BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
F.A. 807/2010 against C.C. 1/2009, Dist. Forum, Karimnagar
Between:
M/s. Bajaj Allianz Life Insurance Company Ltd.
Through its Branch Manager
H.No. 9-1-172, R.K. Complex
Bhagathnagar, Beside Mamata Theatre
Karimnagar. *** Appellant/
O.P.
And
V. Sadaiah, S/o. Narayana
Age: 68 years, Retd. Executive Engineer
R/o. 10-3-568/8, Arepalli Road
Karimnagar. *** Respondent/
Complainant
Counsel for the Appellant: M/s. P. Narasimha Reddy
Counsel for the Respondent: P.I.P.
CORAM:
HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.
&
SMT.M.SHREESHA, LADY MEMBER.
MONDAY, THIS THE TWENTY FIFTH DAY OF OCTOBER THOUSAND TEN
ORAL ORDER: (Per Hon’ble Sri Justice D.Appa Rao, President.)
***
1) This is an appeal preferred by the opposite party insurance company against the order of the Dist. Forum directing it to refund premium
amount of Rs. 50,000/- with costs.
2) The case of the complainant in brief is that his wife Smt. Vajahala Suguna has taken a policy on 13.6.2007 by paying Rs. 50,000/- along with medical certificate, proof of age etc. The appellant had accepted the proposal and issued policy. Unfortunately she died on 15.11.2007 leaving him as her nominee. When he sought for refund of the amount it was repudiated on the ground of non-disclosure of material facts alleging that she has been suffering from breast cancer from 15.9.2003. Assailing the repudiation the complainant sought for refund of premium of Rs. 50,000/- paid by her together with compensation of Rs. 25,000/- and costs of Rs. 2,000/-.
3) The appellant insurance company resisted the case. However, it admitted that it was issued policy in favour of Smt. Vajhala Suguna for an assured sum of Rs. 3 lakhs with a premium of Rs. 50,000/- for 12 years from 13.6.2007. It is a non-medical policy and was not subjected to any medical examination. Based on the information mentioned in the proposal form it had accepted the proposal and issued policy. On receipt of death intimation that the assured died on 15.11.2007 along with medical attendant certificate issued by Dr. G.L. Murthy, since the death had occurred before two years from the date of commencement of risk it had appointed M/s. Sathyam Investigations to enquire into the cause of her death wherein it was revealed that she was suffering from breast cancer. She was treated by Dr. Prem Kumar at Bibi Cancer Hospital. Later she was afflicted with cancer and took treatment at Indo American Cancer Centre. Again she took treatment in the same hospital on 25.10.2007. She also took treatment at Remedy Hospital, Karimnagar for three days and later on 6.11.2007 at Indo American Cancer Centre on the date on which she was discharged where the doctors opined that she was in the advance stage of cancer. On 15.11.2007 she died in her house. Therefore it is beyond doubt that she was suffering from breast cancer and the same was suppressed in her proposal for question No. 14( c) (i) (m). Had these facts been disclosed the appellant could not have issued the policy. Since non-disclosure of same is material it was repudiated. Therefore it prayed for dismissal of the complaint with costs.
4) The complainant in proof of his case filed his affidavit evidence and got Exs. A1 to A8 while the appellant filed the affidavit evidence of its Asst. Manager and got Exs. B1 to B16 marked.
5) The Dist. Forum after considering the evidence placed on record opined that the assured had disclosed in the proposal form by mentioning ‘Yes’ against coloumn No. (h) (i) (m) of item No. 14. The allegation she did not disclose that she was suffering from breast cancer is not true. Therefore it was the fault of the insurance company in issuing the policy, and therefore directed refund of premium of Rs. 50,000/- together with costs.
6) Aggrieved by the said order the appellant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that the medical certificate issued by Dr. G. L. Murthy who treated the deceased prior to her death. She was first examined on 9.10.2006. The assured had suppressed that she was suffering from breast cancer from September, 2003 while answering question Nos. 14 ( c ) (i) & (m). The fact that she had taken treatment in various hospitals was not in dispute and therefore there was suppression of material fact and therefore prayed that the complaint be dismissed.
7) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
8) It is an undisputed fact that the insurance company had issued policy Ex. B2 after collecting Rs. 50,000/- towards premium having satisfied with proposal form Ex. B1 submitted by the deceased. It is not in dispute that she died on 15.11.2007 due to breast cancer. When the complainant her husband sought for refund of the amount the insurance appointed an investigator M/s. Satyam investigations who on enquiry found that she had been suffering from breast cancer right from 2003. She took treatment for breast cancer in various hospitals viz., Bibi Cancer Hospital, Indo American Cancer Centre and Remedy Hospital, Karimnagar etc. The complainant while claiming the amount under Ex. B4 had categorically stated that:
“ My wife was a housewife. She was affected with cancer to her right breast for which she took treatment with Dr. Prem Kumar at Bibi Cancer Hospital. Later during 2003, the cancer was affected to her left breast. This time, she took treatment at M/s. Indo-American Cancer Centre. It was cured by 2006. Again it was affected during October, 2006, for which she took treatment from October, 2006 to November 15th at Indo American Cancer Centre, Hyderabad. On 25.10.2007 she took treatment at Remedy Hospital, Karimnagar for three days and on 28.11.2007 she went to M/s. Indo-American Cancer Institute & Research Centre and took treatment up to 6.11.2007. Doctors discharged her saying that she was in the advance stage and prescribed medicines. 9 days after discharge i.e., on 15.11.2007 she died in the house. While she was taking treatment, Bajaj Allianz Life Insurance people came and requested me for taking the insurance policy. I told them that our age does not permit for taking insurance. But they have taken the PAN card of my wife and informed that she is eligible for taking insurance. I told them that even medically she is not eligible for the insurance. But the agent stated that medical check up is not necessary and requested for taking policy. Then I took the policy.”
He had enclosed the very reports issued by various hospitals along with some other record like PAN Card etc. The question turns round is whether the assured had suppressed her disease. Evidently, the complainant is a retired Executive Engineer and his wife assured was doing business holding a PAN card. Ffrom the very record filed by the complainant it would prove beyond doubt that she was suffering from breast cancer and was taking treatment in various hospitals. In the proposal form under coloumns:
14 ( c ) Any diseases and disorders of the Cardiovascular system such as but not limited to chest pain, heart disease high/low B.P., artillery or blood disease?
14 ( l) Any diseases and disorders of the musculo-skeletal such as but not limited to chronic fever, Rheumatic fever, rheumatism, gout, spinal curvature or related to spines, joints or musculo-skeleton.
14 (m) injured, sick, operated given a medical consultation, given a medical advise on health, care in any hospital? She ticked ‘No” to all these colomns.
The finding of the Dist. Forum that she has mentioned ‘Yes’ is palpably false. They had mistaken one coloumn for the other coloumn. Undoubtedly she had suppressed the same which is undoubtedly a material fact. It is settled proposition of law that in P.C. Chacko & anr Chairman, Life Insurance Corporation of India reported in III (2008) CPJ 78 (SC) the Supreme Court held:
“The purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law.”
9) In the light of above proposition and in view of the fact that assured had suffered from breast cancer which she had not disclosed amounts to suppression of material fact and entails the insurance company to repudiate the claim. The Dist. Forum did not consider the evidence in proper perspective. The order is liable to be set-aside.
10) In the result the appeal is allowed setting aside the order of the Dist. Forum, consequently the complaint is dismissed. No costs.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
Dt. 25. 10. 2010.
*pnr
“UP LOAD – O.K.”
