IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Monday the 28th day of February, 2011
Filed on 04.03.2009
Present
- Sri. Jimmy Korah (President)
- Sri. K. Anirudhan (Member)
- Smt. Shajitha Beevi (Member)
in
C.C.No.116/2009
between
Complainant:- Opposite Party:-
Smt. B. Radhamma Life Insurance Corporation of
Karthika, Eravukadu Ward India, Divisional Office
Thiruvambady P.O. “Jeevan Prakash”
Alappuzha – 688 002 Nagambadam, Kottayam
(By Adv. C. Parameswaran) Pin – 686 001,
Represented by its Senior
Divisional Manager
(By Adv. S. Devalal)
O R D E R
SRI JIMMI KORAH (PRESIDENT)
The case of the complainant is that the complainant is the wife of the deceased Raju. In 2004, Raju had availed a policy from the opposite party for an amount of Rs.100000/-(Rupees one lakh only). Subsequently, the insured succumbed to death following a cardiac ailment. After the death of her husband, the complainant who is the nominee of the deceased submitted a claim with the opposite party for the amount due under the aforesaid policy. The opposite party right away repudiated the complainant’s claim vide letter dated 28th February 2006 on the ground that the deceased had withheld correct information with regard to his health at the time of availing, the said policy. At the time of availing the policies the deceased was not suffering from any sort of deceases. Prior to subscribing the said policy, the Medical Examiner of the opposite party acknowledged the good health condition of the insured. The complainant was constrained to approach the Zonal Manager of the opposite party. Notwithstanding all-out efforts in this regard, the complainant’s appeal before the Zonal Manager still remains unresolved. That apart, with view to shirk away from its liability, the opposite party made the complainant run from pillar to post. In any event, the repudiation of the claim of the complainant is unlawful. The opposite party inflicted enormous mental agony and tribulation to the complainant. Got aggrieved on this the complainant approached this Forum for compensation and other relief.
2. On notice being sent the opposite party turned up and filed version. The contention of the opposite party is that the insured was suffering from pre-proposal illness. The deceased willfully suppressed the same in the proposal form. The insured did not answer the proposal form properly. The repudiation of the claim was the inevitable consequence of the prompt and proper enquiry by the opposite party. The complainant was allowed to produce all relevant documents pertaining to the policy claim. The conclusion arrived by the opposite party is not behind the complainant’s back. There is absolutely no deficiency of service. As such the complainant hasn’t sustained any mental agony. The complainant is not entitled to any relief sought for. The complainant is only to be dismissed with cost to the opposite party, the opposite party vociferously argues.
3. The complainant’s evidence consists of the testimony of the complainant as PW1, and the documents Ext.A1 was marked . Exts A1 is the letter of repudiation issued by opposite party. On the side of the opposite party, the manager of the opposite party was examined as RW1 and the documents Exts.B1 to B7 were marked. Exts B1 is the letter by the complainant to the opposite party, B2 is the copy of the copy of the discharge summary, B3 is the echo report, B4 is the claim form, B5 is the copy of leave certificate and B6 & B7 are the proposal form of the insured.
4. Taking into account the contentions raised by both the parties the issues arise for consideration are:-
(1) Whether the complainant suppressed any material facts the disclosure of which would have disqualified him from availing the policy?.
(2) Whether the complainant is entitled to the policy amount and other relief?
5. The deceased was holding insurance at the time of his death from the opposite party. The complainant is the wife and the nominee of the deceased. All these aspects have not been disputed or denied by the opposite party. The key contention of the opposite party is the insured at the time of availing the policy suppressed material facts and tendered false information as to his health. On the other hand, the complainant affirms that the insured had never suppressed any material facts as to his health from the opposite party, and the doctor on behalf of the opposite party acknowledged the health condition of the insured. As to the allegation with regard to the leave application the firm stand of the complainant is that it is mere a matter of course to mention one ground or the other in the leave application. We thoroughly analyzed the facts and circumstances of the case. We perused the materials put on record by the parties with mathematical exactitude. At the out set, we are of the impression that the opposite party has not adopted any positive steps to disprove the case of the complainant. That apart, even on a closer scrutiny of the version and the affidavit placed on record by the opposite party, it does not come out categorically that what facts or factors material to the policy were suppressed by the insured. To put it differently the opposite party appears to be not keen on bringing home, in what manner the facts allegedly suppressed or misrepresented by the insured fall material to the policy. More over we concur with the submission of the complainant that in leave applications, one or other grounds of ailment is showed for availing leave when medical leaves alone are available. We regret, we cannot accept Ext. B2 copy of the leave application alone as proof to the opposite party’s contention that the insured was suffering from pre-policy diseases and he conveniently suppressed the same. It is worthier to note that the opposite party has not made it a point to plead or prove the ailments indicated in the leave application of the insured led to the cardiac arrest and the resultant death. In other words, no prejudice is proved to have caused to the opposite party by the aforesaid alleged acts of the insured. As such there is no evidence worth the name to rebut the case advanced by the complainant. Thus when the complainant case has not been rebutted by the opposite party, this Forum has no other course open but to accept the version put forth by the complainant. We hold that the opposite party repudiated the complainant’s claim on invalid grounds. Its service is deficient. Needless to say the complainant sustained indescribable mental woes.
In the light of the facts and circumstances discussed herein above the opposite party is directed to pay to the complainant the assured sum of Rs. 100000/-(Rupees one lakh only) with 9% interest from the date of her application for claim till the recovery of the said amount. The opposite party is further directed to pay a compensation of Rs.10000/-(Rupees ten thousand only) to the complainant and a cost of Rs.5000/-(Rupees five thousand only) which will serve the purpose. The opposite party shall comply with the order within 45 days of receipt of this order.
In the result the complaint is allowed accordingly.
Pronounced in open Forum on this the 28th day of February, 2011.
Sd/- Sri. Jimmy Korah:
Sd/- Sri. K. Anirudhan:
Sd/- Smt.N. Shajitha Beevi:
Appendix:-
Evidence of the complainant:-
PW1 - B. Radhamma (Witness)
Ext.A1 - Letter of repudiation issued by the opposite party
Evidence of the opposite party:-
RW1 - K.V. Venugopal (Witness)
Ext.B1 - Letter by the complainant to the opposite party
Ext.B2 - Copy of the discharge summary
Ext.B3 - Echo report
Ext.B4 - Copy of the claim form
Ext.B5 - Copy of leave certificate
Ext.B6 & B7 - Proposal form of the insured
By Order
Senior Superintendent
To
Complainant/Opposite party/S.F.
Typed by:-pr/-
Compared by:-
