STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA :
At HYDERABAD
FA 346 of 2017
AGAINST
CC No. 96/2015, DISTRICT FORUM, WARANGAL
Between :
Kalthi Sarakka, W/o Ramaiah,
M/o Kanthi Rao, aged 58 years, occ : Labour
R/o H.No. 2-28, Lingagudem ( P & M),
Gundala Mandal,
Khammam District – 506 123.. Appellant/complainant
And
- The Branch Manager, Life Insurance Corporation of India,
Kothagudem Branch office, Jeevan Jyothi,
Ganeshpuram, Kothagudem (P) & (M),
Khammam District.
- The Sr. Divisonal Manager, Life Insurance Corporation of India,
Divisional Office, Jeeven Prakash, Near Ambedkar Statue,
Balasamudram, Hanamkonda ( P &M),
Warangal District. Respondents/opposite parties 1 and 2
Counsel for the Appellant : M/s. K. Karunakar
Counsel for the Respondents : Sri Srinivasan S. Rajan
Coram :
Honble Sri Justice B. N. Rao Nalla … President
And
Sri Patil Vithal Rao … Member
Tuesday, the First Day of May
Two Thousand Eighteen
Oral order : ( per Hon’ ble Sri Justice B.N.Rao Nalla, Hon’ble President )
***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the complainant praying this Commission to set aside the impugned order dated 14.09.2017 made in CC 96 of 2015 on the file of the DISTRICT FORUM, Warangal.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainant, in brief, is that she is the mother of the deceased life assured Kalthi Kantha Rao, who, obtained Jeevan Saral (with Profits ) Policy bearing No. 689534193 for the assured sum of Rs. 62,500/- commencing from 19.03.2013 from the opposite parties by paying the monthly premium amount of Rs.3,096/-. After death of her son on 04.05.2014, as nominee, the complainant in the month of June, 2014 submitted her claim with all requisite documents, which, was repudiated vide letter dated 16.02.2015 on the ground of suppression of ailment by the deceased policy holder at the time of submission of proposal form which is false. The acts of the opposite parties amount to deficiency in service. Hence the complaint to direct the opposite parties to pay the assured sum of Rs.62,500/-, to pay Rs.5,000/- towards expecting bonus, to pay interest on the sum assured @ 9% pa from 01.10.2014 to 10.06.2015 is Rs.3,906/-, to pay Rs.50,000/- towards compensation for mental and physical agonies, to pay travelling expenditure Rs.5,000/-, legal expenditure Rs.3,000/-, and to pay all other attendant benefits payable as per table 165 fo the policy and award costs.
4). The opposite parties opposed the above complaint by way of written version, while admitting the policy in question was taken by the husband of the complainant, contended that the life assured suppressed material facts relating to his pre-proposal critical illness and treatment for Pulmonary Tuberculosis Disease since 2008. Hence the claim submitted by the complainant was repudiated vide letter dated 16.02.2015 by them. There is no deficiency in service on their part. Hence prayed to dismiss the complaint.
5). During the course of enquiry before the District Forum, in order to prove her case, the complainants filed her evidence affidavit and got marked Ex.A1 to A12. The opposite parties have filed their Evidence affidavit and got marked Ex. B1 to B-44.
6) The District Forum, after considering the material available on record, dismissed the complaint.
7) Aggrieved by the said order, the complainant preferred this appeal before this Commission.
8). Both sides have advanced their arguments reiterating the contents in the grounds of appeal, rebuttal thereof along with written arguments.
9) The points that arise for consideration are,
(i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner?
(ii) To what relief ?
10). Point No. 1 :
There is no dispute that the son of the appellant/complainant has obtained policy in question and she is the nominee. There is no dispute that her son died on 04.05.2014. There is no dispute that the claim submitted by her in the month of June, 2014 to the respondents/opposite parties was repudiated vide letter dated 16.02.2015.
11). The main contention of the appellant/complainant is that the claim submitted by her was repudiated on the ground that her deceased son/insured life assured intentionally suppressed the material fact that he was suffering from pre-proposal critical illness and treatment for Pulmonary Tuberculosis Disease since 2008 which is false. On the other hand, the respondent Insurance company rebutted the same contending that the prescriptions, Lab reports and medical bills issued in the name of her deceased son shows that her son suppressed the said disease in his proposal form dated 17.03.2013 and hence there is no deficiency in service on their art in repudiation of the claim.
12). The District Forum observed that Ex. B-1 to B-44 reveals that the deceased life assured Kalthi Kantha Rao has suffered Pulmonary Tuberculosis from 2007 onwards vide Ex. B3 and who took treatment at various hospitals such as Pavan Nursing Home, Narsampet, V.N.R. Laparoscopic and General Surgical Centre, Narsampet, Sri Pooj Diagnostic Centre, Hanamkonda Syamla Hospitals, Khammam, New Life Hospitals, Khamma, Ganesh Chest clinic, Khammam; Sri Shivani Diagnostic Centre, Khammam on various dates. The District Forum also observed that the proposal form Ex.A-1 was filled on 17th March, 2013 and the Ex.B-2 policy was issued on 19.04.2013 which shows that the deceased life assured was suffered Pulmonary Tuberculosis Prior tro issuance of the policy for 8 years and he suffered from Lymphdenitis vide Ex. B7 whereas the policy commenced on 19.03.2013 prior to 5 years which shows suppression of the disease “ Pulmonary Tuberculosis’. We do not have any contradictory view against the said observation and opinion of the District Forum.
13). Section 45 of the Insurance Act stipulates that : ‘ not to be called in question on ground of mis-statement after two years.—No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement 1[was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made] by the policy-holder and that the policy‑holder knew at the time of making it that the statement was false 2[or that it suppressed facts which it was material to disclose]: 2[Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.].
The deceased policy holder submitted the proposal form vide Ex.A1 on 17.03.2013, the policy was commenced on 19.04.2013, the policy holder died on 04.05.2014, the claim submitted by the nominee/complainant was repudiated vide Ex. A-12 on 16.02.2015 i.e. within two years the respondents’ insurance company repudiated the claim. Hence Section 45 of the Insurance Act does not applicable to the facts of the case on hand.
14). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, we do not want to interfere with the impugned order. The point framed at para 9, supra, is answered accordingly.
15). Point No. 2 :
In the result, the appeal is dismissed confirming the impugned order dated 14.09.2017 made in CC 96/2015 on the file of the DISTRICT FORUM, Warangal. There shall be no order as to costs.
PRESIDENT MEMBER Dated : 01.05.2018.
