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
Tuesday the 1st day of November, 2011
C.C.No.31/11
BETWEEN:
Smt. Bhuma Sujatha,
W/o Late Bhuma Saradhi Reddy,
H.No.6/59, G.Lingapuram Village,
Bandi Atmakur Mandal,
Kurnool District-518 523. …Complainant
-Vs-
1. The General Manager,
Birla Sun Life Insurance Company Limited,
Registered Situated,
6th Floor, Vamana Centre,
Makhwana Road of Andheri-Kurla Road,
Near Marolnaka,
Andheri East,
MUMBAI-400 059.
2. The Branch Manager,
Birla Sun Life Insurance Company Limited,
Branch Office Situated
OPP: to Sreerama Theatre,
D.No.40/301/10,
M.R.B. Trade Center,
R.S. Road, Kurnool. …OPPOSITE PARTIES
This complaint is coming on this day for orders in the presence of Sri B.Naga Lakshmi Reddy, Advocate for complainant and Sri M.D.V.Jogaiah Sharma, Advocate for opposite party No.1 and opposite party No.2 called absent and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member)
C.C. No. 31/11
1. This complaint is filed under section 12 of C. P. Act, 1986 praying:-
(a) To direct the opposite parties to pay a sum Rs.18,10,000/- being the sum assured under the policy No.002057141 taken by Sri Bhuma Saradhi Reddy, husband of the complainant, dated 14-10-2008.
(b) To award Rs.20,000/- towards mental agony on account of the repudiation by the opposite parties on flimsy grounds;
(c) To award the costs of the complaint;
(d) To grant such other relief as the Hon’ble Forum may 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 wife of the Late Bhuma Saradhi Reddy. On 14-10-2008 Bhuma Saradhi Reddy insured his life with the opposite parties under the policy bearing No.002057141 for Rs.18,10,000/- with an annual premium amount of Rs.6,005/- with its maturity date being 14-10-2033. The said policy is called “Birla Sun Life Insurance ‘Dream Plan’ ”. The opposite parties had issued the policy to the assured, after satisfaction of all the ingredients and formalities. The complainant is the nominee under the policy. On 04-02-2009 the insured died due to ill health. The complainant who is the nominee under the policy submitted the claim to the opposite party No.2. The opposite parties repudiated the claim of the complainant on 30-03-2009 stating that the insured suppressed the material facts regarding his health condition in the Proposal Form. The repudiation of claim by the opposite parties with all untenable and false pleas, and they did not respond to the correspondence of the complainant on phone. 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.2 called absent.
Opposite party No.1 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 contract of Insurance is based on good faith. The proposer concealed and suppressed mis-stated the material facts in the proposal form. The assured obtained the policy by misrepresentation and fraud. The assured is in breach of a pious relationship uberrima fides between the insurer and the insured. The admission form of Asian Institute of Gastroenterology stated that the life assured was admitted in the hospital on 04-08-2008 and was discharged on 07-08-2008, that he was treated for carcinoma Esophagus, that the old report revealed that the long segment, malignant structure involving mild thoracic Cosophagus with Oesophago bronchial fistula, and that the assured underwent surgery for the same during the said hospitalization and the assure died on 04-02-2009 due to the complications developed out of the said ill health or disease. The assured is guilty of fraud and misrepresentation. The opposite parties issued the policy on good faith. The repudiation of claim by the opposite parties was legally valid. There is no deficiency of service on the part of the opposite parties. Hence 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 party No.1 Ex.B1 to B6 is marked and sworn affidavit of the opposite party No.1 is filed.
5. Both sides filed written arguments.
6. The points that arise for consideration are:-
(a) Whether there is deficiency of service on the part of the Opposite parties?
(b) Whether the complainant is entitled for the reliefs as prayed for?
(c) To what relief?
7. POINTS 1 and 2:- Admittedly Late Bhuma Saradhi Reddy, who is the husband of the complainant obtained insurance policy bearing No.002057141 in his name on 14-10-2008, which is marked as Ex.A1. The basic sum assured under the policy was Rs.40,575/- and the enhanced sum assured was Rs.18,10,000/- and annual premium payable under the policy was Rs.6,005-55 Ps. Ex.A2 is the first premium receipt dated 14-10-2008. The complainant is the nominee under the said policy is not under dispute. It is the case of the complainant that the assured died on 04-20-2009 due to ill health. Ex.A3 is the photo copy of Death Certificate issued by Panchayat Secretary, G.Lingapuram Village Bandi Atmakur Mandal dated 13-02-2009. Ex.A4 dated 04-02-2009 is the photo copy of medical attendance certificate issued by Dr.M.Althaf Hussain, R.M.P., G.Lingapuram Village to opposite party No.2, who treated the assured disclosed that the assured was treated for general problems like fever, pains etc. according to the opposite party No.1 under Ex.B4 photo copy of admission form of Asian Institute of Gastroenterology dated 04-08-2008 to 07-08-2008 and Ex.B5 photo copy of progress notes of Asian Institute of Gastroenterology Private Limited, the insured undergoing treatment at that hospital prior to applying the proposal from to the Insurance Company. Admittedly after the death of insured the complainant submitted claim form to the opposite party No.2, which is marked as Ex.B3 dated 20-03-2009. The said claim of the complainant was repudiated by the opposite parties under Ex.A5 and Ex.B6 dated 30-03-2009, stating that the insured had been diagnosed of cancer for which he had consulted, undergone test and admitted into hospital and also underwent surgery prior to the application for insurance. He suppressed the said material fact in the proposal form, hence the complainant is not entitled to the benefits under the policy.
8. Admittedly the contract of insurance is based on good faith. The proposer must disclose all the material facts which are within his knowledge in the proposal form. According to the complainant her husband died due to ill health which is mentioned in complaint and in her sworn affidavit. Under Ex.B1 the copy of proposal form dated 02-09-2008, it is mentioned by the proposer that he was not taking any medication or drugs and he was not suffering from any disease or ill health. Under Ex.B2 the medical report dated 02-09-2008, it is stated by the proposer and signed by him that he was hale and healthy. As seen from Ex.B4 and Ex.B5 as above discuss the admission form and progress report of the insured in Asian Institute of Gastroenterology, it is very clear that the life assured was already suffering from illness by the date of proposal.
The learned counsel for the complainant submitted the decision of Honourable National Commission New Delhi 2011 (1) CPR Page No.167 (N.C.). It was held that there was no attempt by the LIC to prove the preexisting disease and therefore the repudiation was unsustainable and alleged suppression of material fact by insured must be proved by evidence. But the present case on hand the insurance company filed the medical reports and admission form under which the insured undergone his treatment of ill health prior to the making of an application for insurance and the nexus also becomes relevant between the alleged suppression of disease and cause of death. The learned counsel for opposite party submitted the decision in support of his contention. P.C. Chako another Vs Chairman, Life Insurance Corporation of India and others 2007 (13) Scale 329. The Honourable Apex Court held that a deliberate wrong answer which has a great bearing on the contract of insurance, it discovered may lead to the policy being vitiated in law. As the insured had undergone operation for adenoma Thyroid Four Years prior to the obtaining of policy. In this case the fact that the insured was suffering from ill health prior to the date of proposal is not disputed by the complainant.
As seen from Ex.B1 the application of Insurance submitted by the life assured at the time of taking the policy and also Ex.B2 the medical examiner report signed by the assured clearly disclose that the assured did not disclose above his past health condition and earlier hospitalization. As per Ex.B4 and Ex.b5 the admission form and progress notes of Asian Institute of Gastroenterology clearly shows that life assured had deliberately suppressed the material facts about his medical information (Carcinoma Esophagus with Esophago bronchial fistula), which was underwent prior to the application for the policy and he died due to complications arising out of the same. Taking into consideration all the facts and material placed on record, we are of opinion that the opposite parties are not liable to pay any compensation and the complainant is not entitled for any benefits as prayed for.
9. In the result, the complaint is dismissed without cost.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the day 1st of November, 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 policy No.002057141 dated 14-10-2008.
Ex.A2 Photo copy of First Premium Receipt for Rs.6,005–55 Ps dated 14-10-2008.
Ex.A3 Photo copy of Death Certificate issued by Panchayat
Secretary G.Lingapuram Village Bandi Atmakur Mandal
dated 13-02-2009.
Ex.A4 Photo copy of Medical Attendance Certificate issued by
Dr.M.Althaf Hussain R.M.P. G.Lingapuram Village to
Opposite party No.2 dated 04-02-2009.
Ex.A5 Photo copy of Repudiation letter issued by opposite
parties to the complainant dated 30-03-2009.
List of exhibits marked for the opposite parties:-
Ex.B1 Photo copy of Application for Birla Sun Life Insurance
company Limited dated 02-09-2008.
Ex.B2 Photo copy of Medical Examiner’s Report
dated 02-09-2008.
Ex.B3 Photo copy of Claimants statement dated 20-03-2009.
Ex.B4 Photo copy of Admission Form of Asian Institute of
Gastroenterology dated 04-08-2008.
Ex.B5 Photo copy of Admission and Progress Notes of Asian
Institute of Gastroenterology Private Limited.
Ex.B6 Photo copy of Repudiation Letter dated 30-03-2009.
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 :
