BEFORE THE DISTRICT CONSUMER’S 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
Friday the 29th day of June, 2012
C.C.No.136/2011
Between:
B.Peeramma,
W/o Venkata Swamy,
R/o H.No.29-215K-111,
Vivekananda Nagar,
Nandyal – 518 501,
Kurnool District. …Complainant
-Vs-
1. The Manager - Claims,
TATA AIG Life Insurance Company Limited,
Unit – 302, Building No.4,
Infinity IT Park,
Film City Road, Dinodoshi,
Malad East,
Mumbai – 400 097.
2. The Manager,
TATA AIG Life Insurance Company Limited,
4th Floor, D.No.15,
U-Con Plaza, Park Road,
Kurnool – 518 001. ...Opposite ParTies
This complaint is coming on this day for orders in the presence of Sri S.V.Krishna Reddy, Advocate for complainant and Smt. A.Uma Devi, 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 Sri. T.Sundara Ramaiah, President) C.C. No.136/2011
1. This complaint is filed under section 12 of C.P. Act, 1986 praying:-
- To direct the opposite parties to pay assured amount of Rs.1,90,000/- and an amount equal to 3% of the face value of the basic policy;
- To award costs to the complaint;
- To award Rs.5,000/- for mental agony;
- To award interest @24% per annum from 17-02-2010 to the date of payment;
And
- To grant such other relief or reliefs as the Honourable 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 son by name B.Srinivasulu insured his life with opposite parties. The opposite party No.2 issued the policy bearing No.76963443 in favour of the complainant son. The period of the policy is from 24-03-2009 to 23-03-2034. The son of the complainant B.Srinivasulu died on 12-10-2009 due to Jaundice. The complainant being the nominee under the policy submitted the claim to the opposite parties along with relevant documents. The opposite parties having received the claim form did not settle the claim of the complainant. The complainant received a repudiation letter from the opposite parties stating that the life assured was suffering from Tuberculosis by the date of the application form, and that the deceased life assured obtained policy from the opposite parties suppressing the material facts. The opposite parties repudiated the claim of the complainant illegally. The complainant was put to mental agony. There is deficiency of service on the part of the opposite parties. Hence the complaint.
3. Opposite party No.1 filed written version stating that the complaint is not maintainable and it is liable to the dismissed. In the proposal form the life assured answered questions No.4E and 6 in the negative. The life assured was under treatment for Tuberculosis, prior to the application form for insurance. The life insured not disclosed correct information in the application form dated 18-03-2009 regarding his health condition. The life insured was aware of the terms and conditions of the policy. The life insured was suffering from Tuberculosis from 22-12-2008. The life insured did not disclose the same in the application form. The opposite parties received the claim form from the complainant. The opposite parties gave a reply letter dated 17-02-2010. The complaint is liable to be dismissed.
Opposite party No.2 set exparte.
4. On behalf of the complainant Ex.A1 to A4 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite party No.1 Ex.B1 to B5 are marked and sworn affidavit of opposite party No.1 is filed. RW1 is examined.
5. Both sides 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 deceased B.Srinivasulu obtained insurance policy bearing No.76963443 from the opposite parties. The period of policy is from 24-03-2009 to 23-03-2034. Admittedly the complainant B.Peeramma is the nominee under the policy. It is the case of the complainant that her son Bandaru Srinivasulu died on 12-10-2009. It is stated in her sworn affidavit that her son died on 12-10-2009. The complainant also filed Ex.A4 Death Certificate issued by the Registrar of Births and Deaths, Nandyal Municipality, Nandyal. It is clearly stated in Ex.A4 that Bandaru Srinivasulu died on 12-10-2009. Admittedly after the death of the life insured Bandaru Srinivasulu, the complainant who is the nominee under the policy submitted the claim form to the opposite parties. The opposite parties repudiated the claim of the complainant through Ex.A1 stating that the life assured was suffering from Tuberculosis by the date of the application form dated 18-03-2009 and he obtained the policy fraudulently by suppressing material particulars regarding his health condition. The burden is on the insurer to establish that the insured obtained the policy by suppressing material facts regarding his health conditions.
8. The opposite parties filed Ex.B1 application form submitted by the deceased to obtain the policy. The statement made by the deceased life insured regarding his health conditions in Ex.B1 is reproduced below.
4. Have you ever had any of the following: Insured Applicant
Yes No Yes No
a. ………………………………………………..
b. ………………………………………………..
c. …………………………………………………
d. …………………………………………………
e. Asthma, Pneumonia, tuberculosis,
emphysema, coughing, up blood,
persistent cough, or any other
disorder of the chest or lungs? No
f. ……………………………………………………
g. ……………………………………………………
h. …………………………………………………..
i. …………………………………………………..
j. …………………………………………………..
k. …………………………………………………..
l. ……………………………………………………
5. a. …………………………………………………..
b. …………………………………………………..
6. In the last 5 years, have you attended
doctor or any other medical facility
for investigation or diagnostice tests
(such as X-ray, ultrsound, CT scan, blopsy,
ECG, blood or unne, etc)? No
The deceased life insured in the application form Ex.B1 answered the above question in Negative. According to the complainant her son died due to Jaundice. She did not produce any medical evidence on record to establish that her son died due to Jaundice. The opposite parties in order to establish the fact that life insured was suffering from Tuberculosis relied on the evidence of RW1 and Ex.B3. RW1 Medical Officer, T.B. Hospital, Nandyal in his evidence clearly stated that B.Srinivasulu took treatment for T.B. from 22-12-2008 to 31-03-2009. It is admitted by him that Ex.B3 was given by the Hospital. RW1 brought the original record from the Hospital and gave evidence. The evidence of RW1 who is a Public servant goes to show that B.Srinivasulu was suffering from Tuberculosis and took treatment from 22-12-2008. It is submitted by the learned counsel appearing for the complainant that the patient who was treated for Tuberculosis in T.B. Hospital, Nandyal from 22-12-2008 was not the son of the complainant. It is admitted by the RW1 in cross examination that the father’s name of the patient is mentioned as Dommari Venkata Subbaiah. In Ex.B1 application form the father’s name of the life insured is mentioned Venkata Swamy. It is not the case of the complainant that they are not residents of Nandyal. In Ex.B1 application form for insurance and Ex.B3 T.B. Treatment particulars of B.Srinivasulu, it is mentioned that he is a resident of Nandyal. Merely because there is some discrepancy in Ex.B1 and Ex.B3 regarding the father’s name of the B.Srinivasulu it cannot be said that the patient who took treatment as per Ex.B3 was not the son of the complainant. It is suggested to RW1 in his cross examination that the patient came for follow up treatment on 22-02-2009. RW1 denied the same. As seen from the medical evidence available on record it is very clear that the life insured was suffering from Tuberculosis by the date of application form dated 18-03-2009 for insurance. It is submitted by the learned counsel appearing for the complainant that the Doctor who gave treatment to the patient was not examined by the opposite parties and that the treatment particulars in Ex.B3 cannot be believed. In the present case admittedly the Doctor who gave treatment to the life insured was not examined by the opposite parties. The opposite parties examined RW1 who is a Medical Officer presently working in T.B. Hospital, Nandyal. He gave evidence basing on the entries in the original record brought by him. The learned counsel appearing for the complainant relied on a decision reported in IV (2007) CPJ 163. In the said decision it is held that “No substantial evidence supported by affidavit of doctor, who treated deceased, filed on record”. In the present case the opposite parties have examined the Medical Officer attached to T.B. Hospital, Nandyal. He gave evidence basing on the entries in the original record. The decision cited by the learned counsel appearing for the complainant is not applicable to the facts of the present case on him. The opposite parties could able to establish that the life insured obtained the policy by suppressing the material particulars regarding his health conditions. The contract of insurance is based on good faith. The applicant should furnish correct information in his application for insurance. No mention was made by the applicant in Ex.B1 that he was suffering from T.B. and consulted the doctor. The opposite parties rightly repudiated the claim of the complainant stating that he deceased obtained the policy by suppressing the material particulars regarding his health condition. No deficiency of service is found on the part of the opposite parties.
9. In the result, the complaint is dismissed without costs.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 29th day of June, 2012.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties: RW1
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Life Insurance Proposal Form.
Ex.A2. Letter by opposite party No.1 to complainant
dated 04-03-2010.
Ex.A3 Letter by opposite party No.1 to complainant
dated 23-07-2010.
Ex.A4 Photo copy of Death Certificate issued by Municipal
Councel, Nandyal, Kurnool District dated 05-11-2009.
List of exhibits marked for the opposite parties:-
Ex.B1 Photo copy of Application Form dated 18-03-2009.
Ex.B2 Photo copy of Policy terms and conditions.
Ex.B3 Photo copy of T.B. Treatment Particulars
dated 25-02-2010.
Ex.B4 Photo copy of Letter by complainant to opposite party No.1
dated 23-02-2010.
Ex.B5 Photo copy of Letter by opposite party No.1 to complainant
dated 04-03-2010.
RW1 Deposition of Sri Dr.G.Chandra Shekar dated 30-04-2012.
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 :
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