State Consumer Disputes Redressal Commission
Mr. Bandi Ramesh vs 1.M/S. Reliance Life Insurance Co. ... on 24 November, 2023
1
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION :: HYDERABAD.
F.A.No.90/2019
AGAINST ORDERS IN C.C.No.208/2016 ON THE FILE OF
DISTRICT CONSUMER COMMISSION-II, HYDERABAD.
Between:
Bandi Ramesh,
S/o Chandraiah, Alias Rama Chandraiah,
Aged about 41 years, Occ. : Govt. Employee,
Indian, R/o H.No.11-3-357/16/A. Sanjeeva Puram,
Near Vignan Public Schools, Parsi Gutta,
Secunderabad - 500 017.
....Appellant/Complainant
And
1.M/s Reliance Life Insurance Company Ltd., Rep. by it's Chief Manager, H.No.9-1-125/3/1, Siddartha Plaza, 1st Floor, S.D.Road, Secunderabad -500 003.
2. M/s Reliance Life Insurance Company Ltd., Rep. by it's Chairman & Managing Director, H Block, 1st Floor, Dhiru Bhai Ambani, Knowledge City, Navi Mumbai, Maharashtra State -400 710.
....Respondents/Opposite Parties Counsel for the Appellant/Complainant : M/s. K. Visweswara Rao Counsel for the Respondents/Opposite Parties :
M/s. A. Naveen Kumar QUORUM: HON'BLE SRI V.V.SESHUBABU MEMBER - (J) & HON'BLE SMT. R.S. RAJESHREE, MEMBER - (NJ) FRIDAY, THE 24th DAY OF NOVEMBER TWO THOUSAND TWENTY THREE ******* (Per Hon'ble Smt. R.S.Rajeshree, Member-Non-Judicial) Order :
1. This appeal is filed under Section 15 of the Consumer Protection Act, 1986, by the unsuccessful complainant, being aggrieved by the dismissal of his complaint passed by District Consumer Commission-II, Hyderabad in C.C.No.208/2016, vide orders dated 19.12.2018.2
2. For the sake of convenience, the parties are arrayed as the complainant and the opposite parties.
3. Briefly stated facts of the case are that the complainant's deceased mother had purchased a life insurance policy named "Reliance life fixed savings plan" vide policy No.52136001 w.e.f. 24.03.2015 by paying a sum of Rs.99,999/- as the 1st premium.
And that before issuance of the said policy, the insurance Company had conducted a medical test and after being fully satisfied the said policy was issued. And further that his deceased mother was uneducated and she has only affixed her signature in telugu while the agent of the opposite party had filled the proposal form. That on 18.07.2015 when she went to attend a function in the neighbourhood a dog tried to attack her and in order to rescue herself from the dog, she climbed the steps in a hurry and eventually fallen down and subsequently collapsed there and she was immediately taken to Yashoda Hospital, wherein the doctors have declared her "brought dead".
4. That after the death of his mother, the complainant being the nominee had made an application to the opposite party claiming the insurance amount by submitting all the required documents, but, the opposite party had repudiated the claim on the ground that the deceased life assured had suppressed her medical condition and obtained the policy, as such the claim of the complainant was repudiated. That this repudiation on false and baseless grounds is illegal and untenable. Hence, filed the complaint.
5. On the other hand, the opposite party while admitting the issuance of policy so also the premium amount had opposed the complaint on the ground that the Deceased Life Assured (DLA) had suppressed her health condition and had answered in negative to the questions pertaining to her health condition. And since, it was an early death, the opposite parties have conducted an investigation wherein that it is revealed that the DLA suffered from CAD (Coronary Artery Disease), diabetes Mellitus Type-II, ACS 3 (Acute Coronary Syndrome), hypertension, CCF (Cognitive Cardiac Failure) and LRTI (Lower Respiratory Track Infection), since, 30.12.2014. And she was treated at Yashoda Hospital for the above ailments prior to the issuance of the policy. In view of the above, suppression of the health condition by the DLA, this opposite party had rightly repudiated the claim.
6. Before the District Commission, the complainant got himself examined and got marked Ex.A1 to A4. And on behalf of opposite parties Sri B.V.B.S.Chowdhary, Authorized officer of the opposite parties filed the evidence affidavit and got marked Ex.B1 to B4. The District Forum after hearing both sides and considering the material on record, dismissed the complaint. Being aggrieved by such dismissal, the appellant/complainant has filed the present appeal, on the following grounds:-
That the order of the District Forum, is contrary to law, weight of evidence and probabilities of the case. That the District Forum failed to see that Ex.A4 is only for representation purpose, as such, the cause of death has not been mentioned in the said Ex.A4.
That the District Forum failed to consider that the cause of death mentioned in complaint and evidence affidavit is not specifically denied by the respondents/opposite parties. That the District Forum relied only on Ex.A4 and had not considered the other documents filed by the Appellant/complainant.
That the District Forum erred in observing that the death of the mother of the complainant is suspicious in nature. That the District Forum had passed the orders in a routine manner without even considering the judgments filed by the appellant/complainant.
That the District Forum failed to consider that the documentary evidences filed by the opposite parties are not supported by any affidavit of either the doctor or the investigator. The 4 documents filed by the respondents/opposite parties might have been created only to repudiate the claim.
Based on the above grounds, prayed that the appeal be allowed by setting aside the orders of the District Forum and eventually to allow the complaint.
7. Heard both sides. Perused the record so also the order copy of the District Forum. Now the points that arise for consideration are:-
1. Whether the impugned order as passed by the District Commission suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with in any manner ?
2. To what relief ?
8. The grievance of the appellant/complainant is that his deceased mother B.Rajavva, had taken a Life Insurance Policy from the opposite parties during her life time, and after her death, the appellant/complainant being a nominee had made a claim by submitting all the relevant documents. But, the opposite parties have repudiated the claim on the ground of suppression of health condition. But, it is the case of the appellant/complainant that his deceased mother was uneducated and the agent had filled the proposal form and she has only affixed her signature on the proposal form. That the repudiation of the policy by the opposite parties amounts to deficiency of service.
9. On the other hand the opposite parties had resisted the complaint on the ground that the deceased life assured had suffered from heart problem, diabetes, hypertension and had undergone treatment in the year 2014 at Yashoda Hospital, for the above ailments and concealing the said fact the policy was obtained. As such, the claim was rightly repudiated. In support of their contention the opposite party got marked Ex.B2 (10 pages) Medical Record of DLA pertaining to 30.12.2014.
510. A perusal of Ex.B2 reveals that it is a medical record pertaining to Deceased Life Assured (DLA), dated 30.12.2014 wherein the DLA was treated in an emergency and was treated for complaints of shortness of breath on exertion, fever, cough with expectoration and there were several investigations conducted and the said investigation revealed that the DLA was diagnosed with the following problems. 2D Echo showed RWMA of LV +, (LAD territory hypokinetic) moderate LV dysfunction, Grade II diastolic dysfunction, mild MR No. PR/Clot. Trop I was done which was positive). This Ex.B2 proves the contention of the respondents/opposite parties. The appellant/complainant thought denied his document, but did not come forward with any cogent evidence to prove that the DLA was hale and healthy prior to taking of the policy and also failed to produce any document to show the cause of the death of the DLA. When the respondent/opposite parties has come up with documentary evidence under Ex.B2 the burden shifts on the appellant/complainant to prove that the DLA did not die of any such ailments and was hale and healthy. But no such evidence is coming forth from the appellant/complainant.
11. The appellant/complainant counsel had vehemently argued that the Insurance Company had conducted all the medical tests prior to issuance of the policy and upon being satisfied had issued the policy. But, however, the complainant had not filed a scrap of paper to prove that the DLA was subjected to medical tests prior to the issuance of the policy.
12. Now coming to the arguments of the appellant/complainant counsel that the DLA was not educated and had affixed her signature on the proposal form which was filled by the agent of the insurance company. This issue has been settled in a judgement passed by Division Bench of Mysore High Court, in VK Srinivasa Setty vs. M/s Premium Life and General Insurance Company Ltd., wherein it was held that "while filing a proposal form the agent normally ceases to act as agent of insurer but, becomes the agent of insured and no agent can be assumed to have authority from the 6 insurer to write the answers to the proposal form. If an agent nevertheless does that, he becomes merely the amanuensis of the insured and his knowledge of the untruth or inaccuracy of any statement contained in the form of proposal does not become the knowledge of the insurer. Further, apart from any question of imputed knowledge, the insured by signing that proposal adopts those answers and makes them his own and that would clearly be so, whether the insured signed the proposal without reading or understanding it, it being irrelevant to consider how the inaccuracy arose if he has contracted as the plaintiff has done in this case that his written answers shall be accurate". Hence, the allegation of the appellant/complainant cannot be considered.
13. It is to be observed that the contract of insurance is based on the principle of ubberima fides and the proposer is expected to disclose all the material facts sought in the proposal form, which helps the insurer in taking a decision, whether to issue a policy or to reject the same and also to fix the premium. Further section 45 of the Insurance Act, has significance in this case. Since, the policy has commenced on 24.03.2015 and the deceased life assured died on 18.07.2015 i.e. within a span of 04 moths, which is an early claim. Sec.45 of Insurance Act, reads as under :-
(1) No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy i.e. from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever, is later.
(2) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever, is later, on the ground of fraud.
Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and material on which such decision is based.
In view of Sec.45 of Insurance Act, when there is an early claim, as in the instant case, it is sufficient if the insurer proves that there was a suppression of fact which was within the exclusive 7 knowledge of the insured irrespective of it being a material fact, which has been done by the Appellant/opposite party by filing the Ex.B2 medical record. When such proof is filed, the burden shifts on the Respondent/complainant to prove that she did not suffer from such disease as on that date i.e. prior to making the proposal and that she did not have knowledge of the same, but no such proof is coming forth, from the Respondent/Complainant.
14. All the issues raised by the appellant/complainant and also the significance of Section 45 of the Insurance Act, have been elaborately discussed by the Hon'ble Supreme Court, in Reliance Life Insurance Co. Ltd. vs Rekhaben Nareshbhai Rathod on 24 April, 2019 and the Hon'ble Supreme Court, had discussed the relevance of sec.45 in an early claim and had set aside the orders of the Hon'ble NCDRC and SCDRC and had held that non- disclosure of material fact by the proposer had entitled the insurer to repudiate the policy. Hence, in the instant case also the appellant/complainant has not putforth any evidence to prove that the DLA had not suffered from any ailments prior to the taking of the policy and had not supported the cause of death with any documents. Therefore, considering Ex.B2 it becomes inevitable to conclude that the proposer had suppressed her health condition prior to making the proposal. Hence, the Appellant/opposite party had rightly repudiated the claim. In view of the above discussion, based on the factual aspect and the established legal position, we are of the view that the order of the District Forum does not need any intervention. It is a fact borne by record that the DLA had paid the first premium of Rs.99,999/- and passed away within four months of such payment, therefore, considering the principle of natural justice, we are of the view that the Respondents/opposite parties be directed to return 50% of the premium amount to the appellant/complainant. The first premium paid is Rs.99,999/- but the 50% is rounded off to Rs.50,000/-.
815. In the result, the appeal is dismissed by confirming the order of the District Forum-II, Hyderabad, but however, the Respondents/opposite parties are directed to return 50% (Rs.50,000/-) of the premium amount to the appellant/complainant within one month from the date of this order.
Sd/- Sd/-
MEMBER(M-J) MEMBER (M-NJ)
Dt: 24.11.2023 .
AD*