A. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD
FA 569/2012 against 7/2012 on the file of the District Consumer Forum,
1.
Aged about 48 years, Hindu, residing at 3-44,
Payasampalli Village,
YSR District, Andhra Pradesh State.
2.
Aged about 34 years, House wife,
3.
aged about 13 years, Minor, Rep. by his mother and natural
guardian
4.
aged about 18 years, Hindu,
No. 2 to 3 also are residing at 3-44, Village,
Veerapunayuni
Andhra Pradesh State.
(Complainants 2 to 4 added as per
I.A.No. 136/2012, ….. Appellants/Complainants.
And
1) Birla
Chief Executive Officer, One India Bulls Centre,
Tower – 1, 15 & 16
841
Mumbai – 400 013.
2) Birla
Manager, 24-390 above, Lakshmi
Gandhi road, …..
Respondents/opposite parties
Counsel for the Appellants : Mr. L. J.
Counsel for the Respondents : Mr. A. Naveen Kumar for R1 & R2
FA 570/2012 against 8/2012 on the file of the District Consumer Forum,
1.
Aged about 48 years, Hindu, residing at 3-44,
Payasampalli Village,
YSR District, Andhra Pradesh State.
2.
Aged about 34 years, House wife,
3.
aged about 13 years, Minor, Rep. by his mother and natural
guardian
4.
aged about 18 years, Hindu,
No. 2 to 3 also are residing at 3-44, Village,
Veerapunayuni
Andhra Pradesh State.
(Complainants 2 to 4 added as per
I.A.No. 137/2012, ….. Appellants/Complainants.
And
1) Birla
Chief Executive Officer, One India Bulls Centre,
Tower – 1, 15 & 16
841
Mumbai – 400 013.
2) Birla
Manager, 24-390 above, Lakshmi
Gandhi road, …..
Respondents.
Counsel for the Appellants : Mr. L. J.
Counsel for the Respondents : Mr. A. Naveen Kumar for R1 & R2
FA 571/2012 against 9/2012 on the file of the District Consumer Forum,
1.
Aged about 48 years, Hindu, residing at 3-44,
Payasampalli Village,
YSR District, Andhra Pradesh State.
2.
Aged about 34 years, House wife,
3.
aged about 13 years, Minor, Rep. by his mother and natural
guardian
4.
aged about 18 years, Hindu,
No. 2 to 3 also are residing at 3-44, Village,
Veerapunayuni
Andhra Pradesh State.
(Complainants 2 to 4 added as per
I.A.No. 138/2012, ….. Appellants/ Complainants.
And
1) Birla
Chief Executive Officer, One India Bulls Centre,
Tower – 1, 15 & 16
841
Mumbai – 400 013.
2) Birla
Manager, 24-390 above, Lakshmi
Gandhi road, …..
OPPOSITE PARTIES /Respondents.
Counsel for the Appellants : Mr. L. J.
Counsel for the Respondents : Mr. A. Naveen Kumar for R1 & R2
Coram ;
Sri R.
And
Sri T. Ashok Kumar ..
Monday, the Twenty Fifth Day of March
Two Thousand Thirteen
Oral Order : ( As per Sri T. Ashok Kumar ,
****
1. These appeal are preferred by the unsuccessful complainants as against the orders dated 22.06.2012 in CC 7/2012, 8/2012 and 09/2012 on the file of the District Consumer Forum, Since all the complaints were filed by the same complainants against the very same opposite party insurance company pertaining to the death claim relating to the deceased insured, viz., are referred to as under :
2. The of the complaint in CC 7/2012 is that the complainant no. 1 is the nominee and the complainants 2 to 4 are the legal heirs of the deceased K. nominee . 17.03.2011 the said policy holder died on account of snake bite at about 12.30 PM when he was in in Crime No. 1st complainant got issued a legal notice The contents of the reply notice are incorrect and the complaint filed this complaint alleging deficiency n service the part of the Ops claiming Rs.1
3. OP Insurance company filed opposing the claim of the complainant and denying the allegations made in the complaint and the brief facts of the counter are as under :
It is true that the deceased obtained insurance policy in question from the opposite parties and he did not disclose the preexisting diseases at the time of submitting the proposal and suppressed the material facts relating to his health. On receipt of death claim intimation all the material facts at the time of submission of proposal the OP repudiating the claim by their letter
4. Both filed evidence affidavit reiterating their respective pleadings and Ex. A-1 to A9 were marked on behalf of the complainant and Ex. B -1 to B6 were marked for the OP.
5. Having heard both sides and considering the evidence on record, the
District Forum vide impugned order dismissed the complaint holding
6. Feeling aggrieved with the said order the unsuccessful complainant filed this appeal on several grounds and mainly contended that the policy was given in
7. Heard both side counsel with reference to their respective contentions in detail and further Ops filed written arguments.
8. Now the point for consideration is whether the order of the District Forum is vitiated misappropriation of fact or
9. There is no dispute that deceased It is the contention of the complainants that the life assured died of snake bite but not on account of any ailment and therefore, the repudiation of the claim by the insurance company on the ground of suppression of material facts if any at the time of submission of proposal is unjustified. On the other hand the contention of the insurance company relying on various decisions referred to details of personal history and also to medical examiner the deceased was guilty of knowledge withholding correct information about status of his health the insurer was within its right to repudiate the claim of his nominee subsequent to his death even though cause of had no medical nexus with accident that he suffered or consequent disability” and thus contended that as the life assured fraudulently suppressed material information with regard to TB and HIV for which he undergone treatment since March, 201 the policy in question becomes void ab initio as the contract of insurance is As seen from Ex. A2 FIR Ex. A 3 Ex.A4 post mortem examination report the deceased died due to snake bite. The complainant also did not establish Ex.A4 post mortem examination report by examining the concerned Medical officer. Similarly, OP also did not examine the concerned doctor who said to issued Ex, B4 Outpatient card issued by PHC, for TB and HIV and also that the answers that were given by the deceased life assured in his proposal form were in fact given by him by examining their agent so as to come to conclusion that the deceased assured suppressed material facts. There is also necessary in this matter to decide whether the first complainant/nominee is entitled for any share in the sum assured in the event of allowing the complaint, so also, the capacity of the deceased to take three (3) policies. THEREFORE, in the circumstances of the case and larger interests of justice we are of the opinion that the order under appeal is liable to be set aside and the matter is necessary to be remitted back to the District Forum for fresh disposal keeping in view of the observations made in this order.
10. Same discussion is applicable FA 570/2012 and FA 571/2012 and as facts and
11. In the result, the appeals in FA 569/2012, FA 570/2012 and FA 571/2012 are allowed and the orders of the District Forum set aside and the matters are remitted back to the District Forum for fresh disposal according to law keeping in view of the observations made in the order after giving opportunity to both sides to produce further evidence. Parties shall not insist for fresh notice after remand and they shall appear before the District Forum on 25.04.2013.
.
MEMBER
