Shri Ram Life Insurance Co. Ltd vs Namasani Venkata Lakshmamma & 4 Ors

Ram Surat Ram Maurya, Presiding Member

Heard Ms. Meghna Mital Sankhla, Advocate for the appellant and Mr. K. Maruthi Rao, Advocate, for the respondents.

Above appeal has been filed against the order of State Consumer Disputes Redressal Commission, Andhar Pradesh, dated 25.09.2014, passed in Consumer Complaint No.68 of 2011, allowing the complaint and directing the appellant to pay Rs.2250000/- with interest @9% per annum from date of filing of the complaint till the date of payment as the insurance claim.

Namasani Venkata Lakshmamma filed CC/68/2011, for directing Shri Ram Life Insurance Company Limited (the appellant) to pay (i) Rs.2250000/- with interest @18% per annum from 31.07.2009 till the date of payment, as insurance claim; (ii) Rs.one lakh, as compensation; (ii) Rs.25000/-, as litigation costs; and (iv) any other relief, which is deemed fit and proper in the facts and circumstances of the case.

The complainant stated that her husband Late Chenna Kesava Rao had obtained “Shri Plus Insurance Policy No.LN100900033143, from Shri Ram Life Insurance Company Limited on 28.03.2009, for the period of 15 years. Annual premium of the policy was Rs.150000/- and it covers ‘accidental shield’ benefit of Rs.1125000/- and ‘accidental death’ benefit of Rs.2250000/-. Late Chenna Kesava Rao met in an accident on 31.07.2009 at Gurazia, Guntur District, while driving Tractor No.AP7 Y6742 and died on the spot. FIR No.51/2009 of the incident was registered on 01.08.2009 at Police Station Marcheria Rural. The police got conducted inquest and post mortem of the dead body, in which, cause of death was mentioned as “ruptured’. Viscera was preserved. The complainant set up insurance claim through insurance agent along with all the relevant documents. Vide letter dated 20.01.2010, the opposite party informed that the claim was closed on the ground of not producing post mortem report and the medical documents/reports pertaining to liver ailments of the insured, in spite of repeated reminders, although all the documents were submitted. The complainant gave legal notice dated 15.03.2010 to settle the claim. The opposite party gave reply notice on 30.04.2010, stating that comprehensive post mortem report and the medical documents/reports pertaining to liver ailments of the insured were not submitted. The complaint was filed on 30.07.2011.

The appellant filed its written reply and contested the complaint. The facts relating to obtaining insurance policy on 28.03.2010 and accidental death of the life assured on 31.07.2010, have not been disputed. The appellant stated that after receiving insurance claim, they appointed Mr. G. Rama Murthy as an investigator, who conducted an inquiry and submitted his Investigation Report dated 09.10.2009, stating that the deceased life assured had concealed his previous ailment for which he had taken treatment in Para Ovarian Cysts at AMG Hospital and Care Hospital Vizag, in the Proposal Form. The officer of the appellant and the Investigator handed over (i) Claim Form-B- Medial Attendant Certificate, (ii) Claim Form-C- Certificate of Cremation/Burial to the claimant on 27.10.2009 and requested her to fill up these form and provide relevant documents. The complainant submitted Claim Forms in July, 2010 but did not provide other relevant documents. The appellant again vide letter dated 03.09.2010, demanded case sheet/ medical records of the treatments taken in Para Ovarian Cysts at AMG Hospital and Care Hospital Vizag but these documents were not supplied. Then the claim was repudiated on 30.09.2010. There is no deficiency on the part of the Insurer.

State Commission, in the impugned order found that the Insurer raised plea that the deceased life insured was suffering from chronic liver disease and had taken treatment prior to taking insurance policy but no evidence has been produced in this respect. Medical records of Hitech Trauma and Critical Hospitals Limited, Guntur as produced by the Insurer, relating to treatment of the deceased life assured were suspicious documents inasmuch as the Investigator, in his report stated that initially the nurse, who had attended the patient, informed that he was a drunkard and had run away with hospital record. Later on Photostat copies of medical records were produced, stating that it were obtained from record section of the hospital as such, these records were not reliable documents. The claim was repudiated on irrelevant consideration. On these finding the complaint was allowed. Hence this appeal has been filed.

We have considered the arguments of the counsel for the parties and examined the record. Proposal Form for taking insurance policy was filled up on 03.02.2009 and first instalment of the premium of Rs.150000/- was paid. Insurance policy was issued on 31.03.2009. By the letter dated 22.01.2010, the appellant closed the insurance claim on the ground that vide letter dated 11.11.2009, they had asked for Comprehensive Post Mortem Report and Medical report/Case sheets for the treatment taken for ailments of liver at Narsaraopet and Guntur by the deceased life assured but in spite of Reminder-I dated 05.12.2009 and Reminder-II dated 31.12.2009, these documents were not supplied. The repudiation letter did not record any finding that the deceased had concealed previous ailment relating to his liver disease although Investigator in his report dated 10.11.2009, had mentioned that the deceased life assured was a drunkard chronic alcoholic/smoker and had taken treatment for liver problems-alcoholic liver disease.

Before State Commission, the appellant submitted Photostat copies of medical records of Hi-tech Trauma and Critical Care Hospitals Limited, Guntur, relating to treatment of deceased life assured during 29.06.2009 to 02.07.2009. In this medical record, neither date of discharge of patient has not given nor was discharge summary prepared. If these two facts are considered with report of Investigator that initially the nurse, who had attended the patient, informed that he was a drunkard and had run away with hospital record, then grave doubt is created upon the genuineness of these documents. If the patient had run away with hospital record, then from where these records were procured. If these records were with the hospital, then why endorsement was not made in it that the patient had run away without discharge or if discharged then why discharge summary was not mentioned. A Photostat copy of the Affidavit of Dr. Vutukuri Suresh has been filed in the appeal, which shows that entire contents of the affidavit was typed and particulars of Dr. Vutukuri Suresh was filled up in handwriting. Had this affidavit been drafted on the instruction of Dr. Vutukuri Suresh, then there was no reason to not typing his name. This affidavit does not contain the name and seal of any Oath Commissioner. In these circumstances we do not find any reason to take contrary view as taken by State Commission raising grave doubt in respect of genuineness of these records and ignoring these documents.

In any case, there is no evidence that the deceased life assured was suffering from any ailment on 03.02.2009 or prior to it, when proposal form was filled up by him or had taken any treatment in any hospital. As such, the plea taken by the appellant that the deceased had concealed his ailment relating to liver disease is not proved. Copies of FIR, Inquest as conducted by the police, Post Mortem Report, Police Investigation Report were already submitted by the complainant before the appellant. We failed to understand that what was Comprehensive Post Mortem Report, which was demanded by the appellant. These documents were prepared by Public Authorities in discharge of their statutory duties. It was not possible for the complaint to get any other record to prove accidental death of the deceased life assured. Similarly if the deceased life assured had no previous ailment or was ever admitted in any hospital, then no document could be produced by the complainant. From the documents produced by the complainant it was fully proved that the deceased life assured had a valid insurance policy issued by the appellant, his death was accidental and the complainant was a nominee in the policy. Closing the insurance claim was illegal and arbitrary. The impugned order of State Commission does not suffer from any illegality. The appeal has no merit and is liable to be dismissed.

ORDER

In view of the aforesaid discussions, the appeal is dismissed.