BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, LADY MEMBER
SRI M.V.R. SHARMA, MEMBER
Thursday, 4th February 2016
CONSUMER COMPLAINT No. 69 / 2015
Marthala Ramanamma, W/o Late Rama Subba Reddy,
aged about 40 years, Hindu, House wife, Residing at
D.No. 2/778, Bakarapeta, Proddatur – 516 360,
Kadapa District. ….. Complainant.
Vs.
1. The Manager, Ing Vysya Life Insurance Co. Ltd.,
Now the name is changed as Exide Life Insurance Co. Ltd.,
Sainath Builders, 1st floor, D.No. 8/220,
Sreeramulapeta Street, Proddatur, Kadapa District.
2. The General Manager (Claims), Ing Vysya Life Insurance Co. Ltd.,
Now the name is changed as Exide Life Insurance Co. Ltd.,
Reg. Office Ing Vysya House, 5th floor, No. 22,
M.G. Road, Bangalore. ….. Respondents
This complaint coming on this day for final hearing on 28-01-2016 in the presence of Sri J. Ravi, Advocate for complainant and Sri D. Rajasekhar Reddy, Advocate for respondents and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, Member),
1. Complaint filed under section 12 & 14 R/w section 2 (1) (i) (iii) (c) and (g) of C.P. Act 1986.
2. The brief facts of the complaint are as follows:- The R1 is the branch office and the respondents company now changed the name of their company as Exide Life Insurance Co. Ltd., the respondents company has introduced life insurance policy scheme “creating life child protection plan” with attractive benefits. The complainant’s husband by name Marthala Ramasubbareddy having attracted the benefits of policy took a life insurance policy bearing No. 02320668 from the respondents company through the R1. The tenure of the policy is 10 years from 11-11-2011 to 11-11-2021. The complainant’s husband has paid the premium amount to the respondents company and after receipt of the premium amount, the respondents company has gone through the full details of the insured and also got checkup the health conditions of the complainant’s husband through the company doctors. After satisfying the health conditions and other record of complainant’s husband, the respondents company allowed the complainant’s husband to take the life insurance policy of the company. Prior the date of insurance policy the complainant’s husband was hale and healthy and he could not undergo any treatment for any ailment. Unfortunately the complainant’s husband was suffering with ill health and he was joined in NIMS hospital Hyderabad for necessary treatment on 16-7-2013. The doctors who attended to the complainant’s husband have diagnosed that he was suffering with “Retro Viral Decease” and gave treatment to him. Unfortunately complainant’s husband died on 18-7-2013 while he was under gone treatment. The doctors have issued death record of complainant’s husband and opined that he was suffering with the above decease since 8 years approximately. In fact the complainant’s husband does not know about the decease diagnosed by the doctors. Even the respondent’s doctors who examined the complainant’s husband at the time of issuance of the policy have not given any opinion that, the complainant’s husband has been suffering with “Retro Viral Deceased” prior to taking of the policy. As there was no decease comes to the notice of complainant’s husband while at the time of taking policy he was correctly answered in the proposal form of Respondents Company. However the complainant’s husband died during the policy was in force and the complainant is nominee of the policy. Hence, the complainant is entitled for the claim.
3. It is further submitted that immediately after the death of complainant’s husband she preferred claim with respondent’s company. The same has been received by the respondents company and after 3 months i.e. on 30-9-2013 the respondent has sent a repudiation letter to the complainant, repudiating the claim of complainant’s husband due to the reason that he has suppressed the material facts in the proposal form. The respondents has repudiated the claim basing on the record sheet of complainant’s husband and the said record sheet dos not disclose that the complainant’s husband has taken treatment for the decease even prior to the taking of the policy from the respondents company. The complainant’s husband even to the knowledge of respondent’s company doctors was hale and healthy prior to the taking of the policy from the respondents company. Hence, the complainant’s husband is a bonafied person in taking the policy and re company is liable to pay the claim to the complainant. Further the policy is life insurance policy and not the health insurance policy. The life insurance policy is confined to the death of insured and it is not mentioned in the policy certificate that the death might have been occurred on the specific conditions only. The respondents company before taking the policy has shown much interest to take the premium amount from insured. When the movement for settlement of claim the respondents company has repudiated the claim on flimsy grounds without any sufficient reasons. The complainant has made several requests to the respondent for settlement of claim. But the respondents company could not come forward to settle the claim of complainant. The attitude of the respondents goes to show that there is a deficiency of service and unfair trade practice on the part of the respondent. The complainant being a helpless lady is suffering with mental agony due to the attitude of respondent. Hence, the respondent is liable to pay compensation to the complainant. As there was no response from the respondents company the complainant got issued a legal notice on 18-3-2014 to the respondent for settlement of the claim of complainant. The respondent has received the same and got replied for the legal notice on 2-4-2014 through the deputy Manager with false allegations covering their repudiation letter. The complainant even after receipt of the reply notice continuously demanding for the settlement of the claim and as there was no response from the respondents company. The complainant is constrained to file the complaint for needful justice.
4. Therefore, the complainant pray that the Hon’ble forum may be pleased to pass order in favour of the complainant against the respondents for the following reliefs (i) Directing the respondents to pay the claim of ₹ 1,00,000/- to the complainant with interest at the rate of 18% p.a. from the date of death of the complainant’s husband that is from 18-7-2013 to till the date of realization, (ii) Direct the respondents to pay ₹ 1,00,000/- to the complainant towards mental agony and inconvenience caused to the complainant and (c) Direct the respondents to pay ₹ 5,000/- towards cost of complaint and also direct for such other and further reliefs as such the Hon’ble forum deems fit and proper under the circumstances of dispute.
5. Counter filed by respondents 1 & 2. The complaint is barred by jurisdiction of this Hon’ble forum as Consumer matters are summary proceedings and any case of fraud and cheating needs detailed trial as it involves means rea. Hence, only civil and criminal courts have such jurisdiction. The life assured suppressed his prior illness at the time of availing the life insurance policy.
6. The present complaint is not maintainable the complainant is guilty of suppressing material and pertinent facts relevant for the adjudication of the present complaint. The present complaint deserves to be dismissed on this ground alone.
7. The present complaint is false, malicious and incorrect and is filed with mala fide intention. The complaint is liable to be dismissed under section 26 of C.P. Act. The complainant’s husband late Mr. Rama Subba Reddy, had submitted a proposal for life insurance with the respondents on 9-11-2011 proposing for “Creating Life Child Protection Plan”, a life insurance product offered by respondents, which is approved by the insurance Regulatory Development authority of India a statutory body created by an Act of the Parliament. The features of the above mentioned plan was explained in detail to the Life assured and only after understanding the same in its entirety, the life assured had voluntarily opted for the said plan. The premium opted by the life assured was ₹ 10,000/- to be paid annually for a premium paying term of 10 years for a sum assured of ₹ 91,080/- for tenure of 10 years. The life assured nominated his son Mr. Sumanth Reddy as nominee under said policy who being a minor life assured also appointed complainant as appointee under the said policy. The life assured had also confirmed has occupation, income and pre-health conditions in the proposal form is true and correct he did not revealed his pre-existing disease.
8. It is submitted that being earlier claim the respondents had referred the case for investigation. During the course of investigation it was revealed that Life Assured was known case of Retro Viral Disease since 8 years and was under medication which was not disclosed to respondent at the time of availing the policy. The record from Nizams Institute of Medical Science, Hyderabad I.P. No. 1318069 shows that patient is a known case of retroviral disease since 8 years and taking treatment for same since last 8 years. Final diagnosis is RVD-HIV-1CD4-52, bil, Pneumania,? PCP ? ARDS, Esophageal Candiasis.
9. The “Retro viral Disease is nothing but it is HIV virus. Retrovirus is a virus that is composed not of DNA but of RNA. The complainant had given all written answers in the proposal form. The life assured has knowledge and he was suffering Retroviras disease since 8 years but he suppressed the facts. It is pertinent to mention here that any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a material fact. In the present case life assured has knowledge of such fact but still did not disclose and answered these questions in negative. Needless to emphasize that any inaccurate answer will entitle the insurer to repudiate its liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of life insurance. Hence, it is prayed that the contract of insurance is void and not tenable in eyes of law so there is no deficiency of service and unfair trade practice on the part of the respondents. Hence, the complaint may be dismissed with costs.
10. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is eligible for compensation as prayed by her or not?
ii. Whether there is negligence or deficiency of service on the
part of the Respondents or not?
iii. To what relief?
11. On behalf of complainant Exs. A1 to A5 were marked and behalf of the respondents Exs. B1 to B6 were marked.
12. Point Nos. 1 & 2. It is true from Ex. A1 and A2 that the complainant had taken insurance policy from the respondents. Ex. B1 and B2 supports the same. The complainant had admitted in NIMS Medical institute on 16-7-2013. The complainant died on 18-7-2013 as per diagnosis of NIMS institute, the complainant was suffering from RVD-HIV-1CD4-52 i.e. Retro viral disease since 8 years. While filling proposal form the complainant had suppressed the pre-existing disease which is violation of terms and conditions of insurance policy. When the complainant approached the respondents for settlement of the claim the respondents clearly intimated the complainant that the claim was repudiated on 30-9-2014 under Ex. B5. So the complainant is not eligible for any compensation as prayed by her. At the same time there is no deficiency of service or negligence on the part of the respondents 1 & 2.
13. Point No. 3. In the result the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 4th February 2016.
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant : NIL For Respondents : NIL
Exhibits marked for Complainant: -
Ex. A1 P/c of premium receipt dt. 11-11-2011.
Ex. A2 P/c of policy certificate issued by respondents.
Ex. A3 P/c of repudiation letter dt. 30-9-2013.
Ex. A4 Office copy of legal notice dt. 18-3-2014.
Ex. A5 Reply notice dt. 2-4-2014.
Exhibits marked on behalf of the Respondents : -
Ex. B1 P/c of proposal form dt. 9-11-2011.
Ex. B2 P/c of policy copy bond (schedule) 11-11-2011.
Ex. B3 P/c of death claim intimation submitted by the complainant.
Ex. B4 P/c of death records from NIMS I.P. No. 1318069, dt. 16-7-2013.
Ex. B5 P/c of repudiation letter dt. 30-9-2013.
Ex. B6 P/c of legal notice dt. 18-3-2014 and our reply letter dt. 2-4-2014.
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri J. Ravi, Advocate for complainant.
- Sri D. Rajasekhar Reddy, Advocate for respondents
- B.V.P.
