Andhra Pradesh

Nellore

CC/117/2013

Badvelu Hema Latha aged about 38 years - Complainant(s)

Versus

The Manager Shriram Life Insurance company limited. - Opp.Party(s)

R.K.SARMA

23 Oct 2015

ORDER

Date of Filing     :13-11-2013

                                                                                                Date of Disposal:23-10-2015

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM:NELLORE

Friday, this the 23^rd day of  October, 2015

 

PRESENT: Sri M. Subbarayudu Naidu, B.Com.,B.L.,LL.M.,President(FAC) & Member                             

                   Sri N.S. Kumara Swamy, B.Sc.,LL.B., Member.

 

C.C.No.117/2013

 

Badvelu Hema Latha, Aged about 38 years,

W/o.Badvelu Harinatha Reddy,Padugupadu Village,

Kovur Mandal,  S.P.S.R.Nellore District.                                             ..… Complainant  

                                                                           Vs.

 

1.	The Manager, Shriram Life Insurance Company Limited, Tipparajuvari Veedi, Trunk Road, Nellore.
2.	The Manger, Shriram Transport Finance     Company Limited,  Up-Stairs –Damro, III Floor,                                                                                                  Srinivasa colony, Opposite to Magunta Layout, Nellore-3.                                                                                    ..…Opposite parties

                                                              .  

       This complaint coming on 22-09-2015 before us for hearing in the presence of Sri R.K. Sarma, advocate for the complainant and  Sri V. Jaya Rama Rao, advocate for the opposite party No.1 and opposite party No.2 called absent  and having stood over for consideration till this day and this Forum made the following:

 

ORDER

(ORDER BY  Sri N.S.KUMARA SWAMY, MEMBER)

 

The brief averments of the complaint are that complainant father Late Ogili KrishnaReddy ,S/o Ogili Pulla Reddy took a policy under plan “SHRI RAKSHA” in the opposite party company Ltd bearing policy no NP081100080666 dated 17-09-2011. The deceased policy holder paid an amount of Rs.1,00,000/- i.e, by way of Demand Draft No.186052, dated 11-08-2011, challan No.186052 dated 16-08-2011 SBI, Nellore for Rs.17,000/- and by way of Demand Draft No.186053, dated 16-08-2011, challan No 186053, dated 16-8-2011 SBI, Nellore for Rs.49,000/- and by way of Demand Draft No.186120, dated 16-08-2011, challan No.186120, dated 16-08-2011 SBI, Nellore for Rs.34,000/- in total Rs.1,00,000/- paid towards policy. The proposal deposit receipt issued by opposite party insurance company and also first premium receipt                    dated 17-09-2011 .The complainant further averred that opposite party accepted the policy and to that effect acceptance letter dated 28-09-2011 issued to Ogili Krishna Reddy. The complainant further stated that the opposite party company issued bond wherein it is clearly mentioned the sum proposal was Rs.8,00,000/- under column 19 and under column no 20 rider particulars under ADB (AR) sum proposed Rs.8,00,000/- and under FIB sum proposed Rs.8,00,000/-.The complainant further stated that her father paid the premium on 16-08-2011 and next premium due date was 17-09-2012 . Subsequently, her father died on 27-04-2012 at Vidavalur village. The death certificate of her father filed for perusal. Soon after the death of her father, she along with her husband namely, B.Harnath Reddy, went to the office of opposite party insurance company for claiming insurance amount but the opposite party did not pay the insurance amount inspite of repeated demands. Due to dereliction of duty and negligent acts of the opposite party, the complainant suffered loss, injury ,mental agony for which she entitled for compensation. Hence, the complainant filed this complaint and seeking relief as prayed for in the complaint.

 

2.         The opposite party resisted the complaint by filing the written statement except admitting that policy was issued to late Ogili Krishna Raddy vide policy NP081100080666 sum assured Rs.8,00,000/- for a term of fifteen years.

 

3.         The opposite party further contented that the deceased life insured was supplied with proposed form and requested to fill the same with regard to his health conditions, pre-health problems if any, habits, age, occupation, family history etc.,as per the questionnaire of the proposed form. Based on the information provided by the deceased in the proposed form, the opposite party has accepted the risk on his life and thereby issued the policy in good faith.

 

4.         Soon after the death intimation of the policy holder, the claim forms was handed over to the complainant who is the nominee herein. On perusal of medical reports,  it was observed that the deceased life assured was suffering from chronic kidney disease and the said disease was under regular dialysis under Rajiv Arigya Sri Scheme from 31-05-2011 to 25-04-2012.

 

5.         The opposite party further contented that at the time of signing the proposal form by the deceased life assured he was asked specific question vide question no.25 personal medical history of the life to be assured class (b) Are you at present in good health?,(5) Have you ever suffered and or suffering from any of the following (a)Ailments relating to the heart, digestive system, stomach, lungs, kidneys, brain , nervous system? For  that the deceased life assured given negative answers as “No”. Copy of the proposed form filed for perusal.

6.         The opposite party further contented that the above said facts were deliberately suppressed by the DLA in the proposal form which in turn prejudice the interest of the insurer. Had the DLA disclosed in the proposal form about his pre- existing form, the proposal would not have been accepted.Since the deceased violated the contracts governed by the principle of “UBBERIMA-FIDE” and also suppression of material facts of pre-existing disease the claim was repudiated on that ground and a letter dated 10-08-2012 addressed to the complainant in that regard.

 

7.         As there is no deficiency of service on the part of opposite party at any point of time the complaint may be dismissed with exemplary costs.

 

8.         Now the point for determination is:

 

1. Whether there is any deficiency in service on the part of opposite parties in settling the claim of the complainant?  If so, whether the complainant is entitled for the relief as prayed for in the complaint?
2. To what relief?

 

            9.   In order to substantiate  the complainant averments, complainant filed evidence on affidavit  as P.W.1 and marked Exs.A1 to A6.  On the other hand,   on behalf of opposite party No.1 filed chief affidavit as R.W.1 and marked Exs.B1 and B3.  Written Arguments  of both sides filed  Heard, on both sides.

 

10.       POINT NO1: This forum considered the entire material on record and also submissions made by their respective counsels. Before going into the matters in controversy between the parties , it is necessary to state the admitted facts. The deceased life assured namely Ogili Krishna Reddy took a life insurance policy “SREE RAKSHA” bearing policy No NP081100080666 commencing from the date 17-09-2011 for sum assured Rs.8,00,000/-. The policy term is fifteen years on yearly premium. The DLA has nominated his daughter as nominee to receive the death benefits under the policy. The complainant alleged as following that she is the daughter of deceased policy holder namely Ogili Krishna Reddy nominated her as nominee in his policy.  Due to unfortunate death of her father on 27-04-2012 at Vidavalur village ,she being the nominee  went and approached the opposite party along with her husband B.Harnath Reddy  preferred a claim of insurance policy amount but the opposite party did not pay the amount inspite of repeated demands. Due to negligent act and dereliction of duty and also violation of contract of insurance by the opposite party, she is entitled for compensation for mental agony along with insurance amount of Rs.20,00,000/- with subsequent interest there on and for costs .

 

11.       On the other hand, the opposite party repudiated the claim dated 10-8-2012 on the ground that insured suppressed the material facts of pre-existing diseases before taking the policy. These facts came to light on the available medical records obtained from Aravind Kidney Centre, Nellore. As deceased has deliberately suppressed the material facts which were supposed to be disclosed at the time of taking the policy and violated the terms and conditions of the policy the contract becomes un enforceable and not legally binding on the opposite party.  Hence the complaint may be dismissed with exemplary cost as there is no deficiency of service on the part of the opposite party.

 

12.       Here, the onus lies on the opposite party to prove its case

In the instant case, the opposite party challenged the allegations of the complainant and submitted that credible recorded proof of pre-existing disease prior to his having taken the insurance policy . From the proposal form i.e Ex.B2 filled by the insured which was also certified by him and disclosed that the deceased replied negative answers for the specified question no .25 with regard to personal medical history of the life assured viz (b) Are you at present in good health?, (5) Have you ever suffered or are suffering from any of the following ?,(a)Ailments relating to the heart , digestive system , stomach, lungs, kidney, brain or nervous system? . Had the deceased life assured disclosed in the proposed form about his pre-existing disease , the proposal would not have been accepted.

 

13.       The opposite party further contented that the above facts of suppression of material aspects came to light through the medical reports obtained from Aravind Kidney Centre , Nellore which is Ex.B1 .The said report also disclosed that the deceased was under regular dialysis under Rajiv Arogya Sri Scheme from 31-05-2011 to 25-04-2012. The deceased life assured reported to have died on 27-04-2012 which result in early claim in just six months and nineteen days. Hence , it is very clear from the questionnaire that the policy was obtained by the assured in a deceitful manner by suppressing the actual pre-existing health problems. The said suppression is with a fraudulent intention and to have get undue advantage of the policy benefits. Life insurance policies are contracts governed by the principle of “UBERRIMA-FIDE” and the proposer who applied for insurance is expected to correct furnish all the material information regarding the health and habits, family history to the questions framed in the proposal form .As seen from the medical record which is Ex.B1 obtained by searching the website of Rajiv Arogya Sri Scheme ,disclosed that the deceased life assured was also under medication for anti diabetes, anti hypertension, and other tablets etc., for heart and kidney ailments.

 

14.       What is required to be shown is that deceased has not truthfully disclosed the ill health and when the proposal form indicated the questionnaire , the questionnaire must be answered truthfully and if it is found to be false, the opposite party could rightly repudiate the claim.

 

15.       Accordingly and in view of the suppression of material facts in the proposal form, the complainant was informed through a letter dated 10-8-2012 which is Ex.B3 about the repudiation of the claim .  

 

16.       Going by the entirety of the facts and circumstances of  the case and in particular the life assured was suffering from chronic kidney disease and also other diseases before making the proposal for insurance but suppressed the material facts in the declaration given by him in the proposal form . We are of the considered opinion that our findings are in consonance with the decisions of Honourable Apex Court in the case of P.C. Chacko and  anr. V. Chairman, L.I.C. of India, IX (2007) SLT 533=III(2008), CPJ 78 (SC)=IV (2007) ACC 773 (SC)=IV (2007) CLT 229 (SC)-(2008) 1 SCC 321,  and Satwant Kaur Sandhu Vs. New India Assurance Company VI (2009) SLT 338=IV (2009) CPJ 8 (SC)=(2009) 8 SCC 316,  wherein the similar circumstances the Honourable Supreme Court held that the suppression of such material facts about the status of health by the life assured disentitled the nominee /heirs of the insurance claim. There is no bonafide proof placed by the complainant about the sound health of the insured on the date of entering into contract of the insurance and other allegations. On record, we have only self serving and interested statement of the complainant about sound health of insured on the date of entering into the policy. Further the deceased life assured has given declaration in the proposal form that all the statements and answers are all true and complete to the best of his knowledge and belief. The said statement is quite contrary to the evidence placed by the opposite party. It is well settled law from number of judgments including Apex Court that the insurance policy between the two parties is based on the principle of utmost good faith and breach up the same would justify repudiation of the insurance claim .

 

17.       In view of the breach of conditions of the policy, the opposite party issued a letter dated 10-8-2012 addressed to the complainant which is Ex.B3 about the repudiation of the claim. The complainant failed to place any documentary proof of sound health about the insured in support of her claim. The medical record placed by the opposite party is a plausible evidence and cannot be brushed  aside unless something contrary is proved . The complainant denied the documentary evidence which was  furnished by the opposite party as it is a fraudulent one. Further the complainant has not placed any reliances to rebut the evidence of opposite party by filing rejoinder affidavit.

 

18.       Hence , we come to conclusion that the material records with regard to the suppression of facts is justified and same gains from the abundant documentary proof placed by the opposite party. In such is the case we cannot find fault with the opposite party as there is clear violation of terms and conditions of the policy by the complainant .We agree with the evidence produced by the opposite party is sacrosanct but the complainant failed to place any trust worthy evidence to discard the same .As there is no negligence or dereliction of duties on the part of opposite party and as there is no deficiency of service, the complaint is liable to be dismissed . Accordingly, point no.1 is answered.

 

19.       POINT NO 2: In the result, the complaint is dismissed. But in the circumstances of the case, there is  no order as to costs.

 

Typed to the dictation to the Stenographer, corrected and pronounced by us in the open  Forum, this the  23^rd day of  October, 2015.

 

 

                Sd/-                                                                                           Sd/-

           MEMBER                                                                               PRESIDENT(F.A.C.)

 

 

 

 

 

                                                APPENDIX OF EVIDENCE

 

Witnesses Examined for the complainant

 

P.W.1  -

26-03-2015

Smt Badvelu Hema Latha, D/o.Late Ogili Krishna Reddy, Kovur Mandal, S.P.S.R.Nellore District  (Evidence  Affidavit filed)

 

Witnesses Examined for the opposite parties

 

R.W.1  -

07-01-2015

Sri E. Sridhar, S/o.Late E.J. Lingam, Assistant General Manager in Shriram Life Insurance Company, Hyderabad-500032 (Evidence Affidavit filed).

 

                             EXHIBITS MARKED FOR THE COMPLAINANT

 

Ex.A1  -	16-08-2011	Photocopy of Proposal Deposit Receipt No.197820110800030 in favour of Ogili Krishna Reddy issued by the opposite party.
Ex.A2  -	17-09-2011	Photocopy of First Premium Receipt  in favour of Ogili Krishna Reddy issued by the opposite party No.1.
Ex.A3 -	28-09-2011	Photocopy of  letter from opposite party No.1 to the Ogili Krishna Reddy, Nellore District.

 

Ex.A4  -	11-08-2011	Photocopy of Deposit Acknowledgement Receipt for Rs.1,00,000/-  in favour of  Ogili Krishna Reddy issued by the opposite party No.1.
Ex.A5  -	11-08-2011	Photocopies of Proposal for Insurance in favour of O.Krishna Reddy,  letter dated 17-09-2011 from opposite party No.1 to the  Ogili Krishna Reddy, Nellore District  alongwith  letter from opposite party No.1 dated 05-09-2011 to the Ogili Krishna Reddy.
Ex.A6  -	01-05-2012	Photocopy of Death Certificate in favour of Ogili Krishna Reddy.

                         EXHIBITS MARKED FOR THE OPPOSITE PARTIES

 

Ex.B1  -	06-08-2012	Photocopy of  letter and treatment details of  Ogili Krishna Reddy  issued by Aravind Kidney Centre, Nellore-524 001 to the Assistant General Manager, Shriram Life Insurance, Hyderabad.
Ex.B2  -	11-08-2011	Photocopy of Proposal for Insurance in favour of O.Krishna Reddy.
Ex.B3  -	10-08-2012	Photocopy of Repudiation of the Claim from opposite party No.1 to the complainant.

                                                                                                                    Id/-

                                                                                                         PRESIDENT(F.A.C.)

 

Copies to:

 

1.	Sri R.K. Sarma, Advocate & Notary, Tekkemitta, Nellore-3.
2.	Sri V. Jaya Rama Rao, Advocate, Nellore.
3.	The Manger, Shriram Transport III Floor Finance Company Limited, Up-Stairs –Damro, Srinivasa colony, Opposite to Magunta Layout, Nellore-3.

 

Date when free copy was issued: