State Consumer Disputes Redressal Commission
Polina Sudhamani And Others Kadapa vs Life Insurance Corporation Of India And ... on 1 May, 2009
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD. F.A.No. 1641 OF 2006 AGAINST C.D.NO.40 OF 2006 DISTRICT FORUM KADAPA Between: Polina Sudhamani W/o late P.Raveendra R/o Kummarapalli, Nagari Padu (Post) B.P.R.Pall, Chitvel Mandal, Kadapa Dist. Appellant/complainant A N D 1. Life Insurance Corporation of India rep. by its Branch Manager, Rajampeta Kadapa District 2. The Senior Divisional Manager, Life Insuance Coporation of India Kadapa, Kadapa Dist. Respondents/opposite parties F.A.No. 1642 OF 2006 AGAINST C.D.NO.41 OF 2006 Between: Polina Sudhamani W/o late P.Raveendra R/o Kummarapalli, Nagari Padu (Post) B.P.R.Pall, Chitvel Mandal, Kadapa Dist. Appellant/complainant A N D 3. Life Insurance Corporation of India rep. by its Branch Manager, Rajampeta Kadapa District 4. The Senior Divisional Manager, Life Insuance Coporation of India Kadapa, Kadapa Dist. Respondents/opposite parties Counsel for the Appellant: Sri V.R.Reddy Kovvuri Counsel for the Respondents Sri Srinivas Karra QUORUM: SMT M.SHREESHA, PRESIDING MEMBER
& SRI SYED ABDULLAH, MEMBER FRIDAY THE FIRST DAY OF MAY TWO THOUSAND NINE Oral Order ( As per Smt M.Shreesha, Presiding Member) *** Both these appeals arise out of common facts filed by the same complainant against the orders of the District Forum, Kadapa in C.D.No.40 and 41 of 2006 and they are being disposed of by a common order.
The unsuccessful complainant is the appellant and she approached the District Forum aggrieved by the repudiation of her claims on 5.2.2005 lodged on account of death of her husband who during his life time obtained 4 insurance policies which are as under:
Sl.No. Policy No. Sum Assured Rs.
Date of Commencement Yearly premium Rs.
1.
652995810 1,00,000/-
13.12.2002 8,192/-
2. 653241830 1,00,000/-
26.06.2003 7,039/-
3. 653242549 2,00,000/-
28.07.2003 2,580/-
4. 653243706 50,000/-
15.09.2003 3,221/-
The claim was repudiated on the ground that the insured had furnished incorrect information in his proposal forms dated 20.7.200128.6.2003, 28.7.2003 and 15.9.2003 respectively and that he attempted to commit suicide. It was submitted that the insured never suppressed any material facts in regard to his health. He suffered sudden pain and heart attack and he died on 29.11.2003 while undergoing treatment at Vjaya Hospital at Railway Kodur Town. The hospital had issued medical certificate which was submitted to the respondents.
The respondents contested the case by filing joint counter admitting the issuance of the four insurance policies on the life of the husband of the appellant and it was stated that among the four policies three were taken within a period of one year and it was denied that the insured died due to heart attack while undergoing treatment at Vijaya Hospital.
It was stated that the deceased was alleged to have been consumed organo phosphorous poison on 15.9.2003 and he was admitted at Sri Venkateswara Institute of Medical Sciences, Tirupathi and on 23.9.2003 he was discharged on his request and died on 29.11.2003. He was chronic alcoholic and did not disclose the same while proposing for insurance. He gave answers in negative to the question in proposals that whether he was alcoholic, using narcotics or any other drugs or tobacco in any form.
The hospital record shows that the deceased consumed organo phosphorous poison and he had obtained the insurance policy bearing No.653243706 on the same day when he was admitted in the hospital. The deceased aware of his health condition and deliberately he had given declaration that he was in good health at the time of making proposal. Hence the contract is null and void. The appellant approached the District Forum without exhausting the alternative remedy as provided.
Basing on the evidence Exs.A1 to A6 and Exs.B1 to B9 in C.D.No.40 of 2006 and Exs.A1 to A5 and Exs.B1 to B5 in C.D.No.41 of 2006, the District Forum dismissed both the complaints.
Aggrieved by the said orders the complainant filed these appeals stating that the District Forum had relied on Exs.B7 and B8 in C.,D.No.40 of 2006 and Exs.B3 and B4 in C.D.No.41 of 2006 which were not supported by sworn affidavit or oral evidence and that her husband was quite healthy at the time of filing declaration with the respondent and he was examined by the panel doctor of the respondent and also that having been satisfied by the health condition of her husband and enquiry was made by the agents of the respondent and that the concealed facts had no nexus with the cause of death of her husband.
The points for consideration are:
1) Whether the appellants husband suppressed material facts at the time of taking insurance policies?
2) Whether there was deficiency in service on the part of the respondent?
3) To what relief?
POINT NO.1 & 2 : These two points are taken up together since they are interrelated. There is no dispute of the facts that the husband of the appellant P.Raveendra obtained four insurance policies bearing Nos. 652995810 dated 13.12.2002 for Rs.one lakh, No. 653241830 dated 26.06.2003 for Rs.one lakh, No. 653242549 dated 28.07.2003 for Rs.2 lakhs and No. 653243706 dated 15.9.2003 for Rs.50,000/- and he died on 29.11.2003. It is also not in dispute that the claim of the appellant was repudiated vide letter dated 5.2.2005 on the ground that the deceased withheld correct information regarding his health/habits at the time of filing the proposal and that he gave answer in negative to the question No.11
(h) of the proposal that whether he had ever used alcohol, drinks, narcotics, any other drugs and Tobacco in any form and also on the ground that he was a chronic alcoholic and attempted to commit suicide on the same day of taking of policy No. 653243706. It Is the contention of the learned counsel for the appellant that the deceased had not suppressed any material facts while taking insurance policies and the repudiation of the claim of the appellant made by the respondent is arbitrary. Whereas the learned counsel for the respondents submit that the repudiation of the claim was made after taking into consideration relevant facts and it was made basing on the documents.
It is true that to question no.11, the appellants husband gave reply in the negative as to the consultation of a medical practitioner a week prior to the date of the proposal, his getting admitted in any hospital for treatment or operation, being absent from place of work on the ground of health and ailments pertaining to liver, stomach, heart etc., and habits like taking alcohol, drinks, narcotic drugs and tobacco in any form. These proposals Exs.B1 to B3 dated 19.7.2003, 28.7.2003 and 15.9.2003 (C.D.No.40/06) and Ex.B1 dated 13.12.2002 (C.D.No.41/06) in pursuance of which insurance policies were issued. On the date of filing of the proposal, the insurance policies were issued in favour of the husband of the appellant. As there is no dispute about the statements made by the insured in the proposals, the fact that gains significance in the light of the repudiation of the claim of the appellant by the respondents on the ground that the insured suppressed the fact of his taking treatment and the habits inculcated during the time he was alive. The documents for determination of the health condition of the deceased is Ex.A3 (CD NO.40/06) and Ex.A4 (CD NO.41/06) Medical Certificate of cause of death issued by Dr.Raghu, Vijaya Hospital Railway Kodur and Ex.B7 (CD 40/06) and EX.B4 (CD 41/06) certificates of hospital issued by the Panel doctor of the respondent, Medical Officer SVIMS, Tirupati. Ex.A4(CD40/06) and A3 (CD41/06) shows that the deceased died due to Myocardial infarction and the interval between onset and death was approximately half an hour whereas in where as in Ex.B8(CD40/06) and Ex.B3(CD41/06) it is stated that the deceased was admitted in a private nursing home on 15.9.2003 and he was treated there and the duty doctor of SVIMS recorded the history in the case sheet and the doctor had been in service in the hospital. In column No.6 diagnosis arrived at in the hospital, as noted to be Organo Phosphorous Poisoning and he was discharged at request on 23.9.2003.
Therefore it is clear that the deceased was treated in SVIMS as in-patient from 15.9.2003 to 23.9.2003.
It is also established that he died in Vijaya Hospital as seen from the above exhibits due to myocardial infarction. The insurance policies were issued on 13.12.2002, 28.6.2003, 28.7.2003 and 15.9.2003. So far as the fourth insurance policy is concerned, it was issued on the same date i.e., 15.9.2003 on which date the deceased was admitted in SVIMS Tirupathi.
Coming to the question of repudiation of claims, the respondent has to establish by placing documentary evidence to show that the deceased suppressed material fact regarding his ill health. Therefore, so far as the claim of the first three insurance policies is concerned, bearing Nos. 652995810 dated 13.12.2002 for Rs.one lakh, No.653241830 dated 26.06.2003 for Rs.one lakh, No. 653242549 dated 28.07.2003 for Rs.2 lakhs, it can be said that the respondents have not shown any reasonable cause for the repudiation of the said policies. Neither any treatment is said to have been taken by the deceased nor any of the alleged habits like taking alcohol, Narcotics, drugs or tobacco in any form was established. The repudiation held good only in respect of insurance policy bearing No., 653243706 dated 15.9.2003 for Rs.50,000/- and the repudiation of claim in regard to the policies bearing Nos. 652995810 dated 13.12.2002 for Rs.one lakh, No.653241830 dated 26.06.2003 for Rs.one lakh, No. 653242549 dated 28.07.2003 for Rs.2 lakhs cannot be sustainable and the appellant is entitled to the amount and benefits under these insurance policies. Hence we are inclined to allow both these appeals accordingly.
In the result F.A.No.1641 and 1642 of 2006 are allowed setting aside the orders of the District Forum. The respondents are directed to pay the amounts of Rs.1,00,000/-, Rs.1,00,000/- and Rs.2,00,000/- under policies No. 652995810, 653241830 and 653242549 and other benefits together with Rs.2,000/- towards costs.
Time for compliance four weeks.
PRESIDING MEMBER MEMBER Dt.
01.05.2009