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
Tuesday the 06th day of April , 2010
C.C.No. 181/08
Between:
K.Ramalingamma,W/o. Late K.Bhaskara Reddy,
R/o. 1-120, Vemugodu Village, Gonegondla Mandal,
Kurnool - 518463.
…Complainant
-Vs-
1. The Branch Manager,Sriram Life Insurance Company Ltd.,
H.No.1/730, UTY Complex, 1st floor, Park Road,Yemmiganur - 518 360.
2. The Assistant General Manager, Shriram Life Insurance Company Ltd.,
Regd. Office-3-6-478, 3rd floor, anand estate,Liberty Road, Himayatnager, Hyderabad - 500 029.
…OPPSOITE PARTIES
This complaint is coming on this day for orders in the presence of Sri. M. Sivaji Rao , Advocate, for the complainant, Sri. B.V.Ramana Reddy , Advocate for opposite party No. 1 and Sri. S.V. Krishna Reddy , Advocate for opposite party No. 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramiah, President)
CC. 181/08
1. This complaint is filed under section 11 and 12 of the C. P. Act,1986 praying to
a) to pay the assured amount of Rs.1,50,000/- with interest @ 12 p.a from the date of death along 1% of family income benefit rider sum assured per month payable upto the end of the term of the policy or for ten years with other benefits
b) to pay a compensation of Rs.25,000/-
c) to pay costs of the complaint.
d) any other relief or reliefs as the Hon’ble forum may deem to fit and proper in the circumstances of the case.
2. The case of the complainant is as follows:- Sri. K. Bhaskar Reddy husband of the complainant insured his life with the opposite parties for a sum of Rs.1,50,000/- under policy No. LN080700127353 w.e.f 27-02-2004. After taking the policy while the deceased was going to his village in a motor bicycle ,he suddenly met with an accident on 25-05-2008 and sustained injuries . After accident he was shifted to Community Hospital, Yemmiganur for treatment . On the advise of the doctor while the insured was being shifted to Kurnool, he died on the way .After the death of the Sri. K. Bhaskar Reddy his wife who is the complainant submitted claim form claiming the sum assured along with other benefits . The opposite parties appointed investigator and the said investigator obtained the signatures of the complainant on white papers under coercion . The opposite party No. 2 without any record repudiated the complainants claim . On 09-08-2008 alleging that the deceased was having pre-existing health problem. The repudiation of the claim of the complainant by the opposite parties is illegal . Hence the complaint.
3. The opposite party No. 2 filed written version and the same was adopted by opposite party No. 1. It is mentioned in the written version of the opposite party No. 2 that Sri. K. Bhaskar Reddy took the policy bearing No. LN080700127355 for assured sum of Rs.1,50,000/- which has commenced on 23-08-2007 . The complainant who is the wife of the Bhaskar Reddy is the nominee at the time of taking the policy. The policy holder died on 25-05-2008 . During the investigation it is revealed that the deceased was a diabetic by the date of the proposal and he did not disclose said fact to the opposite parties. The complainant is who is the wife of the policy holder in her letter dated 11-07-2008 confirmed that the deceased was suffering from diabetes before obtaining the policy. On 25-05-2008 the deceased policy holder lost his control over the vehicle fell down sustained injuries and died . No FIR was registered regarding the accident to ascertain the cause of death of the deceased. The deceased K. Bhaskar Reddy concealed material facts with regard his health condition while taking the policy . Hence the contract has become void and unenforceable. The opposite parties are not liable to pay any amount to the complainant and the complaint is liable to be dismissed .
4. On behalf of the complainant Ex. A1 and A2 , Ex. X1 and the evidence of P.W.1 are marked and on behalf of the opposite parties Ex.B1 to B5 are marked .
5. On the basis of the above pleadings the points that arise for consideration are
(i) whether there is any deficiency of service on the part of the
respondents/ opposite parties ?
(ii) Whether the complainant is entitled to the relief as prayed
for?
(iii) To what relief ?
Both parties filed written arguments.
6. Point No.1 & 2: Admittedly the complainant is the wife of the deceased K. Bhaskar Reddy . K.. Bhaskar Reddy took the policy bearing No. LN080700127353 from the opposite party No. 2 for an assured sum of Rs.1,50,000/- . The said policy commenced on 23-08-2007 . Admittedly the deceased policy holder met with an motor accident on 25-05-2008 and died on the same day. After the death of Sri. K. Bhaskar Reddy the complainant who is the nominee submitted claim form to the opposite parties and the opposite parties repudiated the claim of he complainant . Aggrieved by the action of opposite parties the complainant who is wife of the deceased Sri. K. Bhaskar Reddy filed the present complaint . There is no dispute about the issuance of policy bearing No. LN080700127353 in the name of Sri. K . Bhaskar Reddy husband of the complainant . Ex.B2 is the policy . The main contention of the opposite parties is that the deceased Bhaskar Reddy was suffering from diabetes by the date of the proposal , that the assured suppressed the material facts and obtained the policy fraudulently . It is for the opposite parties to establish that the deceased was suffering from diabetes by the date of the policy , obtained by the deceased . No doubt the contract of insurance is based on utmost good faith . The assured has to reveal the deceased with which he was suffering from by the date of the proposal . The opposite parties did not place satisfactory material to show that the deceased was suffering from diabetes by the date of Ex.B2 policy. There is no medical evidence on record to show that the deceased was taking treatment for diabetes or some other ailments before he took the policy form the opposite parties.
7. It is submitted by the learned counsel appearing for the opposite parties that subsequent to the death of the Bhaskar Reddy an investigator was appointed and that before the investigation the complainant who is the wife of the deceased confirmed that her husband was suffering from diabetes . The complainant in her sworn affidavit denied that her husband was suffering form diabetes prior to obtaining the policy from the opposite parties.
8. The complainant in support of her condition that her husband died due to the injuries received by him in accident relied on the evidence of PW. 1 who gave first aid to Bhaskar Reddy who met with an accident on 25-05-2008 . It is stated by PW.1, the medical officer attached to Community Health Centre , Kurnool that he examined the injured on 25-05-2008 and that he found internal head injury . Ex.X1 is the case sheet prepared by P.W. 1 . PW.1 was not cross examined by the opposite parties . As seen from the evidence of P.W. 1 and Ex.X1 it is very clear that Bhaskar Reddy sustained injuries in a motor accident and died on 25-05-2008.
9. The opposite parties mainly relied on Ex.B4 letter dated 11-07-2008 said to have been signed by the complainant . No doubt it is mentioned in Ex.B4 letter that Bhaskar Reddy was suffering from diabetes and that he took treatment for diabetes in Bangalore . As already stated the complainant in her sworn affidavit statement denied the contents of Ex.B4 letter . The opposite parties could not place any medical evidence on record to show that the deceased Sri. K. Bhaskar Reddy was suffering from diabetes and obtained the policy by suppressing the said fact.
10. The repudiation of the claim of the complainant by the opposite parties is not reasonable. There is also no evidence on record to show that the assured had knowledge that he was suffering from diabetes by the date of the policy and that he suppressed the said material . The burden of proving false representation and suppression of material facts lies on the insurance company. As the insurance company failed to establish that the deceased was suffering from diabetes by the date of the policy it cannot be said that the opposite parties is not liable to pay the benefits under the policy to the complainant under the policy.
11. Point No. 3 : In the result the complainant is partly allowed directing the opposite parties jointly and severally to pay Rs.1,50,000/- along with other benefits under the policy, to pay compensation of Rs.2,000/- and costs Rs.1,000/- with interest at 9% p.a from the date of the complaint i.e 30-10-08 till the date of realization.
Dictated to the stenographer, transcribed by her , corrected and pronounced by us in the open bench on this the 06th day of April, 2010.
Sd/- Sd/-
MALE MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : For the opposite parties :Nil
PW.1 Deposition of PW-1
(Dr.Rajappa ) Dt.24-03-2009
List of exhibits marked for the complainant:-
Ex.A1. Medical certificate
Ex.A2. Repudiation letter dated 09-08-2008.
Ex.X1. Case record.
List of exhibits marked for the opposite parties:
Ex.B1. Investigation report and death claim in 3 papers.
Ex.B2. Policy bond bearing No. LN 080700127353.
Ex.B3. First premium receipt for the above policy.
Ex.B4. Letter dated 11-07-2008 of complainant to insurance
investigator.
Ex.B5. Letter dated 11-07-2008 of Y. Venkata Rami Reddy.
Sd/- Sd/-
MALE MEMBER PRESIDENT
// 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 :
