State Consumer Disputes Redressal Commission
The Branch Manager,Nizamabad Town ... vs Lingampally Rajamma @ Lingampally ... on 12 February, 2014
BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: HYDERABAD. F.A.No.46 OF 2013 AGAINST C.C.NO.38 OF 2009 DISTRICT FORUM, KARIMNAGAR. Between: 1. The Branch Manager, Reliance Life Insurance Co. Ltd., Vamandas complex, 5-6-291 First floor, Saraswathinagar, Nizamabad Town proper and District. 2. The Branch Manager, Reliance Life Insurance Co. Ltd., Karimnagar proper and District. ..Appellants/opp.parties. And Lingampally Rajamma @ Lingampally Rajamani W/o.late Krishna Reddy, aged 38 years, Occ:Household, R/o.Lambadipally (V) Of Mallai T.Q. of Karimnagar District. ..Respondent/complainant . Counsel for the Appellants: M/s A.Naveen Kumar Counsel for the Respondent: M/s.P.Rajasripathi Rao. QUORUM: SRI R.LAKSHMINARASIMHA RAO, HONBLE MEMBER.
AND SRI THOTA ASHOK KUMAR, HONBLE MEMBER WEDNESDAY, THE TWELFTH DAY OF FEBRUARY, TWO THOUSAND FOURTEEN Order (As per Sri T.ASHOK KUMAR Honble MEMBER) *** This is an appeal preferred by the opposite parties against the order in C.C.No.38/2009 dated 05-11-2012 on the file of District Forum, Karimnagar. For convenience sake the parties as arrayed in the complaint are referred to hereunder:
The brief facts of the complaint are that the complainants husband during his life time obtained Reliance Endowment Plan (Regular) Policy bearing No.10372934 by paying first premium of Rs.5,774/- for an assured sum of Rs.1,00,000/- commencing from 08-11-2006 for a period of 21 years. The life assured died on 21-1-2008 and after his death the complainant informed opposite party No.1 about his death and submitted the requisite documents and requested to settle the claim. The opposite parties by letter dated 19-2-2008 repudiated the claim of the complainant stating that the life assured suppressed material facts with regard to his health. The complainant averred that the allegations made by the opposite parties are wrong and to avoid payment of the claim amount, they levelled false allegations which amounts to deficiency in service. Hence the complaint for a direction to the opposite parties to pay Rs. 1 lakh towards the sum assured and other benefits with interest at 18% p.a. from the date of death of the policy holder together with compensation of Rs10,000/-, Rs.5,000/- towards damages and Rs.3000/- as costs.
Opposite party No.2 filed written version resisting the complaint. It contended that on receipt of the claim from the complainant, an investigation was carried out by the opposite party and it was found that the deceased policy holder was hospitalized on 01-8-2005 at Krishna Institute of Medical Sciences with shortness of breath and was diagnosed to be suffering from dialated cardio myopathy and severe L.V.disfunction and was discharged on 02-8-2005 and the said fact was confirmed by the hospital vide claim form-B. The deceased policy holder suppressed the material facts at the time of obtaining the policy and as per Section 45 of the Insurance Act if there is any mis-statement or suppression of material facts, the policy can be cancelled and contended that there is no negligence or deficiency in service on its part and prayed for dismissal of the complaint.
Both sides filed affidavits reiterating their respective contentions. Exs.A1 to A8 and Exs.B1 to B9 were marked on their behalf. Having heard both sides and considering the material on record, the District Forum vide impugned order allowed the complaint in part directing the opposite parties to pay the complainant a sum of Rs.1 lakh with interest @ 9% p.a. from the date of filing of the complaint i.e. 24-2-2009 together with costs of Rs.1000/-.
Feeling aggrieved by the said order, the opposite parties preferred this appeal contending that it is regulated by the guidelines of IRDA and the deceased policy holder after understanding the features of the policy terms and conditions had voluntarily signed the proposal form and further the insurance company has right to cancel the policy and repudiate the claim in case of the information given in the proposal form being found false. In the proposal form at page 4 pertaining to Medical details, the deceased life assured had purposefully concealed the existence of disease and answered the questions in negative. It contended that on the basis of Section 45 of insurance Act, 1938 and clause 8(3) of IRDA, 2002, it conducted investigation and came to know that the deceased life assured suffered from dilated cardio myopathy and severe L.V. dysfunction and was discharged on 02-8-2005 i.e. prior to the proposal and that the insurance contract is a contract based on utter most good faith and the complainant has not denied in her evidence that any of the documents filed by the opposite parties are fabrciated. The learned counsel for the opposite parties relied on the decision of the Honble Supreme Court of India in SATWANT KAUR SANDHU v. NEW INDIA ASSURANCE COMPANY LIMITED reported in IV (2009) CPJ 8 (SC) and on the decision of the National Commission in LIC V. Smt.Sureka Shankar Jadhav in R.P.No.2130/2007 LIC V. Smt.Sureka Shankar Jadhav in R.P.No.2130/2007 and also on the judgement of Division bench of Honble High Court of A.P in LIC of India v. B.Chandravathamma in AIR 1971 AP 41 wherein it was held that if the life insurance policy contains a special clause putting the insured on notice that in case of any such deliberate misrepresentation, the contract of insurance would become void and amounts paid thereunder shall be forfeited. The learned counsel for the opposite parties contended that the decisions relied by the District Forum in 2010(3) CPC in RP No.1516/2006 and 2011 (1) CPC in FA NO.664/2007 are totally different from the facts of the present case and that if false information is furnished, the contract becomes void ab initio and therefore the complainant is not entitled to any benefit under the policy as the contract becomes void ab-intio and cannot be enforced before court of law and prayed to allow the appeal.
Heard both counsel with respect to their respective contentions in detail.
Now the point for consideration is whether the order of the District Forum is vitiated either in law or on facts?
The facts not in dispute are that the complainants husband, Mr.L.Krishna Reddy obtained Reliance Endowment Plan (Regular) policy from the opposite party No.1 bearing No.10272934 for an assured sum of Rs. 1lakh commencing from 18-11-2006 with yearly premium of Rs.5,774/- for a term of 21 years. The life assured died on 21-1-2008 and the complainant being the nominee preferred a claim along with the required documents but the opposite parties vide letter Ex.A8 dated 19-2-2008 repudiated the claim of the complainant on the ground of non disclosure of heart disease and hospitalization in the proposal form under questions 54(a) and 54 (s) as under which are material in issue as per terms of Section 45 of the Insurance Act, 1935.
54 a. Chest pain, high blood pressure, raised cholesterol, stroke heart attack, heart murmur, other heart/blood vessel disorder No 54 b----
54 c----
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54 s Have you ever been admitted to a hospital/nursing home for treatment for any illness, Medical disorder, alcohol use or drug related condition? If yes, please submit discharge certificate/hospital reports No In this connection, the learned counsel for the complainant contended that as seen from Ex.A7 part of copy of proposal form, the insured affixed his thumb impression and thus he is an illiterate and the agent of the opposite parties has filled in the proposal form and the deceased insured did not give any such answers and the contents of the proposal form were not read over and explained to the insured illiterate and as such the repudiation is unjust. Whereas Ex.B9, full proposal form, filed by the opposite party contains a declaration that one Mr.N.Stallin explained the contents of the proposal to the proposer and endeavoured to ensure that the contents have been fully understood and that he has accurately recorded the responses to the information sought by the proposal form and he has read the responses back to the proposer and confirmed that they are correct and such a declaration was also duly signed by him on 31-10-2006 and this declaration was detached from Ex.A7 and therefore we are inclined to hold that whatever answers given by the assured are duly incorporated in the proposal form and hence there is no substance in the contention of the learned counsel for the complainant.
The learned counsel for the opposite parties basing on Ex.B6, Claim Form B, Medical Attendant certificate of the insured issued by Sreem Remedy Hospital, Karimnagar contended that it discloses that the deceased was admitted in the said hospital on 20-1-2008 at 12.30 p.m. vide admission No.2413 with regard to cardio myopathy and there is also a mention in it that since two years, he has been suffering from the said ailment and also relied on Exs.B1 to B5 of Krishna Institute of Medical Sciences Ltd., which would go to show that the deceased had undergone treatment for such an ailment at those institutions prior to issuance of the policy.
The learned counsel for the complainant contended that none of the doctors said to have treated the assured and gave such certificates filed affidavits supporting the case of the opposite parties and therefore the said material cannot be considered.
In this context the learned counsel for the opposite parties relied on the decision reported in SATWANT KAUR SANDHU v. NEW INDIA ASSURANCE COMPANY LIMITED reported in IV (2009) CPJ 8 (SC) wherein the Apex court held that if the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form and also relied on the decision reported in (2012) 2 CPR (NC) 214 LIC of India v. N.P.Nagarathna wherein it was held that although affidavits of the treating doctors were not given, if the complainant did not place any credible evidence controvert the evidence, on such ground the documents cannot be held as inadmissible. The said decisions support the argument of the opposite parties. Self serving evidence of the complainant is not sufficient to discard the said documents.
He also relied on the decision reported in LIC V. Smt.Sureka Shankar Jadhav in R.P.No.2130/2007 and contended that where there was no evidence in rebuttal that the duly certified copy of the medical record sheet was forged or fabricated, the said medical record has to be believed. All the said decisions support the argument of the opposite parties and the self serving evidence of the complainant is not sufficient to discard the said documents. The learned counsel for the complainant also contended that before accepting the proposal and issuance of policy, the insured was examined by the panel doctor and he certified that the life assured is not suffering from any ailment. In this context the learned counsel for the opposite parties has relied on the decision reported in (2010) I CPR 110 (NC) in SMT. BUDDIBEN PABABHI v. LIC OF INDIA AND OTHERS wherein it was held that for policy not being that of a medi-claim policy, a customer is not subjected to thorough medical examination and endorsement made by doctor is mostly on the basis of the information provided by the customer and in these circumstances the argument of the counsel for the complainant does not hold water.
For the aforementioned reasons, this appeal is allowed and the order of the District Forum is set aside and consequently the complaint stands dismissed.
There shall be no order as to costs.
MEMBER.
MEMBER.
JM Dt.12-2-2014 .