BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, B.L., LADY MEMBER
SRI M.V.R. SHARMA, B.A., MEMBER.
Thursday, 13th November 2014
CONSUMER COMPLAINT No. 77 / 2013
S. Nadiya, D/o Late S. Anand, aged about 24 years,
Residing at D.No. 88/191, Angadi Veedi,
Near Railway Station, Kadapa, Kadapa District. ….. Complainant.
Vs.
1. Life Insurance Corporation of India, Rep. by its
Senior Divisional Manager, Divisional Office,
“Jeevan Prakash”, College Road, Kadapa District.
2. Life Insurance Corporation of India, Rep. by its
Branch manager, Branch Office, Thilaknagar,
Guntakal, Ananthapur Distric ….. Opposite parties.
This complaint is coming before us for final hearing on 29-10-2014 and perusing complaint and other material papers on record and on hearing the arguments of Sri K. Guru Murthy, Advocate for complainant and Sri G. Trivikram Singh, Advocate for O.P.1 and O.P.2 and the matter is having stood over for consideration this day, the Forum made the following:-
O R D E R
(Per Sri M.V.R. Sharma, Member),
1. This Complaint is filed under section 12 of the Consumer Protection Act 1986 requesting this forum to direct the Opposite parties:-
(a) To pay a sum of Rs. 1,00,000/- with interest @ 24% p.a. + vested bonus and other benefits from the date of death i.e. 5-01-2012 till the payment, to the complainant.
(b) To pay Rs. 50,000/- towards compensation and.
(c) To pay Rs. 5,000/- towards costs.
2. The case of the complainant is that her father S. Anand was worked as a store watchman in the office of the Senior Section Engineer / P Way / Office / Kadapa, South Central Railway, Guntakal Division. The deceased S. Anand assured his life with opposite parties and they issued a policy of “Jeevan Anand” bearing No. 653333887 for a sum of Rs. 1,00,000/- for a period of 18 years commencing from 18-3-2008 in favour of Anand, S/o Dora Swmay and the deceased life assured (for short herein after called as DLA) and the DLA has nominated his daughter i.e. complainant as his nominee under the policy. The premium was being regularly deducting from salary of the DLA. At the time of assuming his life under the policy he was hale and healthy and he was attending his duties regularly. Suddenly, he fell ill health and admitted in Image hospital on 22-12-2011 and he died on 5-1-2012.
3. The complainant further stated that the DLA joined in service on 4-4-2003 and worked till his death on 5-1-2012 and also stated that even before getting employment in the year 2003 in Railways the DLA assured number of insurance policies right from the year 1988. As on the date of accident the DLA holds 10 policies commencing from different years. It is also stated that after the death of DLA the Opposite parties paid insurance amount only for three policies bearing numbers Viz., 652741038, 653423595, 653333869 on 13-3-2008 and the complainant approached the opposite parties for payment of insurance amount under the aforesaid policy No. 653333887 and submitted all the required documents including original policy bond. But they did not settled the claim, after one year the O.P.1 issued a letter dt. 30-3-2013 informing that the complainant claim was repudiated stating that DLA was not in good health at the time of assuming life on 18-3-2008. Hence, this complaint.
4. The opposite parties 1 & 2 filed joint counter and admitted that the deceased S. Anand insured his life with them and they received a claim aforesaid policy from the nominee. The contention of the opposite parties that at the time of DLA assuming his life the DLA was not in good health and suffering from Lymphoma of Cancer and taken treatment in a hospital prior to the date of proposal but he did not disclosed all facts in the proposal form dated 16-3-2008 and also stated that death summary dt. 5-1-2012 issued by the Image Hospital, Hyderabad was clearly shows that the DLA suffered from NH Lymphoma underwent CT & RT 5 years, had PTB and was treated 8 years back, K/C/O tuberculosis – Diagnosed in 2003 composite lymphoma – stage IV – 5 years back, received chemotherapy and radiotherapy. It is also stated that the documents such as death summary intimation of death and letters dt. 23-5-2008 issued by Chief Medical Superintendent, South Central Railway, Guntakal proves the fact that the DLA was suffering from tuberculosis and lymphoma of cancer, even prior to taking policy on 18-3-2008. As per the terms of policy contract and the declaration contained the form of proposal for assurance, these opposite parties rightly repudiated the claim of the complainant and the DLA had defaulted by not paying premium in respect of subject policy for 8 months, as a result the policy was in lapsed condition, as on the date of death by taking the defaults into consideration. The complainant intentionally did not choose to mention the cause of death of DLA assured and alleged that another insurance claim is settled and the opposite parties also stated that any payment is an ex-gratia basis and the claimant cannot ask for settlement of another claim is a matter of right and the opposite parties rightly repudiated the claim of the complainant. There is no deficiency of service on the part of opposite parties and prayed this Hon’ble forum to dismiss the complaint with costs.
5. To prove her case the complainant filed an affidavit and got marked Exhibits A1 to A8. To disprove the case the opposite parties filed documents and got marked Exhibits B1 to B9 by consent. PW1 and RW1 cross examined.
6. Heard both sides and considered the written arguments filed by complainant.
7. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant’s father suppressed material facts or not?
- Whether the complainant is eligible for compensation as prayed by him?
- Whether there is negligence or deficiency of service on the part of opposite parties?
- To what relief?
8. Point Nos. 1 to 3. The contention of the complainant is that her father S. Anand insured his life with opposite parties under Ex. A1 and Ex. B5 policy bearing No. 653333887 on 18-3-2008 a sum of Rs. 1,00,000/- and the DLA has nominated the complainant as his nominee. The complainant’s father died on 5-11-2012 in Image Hospital, Hyderabad as seen from Ex. A2. After death of the DLA the complainant approached opposite parties for payment of insurance amount under the policy and submitted all the required documents including original policy bond as nominee. But they did not settled the claim. After one year the opposite parties issued a letter dt. 30-3-2013 informing the complainant claim was repudiated on the ground of that the deceased having withheld correct information regarding his health at the time of taking policy and also contended that simultaneously the opposite parties settled the policy effecting from the date 30-3-2008 along with other two policies.
9. On the other hand the opposite parties contended that the DLA has assured his life was not in good health condition and suffering from Lymphoma of cancer and taking treatment in a hospital prior to date of proposal and he did not disclose all these facts in proposal form dt. 16-3-2008. In this regard as seen from Ex. B6 i.e. original proposal form which is not concern to the subject policy. Hence, the contention of the opposite parties is not tenable.
10. The another contention of the opposite parties is that the DLA suffering from Lymphoma of cancer and as per the death summary dt. 5-1-2012 issued by the Image Hospital, Hyderabad. The DLA suffered from NH Lymphoma underwent CT & RT 5 years, had PTB and was treated 8 years back, K/C/O tuberculosis – Diagnosed in 2003 composite lymphoma – stage IV – 5 years back, received chemotherapy and radiotherapy and also contended that the death summary, intimation of death and letter dt. 23-5-2008 issued by Chief Medical Superintendent, South Central Railway, Guntakal. As per the said letter the DLA was suffering from tuberculosis and Lymphoma of cancer prior to taking proposal form on 18-3-2008. The PW1 cross examined by the respondent on 2-9-2014 in that cross examination the PW1 says that she don’t know her father died due to Lymphoma cancer at Image Hospital, Hyderabad and also stated that the father of the PW1 is hale and healthy at the time of taking policy. As seen Ex. B2 and Ex. B3 is clearly goes to show that the cause of death of DLA due to cardio pulmonary arrest.
11. Further contention of the opposite parties is that the DLA has default in paying premium in respect of the subject policy for 8 months. On the other hand the complainant admitted in the complaint and Chief Affidavit that there were only few installments said to be not adjusted. As seen from Ex. B7 is reveals that there is 8 installments due, it is the duty of the Railway department authority to deduct the premium from salary of the DLA. So there is no fault or negligence on the part of the DLA and the opposite parties settled the policy effecting from date 30-3-2008 along with other two policies, as seen Ex. A8 the policy bearing No. 653333869 commenced 30-8-2008 in the same month of the subject policy. It is Honoured by opposite parties on 21-2-2012, if the DLA suppressed material facts that the opposite parties may reject this policy also. When the opposite parties honoured the above said policy it is clear that the opposite parties admitted that the DLA not suppressed any material fact and also admitted in the cross examination the RW1 stated that claim of the complainant repudiated on the ground that the DLA suppressed the material facts and also admitted that the policy No. 653333869 was issued on 11-4-2008 along with subject matter of the policy and the policy was settled. Hence, the opposite parties are liable to settle the subject policy after deducting 8 monthly premiums which is due of the DLA.
12. As has discussed above the complainant proved deficiency in service of the opposite parties. Hence, the points are answered in favour of the complainant.
13. Point No. 3 In the result, the complaint is allowed, directing the opposite parties to pay Rs. 1,00,000/- (Rupees one lakhs only) along with interest @ 9% p.a. from the date of repudiation of claim till the date of realization, and also pay accrued bonus and other benefits, if any to the policy after deducting 8 premiums and also pay Rs. 1,000/- (Rupees one thousand only) towards costs of the complaint to the complainant, within 45 days from the date of receipt of this order. The rest of the claim is dismissed.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 13th November 2014
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant
PW1 S. Nadiya, dt. 2-9-2014.
For Opposite parties :
RW1 G. Jayarami Reddy, dt. 21-10-2014.
Exhibits marked for Complainant: -
Ex. A1 P/c of insurance policy bearing No. 653333887 issued by the R1 in favour of deceased life assured S. Anand, duly nominating the complainant as nominee.
Ex. A2 P/c of death certificate of S. Anand.
Ex. A3 P/c of policy bearing No. 650107011, dt. 8-7-1988.
Ex. A4 P/c of 3 letters of payment of claim amount, dt. 21-2-2012 issued by the respondents under policy Nos. 652741038, 653423595 and 653333869, dt. 13-3-2008.
Ex. A5 Copy of repudiation letter issued by the respondent to complainant.
Ex. A6 Copy of pay slip of the deceased life assured for the month of April 2011 showing the deductions of LIC premiums amount of Rs. 1486/-
Ex. A7 Three salary pay slips showing the deductions of LIC premium amount of Rs. 1373/- per month.
Ex. A8 Policy bearing No. 653333869, dt. 11-4-2008 of S. Anand and letter of settlement dt. 21-2-2013.
Exhibits marked for Opposite parties: -
Ex. B1 Claim repudiation letter dt. 30-3-2013.
Ex. B2 Death summary of image hospitals, Hyderabad dt. 5-01-2012.
Ex. B3 Intimation of death Provisional issued by Image Hospitals, Hyderabad,
dt. 5-01-2012.
Ex. B4 Letter Ref. No. G/MD.143A, dt. 23-5-2008 issued by Chief Medical Superintendent, S.C. Railway, Guntakal certifying that the DLA was sick and under treatment for non Hodgikins Lymphoma.
Ex. B5 Policy bond bearing No. 653333887 on the life of late S. Anand.
Ex. B6 Proposal form dt. 16-3-2008.
Ex. B7 Policy ledger pertaining to policy bearing No. 653333887.
Ex.B8 Computerized ledger sheet pertaining to policy bearing No. 653333887
showing the gaps in the policy.
Ex. B9 Authorization letter issued by the respondent corporation.
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri K. Guru Murthy, Advocate for complainant.
- Sri G. Trivikram Singh, Advocate for O.P.1 & O.P.2.
B.V.P. - - -
