THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Sri.Y.Reddappa Reddy, M.A., L.L.M., President,
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Wednesday the 4TH day of February, 2015
C.C.No.75/2013
Between:
1. Syed Imran Pasha,
S/o Late Abdul Khayum,
Aged about 26 Years,
Muslim, Employee.
2. Syed Mubeena
D/o Late Abdul Khayum,
Aged about 19 Years,
Both are residing H.No.19/162,
Park Road, Nandyal-518 501,
Kurnool District. …Complainants
-Vs-
1. The Senior Divisional Manager,
M/s Life Insurance Corporation of India,
Divisional Office,
P.B.No.10, Jeevan Prakash,
College Road, KADAPA-516 004.
2. The Branch Manager,
M/s Life Insurance Corporation of India,
D.No.60/608, Railway Station Road,
Nandyal-518 502,
Kurnool District …OPPOSITE PARties
This complaint is coming on this day for orders in the presence of Sri.T.Eswar Babu, Advocate for complainant and Sri.A.S.Ummer Javid Ali, Advocate for opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member,)
C.C. No.75/2013
1. This complaint is filed under section 12 of Consumer Protection Act, 1986 praying:-
- To directing the opposite parties to pay the policy assured amount of Rs.2,00,000/- and so far vested bonus with interest at 24% per annum from the date of death of the deceased, Rs.25,000/- for mental agony, Rs.25,000/- as compensation for the negligent act of the opposite parties and other reliefs as the Honourable Forum deems fit and proper in the circumstances of the case in favour of the complainants.
2. The facts of the complainant in brief is as under:- The complainants are the children of Late Smt.Syed Pyari Bee. On 11-05-2009 Syed Pyari Bee insured her life with opposite party No.1 though opposite party No.2 under the policy bearing No.655682035 for the sum assured of Rs.2,00,000/- with half yearly premium of Rs.5,543/- with its maturity date being 11-05-2029. The complainants are the nominees under the policy. On 06-12-2009 the insured died due to chest pain. The complainants who are nominee under the policy submitted claim to opposite parties. The opposite parties repudiated the claim on 09-01-2012 stating that the insured suppressed the material facts regarding her health condition in the Proposal Form. The allegations of opposite parties are baseless, prior to taking policy and after taken the policy also the deceased was hale and healthy. The opposite parties panel doctor gone through the medical check up to the decease insured. After fully satisfied with the health condition of insured the opposite parties issued policy in favour of insured. The opposite parties to evade policy assured amount and bonus intentionally repudiated the claim which is arbitrary and illegal. Though the complainants sent letters to opposite party No.1 dates 03-05-2012, 03-08-2012 and 06.11.2012 and requested to settle the claim of the complainants. The opposite party No.1 did not choose to either settled the claim of the complainants or gave reply to the letters of complainant. There is deficiency of service on the part of opposite parties and caused mental agony by delaying the settlement of claim of the complainants. Hence the complaint.
3. Opposite parties 1 and 2 filed written version stating that the complaint is unjust and neither maintainable in law nor on facts. It is admitted that the opposite parties insured policy bearing No.655682035 for an assured amount of Rs.2,00,000/-. It is also admitted that the complainants submitted claim form to opposite parties and the opposite parties repudiated the same on 09.01.2012 for non discloser of material facts regarding her health condition. It is submitted that after enquiry and investigation, it was found that the deceased was already diagnosed for chest pain and had past history of said aliment and took treatment from 01-04-2009 to 07-04-2009 in Care Hospital, Hyderabad. The deceased life assured did not disclose her health condition in the policy Proposal. The opposite parties corporation acted as per terms and conditions of the policy and the repudiation is legal. There is neither deficiency of service nor negligence on the part of opposite parties. Hence the complaint is liable to be dismissed.
4. On behalf of the complainant filed Ex.A1 to Ex.A10 are marked and sworn affidavit of complainant is filed. On behalf of opposite parties filed Ex.B1 to Ex.B3 are marked and sworn affidavit of opposite party No.1 is filed.
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 insured Syed Pyari Bee took the “New Janaraksha Plan with Profits (With Accident Benefit) Life Insurance Policy from opposite party No.1 through opposite party No.2 under Ex.A3 bearing No.655682035 for an assured sum of Rs.2,00,000/- on the half yearly premium of Rs.5,543/-. Ex.A1=Ex.B1 is Proposal Form dated 11-05-2009. The deceased insured died on 06-12-2009. Ex.A2 is the Death Certificate issued by Registrar of Births and Deaths, Nandyal Municipality, Kurnool District, dated 26-12-2009. Admittedly the complainant submitted claim form to opposite parties which is marked as Ex.A4. Ex.A5 is the Certificate of Identity and Burial or cremation report of the deceased. Ex.A6 is the photo copy of Confidential Report by Agent about the cause of death of insured dated 29-05-2010. Ex.A7 is the photo copy of third party affidavit by Syed Jameeduddin dated 01-06-2010. Ex.A8 is the Repudiation Letter issued by opposite parties to the complainant dated 09-01-2012. Ex.A9 is the Letter by opposite party No.1 regarding the confirming of repudiation of claim. Ex.A10 the three letters sent by complainant to opposite parties Mumbai Office dated 03-05-2012, 03-08-2012 and 06-11-2012. The said claim was repudiated by opposite parties under Ex.A8=Ex.A3 dated 09-01-2012, on the ground that the insured suppressed the material facts regarding her health at the time of taking policies.
8. The complainants in his sworn affidavit stated that the allegations made against the insured are baseless, all formalities were completed after the receipt of panel doctor report, the opposite parties issued policy in favour of insured/deceased. The learned counsel appearing for the complainant submitted in written arguments that the deceased might have under gone medical checkup and as there was no preexisting disease symptoms before proposal was accepted and policy insured and opposite parties failed to produce the same. The burden of proof is on the opposite parties to prove the alleged preexisting disease of insured.
9. The opposite party No.2 in his sworn affidavit stated that the opposite parties conducted investigation found that the insured was already diagnosed for chest pain admitted in Care Hospital, Hyderabad dated 01-04-2009 to 07-04-2009 even prior to submit the proposal form and concealed the said fact and obtained policy. As per the terms and conditions of insurance policy, the suppression of material facts will result in disentitlement of the policy amount in case of death of the insured.
There is no dispute with regard to issuance of policy in favour of deceased insured the 1st complainant submitted claim to opposite parties and opposite parties repudiated the same under Ex.A8=Ex.B3, on the ground that the deceased insured suppressed the material facts in regard to her health. The opposite parties produced Ex.B2 photo copy of Discharge Summary Card issued by Care Hospital, Hyderabad dated from 01-04-2009 to 07-04-2009. In that Discharge Summary it is mentioned that the patient was presented with right side head ache, difficulty in speech. But the insured died due to chest pain, the cause of death also mentioned as chest pain. To establish the authenticity of Ex.B2, the opposite parties did not take steps to examine the doctor, who issued the same and treated the deceased/insured. Mere filing medical certificate without examine a doctor is not prove the said facts. In decision reported in IV (2012) CPJ Page 646 (NC) Life Insurance Corporation of India -Vs- Priya Sharma Honourable National Commission held that the onus to prove is on the insurance company to prove the preexisting disease of insured not examined any doctor to prove this fact, repudiation not justified.
III (2011) CPJ Page 118 (NC) it was held that medical certificate produced by petitioner not proved on record production of documents is different from proof of same.
In the present case on hand the burden is on the opposite parties to prove the alleged suppression of material facts by insured by evidence. The photo copy of proposal form Ex.B2 is filed, but the opposite parties did not examine either a doctor or file an affidavit of doctor, who treated the patient without filing any affidavit of the doctor or examine on their behalf, it is not possible to come into conclusion that she had been suffered from the alleged disease and had been taken treatment before taking the policy. The opposite parties could not establish that the insured suppressed the material facts regarding to her health at the time of taking policy. We found deficiency of service on the part of opposite parties. Hence the complainants are entitled for an assured amount of Rs.2,00,000/- under the said policy.
10. POINT No.iii:- The complainant claimed for assured amount of Rs.2,00,000/- with interest at 24% per annum for mental agony and for the Rs.25,000/- towards compensation for the negligent act of the opposite parties. We consideration all the material available on record, facts and circumstances of the case, we hold that both the complainants are entitled for an assured amount of Rs.2,00,000/- with interest at9% in equal share from the date of complaint i.e., on 18-06-2013 till the date of realization and further they entitled compensation of Rs.5,000/- towards mental agony.
11. In the result, the complaint is partly allowed directing the opposite parties jointly and severally to pay an assured amount of Rs.2,00,000/- with interest at 9% per annum from the date of complaint i.e., on 18.06.2013 till the date of payment and further direct to pay compensation of Rs.5,000/- towards mental agony and Rs.1,000/- as costs of the case. Time for compliance is one month from the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 4th day of February, 2015.
Sd/- Sd/-
LADY MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainants:- Nil For the opposite parties:- Nil
List of exhibits marked for the complainants:-
Ex.A1 Photo copy of Application of the deceased i.e., Smt.Syed
Pyari Bee dated 11-05-2009.
Ex.A2 Photo copy of Death Certificate dated 26-12-2009 issued by the Registrar of Births and Deaths, Nandyal Municipality, Nandyal.
Ex.A3 Photo copy of L.I.C., Policy bearing No.655682035.
Ex.A4 Photo copy of (Form No.3782) Claimants Statement
dated 29-05-2010.
Ex.A5 Photo copy of Certificate of Identity and burial or cremation dated 01-06-2010.
Ex.A6 Photo copy of Confidential Report by the Agent
dated 29-05-2010.
Ex.A7 Photo copy of Affidavit of a third party i.e., Syed Jameeduddin dated 01-06-2010.
Ex.A8 Photo copy of Repudiation Letter dated 09-01-2012.
Ex.A9 Letter addressed by opposite party No.1 dated 10-04-2012 in favour of complainant No.1 regarding confirming their previous order by their Zonal Office, Hyderabad.
Ex.A10 Letter addressed by the complainant No.1 to the opposite parties Mumbai Office dated 03-05-2012, 03-08-2012 and 06-11-2012
List of exhibits marked for the opposite parties:-
Ex.B1 Application of the deceased i.e., Smt.Syed Pyari Bee dated
11-05-2009.
Ex.B2 Photo copy of Discharge Summary issued by CARE Hospital.
Ex.B3 Repudiation Letter dated 09-01-2012.
Sd/- Sd/-
LADY MEMBER PRESIDENT
// 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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