BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
KADAPA Y.S.R DISTRICT
PRESENT SMT. K. SIREESHA, B.L., PRESIDENT FAC
SRI M.V.R. SHARMA, MEMBER.
Thursday, 7th August 2014
CONSUMER COMPLAINT No. 69 / 2013
Pullagura Nagaraju, B/o Late P. Jayalakshmi,
age 25 years, Hindu, Resident of D.No. 2/242,
Watertank Street, Jammalamadugu Post,
Kadapa District. ….. Complainant.
Vs.
1. The Branch Manager,
Life Insurance Corporation of India,
Jammalamadugu Branch, Kadapa District.
2. The Senior Divisional Manager,
Life Insurance Corporation of India,
Jeevan Prakash College Road, Railway Station Road,
Kadapa City and District. ….. Respondents.
This complaint is coming before us for final hearing on 7-7-2014 and perusing complaint and other material papers on record and on hearing the arguments of Sri P.V. Ramana Reddy, Advocate for complainant and Sri D. Lakshminarayana, Advocate for Respondents and the matter is having stood over for consideration this day, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, President (FAC)
1. Complaint filed under section 12 of C.P. Act 1986.
2. The brief facts of the complaint are as follows:- It is submitted that the complainant is a resident of water tank street, Jammalamadugu post of Kadapa District. The R1 is a branch Manager of Life Insurance Corporation of India, Jammalamadugu Branch. The R2 is the Divisional Manager of Life Insurance Corporation of India, Kadapa. On 15-10-2008 the elder sister of the complainant by name Pulagura Jayalakshmi made a proposal for LIC’s “New Bima Gold” policy for a sum of Rs. 1,00,000/- and taken a policy bearing No. 655322751 under table No. 179/16 on the basis of quarterly premium of Rs. 1369/- (Rs. 1344/- towards installment for basic plan and Rs. 25/- towards installment for Accident Benefit Rider Premium totaling Rs. 1369/-) through the agent of Life Insurance Corporation by name N. Padmavathi agent code No. 1121-65R. The respondents life insurance corporation accepted the said proposal on 15-10-2008 and granted first premium receipt of Rs. 1369/- on 15-10-2008. The complainant is nominee of the said policy. According to the policy terms the policy holder has to pay the premium on the basis of quarterly installments on every 15th day of January, Apirl, July and October in every year. The date of last payment of last premium and date of expiry of policy term of the aforesaid policy is 15-10-2024 and date of expiry of extended term is 15-10-2032. After acceptance of the said policy in the name of the sister of complainant P. Jayalahmi, she had been paying regular payment of premium quarterly installments up to 15th January 2010. Thereafter she failed to make regular payment of premium from April 2010 to April 2011 and same was lapsed on 4-5-2011 the sister of the complainant P. Jayalakshmi had paid the total installments premium from April 2010 to April 2011 with penalty of Rs. 324/-. On the date of premium for one year, the R1, after satisfying the reasons, received the amount of Rs. 7,169/- (Rs. 6,854/- towards premium amount and Rs. 324/- towards late fee) and revived the policy of the sister of the complainant. Accordingly the R1 gave premium date as 15-7-2011 to continue the installments. While the things stood thus, on 13-5-2011 the sister of the complainant P. Jayalakshmi, died all of a sudden due to sudden cardiac in RDI Hospital, Bathalap[alli which clearly indicates in the death certificate issued by RDT care and support center, Bathalapalli of Ananthapur Dist.
3. It is further submitted that after the death of the sister of the complainant P. Jayalakshmi, the complainant approached the R1 and made claim in the capacity of nominee of the insured P. Jayalakshmi and submitted all the originals along with the claim statement in respect of policy bearing No. 655322751. The R1 assured the complainant that after fulfilling the formalities nominally total policy amount will be refunded in the name of complainant as soon as possible. Believing the words of the R1, the complainant, contacted the R1 often for the amount but he has been seeking time on the pretext that he has forwarded the claim application to the R2 office. Surprisingly, in the month of September 2011, the complainant received a letter from the office of R2 which reveals that the policy was allowed to lapse by non-payment of the premium due on 15-4-2010 acquiring no paid up value under the above policy. Which also revealed that the policy was got revived on 4-5-2011 on the strength of a personal statement regarding health made by the deceased P. Jayalakshmi on 4-5-2011 in which the deceased gave the answers were false and as such the respondents have evidences and reasons to believe that the life assured was not in good health and suffering from tuberculosis and Meninztits and taken treatment in a hospital prior to date of revival. Therefore, in terms of the declaration and personal statement, the revival of the policy is hereby declared void and it stands forfeited. On seeing the letter, immediately approached the R1 and questioned him as to why they gave assurance to the life assured to pay the pending installments amount with late fee for revival of policy and same was received the amount. The R1 gave assurance to the complainant that, the office must pay the policy amount to him since the terms and conditions as mentioned in the letter dt. 22-9-2011 does not apply to the deceased concerned since the office after satisfying the reasons given by the deceased P. Jayalakshmi, the policy was revived. Believing the words of the R1 the complainant has been turned around his office hoping that he would pay the policy amount to him, but no payment was made till now. Though the complainant, nearly 2 years, approached the office of R1 with more patience, he every time, except giving misrepresentations, no amount has paid. One week back, the complainant approached the R1 and asked as to why the delay caused in payment of policy amount. Ultimately, the office of the R1 advised the complainant to go to the court of law for recovery of policy amount. Hence, the compliant approached the Hon’ble forum seeking justice.
4. It is further submitted that though there is no any fault or fraud on the part of the deceased P. Jayalakshmi, the R2, in view of evading the policy amount to the compliant, on the pretext of baseless ground rejected the claim of the complainant. The R1 taking the advantage of innocence of the complainant, gave misrepresentations all these time caused delay intentionally stating that the policy amount would be paid by the office in the name of the compliant. The complainant took all the precautionary steps from the beginning due to the act and activities of the R1 all these time passed. Due to the acts of the respondents, a lot of mental agony caused to complainant apart from the expenses. Hence, the complainant claimed Rs. 20,000/- towards mental agony and Rs. 10,000/- towards expenses apart from the policy amount of Rs. 1,00,000/-. The requisite court fee of Rs. 200/- is paid by the complainant by way of postal orders which are enclosed herewith for kind perusal of the Hon’ble forum.
5. In the above circumstances, the complainant prays that the Hon’ble forum may be pleased to pass award for Rs. 1,30,000/- as claimed above under all heads in favour of the complainant and against the respondents with interest @ 24% p.a. till the date of realization of amount as the Hon’ble deems fit and proper in the interest of justice.
6. The R2 field a counter and same was adopted by R1. The complaint filed by the complainant is unjust and not maintainable either in law or on facts.
7. The complainant is put to strict proof of all the allegations made in this complaint except those whi9ch are specifically admitted herein by this respondent.
8. It is submitted that the issuance of the subject policy in favour of the deceased, Pullagura Jayalakshmi is admitted but the allegation that the repudiation of the petitioner’s claim suffers from deficiency in service, is utter false. This respondent submits that the repudiation of the petitioner’s claim is due to deliberate suppression of health condition of the deceased policy holder while submitting personal statement regarding her health. Admittedly, the policy obtained by the deceased policy holder was lapsed due to non payment of the premium due on 15.4.2010. Later, the policy was got revived on 4-5-2011 on the strength of “Personal Statement Regarding Health” find and submitted by the deceased policy holder.
9. In the said person statement duly filled up by the deceased policy holder, she has answered the following questions as stated below:
Questions | Answers |
Since the date of your proposal for the above mentioned policy | No |
a) Have you ever suffered from any illness / disease requiring Treatment for a week or more? | No |
b) Did you ever have any operation, accident or injury? | No |
c) did you ever undergo ECG, X-Ray, Screening blood Urine or stool examination? | No |
Are you in sound health at present? | YES |
10. It is submitted that the medical attendant’s certificate under claim from-B cleared discloses that the deceased policy holder was suffering from T.B. Meningitis, since 3 months prior to her death. She died on 13-5-2011 it is further stated that since 20-01-2011 to 13-5-2011 the doctor who issued the said certificate has attended the treatment of the deceased policy holder. In this case the revival of the lapsed policy is on 4-5-2011.
11. Thus, in view of the above medical certificate of the deceased policy holder, it has become crystal clear that after lapsed of her policy in the year 2010 she was seriously fell sick having attacked by the above said decease and since January 2011 she was taking treatment for the same and when her health condition has become very serious just 9 days prior to her death, deliberately she has got revived the lapsed policy by giving false statements regarding her health condition as on 4-5-2011 though she was under treatment by then itself.
12. It is submitted that as seen from the certificate of hospital treatment of the deceased policy holder under claim Form-B1, dt. 17-5-2011 issued by the medical officer RDT Hospital, Bathalapalli, it is clear that the deceased policy holder was got admitted into on 11-5-2011 i.e. just week days after the revival of the policy and died on 13-5-2011. In the said certificate also it is categorically stated that she was suffering from cough, Fever with chills and Breathlessness, since 3 months and in fact on 18-4-2011 itself she was got admitted and discharged on 28-4-2011 for treatment the said disease.
13. Thus it is clear that the deceased policy holder was deliberately suppressed the material facts regarding her health condition as on 4-5-2011 and with a fraudulent intention she has got the revival of the lapsed policy under an evil advice. Had this respondent corporation been informed about her real health condition and the T.B. Menninztites in particular at the time of revival of the policy they would not have revived the lapsed policy. Hence, for non-disclosure of the material facts about the health condition of the deceased policy holder, through their letter dt. 22-9-2011, this respondent corporation have intimated the complainant that the policy claim has been repudiated and since the premiums have not been paid for a minimum period of 3 years at the time of lapsed and the policy had not acquired any value, nothing is payable under the policy.
14. In the personal statement, the deceased policy holder has made a clear and voluntary declaration which stood as mandatory for revival of the lapsed policy as hereunder-
“I, P. J. Lakshmi do hereby declare that the foregoing statements and answers are true and complete in every particular and agree and declare that these statements and this declarations along with my proposal for insurance under the lapsed policy shall be the basis of the contract or contained there in the said contract shall be absolutely null and void and all moneys which shall have been paid in respect thereof shall stand forfeited to the corporation”.
15. The deceased policy holder, with a fraudulent intention and to have undue advantage of the policy benefits, had suppressed the above material facts. It is submitted that the primary duty of the proposer while taking the life insurance policy or while seeking for revival of a lapsed policy is to disclose about her health conditions, pre-deceased and habits of life proposed for insurance. As late P. Jayalakshmi has deliberately suppressed the material facts which were supposed to have been disclosed at the time of revival of the policy and violated the terms and conditions of the policy, the contract has become void, unenforceable and not legally binding on this respondent corporation. Therefore, the respondent corporation is not liable to pay any amount towards the policy claim as alleged by the complainant.
16. The allegations that the R1 was promising to settle the claim even after the repudiation of the claim by the R2 and that they have advised to approach a court of law etc., are utter false and invented for purpose of the present petition.
17. There are no bonafides in filing the present complaint by the complainant and there is no deficiency in service on the part of this respondent corporation at any point of time much less in repudiating the claim in the present case.
18. This respondent corporation reserves its right to file additional counter, if any, fresh facts comes to its notice or advised so at a later stage. Therefore, it is prayed that the Hon’ble forum may be pleased to dismiss the complaint with exemplary costs in the interest of justice.
19. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is eligible for compensation as prayed by him?
- Whether there is negligence or deficiency of service on the part of Respondents?
- To what relief?
20. On behalf of the complainant Ex. A1 to A11 were marked and on behalf of the respondents Ex. B1 to B3.
21. Point Nos. 1 & 2. It is true that the elder sister of the complainant by name Pulagura Jayalakshmi made a proposal on 15-10-2008 for LIC’s “New Bima Gold” policy for a sum of Rs. 1,00,000/- and taken a policy bearing No. 655322751 under table No. 179/16 on the basis of quarterly premium of Rs. 1369/- through the agent of Life Insurance Corporation by name N. Padmavathi. The same policy was accepted by the respondents corporation. The complainant is the nominee of the said policy. The date of expiry of policy is 15-10-2024 and the date of expiry of extended term is 15-10-2032. The complainant’s sister failed to make regular payments from April 2010 to April 2011 and the same policy was lapsed. Again on 4-5-2011 the sister of the complainant P. Jayalakshmi had paid the total installments premium from April 2010 to April 2011 with penalty of Rs. 324/-. The R1 had received the amount of Rs. 7,169/- towards premium amount along with penalty from the sinister of the complainant. Unfortunately on 15-7-2011 complainant’s Sister P. Jayalakshmi died due to sudden cardiac in RDT Hospital, Battalapalli, Anantapur District. It is true that the complainant was the nominee of the above said policy bearing No. 655322751 dt. 15-10-2008. Ex. A2 is the receipts paid by the complainant’s sister. Ex. A3 clearly proves death of the complainant’s sister. Ex. A4 clearly shows that the cause of death was sudden cardiac death. Ex. A6 also clearly shows that the death is sudden cardiac arrest. Ex. A7 is the claim statement of the complainant. Ex. B1 is the personal statement regarding health statement dt. 4-5-2011. Ex. B2 and A6 are one and same. Ex. B3 clearly shows that the death was sudden cardiac arrest. Under all these evidence on record it is very clear that at the time of proposal for the policy i.e. on 15-10-2008 the deceased P. Jayalakshmi was hale and heathy. Ex. B1 clearly shows that the deceased P. Jayalakshmi was hale and healthy at the time of revival of the policy also. So the deceased P. Jayalakshmi was hale and healthy at the time of proposal and making of the policy bearing No. 655322751. She died after three years after making of the policy. The respondents are also admitted that the issuance of policy for sum assured is Rs. 1,00,000/- and the date of commencement of the policy is 15-10-2008. The corporation will have one medical officer to checkup the policy holders, when the deceased policy holder P. Jayalakshmi had revived her policy in the month of April 2011 under Ex. B1. Why the respondents kept quite in examining her health by their medical officer. So there is wrong on the part of the respondents 1 & 2 itself. After undergoing medical examination of the deceased the respondents had revived the policy. So the burden lies on the part of the respondents to prove that she was not healthy at the time of revival of the policy. Here the respondents 1 & 2 utterly failed to do so and after proposal of the policy, the life assured died after three years. So it does not carry any malafide intention on the part of the complainant. Hence, the complainant is eligible for compensation as prayed by him. At the same time there is deficiency of service on the part of the respondents 1 & 2.
22. Point No. 3 In the result, the complaint is allowed, directing the respondents 1 & 2 jointly and severally liable to pay Rs. 1,00,000/- (Rupees one lakh only) towards the policy amount, pay Rs. 5,000/- (Rupees five thousand only) towards mental agony, pay Rs. 5,000/- (Rupees five thousand only) towards expenses of the complaint, within 45 days of date of receipt of orders.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 7th August 2014
MEMBER PRESIDENT FAC
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Respondents : NIL
Exhibits marked for Complainant: -
Ex. A1 Copy of policy bearing No. 65522751, dt. 15-10-2008 issued by the R1 in
the name of P. Jayalakshmi.
Ex. A2 Copies of payment receipts 4 in number issued by the respondents.
Ex. A3 Copy of death certificate issued by the medical & health department,
dt. 17-5-2011.
Ex. A4 Copy of death certificate issued by the RDT Care and support center,
dt. 13-5-2011.
Ex. A5 Copy of death certificate issued by the Panchayat Secretary, dt. 17-5-2011
Ex. A6 Copy of medical attendant’s certificate issued by the Medical Officer, RDT
Hospital, Bathalapalli.
Ex. A7 Copy of claim statement of the complainant.
Ex. A8 Copy of certificate of identity and burial of cremation.
Ex. A9 Copy of claimants requisition for claim form for consideration of death
claim.
Ex. A10 Copy of confidential report of the agent.
Ex. A11 Copy of repudiation letter issued by the R2, dt. 22-9-2011.
Exhibits marked for Respondents: -
Ex. B1 Personal statement regarding health submitted by the deceased policy
holder dt. 4-5-2011.
Ex. B2 Medical Attendants certificate under claim form – B dt. 17-5-2011 issued
by the medical officer, RDT Hospital, Bathalapalli.
Ex. B3 Certificate of Hospital treatment under claim form – B1, dt. 17-5-2011
issued by the Medical officer, RDT Hospital, Bathalapalli.
MEMBER PRESIDENT FAC
Copy to :-
- Sri P.V. Ramana Reddy Advocate for complainant.
- Sri D. Lakshminarayana, Advocate for Respondents.
B.V.P.
