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.
Friday, 31st October 2014
CONSUMER COMPLAINT No. 91 / 2013
Kadiri Kondamma, W/o Late Kadiri Somasekhar Reddy,
aged 37 years, Hindu, House wife, Resident of
D.No. 5/15, Nallaiahgaripalli Vi, Gondipalli Post,
Pendlimarri Mandal, Y.S.R. District. ….. Complainant.
Vs.
1. Bajaj Allianz Life Insurance Co. Ltd., Rep. by its
Manager, Situated near 7 roads, Dwaraka Towers,
7th Road, Kadapa city.
2. The Bajaj Allianz Life Insurance Co. Ltd., Head Office,
Rep. by its Manager, G.E. Plaza, Airport Road,
Yerawada, Pune – 411 006. ….. Opposite parties.
This complaint is coming before us for final hearing on 16-10-2014 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.V.S. Prasad , 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 Rs. 2,50,000/- towards policy amount.
(b) To pay Rs. 10,000/- towards mental agony.
(c) To pay Rs. 25,000/- which was paid by the husband of the complainant on the date of policy towards premium.
2. The complainant filed the complaint and stated that her husband by name Kadiri Somasekhar Reddy, assured his life on 26-10-2010 under Bajaz Allianz Max Advantage Insurance plan policy bearing No. 0187976066 for a sum of Rs. 2,50,000/- with annual payments and date it came into force on 26-10-2010 on the date of assurance the husband of the complainant shown the complainant as the nominee. According to the terms and conditions of the policy, the deceased Kadiri Somasekhar Reddy should pay the4 annual payments with Rs. 25,000/- on every year 26th day of October towards regular premium. The policy term fixed for a period of 10 years. The premium paying term is 5 years and the due date of the last premium is 26-10-2014. Therefore, the complainant is the nominee of the deceased Kadiri Someskhar Reddy.
3. The complainant further stated that the Opposite parties life insurance co. ltd., had accepted the proposal on 26-10-2010 and after receiving the first premium and issued a receipt in the name of the DLA on 26-10-2010. Further the instalments of the policy premium was to be paid on 26-10-2011 while the things stood thus on 6-8-2011 the husband of the complainant DLA by name Kadiri Somesekhar Reddy died due to sudden heart attack at his residence. The panchayat secretary of the Gondipalli Grampanchyat issued the death certificate to the complainant.
4. The complainant also stated that after the death of her husband she in the capacity of nominee of the insured approached opposite parties and made claim application with respect to the policy bearing No. 0187936066 and submitted all the original records along with claim statements to the satisfaction of the opposite parties. The O.P.1 assured the complainant that after fulfilling the formalities normally total policy amount apart from fund value i.e. Rs. 25,000/- will be refunded in the name of the complainant as soon possible but she surprised when she received the repudiation letter from the office of the O.P.2 on 21-10-2011 with an objection that the claim has been repudiated due to non-disclosure of material facts. After receiving the letter on 21-10-2011 immediately, the complainant approached the O.P.1 to know about the claim but the O.P.1 had assured the complainant that they would pay the policy amount to her as soon as possible. But no payment was made till now though the complainant nearly two years awaited for the amount with more patience neither response nor payment of money with the aforesaid policy. Hence, this complaint.
5. O.P.1 filed counter and same was adopted by O.P.2.
6. O.P.1 filed counter and denied all the allegations made in the complaint. O.P.1 stated that the allegation made in the complaint that the complainant DLA died on 6-8-2011 is put to strict proof of some documentary evidence. The life assured paid the premium of Rs. 25,000/- with the Bajaj Allianz Life Insurance Co. Ltd., Secunderabad who in turn issued the said policy bearing No. 0187936066 commencing from 26-10-2010 with annual premium and subsequent to the DLA all the correspondence was made with the secunderabad office and that none of the transactions pertaining to the above policy was not corresponded through this O.P.1. (Kadapa Office). Therefore, this Hon’ble forum has no jurisdiction also stated that the DLA suppressed his health condition and obtained the above policy which attracts section 45 of Insurance Act which is liable to be dismissed.
7. The O.P.1 further stated that the DLA was attacked by his opponents in a political rivalry in the year 2003, who was bad injured on the account of which his left hand become permanently disabled and become unfit for his day to day livelihood earning capacity. The DLA was issued a disability certificate by the RIMS Hospital, Kadapa that he is suffering with left upper Limb impaired reach, weakness of grip and that he is suffering with 80% disability and the DLA ever since 2003 became handicapped person and having no earning capacity and that he has been getting pension from the Govt. of A.P under physically handicapped quota from January 2007 till August 2011. He was paid Rs. 500/- p.m as pension under physical handicapped quota by receiving pension from the Government. It is clear that the DLA has no earning capacity as such the premium of Rs. 25,000/- paid towards first premium 26-10-2010 is nothing but to enrich themselves by purchasing the policy by playing fraud on Opposite parties company.
8. The opposite parties also contended that the DLA in the proposal form did not disclosed his handicapness nor his suffering disability and the above facts was disclosed by the DLA in the proposal form the O.P.1 company would have declained to issue the policy. Further in the proposal form at page No. 3 though there is column present with regard to any disease or disorders of nerves system such as weak limbs (temporary or permanent disability), the life assured disclosed that he is not suffering with the same but contrary to the above the life assured had been suffering with 80% disability of left hand which is nothing but misleading the O.P. company and obtained insurance policy by playing fraud. DLA had suppressed the material fact of his disability the O.P. company had rightly repudiated the claim of the complainant vide repudiation letter dt. 21-10-2011 addressed to the complainant and that the complainant had not approached the claim review committee Pune if aggrieved against such repudiation though the same was recited in the letter dt. 21-10-2011 and also stated that the complainant had not approached the O.P.1 either at the time of submitting the claim documents nor after the issuance of the repudiation letter and that the O.P.1 never assured the complainant that the assured sum would be paid. The policy was not issued by this O.P.1 the same was issued by Secunderabad Office. Hence, the complaint may be dismissed with costs.
9. To prove his case the complainant filed an affidavit along with documents which are marked as Exts. A1 to A14 are marked and Exts. B1 to Ex. B3 are marked on behalf of opposite parties by consent.
9. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant’s husband 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?
10. Heard both sides.
10. Point Nos. 1 to 3. The contention of the complainant is that her husband Kadiri Somesekar Reddy, assured his life with opposite parties on 26-10-2010 under Bajaj Allianz Max Advantage Insurance Plan, the policy bearing No. 0187976066 for a sum of Rs. 2,50,000/- and it came into force on 26-10-2010. On 6-8-2011 her husband died due to sudden heart attack at his residence. After death of the husband the complainant in the capacity of nominee of the insured approached opposite parties and claim application for aforesaid policy. On 21-10-2011 from office of the O.P.2 with an objection that the claim has been repudiated due to non-disclosure of material fact but there is no suppression of material fact.
11. On the other hand the contention of the opposite parties that they admitted that the complainant’s husband insured his life with them and also contended that the DLA paid premium of Rs. 25,000/- to opposite parties office Secunderabad, who inturn issued the said policy. Subsequent to the DLA the correspondence was made with secunderabad office and that none of the transaction pertaining to the above policy was not corresponded through this O.P.1 (Kadapa Office). Therefore, this Hon’ble forum has no jurisdiction.
13. In this regard we relied upon citation filed by the learned counsel of the complainant reported CPR 2010 (4) 122 United India insurance Co. Ltd., Vs. Smt. Krishna Devi and others held that Hon’ble Himachal Pradesh State Disputes Redressal Commission. Complaint would be maintainable at a place where a opposite parties has a branch office and also as per section 11 of the Consumer Protection Act 1986 the opposite parties branch office i.e. O.P.1 office situated in territorial jurisdiction of District Consumer Disputes Redressal Forum, Kadapa. Hence, the contention of the opposite parties is not tenable.
14. As per the above averments as seen Ex. A1 the complainant husband by name Kadiri Somasekhar Reddy assured his life with opposite parties on 26-10-2010 under Bajaj Allianz Max Advantage Insurance plan for a sum of Rs.2,50,000/- vide policy bearing No. 0187976066 and it came in to force on 26-10-2010. The DLA i.e. husband of the complainant died due to sudden heart attack on 6-8-2011 as per Ex. A3 panchayat secretary of Gondipalli village grampanchayat issued death certificate confirming the death of DLA. After death of the her husband, the complainant in the capacity of nominee of the DLA and insured approached opposite parties and made claim application i.e. Ex. A2 of the aforesaid policy and submitted all original records but the complainant received the repudiation letter from the office of the O.P.2 on 21-10-2011 with an objection that the claim has been repudiated due to non-disclosure of material fact.
15. The contention of the opposite parties that the DLA was attacked by his opponents in a political rivalry in the year 2003, who was badly injured on account of which his left hand became permanently disabled. The DLA suppressed the health condition and obtained the above policy which attracts section 45 of Insurance Act. As seen Ex. B2, it reveals that the certificate issued by RIMS Hospital, Kadapa certified that DLA suffering from permanent disability of the following category.
i. Physical (Locomotors by orthopedic) disability. The disability is in relation to his left upper limb, impaired reach, weakness of grip
ii. Sub-type of disability ; Post traumatic, sequel limbs,
iii. cause of disability ; Accident, percentage of disability in his case 80%.
And also DLA in the proposal form did not disclosed his handicapness nor he suffering from disability as per Ex. B1. In this regard, we relied upon the citation filed by the complainant, reported CPR 2010 (2) 361 of Delhi State Consumer Disputes Redressal Commission, M/s India Limited, Vs. Dharmesh Kumar in that case the Hon’bel Delhi State Redressal Commission held that unless and until a person conceals the factom of having been hospitalized for treatment of particular disease or undergoes any operation in near proximity of the policy save within a year or two before he cannot be accused of concealing the factom of “pre-existing” disease. And also we relied upon with regard pre-existing disease a decision reported in 2011 CTJ 220 (CP) (SCDRC) united India insurance Co. Ltd., and another Vs. Dharamdev Varma. It was held that there was no evidence led proving that the respondents suffered from any pre-existing disease mere producing copies of the clinical summary allegedly issued by treating hospital could not be sufficient to exonerate them from their liability. As per above decision the opposite parties not filed to prove the DLA suffering from above said disease also not filed any inpatient or outpatient and discharge summary of DLA taken treatment for above said pre-existing disease and also not suppressed any material fact because it is not a disease. Hence, the policy does not attracts section 45 of Insurance Act. In our opinion the disability of DLA occurred due to rivalry attack it is not a pre-existing disease and it is also not cause of death. There is no nexus between disability and heart attack. The DLA was died due to heart attack, as stated in complaint.
16. Another contention of the opposite parties since 2003 became handicapped person and having no earning capacity and that he has been getting pension from the Govt. of A.P. as per Ex. B3. Under the Physical Handicapped Quota from January 2007 till August 2011. He was paid Rs. 500/- per month.
17. The Physical handicappedness to the DLA is visible to the opposite parties even at that time of allotting policy. Since the opposite parties known physical status of DLA at the time of entering into contract of insurance, they cannot repudiate the claim now on the ground that the DLA was physically handicapped taking pension from Govt. by DLA does not disentitle the complainant for claiming insurance as the policy was inforce by the date of death of deceased.
18. The learned counsel of Opposite parties filed citations reported in AIR 1974 Mysoor 51 (V6) (17) LIC of India Vs. Canara Bank in first appeal 1970, AIR 1986 Kerala 2001 AS No. 105/1979, and I 2008 CPJ 133 NC Sabnam Devi and others Vs. LIC of India in support of his contention. But all the above citations are not applicable for the present complaint case on hand.
19. As per above discussion and decisions we hold that the complainant proved deficiency in service of the opposite parties as such the points are answered in favour of the complainant.
20. Point No. 3 In the result, the complaint is allowed and directing the opposite parties jointly and severally to pay Rs. 2,50,000/- (Rupees two Lakahs fifty Thousand only) towards policy claim amount, to pay Rs. 2,000/- (Rupees two thousand only) towards mental agony and to pay Rs. 1,000/- (Rupees one thousand only) towards costs of the complaint, payable within 45 days of date of receipt of the orders.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 31st October, 2014
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Respondents : NIL
Exhibits marked for Complainant: -
Ex. A1 Copy of policy bearing No. 0187976066, dt. 26-10-2010 issued by the respondent company in the name of K. Somasekhar Reddy.
Ex. A2 Copy of claim statement of complainant.
Ex. A3 Copy of death certificate issued by the Panchayat Secretary of Gondipalli G.P. Pendilimarri Mandal, Dt. 22-8-2011.
Ex. A4 Declaration form of the complainant.
Ex. A5 Copy of consent letter of the complainant dt. 23-8-2011.
Ex. A6 Copy of certificate of identity and Burial or cremation dt. 23-8-2011.
Ex. A7 Copy of the death claim intimation issued by R2, dt. 23-8-2011.
Ex. A8 Copy of death intimation issued by the complainant
Ex. A9 Copy of know your customer form dt. 23-8-2011.
Ex. A10 Copy of form showing the bank account mandate for electric payout.
Ex. A11 Reminder – 1 issued by the R2, dt. 5-10-2011.
Ex. A12 Reminder – 2 issued by the R2, dt. 15-10-2011.
Ex. A13 A letter issued by R2, dt. 20-9-2011.
Ex. A14 Repudiation letter issued by R2, dt. 21-10-2011.
Exhibits marked for Opposite parties: -
Ex. B1 P/c of proposal form submitted by the life assured.
Ex. B2 P/c of disability certificate issued by RIMS Hospital, Kadapa.
Ex. B3 P/c of pension pass book of life assured.
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri P.V. Ramana Reddy, Advocate for complainant.
- Sri D.V.S. Prasad , Advocate for O.P.1 & O.P.2.
B.V.P. - - -
