complainant does not support her case because mere not availing the medical leave, it does not mean that the complainant’s husband was suffered with ill-health. The deceased might have availed casual leaves instead of medical leaves for his check-up. Hence the above document is not taken into consideration. The counsel argued that the opposite party appointed one Investigator to know real facts of the death of the policyholder. The investigator filed his report along-with the documents showing that the husband of the complainant has taken treatment at Nizam Hospital, Hyderabad and also at Pavani Hospital, Ananthapuramu during his life time. The counsel also submitted that though the husband of the complainant suffered with illness, he intentionally filled the proposal form with wrong information. Basing on the information given by the policy-holder, the opposite party issued the policy in good faith. As the policy-holder suppressed his pre-existing diseases, the complainant is not entitled any claim as nominee. Hence the repudiation made by the opposite party is valid and the complaint is liable to dismissed with costs.
10. It is an admitted fact that the deceased insured his life with the opposite party for sum assured Rs.1,50,000/- and paid a sum of Rs.20,000/- towards first premium and the opposite party issued policy cover note by accepting the proposal No.2080000093 dt.24-04-2008. Thereafter the opposite party issued policy under Ex.B4. It is also an admitted fact that the policyholder died on 10-11-2009. It is also admitted fact that the complainant is a nominee of the policyholder and that after death of the policyholder, the complainant has submitted all the original records to the opposite party alongwith claim forms A & B claiming insurance amount of her diseased husband from the opposite party. It is also an admitted fact that the complainant got issued legal note on 05-03-2010 under Ex.A8 to the opposite party calling upon the opposite party to pay insurance amount for the death of the policyholder and the same was served to the opposite party under Ex.A9.
11. After remand the complainant examined herself as PW1 to prove her case and the complainant also filed Service Register of policy-holder i.e. Ex.A10 and A11 to show that her husband by name Bayanna Gowd never availed medical leave during his life time and the complainant also stated in her cross-examination that till the date of death, her husband was hale and healthy and he never suffered any ailments as alleged by the opposite party. The complainant also categorically stated in cross-examination that she does not know the contents of Ex.B8 as her husband never treated in Nizam Hospital and Pavani Hospital as alleged by the opposite party. The counsel for the complainant argued that the deceased was not having any pre-existing ill health as alleged by the opposite party and he also argued that the report of the investigator under Ex.B7 cannot be taken into consideration because the opposite party has not filed any supporting affidavit of the investigator.
12. When we go through Ex.B7 and B8 investigation reports and documents pertaining the hospitals of Nizam Hospital, Hyderabad and Pavani Hospital, Ananthapuramu, the investigator filed his report alongwith prescriptions of Nizam Hospital, Hyderabad and Pavani Hospital, Ananthapurmu. We are of the considered opinion that Ex.B8 document cannot be taken into consideration as the opposite party has not filed any concrete evidence to support the case of the opposite party that the policy-holder was known case of Bronchial Asthama since childhood having history of Old Koch’s (Tuberculosis), Cor Pulmonale (Pulmonary heart disease is damage to the right ventricle of the heart as a response to resistance or high blood pressure in the lungs). As stated in para 9 of the counter of opposite party because all the material in Ex.B8 only documents filed to support the contention, but the same is not supported by any evidence of Doctor, who allegedly treated the policyholder. Without supporting evidence, Ex.B8 cannot be completely relied upon. At this outset this Forum focused on Ex.A10 filed by the complainant to show that the policyholder never availed any medical leave which shows the doubt on Ex.B8. So the burden is on the opposite party is not fully discharged at the same time in the cross-examination of PW1, the opposite party did not make any effort to confirm the alleged document of Ex.B4 on which the opposite party relying to prove cause of death of the policyholder allegedly submitted by the complainant. This is a fatal failure on the part of the opposite party to substantiate their version.
13. The case of the complainant is that the opposite party has conducted medical examination on the policyholder by their own Panel Doctor before issuing the policy. Hence this Forum stated that opposite party being a private-sector the insurance company it would take all measures meticulously before issuing the policy and this step would have been followed the very contention of opposite party that no examination was held to policy-holder cannot be believed. It is only evasive reply which is not fair on the part of the corporate body. Admittedly the policyholder is Government Head Master and if at all the policy was taken willfully that need not be for meager amount of Rs.1,50,000/- for his social status and income. More-over the policyholder was used to earn a sum of Rs.20,000/- per month as salary and premium for policy is Rs.20,000/-. Hence the contention of the opposite party is not considered by the Forum. Unless there is unchallenging evidence in support, the evidence of PW1 also very clear and there was no confusion. All the contentions of the complainant was proved by documentary evidence and proved beyond reasonable doubt.
14. Admittedly the policy was taken in the year 2008 under Ex.A4. Ex.B8 clearly bears the date after the date of policy and hence it has become irrelevant all-together. If the corporate company do not act fair while disbursing the claims under bonafied circumstances, poor and innocent individuals like complainant will be subjected to humility and mental torture. The very purpose of meaning of insuring lives will become the question mark in their life. Even in the legitimate claims, poor litigants have to move the Forum and fight years together at all stages and this may not be the policy of the corporate body also.
15. Hence this Forum opined that there is gross-negligence and deficiency of service on the part of the opposite party in not considering the claim of the complainant and repudiation of the opposite party is not justified. Hence this point is answered in favour of the complainant and against the opposite party.
16. POINT NO.2 - The complainant proved her case beyond reasonable doubt by filing evidence on affidavit and also documentary evidence that she is entitled claim as a nominee. Hence the complainant is entitled for a sum assured Rs.1,50,000/- and Rs.25,000/- towards mental agony from the opposite party.
17. POINT NO.3 - In the result the complaint is partly allowed. The complainant is entitled an amount Rs.1,50,000/- towards sum assured under policy and Rs.25,000/- towards mental agony and no costs awarded. The amount shall be payable by the opposite party within one month from the date of this order. Other-wise, the complainant is entitled interest @ 9% p.a. on Rs.1,50,000/- from the date of death of the policyholder i.e. 10-11-2009 till the date of realization.
Dictated to Steno, transcribed by him, corrected and pronounced by us in open Forum this the 27th day of June, 2014.
Sd/- Sd/-
LADY MEMBER, PRESIDENT(FAC),
DISTRICT CONSUMER FORUM, DISTRICT CONSUMER FORUM,
ANANTHAPURAMU ANANTHAPURAMU
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
ON BEHALF OF THE COMPLAINANT: ON BEHALF OF THE OPPOSITE PARTY
1. PW1 – Smt.J.Nagaratna,complainant
Examined on 05-05-2014. – NIL -
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Ex.A1 - Attested copy of policy covering letter dt.24-04-2008 issued by the opposite
party to the deceased Jana Gonda Bayanna Gowd.
Ex.A2– Attested copy of letter of the opposite party.
Ex.A3- Attested copy of First Premium Receipt – Shri Plus issued by the opposite party
in the name of the deceased Jana Gonda Bayanna Gowd.
Ex.A4 – Attested copy of Insurance Policy issued by the opposite party in the name of
the deceased Jana Gonda Bayanna Gowd.
Ex.A5 – Attested copy of Claim Form-A submitted by the complainant to the opposite
party
Ex.A6 - Attested copy of Claim Form-B Medical Attendant’s Certificate submitted by the
Assistant Professor, Govt. General Hospital, to the opposite party.
Ex.A7 - Attested copy of Certificate by Employer – Claim Form-C submitted by the
Mandal Educational Officer, Singanamala to the opposite party.
Ex.A8 - Office copy of legal notice dt.05-03-2010 got issued by the complainant to the
opposite party.
Ex.A9 – Postal acknowledgement signed by the opposite party.
Ex.A10 – Attested copy of Service Book of late B.Jayanna Gowd.
Ex.A11 – Original Certificate issued by the Mandal Educational Officer, Singnamala.
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTY
Ex.B1 - Original Proposal form dt.31-03-2008 submitted by the deceased Jana Gonda
Bayanna Gowd to the opposite party .
Ex.B2 - Insurance Policy relating to deceased Jana Gonda Bayanna Gowd issued by
the opposite party .
Ex.B3 - First Premium Receipt – Shri Plus issued by the opposite party in the name of
the deceased Jana Gonda Bayanna Gowd
Ex.B4 - Letter dt.24-11-2009 submitted by the complainant to the opposite party.
Ex.B5 - Death Certificate relating to deceased Jana Gonda Bayanna Gowd issued by
the Registrar Birth’s & Death’s, Anantapur Municipal Corporation.
Ex.B6 - Letter dt.19-01-2010 submitted by the complainant to the opposite party.
Ex.B7 - Letter dt.21-01-2010 sent by the Shriram Life Insurance Co. Ltd., Zonal
Office, Tirupati to the Incharge, Claim Department, Head Office, Hyderabad.
Ex.B8 - Photo copy of Outpatient Card dt.01-06-2009 relating to deceased
Jana Gonda Bayanna Gowd issued by Nizam’s Institute of Medical Sciences
Hyderabad.
Ex.B9 - Photo copy of Haematology Report dt.29-10-2009 relating to deceased
Jana Gonda Bayanna Gowd issued by Pavani Hospital, Anantapur.
Sd/- Sd/-
LADY MEMBER, PRESIDENT(FAC),
DISTRICT CONSUMER FORUM, DISTRICT CONSUMER FORUM,
ANANTHAPURAMU ANANTHAPURAMU
Typed by JPNN
