BEFORE THE DISTRICT FORUM: KURNOOL

Present: Sri. T.SundaraRamaiah, 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

Wednesday the 19^thday of October, 2011

C.C.No.60/2011

Between:

K.Manjula, W/o Late KadavakullaSrinivasulu,

  .      

…Complainant

-Vs-

1. The General Manager,Reliance Life Insurance Company,

   Reliance House, No.6^th floor, Haddows,        Chennai-600006, Tamilnadu State.

2. The Branch Manager, Reliance Life Insurance Company,

   Shop No.39 to 42 RMK Plaza, OPP to ZillaParishad, Railway Station Road,Kurnool District-518001,Andhra Pradesh.

   ...Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri S.Lakshmi Narayan, Advocate for complainant and Sri G.NagendraNathYadav, Advocate for opposite parties 1 and2 and upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Sri.T.SundaraRamaiah, President)

C.C. No.60/2011

1.     This complaint is filed under section 12 of C. P. Act, 1986 praying:-

1. To direct the opposite partiesto pay assured sum of Rs.1,50,000/- with benefits and compensation of Rs.10,000/- to the complainant;

1. To grant interest @ 24% per annum from the date of death;

1. To grant costs of the complaint;

1. To grant such other reliefs as the Honourable Forum may deem fit and proper.                                       

2.    The case of the complainant in brief is as under:- The complainant  is the wife of Late KadavakullaSrinivasulu.  KadavakullaSrinivasulu insured his life with the opposite parties under the policy bearing No.15571096 for Rs.1,50,000/-.  The policy commenced from the year 2009.   The yearly premium payable under the policy is Rs.15,000/-.  The complainant is the nominee under the policy.  On 03-10-2010 the insured died due to Dengue Fever.  Opposite party No.2 was informed about the death of the insured.  The complainant who is the nominee under the policy submitted the claim to the opposite parties.  The opposite party No.2 repudiated the claim of the complainant stating that the insured suppressed the material facts regarding his health condition in the proposal form and that the insured had terminal ill ness at the time of the proposal and the same was not disclosed by the insured in the proposal form.  The repudiation of the claim of the complainant by opposite party No.2 is arbitrary.  On the date of proposal the health condition of the life assured was good.   The life assured did not give false statement 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 worry by falsely repudiating the claim of the complainant.  Hence the complaint.

3.     Opposite parties 1 and 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 contract of insurance is based on good faith.  The proposer concealed the material facts in the proposal form.  The proposer Mis-stated the material facts in the proposal form.  The assured obtained policy by misrepresentation and fraud.  The assured suppressed material facts in the proposal form.  There is no deficiency of service on the part of opposite parties and the complaint is liable to be dismissed.

4.     On behalf of the complainant Ex.A1 and A2 are marked and sworn affidavit of the complainant is filed.  On behalf of the opposite parties 1 and 2 Ex.B1 to B5 are 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:

1. Whether there is deficiency of service on the part of Opposite Parties?

1. Whether the complainant is entitled for the reliefs as prayed for?

1. To what relief?

7.      POINTS 1 and 2:- AdmittedlyKadavakullaSrinivasulu who is the husband of the complainant obtained insurance policy bearing No.15571096 in his name on 12-11-2009.  The sum assured under the policy was Rs.1,50,000/- and yearly premium payable under the policy was Rs.15,000/-.  The complainant is the nominee under the said policy is not under dispute. It is the case of the complainant that her husband died on 03-10-2010 due to Dengue Fever.  The complainant in her sworn affidavit clearly stated that her husband died on 03-10-2010 due to Dengue Fever.  In Ex.B4 investigation reportit is stated that the insured died on 03-10-2010 while undergoing treatment at Government Hospital, Ananthapur.  Admittedly after the death of the insured the complainant who is the wife of the insured submitted the claim to the opposite parties.  The said claim of the complainant was repudiated by opposite party No.2 under Ex.A2 letter dated 23-03-2011 stating that the insured was suffering from terminal illness at the time of the proposal; that he suppressed the said fact in the proposal form and that 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 with in his knowledge in the proposal form.  According to the complainant her husband was keeping good health at the time of proposal and that he died on 03-10-2010 due to Dengue Fever.  Ex.B3 is the copy of the Proposal Form.  In the proposal form it is mentioned by the proposer that he was not taking anymedication or drugs and that he was not suffering from any medical aliments.  It is the specific case of the opposite parties as seen from Ex.A2 that the complainant was suffering from terminal illness by the date of the proposal.  Admittedly opposite party No.1 who filed affidavit has no personal knowledge about the health condition of the insured on the date of the proposal.  The opposite parties mainly relied on Ex.B4 investigation report where in it is mentioned that the insured was a HIV patient and he was on regular treatment at R.D.T. Hospital, Bathalapalli.  Along with the report, the medical certificate issued by Medical Officer R.D.T. Hospital, Bathalapalliis filed.  It is mentioned in the said certificate that KadavakullaSrinivasulu was treated in the said hospital from 01-02-2003 to 23-08-2010 for immune deficiency infection as a regular patient.  The opposite parties did not choose to examine the medical officer attached to R.D.T. Hospital Bathalapalli to establish that the assured was suffering from HIV by the date of the proposal.  Merely basing on the photo copy of the certificate said to have been issued by R.D.T. Hospital, Bathalapalli it cannot be concluded safely that the insured was suffering from HIV by the date of the proposal in the year 2009.  No doubt the insurance company can repudiated the claim if material facts are suppressed by the insured in the proposal from.  In the present case on hand the opposite parties failed to establish that the assured was suffering from HIVon the date of the proposal.  Under section 45 of Insurance Act, insurer must establish that the matter alleged to have been suppressed is material and that suppression was fraudulently made by the policy holder and that policy holder knew at the time of making statement that it was false.  Mear falsity in respect of some recitals in proposal form is not sufficient to repudiate the claim.  Insurance Company should establish that the cause of death of the insurer is an account of suppressed health information.  As already stated the opposite parties could not establish that the insured was suffering from HIV by the date of the proposal and that he fraudulently suppressed said fact in the proposal form.  The repudiation of the claim by opposite party No.2 is not just and proper.  There is deficiency of service on the part of opposite parties.  The complainant who is the nominee under the policy is entitled to assured amount of Rs.1,50,000/-.

 9.    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 complainant with interest at 9% per annum from the date of the repudiation of the claim  i.e., 23-03-2011 till the date of payment along with cost of Rs.500/-.

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 19^thday of October, 2011.

Sd/-                              Sd/-                              Sd/-

MALE MEMBER                      PRESIDENT                 LADY MEMBER

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant :Nill            For the opposite parties:Nill

List of exhibits marked for the complainant:-

Ex.A1                Photo copy of letter issued by opposite party No.2 to

complainantdated 18-02-2011.

 Ex.A2.      Repudiation letter dated 23-03-2011.

List of exhibits marked for the opposite parties:-

Ex.B1                Photo copy of First Appeal No.242-2006 order of

Honourable National Commission, New Delhi,

dated 27-07-2010.

Ex.B2                Letter of Authority dated 27-05-2011.

Ex.B3                Photo copy of common proposal form   for life insurance

linked plan dated 12-11-2009.

Ex.B4                Photo copy of investigation report strictly confidential

                dated 09-30-2011.

Ex.B5                Photo copy of letter by opposite party No.2 to complainant

                dated23-03-2011.

Sd/-                              Sd/-                              Sd/-

MALE MEMBER                 PRESIDENT                   LADY MEMBER

    // Certified free copy communicated under Rule 4 (10) of theA.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties  :

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