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

Friday the 24^th day of February, 2012

C.C.No.142/2011

Between:

M.Sankar Reddy,S/o. Naryana Reddy,Agriculturist,

H.No.45-142-26 E 11G/5, Venus Colony, V.R. Colony,Kurnool - 518 003.                                                       

  …Complainant

                                                    -Vs-      

1. The Manager,H.D.F.C. Standard Life Insurance Company Limited,

   IInd floor, A Wing, Trade Star Building, Andheri - Kurla Road, Andheri (E),MUMBAI - 400 059.

2. The Branch Manager,H.D.F.C. Standard Life Insurance Company Limited,

    I floor, Adil Complex, H.NO.51/1, FD 1, Above Honda Show Room,     Bellary Road, KURNOOL - 518 002.                                                                

...Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri P.V.Ramana Reddy, Advocate for complainant and opposite parties 1 and 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. 142/2011

1.     This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying:-

1.   To direct the opposite parties to pay the policy amount of Rs.10,00,000/-;

1.   To grant compensation of Rs.1,00,000/- towards mental agony suffered;

1.   To grant costs of this application, Rs.5,000/-;

And

1.   To pass such other reliefs as the Honourable Forum deems fit and proper in the circumstances of the case in the interests of justice;

2.    The case of the complainant in brief is as under:- The complainant wife Maheswari obtained insurance policy bearing No.13800032 dated 29-07-2010 from the opposite parties.  The assured amount under policy is Rs.10,00,000/-.  The terms of the policy is 10 years and yearly premium is Rs.50,000/-.  On 28-10-2010 Maheswari developed severe abdomen pain. After investigation it was found that she was suffering from Liver Cancer.  She died on 01-06-2011.  Later the complainant submitted the claim to the opposite parties.  The opposite party No.1 repudiated the claim of the complainant on the ground that the information on Colon Cancer was not disclosed in the proposal form dated 17-07-2010.  Hence the complaint.

3.     Opposite parties called absent and set exparte.

4.     On behalf of the complainant Ex.A1 to A12 are marked and sworn affidavit of the first complainant is filed. 

5.     Complainant filed written arguments.

6.     Now 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 i and ii:- It is the case of the complainant that his wife obtained insurance policy bearing No.13800032 from the opposite parties for an assured mount of Rs.10,00,000/-.  Admittedly the opposite parties issued the policy bearing the above said number to the wife of the complainant.  It is the case of the complainant that his wife died on 01-06-2011 due to Liver Cancer.  Admittedly after the death of Maheswari the complainant who is the husband of Maheswari preferred the claim.  The opposite party No.1 repudiated the claim of the complainant under Ex.A12 stating that the information that Maheswari was suffering from Liver Cancer was not disclosed in the proposal form dated 17-07-2010.  Ex.A1 is the proposal form dated 17-07-2010.  In the said form there is no mention that Maheswari was suffering from Liver Cancer.  It is the case of the complainant that Maheswari suffered from Cancer subsequent to issuance of the policy by opposite parties.  The opposite parties did not place any medical evidence to show that deceased Maheswari was suffering from Cancer by 17-07-2010 i.e., the date of proposal.  The complainant filed Ex.A9 and Ex.A10 to show that Maheswari died on 01-06-2011.  It is for the insurance company to establish that the insured suppressed material facts and that the suppression was made fraudulently.  As already stated there is no material on record to show that the insured suffered from Cancer by the date of the proposal.  The opposite parties did not come forward to let in any evidence to establish that the insured was suffering from Liver Cancer on 17-07-2010.  The repudiation of the claim by the opposite parties is not just.  The insurance company repudiated the claim of the complainant unnecessarily.  There is deficiency of service on the part of the opposite parties.  The complainant who is the nominee under the policy is entitled to the assured amount of Rs.10,00,000/-.

8.     In the result, the complaint is partly allowed directing the                                      opposite parties jointly and severally to pay the policy amount of  Rs.10,00,000/- to the complainant along with cost of Rs.500/- within  two months from the date of order.

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 24^th day of February, 2012.

 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 Proposal Form dated17-07-2010.

Ex.A2.       Photo copy of First Premium Receipt for Rs.50,000/-

                dated 29-07-2010.

Ex.A3                Photo copy of Intimation Letter dated 30-07-2010.

Ex.A4                Prescription issued by Deepak Tej Hospital, Kurnool

                dated 28-10-2010.

Ex.A5                Medical Bill of Rs.166/- dated 28-10-2010 issued by

                Ganapathy Medical General Stores, Kurnool.

Ex.A6                CT Scan Upper Abdomenm issued by Gowri Gopal

                Hospitals Private Limited, Kurnool dated 09-11-2010.

Ex.A7                Office copy of Clinical Laboratory Report

dated 09-11-2010.

Ex.A8                Prescription issued by Deepak Tej Hospital, Kurnool

dated 29-11-2010.

Ex.A9                Photo copy of Death Certificate issued by Village

                Revenue Officer, Pallepadu & Chandoor Manopad

                Mandal dated 03-06-2011.

Ex.A10       Death Certificate issued by Registrar of Births and

                Deaths Municipal Corporation, Kurnool

Dated 08-06-2011.

Ex.A11       Office copy of Legal Notice dated 25-08-2011.

Ex.A12       Office copy of Repudiation Letter dated 31-08-2011.

List of exhibits marked for the opposite parties:- NILL

  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             :

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