Karnataka

Koppal

CC/1/2016

Sri. Subhashachandra, R/o. Achara Narasapura - Complainant(s)

Versus

India First Life Insurance Co.Ltd., Mumbai - Opp.Party(s)

M.V.Mudgal

12 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
OLD CIVIL COURT BUILDING, JAWAHAR ROAD, KOPPAL
 
Complaint Case No. CC/1/2016
 
1. Sri. Subhashachandra, R/o. Achara Narasapura
S/o. Sangappa, Age-30 Years, Occ-Agriculture, R/o. Achara Narasapura, Tq. Gangavathi
Koppal
Karnataka
...........Complainant(s)
Versus
1. India First Life Insurance Co.Ltd., Mumbai
301, B Wing, TRIL IT 4, Infinity Park, Dindoshi - Film City Road, Malad (East), Mumbai-400 097
Mumbai
Maharastra
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MRS. AKATHA H.D. PRESIDENT
 HON'BLE MRS. SUJATHA AKKASAALI MEMBER
 HON'BLE MR. RAVIRAJ KULKARNI MEMBER
 
For the Complainant:M.V.Mudgal , Advocate
For the Opp. Party:
ORDER

Per:  Akatha. H.D.  

JUDGMENT

 

            The Complainant has filed this complaint U/s 12 of the consumer protection Act 1986 against  the OP alleging deficiency in service in not settling the claim of the policy amount of Rs. 3,30,000/-. Hence, prays for relief to settle the policy claim of Rs. 3,30,000/- along with accidental death benefit of Rs. 6,60,000/- and Rs. 50,000/- for physical and mental agony and Rs. 50,000/- for deficiency of service and Rs. 10,000/- for litigation and miscellaneous expenses.

 

Brief averments of the complaint are:-

 

2)         That the complainant mother had made a policy during her life time in branch of OP Company. The policy details pertains the policy No: is 10382483 and the total sum assured is Rs. 3,30,000/- along with accidental death benefit of Rs. 6,60,000/- and it had a half yearly premium of Rs. 9,932/-. The policy was issued on 27-02-2013. The nominee in the policy is the complainant.

 

            That the complainant further alleged that on 23-03-2014. The complainants’ mother died due to Heart attack in her own village Achar Narasapur Gangavati taluka. The complainant after getting the knowledge of the policy informed the OP about the policy and then submitted the claim form along with the necessary and related documents to OP. The complainant further alleged that on 11-12-2015 the OP had posted a letter to the complainant stating that the policy cannot be paid because DLA (Deceased Life Assured) at the time of availing policy the life assured had given wrong information regarding the her age and income, due to this reason the claim of the policy has been repudiated.

 

            The complainant further alleged that his mother had an irrigated land of 5-6 acres and has got good income from it and even she possessed a pan card in her name. The complainant alleged that at the time of availing the policy the DLA had given PAN card to the OP Company. So because of this reason DLA while availing the policy has not given the wrong details of her age and income to the OP. The OP instead of settling the claim is giving silly reasons and has rejected the claim amount of the policy and due to this reason the OP has committed deficiency in service and hence filed this complaint praying for the policy amount of Rs. 3, 30,000/- along with accidental death benefit of Rs. 6, 60,000/- and Rs. 50,000/- towards physical and Mental agony and Rs. 50,000/- towards deficiency of service and Rs. 10,000/- towards miscellaneous and litigation expenses as prayed above.

3)         This forum after admitting the complaint a notice was issued to the OP and the said notice is served upon him. The OP appeared before the forum on the date of appearance and filed vakalatanama and written version to the main petition and then posted for the complainant evidence.

 

4)         The main objections/ written version of the respondents.

 

            The OP submits that the instant complaint  is false, malicious, incorrect and malafide and is nothing  but an abuse of the process of the law and it is an attempt  to waste the precious time of this Hon’ble Forum, as the same has been filed by the complainant just to avail undue advantage. The complaint is thus liable to be dismissed under section 26 of the Consumer Protection Act, 1986 (hereinafter referred to as the “Act”).

 

            The OP further submits that at the very outset it is submitted that misrepresentation of income and age was a material fact as, had it would been correctly disclosed the said policy would not have been issued at all as the DLA was beyond the Insurable Age (Maximum 65 years as on proposal date allowed) for this product. It is further submitted that DLA was having a very little income and was a BPL Card holder. It is pertinent to mention here that DLA was not having the annual income of Rs. 2 lakhs as mentioned in the proposal form. It is further submitted that age of DLA was 80 years at the time of signing the proposal form however she intentionally and with malafide intention mentioned her age as 45 years (approx). Insurance being a contract of “uberrimae fidae”, the policy holder was duty bound to reveal all relevant facts to the insurer in order for the insurer to determine the policy holder’s eligibility for availing the insurance.

 

            That the above complaint is neither maintainable in law nor on facts and the same is to be dismissed in limine.

 

            The OP further submits that the OP at the very beginning states that there has been no negligence or deficiency in services whatsoever, on part of the OP in dealing with the concerned Policy as the claim was rightly repudiated on the ground of misstatement of material fact as stated in the repudiation letter, thus the present complaint is liable to the dismissed by this learned forum on this ground alone.

 

            That it is most humbly submitted that the instant complaint lacks a cause of action. The complaint is based on mere surmises and conjectures. It is an established principle of law that the machinery of law cannot be invoked on the basis of mere conjectures. Therefore, this complaint is liable to be dismissed for want of cause of action.

 

            The OP further submits that it is submitted that the contract of insurance including the contract of Life Insurance are contracts uberrima fides and every material fact must be disclosed otherwise there is good ground for rescission of the contract.

 

            The OP further submits that the DLA passed away within a short span of signing of the Proposal Forum and issuance of the policy, which itself is a strong ground to raise reasonable doubt over the correctness of the material representations made in the proposal form. 

 

            The OP further submits that without prejudice to above stated contentions; the OP submits the correct facts and details of the case, which are as follows;

 

  1. That after understanding all the terms and conditions of the policy, the Smt. Amaramma (hereinafter referred to as DLA) submitted the duly signed Proposal form bearing No: F00345741 on 08-02-2013 for an “India First Maha Jeevan Plan”,  giving all relevant details and information in the prescribed form, for a basic assured sum of Rs. 3.3 lacks. Under the said policy, a modal annual premium of Rs. 9,932/- was to be paid semi annually.
  2. That in the proposal form at page No.1 under section “proposer/policy owner Detail” has declared wrong information regarding her profession/occupation and income. The DLA has declared the following

Occupation:                            Business + Landlord

Industry Type:                       Petty Shop

Name of Org. /Business      Land Lord + Business

Income:                                    2, 00,000

 

Moreover, the DLA had also signed a declaration in the Proposal form with respect to complete, true and accurate disclosure of all the facts and circumstances as may be relevant for the acceptability of the proposal form about his work detail and annual earning. A copy of proposal form is annexed herewith as Annexure-OP-1.  

  1. That in the proposal form at page No: 1 in section of Proposer/Policy owner Details, wherein age of DLA was mentioned as 01-06-1967 i.e. 45 years (approx.) at the time of signing the Proposal form. Moreover, the DLA had also signed a declaration in the proposal form with respect to complete, true and accurate disclosure of the all the facts and circumstances as may be relevant for the acceptability of the proposal. It is further submitted that DLA submitted a PAN card as proof of her age.
  2. That it is humbly submitted that the proposal form duly signed by the DLA clearly had a provision for the declaration by the owner of the policy i.e. DLA to the effect that she had read the Application Form and furnished the information after fully understanding the contents thereof, understood the terms and condition of the plan, had made complete and true disclosure of the facts in the proposal form and had not withheld any information. Further, she had also agreed under the agreement therein that if any untrue statement be contained in the proposal form, the policy contract shall be null and void and the money which has been paid in respect thereof shall stands forfeited to India First. It may be noted that the page 3 of the Application/proposal form, DLA has put his signature. Please refer to the Declaration heading on Page-3 proposal form.
  3. Thus, the DLA in this case had fully understood the terms and conditions of the policy and further agreed under the agreement therein that if any untrue statement be contained in the application/proposal form, the policy contract shall be null and void and the money which has been paid in respect thereof shall stands forfeited to India First.
  4. That based on the information provided and declaration made in the proposal form and on receipt of the premium, policy bearing No: 10382483 (hereinafter referred to as the “Policy”) was issued to the DLA with effective date of coverage as 27-02-2013. A copy of the policy document is annexed herewith as Annexure OP-2 (Colly).
  5. That on 03-02-2015 OP received claim intimation from the complainant that mother of complainant Late Smt. Amaramma had expired on 20-03-2014 due to Heart Attack and complainant also claimed the sum assured under the said policy. A copy of claim intimation form is annexed herewith as Annexure-OP-3.
  6. That as the claim being an early claim and after perusal of the documents submitted by the complainant, the OP investigated the matter through Swifts investigation agency in order to settle the claim as per terms and conditions of the policy contract. After the perusal of investigation report and copy of BPL Ration Card bearing No: GAGR00103008 of DLA procured during the investigation of the matter, it came to the knowledge of OP that DLA was under BPL Scheme and his annual income as less that Rs. 2,00,000/- . It is pertinent to mention here that DLA was not doing any business and her annual income was not Rs. 2 lakhs as mentioned in the proposal form. DLA intentionally and with mala-fide intention wrongly stated in the proposal form that she is land lord and doing business and her annual income is Rs. 2 lacks. A copy of BPL Ration card of DLA procured during the investigation and Investigation Report are annexed herewith as Annexure –OP-4 and Annexure-OP-5 (colly) respectively.
  7. That during the investigation of the matter investigator also procured the online voter ID card list of DLA reflecting the age of DLA as 80 years. Copy online voter list is annexed herewith Annexure-OP-6 (colly).
  8. It is further submitted that based on the above mentioned observation, investigation report and document procured during the investigation of the matter OP strongly believe that said policy got issued by concealing or misstatement of material facts i.e. annual income and actual age of DLA and there is an involvement of fraudulent group.
  9. That it is submitted that based on above mentioned observations and documents collected during the course of the investigation, it clearly reflects that these material details (annual income and age of DLA) affecting the decision of the insurer for the acceptance or rejection of the contract of insurance ere willfully mis-represented and concealed by the DLA as the same was not disclosed by her in the Proposal form duly filed and signed by her at the time of availing the said policy, in spite of the specific question in the proposal form. It is submitted had it been in the knowledge of the OP the policy as proposed would not have been issued at all as DLA had a very little income and she was completely beyond the insurable age (maximum age at entry under the product is 65 years) at the time of filling the proposal form. DLA intentionally and with malafide intention filled as business and land lord as her occupation and having an annual income of Rs. 2 Lakhs. DLA also misguided OP by concealing her actual age which as beyond the insurable age which is 65 years for captioned policy. Thus by making misrepresentation about the income and age the DLA got a policy issued which would not have been issued if the correct fact would have been disclosed about her Occupation, Income  and Actual age. It is submitted that the contract of insurance being of utmost good faith, Deceased policy Holder was under an obligation to disclose the said material details in the Proposal form which was necessary for the underwriting decision of the OP. Thus, the OP has rightly repudiated the claim of the complainant on the ground of suppression and misrepresentation of material facts by the DLA at the time of submission of the proposal form. The misrepresentation of work details and income as a material fact as it would have been correctly disclosed the said policy would not have been issued. This amounts to serious misrepresentation of material facts, which is a violation of the terms and conditions of the insurance policy. Insurance being  a contract of “uberrimate fide, the policy holder was duty bound to reveal all relevant facts to the insurer in order for the insurer to determine the policy holder’s eligibility for availing the insurance. The fact of repudiation was communicated to the complainant vide letter dated 19-05-2015. A copy of the said repudiation letter dated 19-05-2015 is annexed herewith as Annexure OP-7.
  10. In November, 2015, OP received legal notice dated November 30, 2015 from the complainant which was duly replied vide letter dated 11-12-2015. OP vide letter dated 11-12-2015 duly informed that since DLA obtained said policy by concealing the material fact about her annual income and actual age. Hence OP in the light of section 45 of the Insurance Act rightly repudiated the claim of complainant.
  11. It is submitted that the non-disclosure amounts to fraud and complainant cannot take the benefit of its own wrongs. It has been held u/s 19, of the contract Act (9 of 1872).

Explanation – “Fraud or Misrepresentation not causing consent to contract – Does not render contract voidable – Person who knows and claims about discontinuity of relationship, supposed to disclose about discontinuity – if not, it must amount to fraudulent misrepresentation or active concealment of fact by one having knowledge or belief of fact – Since DLA  intentionally and with malafide intention misrepresented that he was doing business trade and also having  an annual income of Rs. 2,00,000/- and that she was 45 years (approx.) of age at the time of proposal. It amounted to active concealment of material fact by one having knowledge of correct facts”.

 

           Para wise reply:-

 

  1. That the contents of Para -1 of the complaint are matter of record and complainant may be put to strict proof thereof.
  2. That the contents of para-2 of the complaint are matter record and complainant may be put to strict proof thereof. However it is further submitted that in the proposal form at page No: 1 under section “Proposer/policy owner Details” has declared wrong information regarding her profession/occupation and income. The DLA has declared the following;

Occupation:                            Business + Landlord

Industry Type:                       Petty Shop

Name of Org. /Business:     Land Lord + Business

Income:                                    2, 00,000

 

Moreover, the DLA had also signed a declaration in the proposal form with respect to complete, true and accurate disclosure of all the facts and circumstances as may be relevant for the acceptability of the proposal form about her work details and annual earning. In the proposal Form at Page No: 1 in section of Proposer/Policy owner Details, Where in age of DLA was mentioned as 01-06-1967 i.e. 45 years (approx.) at the time of signed a declaration in the proposal form with respect to complete, true and accurate disclosure of all the facts and circumstances as may be relevant for the acceptability of the proposal. However on investigation of the matter, it was found that DLA was BPL card holder and her age as 80 years at the time of signing the proposal form.

  1. That the contents of para-3 & 4 of the complaint are matter of record and complainant may be put to strict proof thereof.
  2. That the contents of para-5 of the complaint are wrong and denied. It is vehemently denied that DLA provided the correct age and income at the time of signing the proposal form. It is further submitted that claim being an early claim and after perusal of the documents submitted by the complainant, the OP investigated the matter internally from Swifts investigation agency in order to settle the claim as per terms and conditions of the policy. After the perusal of investigation report and copy of BPL Ration Card bearing No: GAGR00103008 of DLA procured during the investigation of the matter, it came to the knowledge of OP that DLA was under BPL Scheme and her annual income as less than Rs. 2,00,000/-. It is pertinent to mention here that DLA was not doing any business and her annual income was not Rs. 2 Lakhs as mentioned in the proposal form. DLA intentionally and with mala-file intention wrongly stated in the proposal form that she is land lord and doing business and her annual income is Rs. 2 Lakhs.

Investigator also procured the online voter ID card list of DLA reflecting the age of DLA as 80 years. It is further submitted that based on the above mentioned observation,  investigation report and document procured during the investigation of the matter OP strongly believe that said policy got issued by concealing or misstatement of material facts i.e. annual income and actual age of DLA  and there is an involvement of fraudulent group. It is submitted that the contract of insurance being of utmost good faith, DLA was under and obligation to disclose the said material details in the proposal form which was necessary for the underwriting decision of the OP. Thus, the OP has rightly repudiated the claim of the complainant on the ground of suppression and misrepresentation of material facts by the DLA at the time of submission of the proposal form.  The misrepresentation of work details and income was a material fact as had it been correctly disclosed the said policy would not have been issued at all. This amounts to serious misrepresentation of material facts, which is a violation of the terms and conditions of the insurance policy. Insurance being a contract of uberrimae fide, the policy holder was duty bound to reveal all relevant facts to the insurer in order for the insurer to determine the policy holder’s eligibility for availing the insurance. The fact of repudiation was communicated to the Complainant vide letter dated 19-05-2015.

  1. That the contents of para-6 of the complaint are wrong and denied.
  2. Those contents of next para are prayer in nature which is strongly opposed and hence prays for the dismissal of the complaint.

 

5)         On the basis of the above pleadings the following points that arise for our consideration are

 

POINTS

 

1)         Whether the complainant proves that there is deficiency in service in not settling the policy claim amount after the death of his mother?

2)         Whether the opponent proves that the complainant’s mother has failed to disclose the true and correct materials to the insurer at the time of availing of the policy?

 3)        Whether the complainant further proves that he is entitled for the relief sought for?

4)         What order?

 

6)   To prove the case of the complainant, the complainant himself examined as PW1 and got marked documents as per Ex.A.1 to Ex.A.9 and closed their side evidence.  The respondent himself examined as RW1 and got marked documents as per EX B1 to EX B7 and closed their side evidence.

 

7)   Heard the arguments of counsel and perused the records.

 

 

 

8)  Our findings on the above points are as under;

 

Point No. 1:   In the affirmative

Point No. 2:  In the Negative

Point No. 3:   In the Affirmative

                  Point No. 4:  As per final Order for the following

REASONS

 

9)  POINT No. 1, 2 and 3:  As these issues are interconnected each other, hence they are taken together for common discussion to avoid repetition of facts, evidence documents and arguments.

 

10)  On perusal of the pleadings, evidence coupled with the documents of respective parties on record, It is the case of the complainant alleging deficiency in service in not settling claim of the policy amount of Rs. 3,30,000/- along with accidental death benefit of Rs. 6,60,000/-. There is also no dispute regarding that the complainant mother during her life time had obtained policy by name “India first maha jeevan Plan”,  With a policy No: 10382483 which was commenced on 27-02-2013 with a premium of Rs. 9,932/- half yearly and the sum assured amount is 3,30,000/- along with accidental death benefit of Rs. 6,60,000/-. There is also no dispute that the premium of the policy is not paid. On 20-03-2014 the complainant mother died due to Heart attack in her village Achar Narasapur, Gangavati Taluka leaving the complainant as nominee in the policy. Being a beneficiary in the policy the complainant approached and claimed for assured amount and other benefits and submitted the claim form and necessary documents. Till today the op has not settled the claim and the complainant alleged deficiency in service.

 

11)       To prove the case of the complainant the PW-1 has reiterated the complaint averments in his examination in chief and in support of his case he has produced the policy documents which has been marked as Ex A1 it is admitted that the policy was issued by Op after going through the proposal form i.e. Ex B1. This policy was issued to the complainant mother at the time of the availing policy. He has further averred that the policy contain the details of the sum assured and the premium to be paid i.e. Ex A1. Ex A-1 clearly reveals that the policy is issued in the name of the complainant mother (DLA) during her life time.  

 

12)       As per Ex A2 it is the death certificate issued by the Chief Registrar of Birth and death. As per Ex A-4 the claim repudiation letter is given by Op.  On perusal of it is crystal clear that OP has rejected the claim stating that DLA has mentioned her age and income wrongly in the proposal form i.e. Ex B-1 prior to the availing of the policy and this was known to them from investigation to prove that the DLA has suppressed his age and income, the OP has not produced any cogent evidence. The OP company has furnished the Voter list as per Ex B6 showing the name of the DLA Amaramma w/o Sangappa at Sl. No: 421. At the time of availing of the policy it becomes the duty of the Insurance officer to verify and see that the particulars are filled correctly. The DLA has mentioned the date of birth as 01-06-1967 and the age at that time was 45 years. This is clear in Ex A1, that her age was mentioned as 45 years. So here the question of suppressing the age of DLA is no way applicable as per the suggestions made by the OP in their claim repudiation letter.

 

13)       The Hon’ble National Consumer Disputes Redressal Commission, New Delhi reported in II (2011) CPJ 7 (NC) Life Insurance Corporation of India and Anr. V/s Gopal Singh

 

            “Consumer Protection Act, 1986 – Sections 2(1) (g), 14 (1) (d), 21 (b) – Insurance (Life)  - Endowment Assurance Policy with Profits – Suppression of material facts – Dispute in age – claim repudiated – Forum allowed complaint – State Commission dismissed appeal – hence, revision – Contention, assured had given his age incorrectly while filling proposal form on basis of voter’s list – Not accepted – Age given in voter’s list cannot be taken as sure test to determine exact age of a person – It is a common knowledge that frequently small mistakes regarding residence, age, parent age do occur while preparing voter’s list – No conclusive evidence on record to show that assured had mentioned his age incorrectly which mala fide intention which any ulterior motive – Assured has correctly mentioned age in proposal form.

 

            The citation reported in II (2014 CPJ 20A (CN) (AP) Reliance Life Insurance Ltd., and another V/s B. Koti Ratnam that;

 

            “Consumer Protection Act, 1986 Section 2(1) (g), 14 (1) (d), 15 – Insurance (Life) – Death claim – Alleged suppression of correct age – Claim repudiated – Alleged deficiency in service – District Forum allowed complaint  - Hence appeal – Entries made in ration card or voter list by themselves cannot be considered as criteria to ascertain correct age of insured more particularly when there has been discrepancy in age of insured as seen from voter’s list and ration card – Insurance Company that failed to substantiate its contention that insured was aged 68 years at time of submitting proposal form – Repudiation not justified.

Result: Appeal dismissed.”

 

14)       It has been held that entries made in ration card or voter list by themselves cannot be considered as criteria to ascertain correct age of the insured. The lordships have held that there is no conclusive evidence on record to show that assured has mentioned her age incorrectly with a malafide intention with any ulterior motive.

 

            The facts and circumstances of the case in hand and circumstances of the said citations are same and applicable in this case.

15)       Therefore, in the light of principle laid down by this lordship in the aforesaid citation more specifically with respect to suppressed the age it is crystal clear that the DLA has mentioned as 45 years in the proposal form. Therefore, it can be presumed that the complainant’s husband (DLA) has not mentioned the age incorrectly.

 

16)       The facts and circumstances of the case in hand and the fact and circumstances of the said citation are same. Hence OP has failed to prove that the DLA has suppressed the age and income with malafide intention.

 

17)       The counsel for the complainant has relied upon citation reported in I (2016) CPJ 312 (NC) by National Consumer Disputes Redressal Commission, New Delhi in Vinay Kumar Swarnkar V/s Life Insurance Corporation of India & Ors.

 

            “Consumer Protection Act, 1986 – Sections 2(1)(g), 14(1)(d), 21(b) – Insurance (Life) – Four policies – Death of life assured – Claim repudiated – Dispute over age proof – Non disclosure of material facts – Deficiency in service – District Forum allowed complaint – State Commission allowed appeal – Hence revision – Petitioner based his claim of age on school certificate and voter list whereas respondent placed nothing to dispute – Rejection of claim on basis of age is not justified.

Result: Revision Petition partly allowed.

 

18)       On contrary OP had taken contention that the policy was issued based on the details mentioned by the life assured in the proposal form and believing the same to be true correct. It is only during the processing of death claim, it came to light that the deceased life assured (DLA)  was covered under the BPL ration card  and thereby making it clearly evident that an annual income of Rs. 2 Lakhs is disclosed by her in the proposal form  which was  wrong and contrary to the facts. The material fact deliberately concealed in the proposal form submitted by the DLA and the same was done with an intention to deceive the OP.  Thus the claim of the complainant was repudiated on grounds of non disclosure of material facts regarding the income and age details of the DLA.

 

19)       The OP did not submit any of the documents showing that the insurance policy was obtained by suppressing material facts. On perusal of Ex A5 to Ex A8 the record of rights (ROR). Shows that the DLA was the owner of the agricultural lands and from these lands she used to get the income. The DLA also possessed a PAN in the name showing that the DLA had income.  The same is clear in Ex A9. When the DLA was the owner of Agricultural lands and the income is earned by cultivating the agricultural lands.  It is sufficient to prove that the DLA has an income source for her survivability and engaged in an agricultural profession.

 

20)       To determine the income proof the best evidence is the record of rights (ROR) and pan card which shows clearly that DLA is the owner and has source of income.

 

            As per as the contention taken by the OP that the DLA was covered under the BPL Ration card it is the duty of the Food Department to take notice regarding the issuance of Ration card. On the basis of ration card one cannot come to the conclusion that income of the complainant’s mother has mentioned wrongly.

 

21)       At the time of issuing the policy it becomes the duty of the insurance officer to verify and look after all the documents and then issue the policy to the insurer but not blindly issue the policy just to reach the target of the company in making insurance policies. When the mistake is made by the insurance officer without verifying the age and income of the DLA now they cannot deny the claim by saying that the DLA has not disclosed the material fact regarding the age and income.

 

22)       It is also reported in III (2014) CPJ 582 (NC) where it is held thus.

            “Consumer Protection Act 1986 – Section 2(1)(g) 14(1)d), 21(b) Insurance – Agents mistakes – Non disclosure fact relating to earlier policy – not material fact – claim repudiated – Deficiency in service – State Commission is allowed complaint – Hence revision – insurer or her legal representative should not suffer for omissions – Commissions by agent – Repudiation smacks of malafide intention on part of OP – Insurance company has no bond to pluck with complainant.”

            The lordships have held that, it is the agent mistake for non disclosure of the facts relating to the policy.

 

23)       From the arguments submitted by the learned counsel we are of the opinion that the DLA has not given any wrong material facts to the OP. Hence the OP is not supposed to repudiate the claim of the complainant because the onus lies on the OP Company to establish the assured has suppressed material facts regarding income and age.  In absence of such evidence we found deficiency in service on part of OP in not settling the claim. As such the OP is liable to pay the sum assured amount along with accidental benefit amount to the complainant.

 

24)       OP company is also liable to pay compensation of Rs. 5,000/- for deficiency in service along with litigation expenses of Rs. 1,500/- to the complainant and accordingly we constrained to hold point No. 1 & 3 in the affirmative and point No: 2 in the negative.

 

25)       Point No: 4:- In view of the above discussion and findings, we proceed to pass the following;

 

 

 

ORDER

  1. The complaint filed by the complainant is hereby partly allowed.
  2. The OP is directed to pay the sum assured of the policy amount of Rs.3, 30,000/- (Rupees Three lakh thirty thousand only) along with Accidental Death Benefit of Rs. 6, 60,000/- (Rupees Six Lakhs Sixty thousand only) under the policy and along with compensation of Rs. 5,000/- (Rupees Five thousand only) towards deficiency service and physical and mental agony and along with Rs. 1,500/- (Rupees One thousand five hundred only) towards litigation expenses to the complainant within one month from the date of receipt of this order.  Failing which 12 percent p.a. interest will be charged from the date of filing of this complaint till realization.

 

  1. Send the free copies of this order to both parties.

 

Dictated to the Stenographer, transcribed, typed by him, typescript, corrected by me and then pronounced in the Open Forum on 12th day of July 2016.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

// ANNEXURE //

 

List of Documents Exhibited for the Complainant.

 

Ex.A.1

Policy bond  

28.02.2013

 Ex.A.2

Death Certificate

30.04.2014

Ex.A.3

Legal notice

30.11.2015

Ex.A.4

Repudiation letter

11.12.2015

Ex. A5

R O R S. No: 90

 

Ex. A6

Ex. A7

Ex. A8

Ex. A9

R O R S. No: 50

R O R S. No: 61/2

R O R S. No: 61/3

Pan Card

 

 

 

01.06.1967

 

List of Documents Exhibited for the Opposite Party

Ex.B.1

Proposal Form

 

Ex.B.2

Policy Bond

28.02.2013

Ex.B.3

Claim intimation form - Death

 

Ex.B.4

BPL Ration Card

 

Ex.B.5

Investigation Report

 

Ex.B.6

Voters I.D.

 

Ex.B.7

Claim repudiation letter

19.05.2015

 

Witnesses examined for the Complainant / Respondent.

 

P.W.1

Subhaschandra S/o Sangappa dated: 22.03.2016

R.W.1

K. R. Viswanarayan dated: 26.04.2016,

 

 

 
 
[HON'BLE MRS. AKATHA H.D.]
PRESIDENT
 
[HON'BLE MRS. SUJATHA AKKASAALI]
MEMBER
 
[HON'BLE MR. RAVIRAJ KULKARNI]
MEMBER

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