BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ADDITIONAL BENCH, MANGALORE
Dated this the 25th May 2017
PRESENT
SRI VISHWESHWARA BHAT D : HON’BLE PRESIDENT
SRI T.C. RAJASHEKAR : HON’BLE MEMBER
ORDERS IN
C.C.No.59/2014
(Admitted on 10.02.2014)
Smt. Annapoorna,
W/o Prathap Shetty, aged 40 years,
3.20.1739/F9, Coral Apartments
Flat No.204, Kadri, Mangalore,
D.K 575 002. (Since dead)
(a) Sri Prathap Shetty,
S/o Padmanabha Shetty, aged 55 years.
(b) Mr. Pranav Prathap Shetty,
S/o Prathap Shetty, aged 18 years,
Both are residing at 204, Coral Apartments
Alvares Road, Kadri, Kaibattal
Mangaluru 2.
….........COMPLAINANTS
(Advocate for the Complainants: Sri SY)
VERSUS
1. Senior Branch Manager,
L.I.C of India, Branch II,
Ibrose Commercial Complex,
Jail Road, Mangalore 3.
2. Family Health Plan (TPA) Limited,
Ground Floor, Srinilaya,
Cyber Spazio Road No.2,
Banjara Hills, Hyderabad 34.
…..........OPPOSITE PARTIES
(Advocate for the Opposite Party No.1: Sri AKU)
(Opposite Party No.2: Ex parte)
ORDER DELIVERED BY HON’BLE PRESIDENT
SRI VISHWESHWARA BHAT D:
The above complaint filed under Section 12 of the Consumer Protection Act by the complainants against opposite parties alleging deficiency in service claiming certain reliefs.
The brief facts of the case are as under:
The original complainant Smt. Annapoorna was holder for Jeevan Arogya Scheme of LIC which was in force on 21.03.2012 on a monthly premium payment by way of E.C.S deduction directly from the bank account. On 19.12.2012 she became ill and admitted to the hospital for certain treatment for surgery and discharged on 30.12.12 and filed claim for Rs.76,916/ before opposite party and was rejected on the grounds revival of 90 days after the lapse. Even appeal filed before the Divisional Health Unit, Udupi was also rejected without any sufficient reasons. One of the objection raised in the rejection was hospitalization within 90 days from the date of the policy and the revival was after 90 days from the lapse date. In fact the original complainant is deceased and her husband and son as legal heirs came on record and prosecuted the claim.
2. The ground urged in the version by opposite party No.1 is the premium payment by complainant is Rs.278/ per month under ECS mandate form duly signed by complainant on 21.11.2011 and premium were received till October 2012. After November 2012 the ECS claims made with the banker by LIC was dishonoured by the bank for reasons No such Account Found and premiums are not received from November 2012 hence policy was lapse condition from November 2012. The complainant revived the policy by submitting revival form along with personal statement regarding her health on 16.03.2013 by paying of Rs.1,415/ towards the premium of March 2013. After the revival was done after the lapse of 90 days from the date of lapsing of the policy opposite party sought for personal statement regarding her health condition. While answering question No.2 she has mentioned as not suffered from any illness or disease requiring treatment for a week or more. But subsequently filed claim petition for hospitalization from 19.12.12 at 10.30 am to 30.12.2012 at 12:00 pm with discharge summary from the said hospital Mangalore. On that counts the claim of complainant is repudiated. Hence seeks dismissal of the complaint.
3. Additional version was also filed subsequent to amendment on the gurned that there are no document are forthcoming to show the relationship of the persons claim to be legal heirs.
4. In support of the above complaint Smt. Annapoorna (Deceased) filed affidavit evidence as CW1 and answered the interrogatories served on her and produced documents got marked at Ex.C1 to C7 as detailed in the annexure here below. On behalf of the opposite parties Mrs. M. Jacintha Pais (RW1) Manager (L&HPF) Divisional Office, also filed affidavit evidence and answered to the interrogatories served on her and produced documents got marked at Ex.R1 to R15 as detailed in the annexure here below. Mrs. Veena Shenoy (RW2) Manager, Canara Bank, Shiva Bhag Branch was cross examined.
5. In view of the above said facts, the points for consideration in the case are:
- Whether the Complainant is a consumer and the dispute between the parties?
- If so, whether the Complainant is entitled for any of the reliefs claimed?
- What order?
Learned counsels for both sides filed notes of arguments. We have considered entire case file on record including evidence tendered by the parties. Our findings on the points are as under are as follows
Point No. (i): Affirmative
Point No. (ii): Negative
Point No. (iii): As per the final order.
REASONS
6. POINTS No. (i): The health policy purchased by original complainant Smt. Annapoorna from opposite party is undisputed. Hence there is relationship of consumer and service provider between the parties and the claim made by complainant for revival of policy admitted and repudiated by opposite party. As such there is lies between the parties as contemplated under section 2 (1) (e) of the C P Act. Hence we answer point No.1 in the affirmative.
7. POINTS No. (ii): It is not necessary for us to go into every details of complaint in the case as far as the heir of deceased complainant her husband and son coming on record opposite party cannot raise its little finger as to the relationship of the complainant having come as the relatives in version. Hence objection raised on this count is rejected.
8. It is not in dispute that there was policy with instruction ECS to the bank for transferring the monthly premium amount from the account of complainant to the LIC towards the monthly premiums. Opposite party on the other hand contending till the October 2012 and thereafter the premium claim was not honoured by the complainant’s bank on the ground that there is no such account.
9. Thus as rightly pointed out for opposite party it is the responsibility of complainant to verify as to whether the premium are paid regularly. That evidently was not done of verification of the pass book entry or getting entry by the original complainant. Be that as it may, we have to note that subsequently after October 2012 complainant fell ill, admitted to hospital for treatment and after discharge from the hospital she renews the policy by paying the arrears of premium of Rs.1,415 is not in dispute. But complainant was required to give a statement before the LIC about the revival of the policy at that time original complainant made a statement that as to whether she was hospitalized for more than a week during the period of lapse of the policy the answer given was negative. These aspect is not disputed by the complainant. It was evidently wrong and as subsequent to the revival of the policy the original complainant made claim for the reimbursement of the amount under the same said policy during the lapsed period. Hence in the circumstance in our view the repudiation of the claim by opposite party in our view is justified.
10. In fact Ex.R3 is the copy of the personal statement regarding health dated 16.3.13 of Smt. Annapoorna the original complainant in which to the question No.2 (a) Have you ever suffered from any illness/disease requiring treatment for a week or more the answer furnished was no. Thus, on this answer is false, under the circumstance the repudiation of the claim by opposite party is justified.
11. The reason for the dishonouring of policy/failure to credit from the account of the original complainant to the LIC towards the premium was only of the bank. But the said Canara Bank is not a party to this case. Hence we are of the opinion that there is no deficiency in service on the part of the opposite party. Hence we answer point No.2 in the negative.
12. POINTS No. (iii): Wherefore the following
ORDER
The complaint is dismissed.
Copy of this order as per statutory requirements, be forwarded to the parties free of cost and file shall be consigned to record room.
(Page No.1 to 7 directly typed by steno on computer system to the dictation of President revised and pronounced in the open court on this the 25th May 2017)
MEMBER PRESIDENT
(T.C. RAJASHEKAR) (VISHWESHWARA BHAT D)
D.K. District Consumer Forum D.K. District Consumer Forum
Additional Bench, Mangalore Additional Bench, Mangalore
Anexure
Witnesses examined on behalf of the Complainant:
CW1 Smt. Annapoorna (Deceased)
Documents marked on behalf of the Complainant:
Ex.C1: 21.03.2012: Notary copy of the Insurance policy
Ex.C2: 17.06.2013: Original Rejection Order of opposite party served on the complainant
Ex.C3: 18.07.2013: Office copy of the Appeal filed by the Complainant
Ex.C4: 20.07.2013: Order of the Appellate Authority Udupi Division
Ex.C5: 20.08.2013: Representation before the Zonal Manager
Ex.C6: : Postal acknowledgement for having served Doc No.5
Ex.C7: : Notary copy of Bank Account Pass Books
Witnesses examined on behalf of the Opposite Parties:
RW1 Mrs. M. Jacintha Pais, Manager (L&HPF) Divisional Office
RW2 Mrs. Veena Shenoy, Manager, Canara Bank, Shiva Bhag Branch
Documents marked on behalf of the Opposite Parties:
Ex.R1: : Certified copy of policy bearing No.15065 along with Terms and conditions
Ex.R2: 21.11.2011: Certified copy of policy mandate form for Paying premium through ECS
Ex.R3: 16.03.2013: Revival of lapsed policy statement
Ex.R4: 16.03.2013: Ordinary revival quotation
Ex.R5: 10.05.2013: Certified copy of claim intimation form
Ex.R6: 14.05.2013: Form for claiming HCB/MSB
Ex.R7: 14.05.2013: Hospital treatment form
Ex.R8: : Discharge summary
Ex.R9: 17.06.2013: Repudiation letter
Ex.R10: 20.07.2013: Repudiation letter
Ex.R11: : State of Accounts
Ex.R12: : Copy of Mandate form signed by Manager, Canara Bank
Ex.R13: : Copy of pass book entry made in Annapoornas Account
Ex.R14: : True copy of dishonoured code list
Ex.R15: : Forwarding letters dated 09.02.2017 for Dishonour of ECS.
Dated: 25.05.2017: PRESIDENT
