BEFORE THE DISTRICT CONSUMER FORUM AT KHAMMAM

Dated this, the 19^th day of July 2018

          CORAM:     1. Sri. P. Madhav Raja, _{B.Sc., M.Li.Sc. LL.M.,}– President

2. Sri. R. Kiran Kumar_{, B.Sc., LL.M.} – Member

C.C. No.57/2015

Between:

K. Srinivasa Rao, S/o. Subba Rao,

Age: 38 years, Occu: LIC Agent,

R/o. H.No.3-1-40/1, Raja Veedhi,

Bhadrachalam – 507 111.

Khammam District.                                                        …Complainant

And

1. The Life Insurance Corporation of India,

Rep. by its Marketing Manager (Claims),

Divisional Office, “Jeevan Prakash”, Balasamudram,

Hanmakonda – 506 001, Warangal District.

2. The Life Insurance Corporation of India,

Rep. by its Branch Manager,

Bhadhrachalam, Khammam District.                           …Opposite parties

        This C.C. is coming before us for hearing in the presence of                     Sri.  Potla Madhava Rao Advocate for complainant; and of Sri. K.Jagan Mohan Rao, Advocate for opposite parties No.1 and 2; upon perusing the material papers on record; upon hearing arguments and having stood over for consideration, this Forum passed the following:-

ORDER

(Per Sri. P. Madhav Raja, President)

This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. 

2.      The set of brief facts in the complaint are that the complainant is the nominee of the deceased Kotha Krishna, he had obtained insurance policy in the month of 28^th March 2012 bearing No.689135555 for sum assured amount of Rs.5,00,000/- and another policy bearing No.689136784 for sum assured amount of Rs.5,00,000/-  is started on 28-02-2012 from the opposite party number 2. The insured was taken divorce as per his caste custom and did not have wife and children at the time of obtaining policies. He was 39 years old hail and healthy at the time of obtaining policy. On 29-05-2015 the policy holder Kotha Krishna died due to heart failure and as the complainant taking care of the deceased he has shown as nominee and the deceased/insured had also obtained two more policies. On 20-06-2015 with all relevant documents the complainant submitted claim form on 17-07-2015 the opposite party No.1 raised objections through a letter which were answered on 05-08-2015 by the counsel for the complainant by way of legal notice. Sri Valuddin Advocate issued reply notice on behalf the opposite parties thereby repudiating all the claims. It is further submitted that 17-07-2015 opposite party notice stated that the school certificate produced for age proof is bogus, the Mandal Parishad High School Kistaram of Sathupally itself is not in existence but being the nominee he is no way concerned with it, the certificate produced is the life assured at the same time admittedly there is no dispute about the age of the deceased Krishna and cannot be ground for the repudiation. The second objection taken by the Opposite parties is that the deceased is married but shown in proposal form as unmarried.  The deceased got married 20 years back and took divorce before the caste elders that is the reason he was treated as unmarried. With regard to Third objection i.e. in respect of policy No.689135555 and 689136784 the previous policies particulars have not furnished, since  an assistant had filled the form and  the fourth objection taken by the opposite parties is that the death certificate dated 12-06-2015 was said to be issued by the  Secretary Gram panchayath Kistaram but the secretary who was issued was under suspension  from 20-04-2015 and there is no dispute about the date of death and the question of suspension of issuing authority would not alter the date of death of the deceased hence it is also not ground for the repudiation of the policy. The letter dated 20-04-2015 issued by the district Collector, Khammam confirming the suspension of the Secretary Gram Panchayath Krishnapuram is no way concerned with the deceased or the complainant and  the new register of death and birth of Telangana state does not show but in records of the erstwhile  state of Andhra Pradesh  the name was shown  and to remove the doubts the said records are filed here with  The income of the life assured  was also shown as suspicion by the opposite parties and was shown as Rag picker, labour and drunkard but the payment of premium is Rs.16,000/- for a person is not hard and the cause shown for repudiation is not tenable hence it is prayed that to direct the opposite parties to pay the policy amount  Rs.10,00,000/-.

3.     In support of the complaint the complainant filed the following documents

which are marked as Ex.A-1 to Ex.A-9

Ex.A-1:Death certificate dt.10-06-2015, issued by Sarpanch, Grama Panchayath, Kistapuram.

Ex.A-2:Death Certificate dt.12-06-2015, issued by Sarpanch Grama Panchayath, Krishnapuram.

Ex.A-3:Death Certificate dt.16-10-2015, issued by Sarpanch Grama Panchayath, Krishnapuram.

Ex.A-4:Extracts of Births & Death Register for the year 2014-15 of Krishnapuram, Wazeedu Mandal, Khammam district.

Ex.A-5:Extracts of Births & Death Register for the year 2015-16 of Krishnapuram, Wazeedu Mandal, Khammam district.

Ex.A-6:Office copy of Legal notice dt.05-08-2015.

Ex.A-7:Reply Notice by opposite party, dt. 24-08-2015.

Ex.A-8:Photostat copy of policy bearing No.689135555,             dt. 28-03-2012.

Ex.A-9:Photostat copy of policy bearing No.689136784,             dt. 28-03-2012.

4.      On receipt of notice, the opposite parties appeared through their counsel and filed written version by denying the averments as mentioned in the complaint.  The opposite parties in their written version submitted that the complainant is an agent of the opposite parties corporation from 26-05-2000 i.e. for past 15 years and was acquainted with new business rules of life insurance policies and claim procedures of the opposite corporation. Further submitted that there is no such designation called Marketing Manager (claims) in the opposite parties corporation and Manager (Claims) and Marketing Manager are Two different designations.

Opposite Party had further contended that the life insurance policy bearing number 689135555 and 689136784 was issued to Sri Kotha Krishna S/o.Subba Rao on 28-03-2012 for sum assured of Rs.5,00,000/- each showing K. Srinivasa Rao brother as a nominee. It is also contended that this written version may be perused in conjunction with two other complaints viz.CC No.56 and 58 of 2015 filed by the same complainant covering all four life insurance policies issued on the life of Sri Kotha Krishna, which are total rated up sum assure of Rs.21,00,000/- and contended that why the complainant filed three complaints covering four policies  is not known and further stated that the complainant played three different roles under the policy is question. The complainant had shown himself as brother and nominee and procured three policies out of four. The complainant is working as agent of the opposite party corporation for past 15 years and intentionally suppressed his relationship with the life assured in his agent’s confidential report which is mandatory for considering any proposal for insurance by the opposite party corporation. As per new Business under writing rules of the opposite party corporation when the proposer is related with the Agent the Agent’s confidential Report will be obtained by the Development officer or Assistant Branch Manager of the Branch office so as to rule out any suppression of material facts. The question number 6 of Agent’s confidential report reads as  “ Are you aware of anything in the occupation financial or social position of the life proposed his/her personal habits or any other circumstances which might be likely to add the risk, the complainant herein and also an agent introducing the proposal for life insurance to the Opposite parties answered as  “NO”, in his agent’s confidential  report dated 30-04-2012 for  Policy No.689137912 which is subject matter of CC.56/2015  and was generated from Bhadhrachalam branch, later on transferred to Khammam branch office for servicing. The cause of death of the life assured late Kotha Krishna shown as Heart failure but not established with proofs. The claim eligibility under life insurance policy is directly linked up with the position of premium payments on the date of death of the life assured. All the bonafides related to the death of policy holder are very much material and relevant for the opposite parties taking the admissibility of death claim. The date of death, bonafides of the person died and the authenticity of death certificate play vital role in the settlement of the claim. The complainant submitted  an intimation of death and death certificate allegedly  issued by the Gram Panchayath Secretary Mr. Shyamala Babu Rao with date of issuance of certificate as 12-06-2015 showing the date of death of Kotha Krishna s/o: Subba Rao as 29-05-2015 and while processing the claim at Khammam branch office of opposite parties corporation under all the four polices claimed by the complainant it was observed that the relationship of the complainant/Agent with the proposer/policy holder was suppressed and false reply was given to the question No.1(b) in the Agent’s confidential report under three out of the four policies and being the 12 years experience zonal Manager club member the complainant is very much having knowledge of importance of rely of each question of the Agent’s confidential report.  As suspicion grow up about bonafides further investigation have made and revealed that the date of birth certificate is bogus and on 10-07-2015 sri G. Mohan Reddy the PG head master of ZPSS Kistaram duly signed and stated that the actual name of their school name is ZP Secondary School, Kistaram where as the name mentioned in the produced birth certificate as Mandal Parishad Unnatha Pathashala Kistaram Sathupally Mandal, Khammam Dist. This school is being ZP secondary School is for the education of 6^th to 9th class whereas in the certificate in question class of standard is 5^th to 7^th standard class and as per head master there is no 5^th standard class in their school and their seal put up in the said certificate is also not belongs to them and actual seal/stamp has also put up for cross examination and certified. The  head master of the primary school Sri V. V. Rathnam of Kistapuram under his ID No.1629485 gave certificate on 10-07-2015 stating that The MPP School  was started in the year and admission was started serially from number one and the admission number mentioned in the produce certificate as 1315 dated 04-07-1983 does not pertain to this school in fact the admission number 1315 is of Miss Vudathaneni Mounisha  D/o: Ravi and date of admission is 26-08-2004 as per school record and the standard of classes are from 1^st to 5^th class and study class as 5^th to 7^th is false and  the seal of the school and head master on the certificate is also not belongs to the said school and for cross verification the original seal was put up and certified by him. A person said to be un married when he was not married but  at the time of taking the polices late Kotha Krishna was aged 39 years and have no wife and children as he has obtained divorce as per their custom long ago  but customary divorce is not recognized under Hindu Succession Act and complainant is not entitled. The income source of life assured is also put to strict proof. The life assured name and address is not there in the voter list which was updated up to 2013 and birth and death register also not there. The Death certificate issued by the predecessor Mr. Shyam Babu Rao as GP. Secretary has been suspended by the district collector Khammam vide suspension order No.P6/253/2015 dated 20-04-2015 and in view of the letter dated 09-07-2015 of extension office (PR&RD) Wajedu the Death certificate of Kotha Krishna is fake fabricated and false. The purpose of insurance is false and insurable interest in all policies are suspicious and were got transferred from Bhadhrachalam branch office to Khammam office to avoid the attention of the original branch office. The policy taken by the late Kotha Krishna is a pure Term Insurance Policy for which production of Age Proof is mandatory and as per the rules in the under writing manual of the Opposite party corporation Election (Voter) Identity card is treated as non standard age proof. Being Zonal Manger cub member, and having 15 years standing the complainant is very much aware of it stating that the proposal form was filled up by the assistant. The complainant/Agent cannot shirk away his responsibilities as an agent of zonal manager club member of the opposite party corporation by throwing the blame on the assistant. The opposite party  corporation  is established  under LIC Act 1956 ( Act XXXI of 1956) and LIC (Agents) Regulations,1972 has got the force of statute and complainant is governed under the said Regulations  and there is no provision to engage an assistant to write proposal as per LIC (Agents ) Regulations1972.It is also observed  previous policies particulars were also not given while obtaining the polices No.689137912 and 689136784 and the complainant intentionally transferred all policies to Khammam branch office.  It is a common knowledge that opposite parties will pay the claim after 3 years. The opposite parties filed a copy of FIR of PS II Town Khammam with crime number94/17 dated 27-2-2017 attested by Addl. Public  Prosecutor, III Addl. Dist& Sessions Court (FTC-II) Khammam  through IA.No:56/17, hence the claim is made with all bogus and fabricated document to hush up the fatty amounts therefore the complaint may be dismissed with exemplary costs.

5.      In support of the opposite parties contentions filed the following documents which are marked as Ex.B-1 to B-18.

Ex.B1:Office copy of policy bearing No.689135555, dt. 28-03-2012

Ex.B2:Proposal form dt.29-03-2012.

Ex.B3:Office copy of Policy bearing No.689136784, dt. 28-3-2012.

Ex.B4:Proposal Form, dt. 31-05-2012.

Ex.B5:Reply by opposite party, dt. 24-08-2015.

Ex.B6:Office copy of Reply letter by opposite party, dt. 17-07-15.

Ex.B7:Postal Acknowledgement.

Ex.B8:Office copy of Reply letter by opposite party, dt. 22-07-15.

Ex.B9:Postal Acknowledgement.

Ex.B10:Office copy of Reply letter by opposite party, dt. 22-07-15.

Ex.B11:Death Certificate, dt.12-06-2015 issued by Grama Panchayath Secretary, Krishnapuram.

Ex.B12:Photostat copy of Study Certificate dt. 04-07-1983.

Ex.B13:Certificate issued by P.G. HM Krishnapuram. 

Ex.B14:Certificate dt.10-07-2015 issued by HM Krishnapuram. 

Ex.B15:Certificate issued by Executive Officer PR&RD, Wazeedu.

Ex.B16:Extracts of Births & Death Register of Krishnapuram.

Ex.B17:Proceedings of District Collector,Khammam Dt.20-04-15.

Ex.B18:FIR, Charge Sheet, Case Diary, 161 statements of witnesses, CDF Discharge Voucher and Claimant Statement.

6.      Heard complainant oral arguments, the Opposite party called absent to advance his argument then it is treated as no arguments.  

7.      In view of above submissions, now the point that arose for consideration is

       1) Whether the complainant is entitled as prayed for? if so to what relief ?

Point No.1:-       

          According to the afore mentioned averments and basing on the material available on record it is evident that the complainant is a nominee of deceased Kotha Krishna, who had obtained policies in the month of 12^th March 2012 bearing No.689135555  and 689136784 for sum assured of Rs.5,00,000/-  each from the opposite party number 2 and the complainant was  nominee. On 29-05-2015 the insured died due to heart failure and on 20-06-2015 with all relevant documents the complainant submitted claim form and on 05-08-2015 the opposite parties repudiated all the claims. It is settled law that only after due verification only the claims will be settled and so on the opposite parties have verified and found the documents which were produced by the complainant are false and fabricated for the purpose of hush up the opposite party custodians  amount. The opposite parties have filed an FIR Ex. B1. which reveals that a criminal case is lodged against the complaint with crime number 94/2017 under section 420,468 and 471 of IPC. The complaint contentions all are considered to be false. The death certificate issued by Shyam Babu Rao as GP. Secretary is fake in view of the letter dated 09-07-2015 of extension office (PR&RD) Wajedu the Death certificate of Kotha Krishna was issued by Shyam Babu Rao GP. Secretary, he had been suspended by the district collector Khammam vide suspension order No.P6/253/2015 dated 20-04-2015 and he has no power to issue the alleged certificate. The date of birth certificate is bogus. Sri G. Mohan Reddy the PG head master of ZPSS Kistaram duly signed  on 10-07-2015 stated that the actual name of their school is ZP Secondary School, Kistaram where as the name mentioned in the produced birth certificate as Mandal Parishad Unnatha Pathashala Kistaram Sathupally Mandal, Khammam Dist. This school is being ZP secondary School is for the education of 6^th to 9th class whereas  the certificate  class is 5^th to 7^th standard class and as per head master there is no 5^th standard class in their school and their seal put up in the said certificate is also not belongs to them, and actual seal/stamp has also put up for cross examination and certified. The head master of the primary school Sri V. V. Rathnam  of Kistapuram under his ID No.1629485 gave certificate on 10-07-2015 stating that The MPP School  was started admission with serial number one and the admission number mentioned in the produce certificate as 1315 dated 04-07-1983 does not pertain to this school in fact the admission number 1315 is of Miss Vudathaneni Mounisha D/o: Ravi and date of admission is 26-08-2004 as per school record and the standard of class are from 1^st to 5^th class and study class as 5^th to 7^th is false and  the seal of the school and head master on the certificate is also not belongs to the said school and for cross verification the original seal was put up and certified by him. Term Insurance Policy  for which production of Age Proof is mandatory and as per the rules in the under writing manual of the Opposite Party corporation  Election (Voter) Identity card is treated as non standard age proof  and being Zonal Manger cub member having 15 years standing the complainant in very much aware of it, and he must aware that the proposal form was filled up by the assistant is not tenable. The LIC (Agents) Regulations,1972 has got  the force of statute and governed under the said Regulations there is no provision to engage an assistant to write proposal. It is also observed that previous policies particulars were also not given while obtaining the policies No.689137912 and 689136784.  As per new business under writing rules of the opposite party corporation when the proposer is related with the Agent, the Agent’s confidential Report has to be obtained from the Development Officer or Assistant Branch Manager of the Branch office so as to rule out any suppression of material.  The Opposite Parties filed photocopy of Charge sheet in Crime number 94/2017, P.S. Khammam II Town, which is marked as Ex.B18 reveals that the complainant obtain the said policies fraudulently. Therefore we are in view that the complainant with wrongful intention suppressed the facts to obtain the insurance policies to gain insured amount fraudulently from the opposite parties hence the point is answered against the complainant.

7.      In the result, the complaint is dismissed. No costs.

(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum, on this the 19^th day of July, 2018).

                    Member                           President

                                                          District Consumer Forum, Khammam.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant                                                    For Opposite parties  

       None                                                                          None

DOCUMENTS MARKED:-

For Complainant                                                    For Opposite parties

                      Member                         President

                                                          District Consumer Forum, Khammam.