IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM
Present:
Hon’ble Mr. Bose Augustine, President
Hon’ble Mr. K.N. Radhakrishnan, Member
Hon’ble Mrs. Renu P. Gopalan, Member
CC No. 201/11
Wednesday the 10th day of June, 2015
Petitioner : Reeja.P.George,
Podimattathil House,
Thellakom PO,
2) Rosamma George
-do-
(By Adv. G.Jayasankar)
Vs
Opposite parties : 1) S.B.I. Life Insurance Co.Ltd
State Bank Bhavan, Corporate
Centre, M.C.Roadddddd, Mumbai-21
2) The Branch Manager,
State Bank of Trvancore,
Ammencherry Branch, Kottayam.
(By Adv. Agi Joseph)
O R D E R
Hon’ble Mr. Bose Augustine, President
The case of the complainant filed on 28/4/08 is as follows.
The complainant’s case CC No.70/08 was ordered on 25-2-2010. Against the said order 1st opposite party filed appeal before the SCDRC No.245/10. In the said appeal the Hon’ble SCDRC was set aside the order on cost of Rs.25,000/- and directed to permit the opposite party to contest the matter and disposed off the case on merits. After remand the case was renumbered as CC No.201/11.
The brief of the case is as follows.
The 1st complainant is the daughter of the 2nd complainant. The father of the 1st complainant, who is the husband of the 2nd complainant P.T.George was died on 23-5-06. The deceased P.T.George was the policy holder of 1st opposite party as No.15000974710. The basic sum assured is Rs.3,00,000/- and the nominee of the deceased is the 1st complainant. After the death of the deceased P.T.George the complainants submit claim form with the opposite party. But the claim of the complainants was repudiated by the opposite party as per its order dated 10-2-07 stating baseless reasons. According to the complainants the act of opposite parties, in repudiating the genuine claim amounts to deficiency in service. Hence this complaint.
The opposite parties entered appearance and filed version admitting issuance of policy in the name of P.T.George and the repudiation of the complainants claim. According to the opposite parties, P.T.George obtained the policy by suppressing materials facts and thereby misguiding the 1st opposite party. The policy holder has stated in his proposal form, false answers with ulterior motive to misguide the 1st opposite party for obtaining the insurance policy. The policy holder has not disclosed regarding the alcoholism, smoking, liver disease etc. According to the opposite parties, on investigation it is understand that Mr. P.T.George was a chronic smoker and chronic alocoholic and he was suffering from chronic liver disease for a long time. As per the medical attendants’ certificate, the chronic liver diseases were one of the causes contributed to the death of the deceased life assured. It is clear that his alcoholic habits contributed to chronic liver disease which in turn caused death of the policy holder. According to the opposite parties they had repudiated the claim of the complainants because of the suppression of material fact by the deceased life assured and it is legal and valid grounds. So opposite parties prayed for dismissal of the complaint with their costs.
Points for determinations are:
- Whether there is any deficiency in service on the part of opposite parties?
- Relief and costs?
Evidence in this case consists of the proof affidavits of the both sides and the deposition of the complainant as PW1. Ext.A1 and A2 documents from the side of the complainant. Even after remand opposite parties has not adduced any evidence. First opposite party filed argument note.
Point No.1
The gist of the complainants case is that, their genuine claim was repudiated by the opposite parties. According to the opposite parties the policy holder has not disclosed, at the time of taking policy regarding the alcoholism, smoking and liver disease. So they had repudiated the claim of the complainants on the ground that the life assured suppressed the material facts. Complainant produced copy of the repudiation letter dtd 10-2-2007 and the same is marked as Ext.A2. In Ext.A2 the reason for repudiation is stated that as per the reports the late P.T.George was a chronic alcoholic and chronic smoker prior to commencement of risk and died due to chronic liver disease. The life assured had concealed material facts while proposing insurance cover. So they repudiated the claim on the ground that suppression of material facts. Even though the opposite parties has a definite case that the life assured had suppressed the material fact that deceased was a chronic alcohol and chronic smoker prior to the commencement of the risk. And the deceased died due to liver disease and his habits were directly related to the cause of death. But opposite parties has not adduce any evidence to prove that the life assured consumes tobacco and alcohol or else opposite parties have not adduce any evidence to prove that habits of the life assured were directly the cause of his death. So in our view the act of opposite party in repudiating the claim of the complainants is a clear deficiency in service. Point No.1 is found accordingly.
Point No.2
In view of the findings in Point No.1 complaint is allowed.
In the result
- The opposite parties are directed to pay Rs.3,00,000/- the sum assured with 9% interest from 10-2-2007, the date of repudiation, till realization of the amount, to the complainants.
- Since interest is allowed no separate compensation is ordered.
- The opposite parties are directed to pay Rs.5000/- as litigation cost to the complainant.
The complainants are equally entitled for the award amount.
The order shall be complied with within 30 days from the date of receipt of copy of the order. If not complied as directed, complainants are entitled 15% interest for award amount from the date of order till realization.
Pronounced in the Open Forum on this the 10th day of June, 2015.
Hon’ble Mr. Bose Augustine, President Sd/-
Hon’ble Mr. K.N. Radhakrishnan, Member Sd/-
Hon’ble Mrs. Renu P. Gopalan, Member Sd/-
Appendix
Documents for the complainant
Ext.A1- Copy of the policy No.1500974710
Ext.A2-Copy of Repudiation letter dtd 10/2/2007
PW1-Rosamma George
By Order,
Senior Superintendent
