KAMBALA SANDHYA Vs. SBI LIFE INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) Aggrieved by the order in C.C.No.394/09 on the file of Dist Forum-II, Vsiakhapatnam, the complainant preferred this appeal.

(2.) The brief facts as set out in the complaint are that the complainant?s husband Kambala Masenu who is working as a Khalasi in RINL, Visakhapatnam Steel Plant during his life time submitted a proposal to the opposite parties for obtaining insurance policy. The opposite parties, after necessary verification and medical examination, issued policy bearing no.160 02601 401, under Shield Plan A?Level Cover for a sum assured of Rs.3 lakhs, the date of commencement of the policy being 27.7.2006 and the complainant is the nominee under the said policy. The complainant?s husband paid the premiums by salary deduction to the opp.parties. The complainant?s husband died on 14.9.2008 at Seven Hills Hospital, Visakhapatnam. The complainant intimated the opp.parties in the month of October,2008 about the death of the policy holder and submitted necessary claim forms along with necessary enclosures for payment of the amount due under the policy. On 28.5.2009 the complainant obtained the attendance certificate from the Visakhapatnam Steel Plant and sent the same on the same day to the opposite party as asked by them and requested to settle the payment of policy amount , since her second daughter?s marriage was fixed on 31.7.2009. Opp.parties repudiated the claim of the complainant on 17.6.2009 stating that as per the records available the policy holder was diagnosed for Erosive Duodenitis and Diabetes prior to the date of commencement of the policy and had not disclosed the material facts at the time of signing the contract of insurance and therefore repudiated the claim. The complainant submits that the policy holder never suffered from any disease as mentioned in the repudiation letter. Hence the complaint seeking direction to the opposite parties to pay the policy amount of Rs.3 lakhs together with interest @ 18% from the date of complaint till the date of payment, to pay Rs.50,000/- towards compensation and to pay costs of Rs.5000/-.

(3.) Opposite party no.1 filed written statement/counter and opposite party no.2 filed memo adopting the written statement filed by the opposite party no.1. The opposite party submits that after receiving the information about the death of the policy holder they have conducted investigation into the cause of the death. In the investigation it was found that since 2005, the policy holder was suffering from Haemoptysis, Type II Diabetic Mellitus and pulmonary TB, as per the hospital report of Kanaka Durga Hospitals, Visakhapatnam. The deceased life assured committed a breach of the principle of utmost good faith by suppression of the fact that he was suffering from Haemoptysis and diabetes mellitus prior to the date of commencement of the policy. The cause of death is directly related with his pre existing illness. The reports dated Feb?2005 clearly prove diabetes and the endoscopy report proves the erosive duodenitis and hence the repudiation of the policy. The insurer has right to repudiate the claim on the ground of mis representation and concealment of material facts. The attendance records given by the employer of the policy holder established that the policy holder was taking unauthorized leave on regular basis. The opposite parties submit that there is no deficiency in service on their behalf and prayed for dismissal of the complaint.