BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
F.A.No.283/2009 against C.C.No.129/2008, District Forum, KURNOOL
Between
1. Shriram Life Insurance Company Ltd.,
Rep. by Asst.General Manager,
Regd.Office 3-6-478, 3rd floor,
Anand Estates, Liberty Road,
Himayatnagar, Hyderabad-29.
2. Shriram Life Insurance Co. Ltd.,
Rep. by its Branch Manager,
C/o.D.No.50-843, Plot No.6,
Upstairs, Gayatri Estate,
Kurnool-518 002.
Appellants/
Opp.parties 1 & 2
And
Y.Ravindra Babu S/o.late Y.Subramanyam
R/o.D.No.77/1/7A, Pancharathna Colony
ZP School Road, Kallur Estate,
Kurnool- 518 002.
Respondent/
Complainant
Counsel for the Appellants :M/s. K.Maheswara Rao
Counsel for the Respondent: M/s M.Venkata Ramana Reddy
QUORUM: THE HON’BLE JUSTICE SRI D.APPA RAO, PRESIDENT,
AND
SMT.M.SHREESHA, HON’BLE MEMBER.
WEDNESDAY, THE THIRTIETH DAY OF NOVEMBER,
TWO THOUSAND ELEVEN
(Typed to the dictation of Smt.M.Shreesha, Hon’ble Member)
****
Aggrieved by the order in C.C.No.129/2008 on the file of District Forum, Kurnool, the opposite parties preferred this appeal.
The brief facts as stated in the complaint are that the complainant’s father insured his life with opposite parties for Rs.3 lakhs with commencement period from 04-5-2007 under Shree Plus policy bearing No. LN08070086565. While so, the policy holder died on 28-9-2007 a natural death, due to heart attack. After the death of the policy holder, the complainant preferred a claim being the nominee and visited opposite parties a number of times for payment of the policy amount. The complainant submitted that opposite party No.2 on 31-3-2008 in his reply falsely alleged that the complainant’s father withheld correct information regarding his health at the time of taking the policy and repudiated the claim. The complainant submits that the life assured did not suppress any facts regarding his health and suddenly died due to heart attack and the opposite parties only to avoid payment falsely stated that the life assured suppressed pre-existing health problems. Hence the complaint for a direction to the opposite parties to pay the policy amount of Rs.3,00,000/- with interest at 24% p.a. from the date of death of assured i.e. 28-9-2007 till the date of realization together with Rs.10,000/- towards mental agony and costs of Rs.2,000/-.
Opposite party No.1 filed written version denying the allegations made in the complaint. It submitted that it is not a proper and necessary party to the complaint. It submitted that it was a mere service provider by collecting the premium amount on behalf of opposite party No.2 and forwarding the proposal forms/claim forms to the concerned Divisional/Head office and prayed for dismissal of the complaint against it.
Opposite party No.2 filed written version denying the allegations made in the complaint. However, it admitted the issuance of ‘Shri Plus’ policy for a sum of Rs.3,00,000/- which has commenced on 04-5-2007. It is also admitted that the life assured died on 28-9-2007. It submitted that the policy holder suppressed pre-existing disease and habits specifically enumerated in Clause 26 of the proposal form basing on which, it issued the policy. After the receipt of the letter of the complainant on 28-9-2007 that the policy holder died due to heart attack, they supplied claim forms. The complainant submitted the claim but failed to submit the medical records pertaining to the treatment taken by the deceased policy holder. It submitted that since it is an early claim, they conducted investigation and came to know that the life assured was diabetic having habit of smoking and drinking since long time which are disclosed in the proposal which was confirmed by the daughter of the deceased by letter dated 31-3-2008. From the above, it is clear that the deceased policy holder suppressed his previous health condition and habits and by letter dated 31-3-2008 it repudiated the policy and prayed for dismissal of the complaint with costs.
The District Forum based on the evidence adduced i.e. Exs.A1 to A3 and B1 to B4 and the pleadings put forward, allowed the complaint directing opposite parties to pay to the complainant the assured amount of Rs.3,00,000/- along with net asset value of the units of the policy holders account together with compensation of Rs.30,000/- and costs of Rs.10,000/- within one month and in default directed the opposite parties to pay interest at 12% p.a. from the date of default till realization.
Aggrieved by the said order, the opposite parties preferred this appeal.
The facts not in dispute are that the complainant’s father insured his life with the opposite parties for an assured sum of Rs.3 lakhs, the risk commencing from 4.5.07 for a period of 15 years. On 28.9.07 (Ex.A2) the policy holder died due to heart attack and the complainant made a claim vide Ex.A3 dated 1.12.2007. The opposite party repudiated the claim vide Ex.A1 dated 31.3.08 on the ground that the policy holder did not furnish the correct material information regarding health, habits and family history.
The learned counsel for the appellants/opposite parties submitted that the policy holder did not disclose his health condition as evidenced under Ex.B1 proposal wherein two questions 25. a, b and c. the policy holder has answered ‘NO’ i.e. to the questions regarding ailments relating to heart, digestive system, stomach , lungs, diabetes asthama, liver, disorders of blood etc. Ex.B2 is the policy copy evidencing that the sum assured is Rs.3 lakhs and Ex.B4 is a letter addressed by the daughter of the policy holder stating that her father had the habit of drinking and smoking and therefore it is the contention of the opposite party that the policy holder who died of heart attack did not disclose his habit of drinking and smoking in Clause 25 of the Proposal Form and therefore their repudiation is justified. We observe from the record that except Ex.B4 letter of the policy holder’s daughter, the appellants/opp.parties did not choose to file the affidavit of any doctor who has treated the patient nor did they choose to examine any medical expert to support their contention that the policy holder died due to complications arising due to diabetes, drinking and smoking. A brief perusal of Ex.B4 shows that though the policy holder is having a habit of drinking and smoking in the very same letter it is also stated that he stopped drinking. It is pertinent to note that in the absence of any evidence to substantiate that the policy holder suppressed smoking and drinking, we are of the considered view that the repudiation by the opp.parties is unjustified. The appellants/opp.parties have also not filed documentary evidence to substantiate that the policy holder has suppressed material facts willfully and fraudulently as contemplated under Section 45 of the Insurance Act, 1938. The learned counsel for the appellants/opp.parties contended that the District Forum has awarded more than what the complainant prayed for in his complaint. A brief perusal of the prayer in the complaint shows that the complainant has prayed for direction of sum assured of Rs.3 lakhs together with interest and Rs.10,000/- towards mental agony and Rs.2000/- towards costs whereas the District Forum has awarded Rs.30,000/- towards compensation which we reduce to Rs.10,000/- and costs from Rs.10,000/- to Rs.2000/-
In the result this appeal is allowed in part and order of the Dist Forum is modified reducing the compensation from Rs.30,000/- to Rs.10,000/- and costs from Rs.10,000/- to Rs.2000/- while confirming the rest of the order of the District Forum . Time for compliance four weeks.
PRESIDENT
MEMBER
Pm* Dt. 30.11.2011.
