Date of filing:28.12.2013
Date of Disposal:27.8.2014
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II::
VIJAYAWADA, KRISHNA DISTRICT.
Present: SMT N. TRIPURA SUNDARI, B. COM., B. L., PRESIDENT (FAC)
SRI S.SREERAM, B.COM., B.A., B.L., MEMBER
WEDNESDAY, THE 27th DAY OF AUGUST, 2014.
C.C.No.8 OF 2014
Between :
Mahankali Sujatha, W/o Venkataramaiah, D/o Late Siriveri Venkateswarlu, R/o Door No.16-6-12/1, Near Brahmamgari Temple Street, 17th Ward, Sattenapalli, Guntur District.
….. Complainant.
And
1. Future Generali India Life Insurance Company Ltd., Rep., by it’s Branch Manager, 40-2-5, 3rd and 4th Floor, CVR Chambers, Bandar Road, Near Kalanikethan, Mogalrajapuram, Vijayawada, Krishna District.(Policy Number.00130851 & 00422579)
2. Future Generali India Life Insurance Company Ltd., Rep., by its Regional Manager, 001m Trade Plaza, Ground Floor, 41, Veer Savarkar Marg, Prabhadevi, Mumbai – 400 025.
…....Opposite Parties.
This complaint is coming before us for final hearing on 12.8.2014 in the presence of Sri R.K.Srinivasa Murthy, Advocate for complainant and Sri J.Venkateswara Prasad, Advocate for opposite parties and upon perusing the material available on record, this Forum delivers the following:
O R D E R
(Delivered by Hon’ble President (FAC) Smt N. Tripura Sundari)
This complaint is filed under Section 12 of the Consumer Protection Act, 1986.
The averments of the complaint are in brief:
1. The father of the complainant during his life time obtained two life insurance policies from the 1st opposite party for a sum of Rs.7,50,000/- (Rs.4,50,000/- + accidental rider for Rs.3,00,000/-) and Rs.9,60,000/- (Rs.4,80,000/- + Accidental rider for Rs.4,80,000/-) in the year 2009 and 2010. The complainant is the only daughter to the life assured and he nominated the complainant herein under the said two policies. While so unfortunately the policy holder died in a train accident on 28.2.2011 leaving behind the complainant alone as his legal heir as well as nominee for death benefits. Immediately the complainant approached the opposite parties and informed about the death of her father and they advised the complainant to submit claim form along with necessary documents. The complainant submitted claim form along with required documents. Subsequently the complainant approached the opposite parties several times requested them to pay the death benefits under those policies. Whenever the complainant approached the opposite parties they inform that the claim is under process in their head office. Later in the first week of September, 2013 the complainant approached the 1st opposite party who informed that the claim was already repudiated by the 2nd opposite party on 31.12.2011 and handed over letter of repudiation of the claim. The said letter discloses that the deceased/policy holder furnished wrong information that the life assured has life insurance cover with another insurance company even prior to the date of his application i.e., taken by the opposite parties is not valid and unjust. Hence the complainant is constrained to file this complaint against the opposite parties praying the Forum to direct the opposite parties to pay the death benefit amounts of Rs.17,10,000/- with interest from the date of death of the policy holder to pay Rs.1,00,000/- each towards compensation for mental agony and towards deficiency in service and to pay costs of Rs.5,000/-.
2. The version of the opposite parties is in brief:
The opposite parties denied all the allegations of the complaint and submitted that the life assured has taken various insurance policies from different companies situated all over India and complainant willfully failed to disclose various insurance policies taken by life assured in her complaint. All the insurance policies taken by the life assured from various companies shall be disclosed along with the documents like proposal form documents submitted at the time of proposal form about the policies issued to life assured, each claim form submitted with such insurance companies status of insurance claim with various companies including the documents processed and perused to process the claim. The life assured has concealed and suppressed material and relevant facts at the time of obtaining the insurance policy IES from the opposite parties. Instructions for completing the proposal form mentioned at the top of the proposal form which was duly signed by the deceased life assured. The answers of life assured to the question IN 6.1 AND 6.2 in the said proposal form is ‘No’.
Q.No. | Questions | Answers |
6.1 | Details of applications submitted to & existing life insurance policies with future generali and with anyinsurer. (In case of housewife, major student or minor life to be assured please give details of husbands and parents insurance also) | No. |
6.2 | Whether any proposal for life cover or critical illness rider or accident and disability benefit rider? Application for revival of any policy has been made to any life insurer, declined/plostponed/dropped/accepted revived at modified rates | No. |
The said information provided in proposal forms constitute the basis on which contract of insurance was entered between the parties. The life assured had not disclosed any insurance policy under the said question 6.1 and 6.2 of the proposal forms and given the answer as No. Believing the information given by the life assured in the proposal form to be proved and correct in all aspects the said proposal was accepted by the opposite parties at standard rates of premium. The life insured was issued policies bearing No.00422579 and 00130851 on his life as per the nomination clause the complainant was nominated as nominee of policy under Section 39 of Insurance Act. For every insurance proposal shall mean and include all important essential and relevant information in the context of underwriting the risk to be covered by the insurer. Thus question as to existing insurance policy as specifically asked in proposal form and status thereof having direct nexus with life assured or relevant for understanding the risk of life assured including for present life assured. The life insured is obliged to disclose it particularly while answering questions in proposal form thus any inaccurate answer will entitle by insurer to repudiate his liability because there is clear presumption that any information sought for proposal form is material for the purpose of entering into a contract of insurance on the basis of principles of law of insurance thus on the basis of said principles and law of insurance the claim under the policy is repudiated. The personal information like existing insurance policy and status thereof, health and habits disclosed by the life insured is very vital in a contract of life insurance as it is on the basis of those information that the opposite parties decides whether to take the risk or not. It was reported that on 28.2.2011 the life assured is died within two years from the date of policies taken on 7.5.2009 for term assurance plan and dated 24.3.2010 for Future Generali Sanjeevani Plus – Regular premium unit link plan, whole life unit linked plan. As per the certificate of death issued the cause of death was stated as accidental as he found dead near the Railway Track reported to be hit by some unknown train. After the death of the life assured the complainant lodged a death claim with the opposite parties. During the investigation of the claim process it was found that the deceased life assured has taken multiple life insurance policies on his name without disclosing the simultaneous risk cover to the respective insurers. If the opposite parties company is aware about the said policies and the existing risk cover for which the deceased life insured was already insured with other insurance companies at the time of assessment of risk under the captioned policy the opposite parties would have certainly not issued the above policy at all. The life assured has applied for a life insurance cover of Rs.71 lacks approximately on his life. In view of such suppressing of material fact repudiation letter was sent on 31.12.2011 and the said letter was received by the complainant. The proposal was accepted by the opposite parties on the basis of the results of the medical reports, details of previous insurance of the life assured and the information given by the life assured in the proposal form and the supporting documents. The insurance is a contract of utmost good faith and that the opposite parties believed that the information given by the life assured was true and correct in all aspects in respect to the disclosure of existing policies issued in favour of life assured. On this faith the opposite party issued policies on the life of the assured. The claim repudiated by the opposite parties on account of suppression of material fact and there is no deficiency in service provided by the opposite parties at all. Hence the opposite parties prayed to dismiss the complaint with costs.
3. On behalf of the complainant she gave her affidavit and got marked Ex.A.1 to Ex.A.11 and on behalf of the opposite parties Mr.Madan Gopal Jalan, Senior Vice President, legal and company secretary for opposite parties gave his affidavit and got marked Ex.B.1 to Ex.B.6.
4. Heard and perused.
5. Now the points that arise for consideration in this complaint are :
1. Whether there is any deficiency in service on the part of the opposite parties
towards the complainant in repudiating the claim of the complainant?
2. If so is the complainant entitled for any relief?
3. To what relief the complainant is entitled?
POINTS 1 AND 2:-
6. on perusing the material on hand the father of the complainant during his life time obtained two life insurance policies under Ex.A.1 from the 1st opposite party for a sum of Rs.7,50,000/- (Rs.4,50,000/- + accidental rider for Rs.3,00,000/-) and Rs.9,60,000/- (Rs.4,80,000/- + accidental rider for Rs.4,80,000/-) in the year 2009 and 2010. The complainant says that as she is the only daughter to the life assured, he nominated the complainant under the said two policies. Ex.A.1 discloses the name of the complainant as nominee of the life assured. The opposite parties received the premiums under the said policies and sent the receipts and policy certificates to the life assured under Ex.A.2, Ex.A.3, and Ex.A.4 under acknowledgements dated 5.5.2009, 7.5.2010 and 27.3.2010 for Rs.4,737/-, Rs.4,737/- and Rs.30,000/- respectively. As per opposite parties Future care term assurance policy No.00130851 and Future Generali Sanjeevani Plus – regular premium unit linked plan, whole life unit linked plan policy No.00422579. While so unfortunately the policy holder died in train accident on 28.2.2011 leaving behind the complainant alone as his legal heir as well as nominee. Ex.A.6 death certificate Ex.A.8 post mortem report issued by Government Medical Officer, Government Hospital Vinukonda, Ex.A.7 First Information Report and inquest report issued by the Sub-Inspector of Police, Government Railway Police Station Narasaraopet dated 28.2.2011 evidences the death of the life assured. Ex.A.9 certificate dated 1.6.2011 issued by Tahsildar, Sattenapalli, Sattenapalli Mandalam, Guntur District discloses that the complainant is the only proper person to receive amount from opposite parties on behalf of her father deceased life insured. Ex.A.10 income tax I.D. of the complainant issued by Income Tax Department of India discloses that the complainant is the daughter of deceased life insured Siriveri Venkateswarlu. Ex.A.11 repudiation of the claim letter dated 31.12.2011 from opposite parties sent to the complainant.
7. It is an admitted fact by the opposite parties that they issued two insurance policies to the deceased life insured and received the premiums from him under Ex.B.1 to Ex.B.4. Due to accidental death of deceased life insured, the complainant who is the only legal heir and nominee of the deceased life insured made a insurance claim on behalf her father. When the opposite parties received the claim form the complainant, they wake up and sent repudiation letter Ex.B.5 stating that With regard to the applications dated 22nd March, 2010 & 05th May, 2009, under above mentioned policies, on the life of Mr.Siriveri Venkateswarlu; we are reproducing below the aforesaid questions and the replies thereto in application forms, Q.No.6.1, 6.2 for your reference:
Q.No. | Questions | Answers |
6.1 | Details of applications submitted to & existing life insurance policies with future generali and with any insurer. (In case of housewife, major student or minor life to be assured please give details of husbands and parents insurance also) | No. |
6.2 | Whether any proposal for life cover or critical illness rider or accident and disability benefit rider? Application for revival of any policy has been made to any life insurer, declined/postponed/dropped/accepted revived at modified rates | No. |
However, on the basis of the investigations carried out by us, we are satisfied that the aforesaid replies in the applications are false in as much as we hold documentary proof to show that the life assured had substantial life insurance cover with another insurance company even prior to the date of his application. After careful evaluation of all facts, documents submitted and circumstances in this case, we have come to the conclusion that the replies to the aforesaid questions in the application form, are incorrect. Has such information been disclosed, our underwriting decision would have materially changed.
The contract of insurance is based on the principle of utmost good faith and the company relies on the information provided by the life to be insured in the application for insurance. Hence, despite making every attempt to consider the claim favorably, the facts regrettably demonstrate that this is not a valid claim on the above grounds. We therefore regret that we are unable to honour your claim and are repudiating our liability under the policy”.
We, the Forum came to conclusion that there is no documentary evidence to show that the deceased life insured had taken various insurance policies from various companies and disclosed the same in the present policies. Hence the repudiation of the claim of the complainant is not justified. Therefore there is deficiency in service on the part of opposite parties towards the complainant in repudiating the claim of the complainant. The opposite parties are liable to pay the claim amount to the complainant and the complainant is entitled to receive the same.
POINT No.3:-
9. In the result, the complaint is allowed in part and the opposite parties are directed to pay the insurance amount of Rs.7,50,000/- + Rs.9,60,000/- under two policies jointly and severally with interest at the rate of 6% per annum from the date of repudiating the claim of the complainant i.e., 31.12.2011 till realization and to pay costs of Rs.2,000/- to the complainant. Time for compliance one month. Rest of the claims of the complainant are rejected.
Typewritten by Stenographer K.Sivaram Prasad, corrected by me and pronounced by us in the open Forum, this the 27th day of August, 2014.
PRESIDENT(FAC) MEMBER
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For the complainant: For the opposite parties:-
P.W.1 M.Sujatha, D.W.1 Mr.Madan Gopal Jalan,
Complainant Senior Vice President,
(by affidavit) legal and compliance and
company secretary for
opposite parties
(by affidavit)
DOCUMENTS MARKED
On behalf of the Complainant:-
Ex.A.1 . . Bunch of photocopies of documents.
Ex.A.2 05.05.2009 Photocopy of Acknowlegement issued by opposite party.
Ex.A.3 07.05.2010 Photocopy of Acknowlegement issued by opposite party.
Ex.A.4 27.03.2010 Photocopy of letter from the opposite party to the father of the complainant.
Ex.A.5 22.03.2010 Photocopy of Acknowlegement issued by opposite party.
Ex.A.6 20.06.2011 Photocopy of Death Certificate.
Ex.A.7 28.02.2011 Photocopy of First Information Report.
Ex.A.8 05.03.2011 Photocopy of Post-Mortem Certificate.
Ex.A.9 01.06.2011 Photocopy of Certificate issued by Tahsildar, Sattenapalli Mandal, Guntur District.
Ex.A.10 . . Photocopy of pan card.
Ex.A.11 31.12.2011 Photocopy of letter from the opposite party to the complainant.
For the opposite parties:-
Ex.B.1 22.03.2010 Photocopy of ULIP proposal form.
Ex.B.2 05.05.2009 Photocopy of Proposal for life insurance.
Ex.B.3 . . Photocopies of letter from the opposite party to the father of the complainant and first premium receipt and terms and
conditions of the policy.
Ex.B.4 . . Photocopies of letter from the opposite party to the father of the complainant and first premium receipt and terms and
conditions of the policy.
Ex.B.5 31.12.2011 Photocopy of letter from the opposite party to the complainant.
Ex.A.6 31.12.2011 Photocopy of letter from the opposite party to the complainant.
PRESIDENT(FAC)
