Andhra Pradesh

Nellore

CC/116/2013

Badvelu Hema Latha - Complainant(s)

Versus

The ManagerShriram 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.116/2013

 

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 that she is the daughter of late Ogili Krishna Reddy, S/o.Ogili Pulla Reddy.The deceased Ogili Krishna Reddy took a regular premium policy under plan “Shri Raksha” in the opposite party company limited bearing policy No.NPO81100080654, dated 17-09-2011.  The complainant stated that her father paid amount of Rs.1,00,000/- by way of D.D.No.186054, dated 11-08-2011,  challan No.186054, dated 16-08-2011, S.B.I., Nellore for Rs.49,000/- and by way of D.D.No.186055, dated 11-08-2011, challan No.186055,dated 16-08-2011, S.B.I., Nellore for Rs.49,000/- and by way of D.D.No.186091, dated 12-08-2011, challan No.186091, dated 16-08-2011, S.B.I., Nellore for Rs.2,000/- in total  Rs.1,00,000/- paid towards the policy under Shri Raksha plan bearing policy No.NPO81100080654, dated 17-09-2011.  The proposal deposit receipt issued by opposite party company is filed alongwith                    1^st premium receipt dated 17-09-2011 for perusal.  The opposite party company issued acceptance of policy by way of letter dated 28-09-2011 to Ogili Krishna Reddy and  a letter dated 28-09-2011 and deposit acknowledgement receipt dated 10-08-2011 are filed for perusal.  The complainant further stated that opposite party company issued a bond to her father Ogili Krishna Reddy and her father given her name as his name in case of his death to receive death benefits. In the said bond issued by the opposite party company in page No.2, column No.19, it is clearly mentioned the sum proposed is Rs.8,00,000/- and in column No.20 rider particulars under AOB(AR) sum proposed is Rs.8,00,000/- and under FFB(FIB) sum proposed is Rs.8,00,000/-.  The complainant father died on                    27-04-2012 at Vidavaluru village.  Soonafter the death of her  father, she herself and her husband B. Haranatha Reddy approached the office of the opposite party insurance company to pay insurance amount of total Rs.24,00,000/-, restricted the claim of  Rs.20,00,000/- on the point  of Jurisdiction with interest, but the opposite party did not pay the said amount inspite of repeated demands.  Due to the dereliction of duty  and negligent acts of opposite party, the complainant suffered loss, injury and mental agony for which she is entitled for compensation.  Since, the opposite party is liable for breach of contract, the complainant is entitled for the reliefs as prayed for in the complaint.  Hence, the complaint.

 

            2.         The opposite party filed written version denying all the averments made in the complaint except that late Ogili Krishna Reddy took a insurance policy of  Shri Raksha bearing No.NPO81100080654, dated 17-09-2011 for a sum assured Rs.8,00,000/-  +  A.R. and F.I.B. policy term 15 years, mode of premium yearly. The D.L.A. has nominated her daughter as nominee to receive the death benefits under the policy.   At the time of issuing the policy, the deceased life assured was supplied with proposal form and requested to fill the same with regard to his health conditions, habits, age, family history etc., as per the questionnaire in the proposal form.  Basing on the information provided by the diseased in the proposal form, the opposite party accepted the  risk on his life and thereby issued the subject policy in good faith.  Subsequently, the complainant intimated  the deceased policy holder died on 27-04-2012 and accordingly the concerned claim forms were handedover to the complainant, who is nominee under the above policy. On perusal of the  medical reports, it was observed that the deceased life assured was suffering from chronic kidney disease   and also noticed that the deceased was under regular dialysis under Rajiv Arogyasree Scheme from 31-05-2011 to 25-04-2012.  Copy of the medical report is submitted  for perusal.  Further, the life assured was asked specific question vide questionnaire number 25, personal medical history of the life assured clause (b) : Are you at present  good health? (5)   Have you ever suffered or suffering from any of the following?  (a)  Ailments relating to the heart, digestive system, stomach, lungs, kidney, brain or nerves system? The policy holder replied negatively as “No”.  The proposal form also submitted for perusal.

 

            3.         From the above questionnaire, it is very clear that policy was obtained by the deceased life assured in a  deceitful manner by suppressing the actual pre-existing health problem.  The opposite party submitted that life insurance policies are contracts governed by the principle of “UBERRIMA-FIDE” and the proposer applying for insurance is expected to correctly furnish all material information regarding health, habits, family age, etc., of the life proposed.  But the life assured in the present case has provided incorrect details  and took the policy and the said policy is void and not enforceable in law.  As the deceased life assured provided incorrect details of his health problems and as there is no valid contract between the parties, the claim is repudiated and the repudiation letter dated 10-08-2012 is filed. 

 

4.         Since, the deceased deliberately suppressed the material facts which were supposed to disclose at the time of taking the policy, the complainant claim is not maintainable and as there is no bonafidies in the complaint, the complaint may be dismissed with exemplary costs.

 

5.         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?

 

            6.   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.

 

7.  POINT No.1: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 that the admitted facts. The deceased life assured namely Ogili Krishna Reddy took a life insurance policy “SREE RAKSHA”bearing no NP081100080654 commencing from the date 17-09-2011 for sum assured Rs.8,00,000/- plus AR and FIB .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 .

 

8.         On the other hand, the opposite party repudiated the claim 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 unenforceable 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.

 

9.         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 proposal form about his pre-existing disease , the proposal would not have been accepted.

 

10.       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 resulted 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 correctly 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 disclosed that the deceased life assured was under medication for anti diabetes, anti hypertension, and other tablets etc., for heart and kidney ailments.

 

11.       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.

 

12.       Accordingly and in view of the suppression of material facts in the proposal form, the complainant was informed through a letter  dated 10-08-2012, which is Ex.B3 about the repudiation of the claim.  

 

13.       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 Hon’ble 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 proposed 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 of the same would justify repudiation of the insurance claim .

14.       In view of the breach of conditions of the policy, the opposite party issued a letter dated 10-08-2012 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. 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.

15.       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.197820110800029 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  -	17-09-2011	Photocopy of  letter from opposite party No.1 to the  Ogili Krishna Reddy, Nellore District.
Ex.A4  -	10-08-2011	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	Photocopy of Proposal for Insurance in favour of O.Krishna Reddy in  proposal No.197811000095.
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 in  proposal No.197811000095.
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 Finance Company Limited, Up-Stairs –Damro,            III Floor, Srinivasa colony, Opposite to Magunta Layout, Nellore-3.

 

Date when free copy was issued: