State Consumer Disputes Redressal Commission
Branch Manager,Bajaj Allianz Life ... vs S.Veni,Tuticorin. on 11 March, 2015
IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MADURAI BENCH.
Present: Thiru.A.K.ANNAMALAI, M.A.M.L.,M.Phil., Presiding Judicial Member
F.A.No.491/2012
(F.A.No.428/2012 on the file of State Consumer Disputes
Redressal Commission, Chennai)
(Against the order in C.C.No.67/2010 dated 10.03.2011 on the file of DCDRF,
Tuticorin.)
THIS WEDNESDAY, 11th DAY OF MARCH 2015.
The Bajaj Alliance Life Insurance Co.Ltd.,
Through its Branch Manager,
First Floor, Balavinayagar Kovil Street,
Tuticorin. Appellant/Opposite Party
Vs
S.Veni,
W/o. Late Subbiah,
3/30A, Thoppu Street,Muthiapuram,
Tuticorin. Respondent/Complainant
Counsel for Appellant/Opposite Party : Mr.V. Sakthivel, Advocate.
Counsel for Respondent/Complainant : Served. Called Absent.
This complaint coming before this Bench for final hearing on
03.03.2015 and on hearing the arguments of appellant side and upon perusing
the material records this Bench made the following:
ORDER
THIRU. A.K. ANNAMALAI, PRESIDING JUDICIAL MEMBER.
-
1. The opposite party is the appellant.
2
2. The complainant's husband availed a Life Insurance Policy from the opposite party for Rs.2,00,000/- and on 26.09.2007 the annual premium amount of Rs.20,000/- paid to the opposite party having maturity period is after 19 years and the insured complainant's husband had died on 12.04.2008 and thereby a claim was made on the basis of insurance policy. But the opposite party repudiated the claim by their letter dated on 02.08.2008 and thereby a consumer complaint came to be filed claiming payment of Rs.2,00,000/- towards insurance claim amount and to pay Rs.2,00,000/- as compensation for deficiency of service and to pay Rs.2,00,000/- for mental agony in all for Rs.6,00,000/- and for costs.
3. The opposite party in their version contended that the insured had suppressed the materials facts regarding the earlier diseases and thereby claim was repudiated.
4. The District Forum on the basis of both sides materials allowed the complaint directing the opposite party to pay a sum of Rs.2,00,000/- as insurance claim amount and Rs.35,000/- compensation for mental agony and Rs.5000/- towards costs.
5. Aggrieved by the impugned order, the opposite party had come forward with this appeal contending that the District Forum erroneously allowed the complaint without taking into considerations of nature of contract and since the complainant's husband was suffering from chronic liver disease and diabetes mellitus hypertension and without disclosing the same availed the policy and thereby claim was repudiated and the District Forum order has to be set aside. 3
6. The respondent/complainant even after service of notice failed to appear before this Bench and remained absent. Hence on the basis of appellant side arguments and on material records the order being passed on merits.
7. It is the admitted case of both sides that the complainant's husband availed a policy for Rs.2,00,000/- on payment of Rs.20,000/- as annual premium on 26.09.2007 and subsequently he died on 12.04.2008 within 7 months from the date of policy and thereby the claim came to be made. The opposite party/appellant contended in the grounds of appeal that the death was occurred within 2 years and as per provision under section 45 of the Insurance Act they have investigated the matter to settle the claim and thereby came to know the insured was having previous history of diabetes mellitus, systemic hypertension chronic liver disease Hypatorinal Syndrome, Disseminated Intra Vascular Viaagulation and he was treated for the same and died out of the same and he had suppressed the same for which the appellant relied upon under Exhibit B4 the medical certificate issued by Dr.C.Ramamoorthy. But the District Forum rejected this letter on the grounds that the certificate has been received by the opposite party after the claim of the complainant had been repudiated and also since the opposite party sent the notice for subsequent premium even without knowing the death of the insured under Exhibit A4 showing carelessness on the part of the opposite party.
4
8. While considering this aspects it is to be taken in to account that the policy holder K.Subbiah died within the period of 7 months from the date of availing policy with effect from 26.09.2007 for Rs.2,00,000/- by paying only one annual premium of Rs.20,000/- for the same and even before the second premium due he died. It is in the routine course of business the opposite party has sent the payment for premium notice under Exhibit A4 and it cannot be taken up as the reason for accepting the claim by issuing the same carelessly and as far as the medical certificate under Exhibit B4 is concerned on perusal of the same it is seen that it was issued by one Dr.C.Ramamoorthy dated 01.05.2009 said that the deceased K.Subbiah aged 53 years was taking treatment under him for Chronic Liver disease and Diabetes mellitus in its clinic from 01.09.2007 the policy was taken on 26.09.2007 within 26 days from the date of treatment, so it is clear the disease was aware of the nature of sufferings with him and as per the section 45 of Life Insurance Act the insurer has gone right to investigate if any death is caused and claim is made for the same within 2 years from the date of policy to investigate the nature of death and on the basis of same they are entitled to repudiate the claim if the cause of death is proved otherwise then as per the terms and conditions of the policy. Further the District Forum observed since the Ex.B4 was obtained only after claim is made alone the insurer investigated the matter and found that he had suppreseed the previous diseases and thereby violated the policy condition and thereby this bench has no doubt on 5 the certificate details and there is no need for the doctor who has issued Ex.B4 to said the opposite party.
9. On perusal of the proposal form under Ex.B1 the deceased K.Subbiah answered categorically for all the questions relating to the health treatment etc., in negative form certifying in good health condition and on that basis alone the insurance policy was allowed in good faith and thereby while considering the date of policy taken and date of death occurred as soon as the policy taken within few months it is clear that the insurer has not come forward with clean hands in filing the proposal furnished details regarding the health condition and thereby there was suppression of material facts which could be taken into consideration by the opposite party for repudiation of the claim.
10. The appellant/opposite party relied upon the following rulings in this regard, (1) In the case of Om Prakash Moda Vs. L.I.C. of India and another Vol.4) 2236.
(2) In the case of Shanti Lal Swaroopchand Soni vs the New India Assurance Company Limited 2008 (3) CPR 204 (NC).
(3) In the case of Shankar Soni Vs Life Insurance Corporation of India 2008 (3) CPR 176 (NC).
On the basis of above rulings of the same also it is clear that the opposite party/appellant proved their case and thereby this bench is of the view that the appeal deserves to be allowed by setting aside the order of the District Forum. 6
11. In the result, the appeal is allowed and the order of the District Forum, Tuticorin passed in C.C.No.67/2010, dated 10.03.20111 is set aside and the complaint is dismissed. However; the opposite party/appellant is directed to refund the amount of Rs.20000/-paid by the complainant's husband towards premium to the complainant.
The directions shall be complied within six weeks from the date of copy of this order.
Sd/-xxxxxxxx A.K.ANNAMALAI, Presiding Judicial Member