Karnataka

Kolar

CC/30/2015

Sr.Srinivasa.B - Complainant(s)

Versus

Exide Life Insurance Previously ING Vysya Life Insurance Company Limited - Opp.Party(s)

Sri.B.Kumar

15 May 2017

ORDER

Date of Filing: 11/08/2015

Date of Order: 15/05/2017

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, D.C. OFFICE PREMISES, KOLAR.

 

Dated: 15^th DAY OF MAY  2017

PRESENT

SMT. PRATHIBHA.R.K., BAL LLM, PRESIDENT

SMT. A.C. LALITHA, BAL., LLB           ……  LADY MEMBER

CONSUMER COMPLAINT NO :: 30 OF 2015

Sri.Srinivasa.B @ Srinivasappa,

S/o. Changalarayappa,

Aged About 33 Years,

R/at: House No.80, Majara

Upparahalli, Byatanuru, Mulbagal

Taluk, Kolar District.

(Rep. by Sri.G.N. Narayanaswamy, Advocate)                      ….  Complainant.

 

- V/s -

M/s. Exide Life Insurance Previously

ING Vysya Life Insurance Company Limited,

M.B. Road, Kolar.

(Rep. by Sri.V.R. Muralidhara, Advocate)                  …. Opposite Party.

-: ORDER:-

 

BY SMT. PRATHIBHA.R.K, PRESIDENT

01.   The complainant has preferred this complaint as envisaged Under Section 12 of the Consumer Protection Act, 1986 against the OP-Insurance Company seeking directions against the OP to pay Rs.1,35,000/- under policy bearing No.02150727, dated: 21.03.2015 and Rs.7,50,000/- under policy bearing No.02892288, dated: 26.03.2014 respectively towards the assured amount on account of the death of Smt. Narayanamma wife of complainant and also to direct the OP to pay Rs.3.37,927/- towards assured amount on account of death of Changalrayappa under policy bearing No.03055897, dated: 16.02.2015 and to pay Rs.2,50,000/- towards loss of estate along with litigation expenses.

 

02.   The facts in brief:-

(a)    It is contention of the complainant that, the complainant is an agriculturist and his parents Sri.Changalarayappa and Narayanamma were owning properties at Palamner and also in Mulbagal.  The complainant’s father had 3 acres of agricultural land in Byrakur Village, Mulbagal, and complainant’s mother was possessing 5 acres and 4 cents of land among which 4 acres are cultivable land at Jangapalli Village, Gandarajpalli, Gangavaram Mandal, Palamner Taluk, Andhra Pradesh.  The annual agricultural income of the complainant’s parents is Rs.20,33,933/- and Rs.7,61,619/- for the years 2013-2014 and 2012-2013 respectively. 

 

(b)    The complainant further submits that, during the life time of Late Smt. Narayanamma, she had obtained insurance policy baring No.02150727 for an assured sum of Rs.1,33,550/-, dated: 21.03.2011 for a period of 15 years.  A sum of Rs.10,000/- was to be paid annually towards premium.  The complainant submits that, Rs.40,000/- has been paid by Smt. Narayanamma.  The complainant is the Nominee.  Smt. Narayanamma during the subsistence of the previous policy has obtained another insurance policy bearing No.02892288 for an assured sum of Rs.7,50,000/- on 26.03.2014.  For which a sum of Rs.78,717/- was to be paid annually towards premium and the complainant is shown as nominee.  The OP has accepted the proposal submitted by the mother of the complainant and have issued insurance policy. 

(c)    Further complainant submitted that, on 19.08.2014 Smt. Narayanamma, complained about chest pain, immediately she was taken to Dr.K.Kadirappa, Civil Surgeon at Srinivasa Nursing Home, M.B.T. Road, Palamner, Chittor District, Andhra Pradesh.  After examination Dr. K.Kadirappa referred her to higher hospital as she was suffering from Myocardial Infraction.  As per the advice of Dr. K.Kadirappa, complainant tried to shift Smt.Narayanamma through 108 Ambulance to R.L. Jalappa Hospital, Kolar, but while on the way near Mulbagal Smt. Narayanamma lost her breath.  Immediately complainant rushed to Manohara Sai Gowda Memorial Hospital, Mulbagal, where the doctor declared her death and the cause of death may be massive heart attack. 

 

(d)    Further contention of the complainant is that, claim was submitted to the OP towards above said policies, but the OP has repudiated the same through letter dated: 05.01.2015 and 17.04.2015. 

 

(e)    The complainant further contention is that, the OP has agreed to settle the claim subject to condition that, the complainant has to take policy of insurance in the name of father and accordingly complainant’s father Sri. Changalarayappa has also taken insurance policy on 16.02.2015 bearing No.03055897 for an assured amount of Rs.3,37,927/- by paying Rs.50,514/- towards yearly premium.  The OP also asked Sri. Changalarayappa to keep Rs.9,000/- as deposit in order to cover the accidental risk for a sum of Rs.52,00,000/- and accordingly complainant has taken policy of insurance with the OP and the OP had issued policy of insurance of ICICI Lombard General Insurance Company Limited. 

(f)     The complainant’s further submission is that, in spite of several approaches and requests made by the father of the complainant Sri.Changalarayappa, the OP instead of settling the claims, used to postpone the matter on one pretext of the other.  The father of the complainant could not withstand this attitude of the OP and due to stress and strain given by the OP he died on 29.04.2015. 

 

(g)    Further complainant’s submission is that, due to the demise of both father and mother complainant became an orphan and was thrown to the street.  On account of delay committed by the OP in settling the claim the complainant approached office of the Insurance Ombudsman (Karnataka) and lodged complaint in BNG-L-025-1516-0143/0144 and on 15.07.2015 it observed that, this complainant has taken policies from other insurance companies for huge sum of Rs.30 lakhs which does match her source of income and according to them, a fraud case and thus they have decided to initiate legal action against the claimant.  One Smt. Narayanamma, W/o. Narayanappa, residing at Upparahalli, Mustur Post, who belongs to same village has visited Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011.  The OP by referring to the above document has repudiated the claim of the complainant. So contending, the complainant has filed this complaint seeking the above set-out reliefs against the OP.

 

(h)    Along with the complaint the complainant has filed following copies of documents:-

(i) Copy of the ROR issued by Mee Seva, AP.

(ii) Copy of the Pass-book issued by the Government Office of AP.

(iii) Certificate issued by Deepthi.A.V., Chartered Accountant.

(iv) Policy documents issued by the OP with policy schedule and terms and conditions.

(v) Claim Form-B of Reliance Life Insurance issued by Dr.K.Kadirappa, Palamner, Chittoor District.

(vi) Certificate dated: 10.10.2014 issued by Dr.Doddabadre Gowda, Manohara Sai Gowda Memorial Hospital, Mulbagal.

(vii) Death certificate dated: 17.10.2014 of Smt. Narayanamma.

(vii) Repudiation letter dated: 05.01.2015 issued by the OP.

(viii) Case Summary Sheet, follow-up notes issued by Kidwai Memorial Institute of Oncology

(ix) Copies of Policy terms and conditions.

(x) Copy of Death Certificate dated: 04.05.2015 of Sri. B.Changalrayappa.

(xi) Copy of the complaint made before the Office of the Insurance Ombudsman (Karnataka)

 (xii) Copy of the policy bearing No.21472361 issued on behalf of Sri. Changalarayappa By pnb Metlife Bajaj.

(xiii) Copy of the policy bearing No.0321790967 issued on behalf of Sri.Changalarayappa by Bajaj Allianz along with first premium receipt.

(xiv) Copy of the Key feature document pertaining to policy bearing No.256561366 issued by Max Life on behalf of complainant.

(xv) Copy of welcome Letter pertaining to policy bearing No.21325204 issued by pnb Metlife on behalf of complainant. 

(xvi) Patient’s ID Card and Election card of Narayanamma, W/o. Narayanappa.

 

03.   In response to the notice issued from this Forum, counsel for OP appeared and filed his version by resisting the claim of the complainant in toto.

 

(a)    The OP submitted that, the present complaint is barred by the jurisdiction of this Hon’ble Forum as Consumer matters are summary proceedings and any case of fraud, cheating and forgery needs detailed trial.  Hence only Civil and Criminal courts have such jurisdiction.  Therefore the said case needs to be dismissed solely on this ground without going to the merits.  The complainant is guilty of suppressing the material facts and hence present complaint deserved to be dismissed.  The complainant has filed this complaint just to avail undue advantage and is nothing but an abuse of process of law.  The policy of life insurance is a contract of utmost good faith, wherein policy holder is under obligation to disclose all true facts and information pertaining to her previous illness, health condition, habit, occupation and income details in the proposal form.  The complainant’s mother Smt. Narayanamma has submitted proposals to this OP on 22.03.2011 and 26.03.2014 for “Reassuring Life Endowment with Reversionary Bonus Plan” and “Guaranteed Income Insurance Plan” and the premium opted was Rs.10,000/- and Rs.80,000/- annually for a term of 15 years and 30 years respectively for an assured amount of Rs.1,33,550/- and Rs.7,50,000/- respectively.  On believing the answers, statements and declarations made in the proposal forms this OP issued policy bearing No.02150727 and 02892288 to the life assured.  The brief details of both policies are hereunder:-

Policy Number	02150727	02892288
Policy Name	Reassuring Life Endowment with Reversionary Bonus	Guaranteed Income Insurance Plan
Name of the Policy holder	B.Narayanamma	B.Narayanamma
Nominee & Relation	B.Chengalrayappa (Husband)	Srinivasa B (Son)
Proposal Date	22.03.2011	26.03.2014
Risk Commencement date	26.03.2011	26.03.2014
Policy Maturity Date	26.03.2011	26.03.2014
Sum Assured	Rs.1,33,550/-	Rs.7,50,000/-
Premium Amount & Mode	Rs.9,631/- (Annual)	Rs.76,358/- (Annual)
Premium Paying Term	15 years	15 years
Policy Term	15 years	30 years

 

(b)    The OP further submits that, on 06.10.2014 it received death claim intimation for both policies along with death certificate.  Subsequently the OP bearing early claim had referred the case for investigation and during investigation it reveals that, Life Assured was diagnosed with Carcinoma Lump (commonly known as “Breast Cancer”) and had undergone treatment for the same and also underwent surgery of hysterectomy (Removal of Uterus) which are vital information for OP in order to assess the life risk.  However the life assured had not disclosed about her illness, surgery and treatment at the time of availing the insurance policies.  In this regard investigator had collected the following documents:-

Case summary sheet issued by Kidwai Memorial Institute of Oncology, Bangalore.

Surgical case record issued by Kidwai Memorial Institute of Oncology, Bangalore.

New Registration details issued by Kidwai Memorial Institute of Oncology, Bangalore.

 

With these documents on record the intention of making fraudulent claim on the life of a medically ill person is crystal clear.  In addition to that, it was also detected that, life assured had availed two more insurance policies bearing Nos.51641203 and 51649754 for an assured sum of Rs.10,49,667/- and Rs.6,17,000/- from Reliance Life Insurance Company Limited and they have also repudiated the claim on the ground of non-disclosure of pre-existing illness.  As per Section-VII at Page-4 of the proposal form some specific questions and the same were answered in the negative by the life assured and she had also given declaration to that effect.  And the OP had repudiated the claim of the complainant through letter dated: 05.01.2015 and 17.04.2015.  The Hon’ble Ombudsman, Bangalore, vide case No. BNG-L-025-1516-0143 had dismissed through its order dated: 15.07.2015 stating that, the case is fraud case.  The allegation made by the complainant with regard to assurance made to complainant’s father that, OP will settle the claim of life assured if he avails the policy from the OP are baseless allegations.  The complainant had not logged any claim intimation for the policy bearing No.03055897 till date with OP.  The complainant has no “locus standi” to claim any alleged sum assured, as the insurance policy was obtained by the life assured by fraudulent way in order to defraud the OP.  Hence the contract of life insurance is void, and not tenable in the eyes of law. 

 

(c)    So contending, the OP has prayed for dismissal of the complaint with exemplary  costs.

                                

04.   On 05.12.2016 counsel for complainant has filed affidavit evidence by way of examination-in-chief.  On 30.12.2016 counsel for OP submitted interrogatories and on 01.02.2017 counsel appearing for complainant has filed reply to the interrogatories.  On 07.03.2017 counsel for OP has submitted affidavit of one Sri. Madhu.N.R, S/o. Rajanna.N.P, Manager of the OP. 

 

05.   On 21.03.2017 counsel appearing for the OP has filed written arguments and on 25.04.2017 counsel appearing for complainant has filed complainant’s written arguments with below stated documents:-

(i) Land Pass book

(ii) Certificate issued by the chartered accountant

(iii) Medical certificate issued by Dr.K.Kadirappa

(iv) Death report issued by Sai Manohara Gowda Hospital, Mulbagal.

(v) Bank pass book

(vi) Policy bonds-2 in nos.

(vii) Voter List.

(viii) Serology report issued by Kidwai Hospital of Narayanamma,

 

06.   Therefore the points that do arise for our consideration in this case are:-

 (A) Whether the complainant has proved  

     deficiency in service on the part of the 

      OP?

 (B) Whether the complainant is entitled for the reliefs sought for in the complaint?

(C)   What order?

 

07.   Findings of this District Forum on the above stated points are:-

POINT (A) & (B):- In the Negative

POINT (C):-  As per the final order

for the following:-

 

REASONS

POINTS (A) & (B):-

08.   On perusal of the pleadings along with documents, affidavit evidence and written arguments produced by both parties, it is an admitted fact that, the complainant is an agriculturist and his parents Sri.Changalarayappa and Smt. Narayanamma owning and possessing the property at Palmaner and also at Mulbagal. 

 

09.   It is also an admitted fact that, the complainant’s mother Smt. Narayanamma during her lifetime had obtained 02 insurance policies bearing Nos. 02150727 dated: 21.03.2011 for an assured sum of Rs.1,33,550/- and policy bearing No.02892288 dated: 26.03.2014 for an assured sum of Rs.7,50,000/- from the OP.  The complainant’s mother has paid annual premiums in respect of both policies. 

 

10.   The complainant submitted that, on 19.08.2014 Smt. Narayanamma complained about chest pain, immediately she was taken to Dr.K.Kadirappa, Civil Surgeon at Srinivasa Nursing Home, Palamner, Chittor District, Andhra Pradesh.  The doctor diagnosed Myocardial Infraction and referred to go any higher hospital.  Hence complainant taken deceased Narayanamma in 108 Ambulance to R.L. Jalappa Hospital, Kolar, On the way to R.L. Jalappa Hospital, near Mulbagal Smt. Narayanamma lost her breath and doctor of Manohara Sai Gowda Memorial Hospital, Mulbagal, declared cause of death may be massive heart attack.  After the death of complainant’s mother, complainant submitted claim application to OP.  But the OP has repudiated the claim on 05.01.2015 and 17.04.2015 on the ground that, deceased Narayanamma died on account of Breast Cancer.

 

11.   On rejecting the claim of the complainant, the complainant’s father could not withstand the attitude of OP hence the complainant’s father due to the stress and strain succumbed on 29.04.2015. 

 

12.   The complainant further submitted that, the complainant approached the office of the insurance Ombudsman (Karnataka) and has also lodged a complaint bearing No. BNG-L-025-1516-0143/0144.  On 15.07.2015 Insurance Ombudsman has observed that, “the complainant has taken policies from other insurance companies for huge sum assured of Rs.30 lakhs which does match her source of income.  It is according to them, a fraud case and thus they have decided to initiate legal/police action against the claimant.”  In view of the above position, the complainant’s grievance cannot be entertained and thus, the same is treated as closed. 

 

13.   The complainant further submitted that, one Sri.Narayanamma, W/o. Narayanamma, who is also residing in the same village i.e., Upparahalli, Mustur Post, has visited the Kidwai Memorial Institute of Oncology, Bangalore, on 15.03.2011 and the OP by referring to the above documents has refused to settle the claim of the complainant.  Hence the complainant submitted that, this act of the OP may lead to deficiency in service and hence complainant approached this Forum.

 

14.   The main allegation of the complainant is that, the OP had repudiated the claims of the complainant by falsely referring the case of another person Smt. Narayanamma, W/o Sri.Narayanappa who is also residing in the same village and she was suffering from “Breast Cancer”.    

 

15.   Admittedly the DLA had obtained insurance policy on 21.03.2011 and 26.03.2014.  On perusal of the Case Summary Sheet issued by the Kidwai Institute of Oncology, Bangalore, dated: 15.03.2011 it is mentioned as, patient name Smt. Narayanamma, husband name Sri.Changalarayappa and attender’s name Sri.Srinivas and relation column it is clearly mentioned as Son.  Hence we cannot believe the contention raised by the complainant that, another person who is residing in the same village was suffering from Breast Cancer and by referring the said case the OP has wrongly come to the conclusion that complainant’s mother is suffering from Breast Cancer and have repudiated the claims. The burden of proof will always lies on the complainant to prove his case by producing cogent evidence.  But here the complainant has failed to produce any cogent evidence.  Hence we come to the conclusion that, the DLA is suffering from cancer before taking policy and the same was suppressed at the time of submitting of proposal forms.  Further at the time of submission of proposal forms the life assured has answered the question Nos.70, 72, 75, 77 as “No”.  The life assured is well aware of the diseases and she undergone operation and answered the above questions in the negative which amounts to suppression of material facts and it violated the terms and conditions of the policy. 

 

16.   Further the complainant has also submitted that, believing the assurance of the OP his father Mr. Changalarayappa has deposited a sum of Rs.9,000/- towards accidental risk of Rs.52,00,000/- for which the OP has issued insurance policy of ICICI Lombard General Insurance Company Limited.  Further in the prayer column of the complaint the complainant has prayed for assured sum of Rs.3,37,927/- with respect to the policy bearing No.03055897 dated: 16.02.2015 on account of death of Changalarayappa.  But however the complainant has failed implead the ICICI Lombard General Insurance Company Limited as a necessary party to this proceedings.  Further the complainant has failed to adduce the brief facts pertaining to obtaining policy bearing No.03055897 dated: 16.02.2015 and the cause of death of Mr. Changalarayappa and he also failed to produce any cogent evidence issued by concerned medical authority to appreciate his case.  Hence we hold that, the complainant has failed to prove deficiency in service on the part of the OP.

 

17.   In view of the above facts and circumstances, it is clear that, Smt. Narayanamma, W/o. Changalarayappa, was suffering from Breast Cancer before taking the policy.  And she has suppressed the real facts and falsely obtained the policy.  Hence we came to the conclusion that, there is no deficiency of service on the part of the OP. Accordingly we answered to the issue Nos. (A) & (B) in the negative. 

 

POINT (C):

18.   We proceed to pass the following:-

 

15.05.2017:-

COMPLAINANT/BY SRI.

OPPOSITE PARTY/IES BY SRI.

ORDER

01.   The complaint filed by the complainant is hereby dismissed.  No orders as to costs.

 

02.   Send a copy of this order to both parties free of cost

 

(Dictated to the Stenographer in the Open Forum, transcribed by him, corrected and then pronounced by us on this 15^th DAY OF MAY 2017)

 

                                                      

 

LADY MEMBER                                    PRESIDENT