PER SMT. JYOTI IYER - HON’BLE MEMBER :
1.This Complaint has been filed by the Complainant alleging that he is the beneficiary of the 2 policies of late Mr.A.P.Naringrekar by virtue of the order dtd 9th Dec 2004 of the Hon’ble Mumbai High Court against the Opposite Party alleging them of deficiency in service for illegally & arbitrarily repudiating the claim of late Mr.A.P.Naringrekar(insured) for the 2 policies availed by him on ground that the insured had suppressed material information that he was suffering from manic-depressive psychosis prior to taking cover& for failing to consider the requisitions of the Complainant in his letter dtd 25/10/07 & further for directions to the Opposite Party to pay the claim of Rs l lakh alongwith 18% interest w.e.f 15th December 2003 till realization & Rs.10 Lakhs towards mental agony. Cost of litigation etc
2) The facts of the case in a nut shell are as follows –
It is case of the Complainant that he had filed Summary Suit No.4089/1993 in the High Court, Bombay against one Mrs.K.P.Naringrekar, the mother of the insured the late Mr.A.P.Naringrekar during her life time, the said suit was decreed Ex-parte in favour of the Complainant on 30/06/1997. Copy of the said order dated 30/06/97 is at Annexure-“2” to the complaint. The Complainant states that part of the decretal amount decretal amount was satisfied by sale of immovable property belonging to the late Mr.A.P.Naringrekar, however, an amount of Rs.93,235.15 was still due and owing to the Complainant with18 % interest from the date 15/08/2003 till full and final payment and / or realization of the entire amount. The Complainant further avers that since the amount due and payable under the said decree remained unpaid. He initiated execution proceedings to execute the said decree. The Complainant amongst other proceeding also filed Chamber Summons No.1799/2003 in which order dated 09/12/2004 was passed by the Hon’ble Bombay High Court wherein it was stated that the Complainant was entitled to receive amount due under the insurance policies nos.891755972 & 891755973 in satisfaction of the balance decretal amount owed to the Complainant. In the said order also the heirs of the late Mr.A.P.Naringrekar were directed to comply with the formalities as requested by the Life Insurance Corporation of India (hereinafter for the sake of brevity and convenience referred as Opposite Party) so that the amount due to the Complainant could be expeditiously paid to the Complainant under the aforesaid policy. The copy of the said order dated 09/12/2004 passed by Hon’ble High Court, Bombay is at Annexure “3” to the complaint.
3) The Complainant further avers that he had filed Summons for Judgement being no. 705/1994 in the said Summary Suit being No.4089/1993 which was disposed off by an order dated 26/08/1996. During the legal proceedings (Summons for Judgement) it was contended by Mrs.K.P.Naringrekar that the deceased Mr.A.P.Naringrekar was of unsound mind and in support of this contention the Doctor’s prescription was also relied and produced before the Hon’ble Bombay High Court in the said proceedings. It is averred by the Complainant that in the said order dated 26/08/1996 which has been passed by the Hon’ble Bombay High Court it is observed that there is no evidence to show that the deceased Mr.A.P.Naringrekar was of unsound mind and it was held that there is no merit in defence that was advanced by legal heirs of late Mr.A.P.Naringrekar. Copy of the said order 26/08/1996 passed by the Hon’ble Mumbai High Court is at Annexure “4” to the complaint.
4) The Complainant avers that he had taken out 3 contempt petitions for non compliance with the order dated 09/12/2004 passed by the Hon’ble High Court. The Complainant further avers that in Contempt Petition No.89/2005 Hon’ble Bombay High Court had vide an order dated 20/01/2006 directed the legal heirs of the late Mr.A.P.Naringrekar to comply with the formalities of the Opposite Party- Life Insurance Corporation of India within 4 months from of the said order i.e. by 20/05/2006 but the Opposite Party failed to comply with the said order. However, the Opposite Party vide their letter dated 13/06/2006 addressed to the Complainant informed the Complainant that all documents have not been submitted to the Opposite Party by the heirs of the late Mr.A.P.Naringrekar therefore, the Complainant filed their 2nd contempt petition no.83/2006 in the affidavit in reply filed by the legal heirs of late Mr.A.P.Naringrekar placed on record that all documents had been submitted by the Opposite Party by them as requisitioned by the Opposite Party. Hence, accordingly an order dated 21/02/2007 giving permission to withdraw the contempt petition with liberty to adopt appropriate proceedings was passed by the Hon’ble Mumbai High Court.
5) The Complainant thereafter through his advocate addressed a letter dated 23/03/2007 and through his constituted attorney who personally delivered the said letter on 26/03/2007 to the Opposite Party placing on record the facts as had transpired and informed the Opposite Party that irrelevant doctors prescription for treatment of alleged mental disorder of the late Mr.A.P.Naringrekar were submitted to the Opposite Party and also drew the attention of the Opposite Party to the order dated 26/08/1996 of the Hon’ble Mumbai High Court wherein the alleged contention of mental disorder of the insured was already considered, it was observed in the said order that no medical certificate has been produced and therefore, there is no evidence to show that the insured was of unsound mind Therefore, the Complainant called upon the Opposite Party-Life Insurance Corporation of India to pay the insurance claim to the Complainant as he was beneficiary to the said amount vide order dated 09/12/2004 passed by the Hon’ble Mumbai High Court, however, in vain. Copy of the said letter dated 23/03/2007 addressed by the advocate for the Complainant to the Opposite Party is at Annexure “5” to the complaint.
6) The Complainant contends that he was constrained to filed contempt petition no.61/2007 in which the Opposite Party had been made as a Respondent. In the reply filed by the Opposite Party in the said contempt petition as forwarded by an order dated 24/09/2007 had annexed as Exhibits in the said reply repudiation letter dated 18/07/2006 before reference numbers SSS/DCL/SBD addressed to the legal heirs of the late Mr.A.P.Naringrekar. It is contended by the Complainant that he was not even informed by the Opposite Party that they had repudiated the claim under the said policy despite being aware of the fact that he was beneficiary under the said aforesaid policy standing in the name of the deceased Mr.A.P.Naringrekar. The Complainant therefore submits that this act on part of the Opposite Party amount to gross deficiency in services and the repudiation letter proceeded was on the mistaken and unsubstantiated premise that the insured the late Mr.A.P.Naringrekar was suffering from manic-depressive psychosis and was allegedly taking treatment from a psychiatrist for 9 to 10 years and further it is contended by the Complainant that the said repudiation letter records that the late Mr.A.P.Naringrekar had not disclosed material information regarding his health at the time effecting insurance with the Opposite Party and the questionnaire with regard to the state of health of late Mr.A.P.Naringrekar from the proposal of assurance was reproduced and the letter had attached therewith a leaflet captioned why a life insurance claim is repudiated and reference to the contract being of utmost good faith was drawn. Aggrieved by the said repudiation which in view of the Complainant is without application of mind as it is based on the documents submitted by the Legal Heirs and no independent & proper investigation has being done. In the meanwhile another order date 28/09/2007 was passed by the Hon’ble Justice Mr.S.C.Dharmadhikari of the Bombay High Court wherein his lordship has observed that Contempt Petition was not the remedy of the Complainant if he was aggrieved by the action of the legal heirs of late Mr.A.P.Naringrekar and the Opponent and further that all remedies were available to the Complainant to be invoked and all such proceedings would be uninfluenced by the Contempt Petition No.61/2007. Copy of the said order dated 28/09/2007 passed by the Bombay High Court is at Annexure- “7”to the said complaint. The Complainant was beneficiary under the said above referred insurance policies he through his advocate addressed letter dated 25/10/2007 calling upon the Opposite Party to reconsider the claim. The said letter dated 25/10/2007 is at Exhibit 1 to the complaint. In the said letter addressed by the advocate to the Opposite Party all was pointed out to the Opposite Party that the repudiation was arbitrary and illegal and bad in law as there were no documents to support their said repudiation and further requested the Opposite Parties for hearing apart from contentions raised above various other contentions were raised by the Complainant, however, in vain. Hence, the Complainant was constrained to file the present complaint by the Complainant but the Opposite Party failed to consider the same. The Complainant had also sought intervention of the Hon’ble Insurance Ombudsman and vide his application dated 11/12/2002. However, vide its reply dated 19/12/2007 the Insurance Ombudsman stated that it could not intervened in the matter for the reason stated in the said letter. Copy of the said reply dated 19/12/2007 is at Annexed “10” to the complaint. Hence, the present complaint was filed against the Opposite Party claiming deficiency in their services. Earlier in time the same complaint was filed before the State Commission. It was under the direction given by the Hon’ble State Commission the claim was restricted below 20 lacs and therefore, it came before this Forum.
7) Pursuant to the issuance of the notice, the Opposite Party appeared and filed their written statement denying all the allegations made by the Complainant in the complaint. Firstly it is contended by the Opposite Party that the said complaint is not maintainable in law as the Complainant has made statements which are false to his own knowledge and is guilty of suppression of material facts. The insured deceased Mr.A.P.Naringrekar had initially submitted his proposal for insurance for 2 policies bearing no.891755972 & 891755973 under Plan and term was 75 to 20 for the sum insured to the tune of Rs.25,000/- each and that the deceased insured had paid his first premium on 30/09/1991 and that said policy was issued subject to terms and conditions printed on it. The copy of the proposal form and the said insurance policies are at Exhibit- “1” & “2” to the written statement. It is further contended by the Opposite Party that on intimation of the death claim under the said policies and the same being within 7 months from the issuance of the said policy. The Opposite Party initiated mandatory enquiry in the year 1993 as the claim of the Complainant was early death claim which arose from the policy nos.8917559972 & 8917559973. The Opposite Party further avers that they had called for the particulars in respect of the cause of death, and other details and independent inquiries were also conducted where the insured died and after going through the report of the Enquiry Officer who conducted enquiry it was observed that insured had been taking treatment for maniac-depressive psychosis for many years duly evidence by old prescription of Dr.Lakdawala, the Psychiatrist dated 22/03/1991. Subsequently certificate was issued by the said Psychiatrist stating that he had treated deceased life insured for many years for his maniac-depressive psychosis treatments for his said sickness under the other doctors guidance. Then it was further enquires with his neighbours and relatives revealed that the deceased life insured had been suffering from mental illness and possibilities of suicide cannot be ruled out. The copy of the said claim enquiry report conducted by the Opposite Party is at Exhibit- 3 to the written statement. The Opposite Party further contends that in view of the suppression of non discloser of the illness by a deceased insured at the time of taking out the said policy would render the said policies as null and void. The insured late Mr.A.P.Naringrekar had in his proposal form answered that his health condition was good and that he suffered from no pre-exiting disease. The Opposite Party contends that the said disease the life insured suffered was existing prior to availing the policies. Therefore, the nominees of the deceased life insured were informed about the repudiation of the claim of by their letter dated 18/07/2006. The copy of the said letter dated 18/07/2006 is at Exhibit-“4” to the written statement. It is also averred by the Opposite Party that the deceased insured expired on or about 30/04/1992 and the claim was lodged on 25/06/1992 which was replied by the Opposite Party vide their letter dated 08/07/1992. The copy of the said letter dated 25/06/1992 and 08/07/1992 are at Exhibit-“5” & “6” to the written statement. The Opposite Party averred that inspite of the receipt of the said letter, the nominees of the deceased insured failed and neglected to comply with the requirements called for in the said reply till the year 2006 and therefore, the claim is grossly barred of law of limitation and not maintainable. The Opposite Parties therefore, submitted that there is no deficiency on service on their part and hence, the complaint be dismissed with exemplary cost.
8) We have perused the entire record, so also heard the Ld.Advocate for the Complainant and Legal Officer, Mr.M.V.Damle for the Opposite Party and considered all the rival contentions raised by both the parties. Our findings, observations, reasons are as follows :-
9) On perusal of the documents filed by the Complainant in support of his claim at Annexure-“2” to the complaint is the copy of the Ex-parte decree in favour of the Plaintiff i.e. the present Complainant dated 30/6/1997 passed against Mrs.K.P.Naringrekar & others in Summary Suit No.4089/1993 passed by the Hon’ble Mumbai High Court. Execution proceedings were initiated as decretal amount of Rs.93,235/- remained unpaid. Therefore Chamber Summons being No.1799/03 in the Summary Suit No.4089/1993 was filed against Mrs K.P.Naringrekar & legal heirs seeking directions that the amounts due & payable by the Life Insurance Corporation of India under Policy No.891755972 & 891755973 belonging to late Mr.A.P.Naringrekar be directed to be paid to the Plaintiff towards the satisfaction of the decree obtained by the plaintiff i.e the present Complainant. The said Chamber Summons was allowed vide order dated 9/12/04 wherein a direction was given to the Legal heirs of the late Mr.A.P.Naringrekar to comply with the formalities if any required by the L.I.C. i.e. the present Opposite Party. Copy of the order dtd 9/12/04 passed by the hon’ble Mumbai High Court is at Annexure-“3” to the complaint so also it was observed in the said order that the Complainant is entitled to the claim amount under the life insurance policies being numbers 891755872 & 891755973 of the late Mr.A.P.Naringrekar issued by the Opposite Party as the beneficiary of the said polices. Hence, by virtue of the order dated 09/12/2004 passed by the Hon’ble Bombay High Court wherein the court has decreed that the Plaintiffs i.e. the present Complainant is entitled to the proceeds therefrom. In view of the above observations made by the Hon’ble Mumbai High Court in the said order. Therefore the Complainant is a “Consumer” within the ambit of section 2(1)d of the Consumer Protection Act 1986.
10) The issues which arise for our consideration are that a) Whether the late insured Mr.A.P.Naringrekar was suffering from pre-existing disease i.e.manic-depressive psychosis before availing the policies ? If no what reliefs the Complainant is entitled to ?
11) On perusal of the order dated 26/08/1996 at Annexure –“4” to the complaint passed in the Summons for Judgement no.708/1994 in the said Summary Suit No.4089/1993. Some of the observations made Lordship Mr S.H.Kapadia in the said Summons for Judgement are reproduced hereunder “It is next contended that in the present case, the deceased was a person of unsound mind. In support of the above contention, the defendant has relied upon doctor’s prescription. The said prescription is issued by a psychiatrist. However, Medical certificate has not been produced. In any event, there is no evidence to show that the person was of unsound mind. In the circumstances, there is no merit in the second defence advanced on behalf of the defendant”. The Hon’ble Mumbai Court has already adjudicated upon the said contention that Mr.A.P.Naringrekar was not of unsound mind and had rejected the said Dr’s (psychiatrist) prescription and after considering the material on record concluded that the deceased Mr.A.P.Naringrekar was of sound mind. It is pertinent to note that neither the Opposite Party nor legal heirs of Mr.A.P.Naringrekar challenged the said order dated 26/08/96 in appeal and/or in any Superior Court. Hence the said order has attained finality. The said order is therefore, binding on the Opposite Party/ Legal Heirs of Mr.A.P.Naringrekar. Therefore, the Opposite Party is now estopped from taking up the said plea of late Mr.A.P.Naringrekar being of unsound mind. It appears that the Opposite Party raised this contention only on the basis of the contention raised by the Legal Heirs that the deceased Mr.A.P.Naringrekar was of unsound mind in the Summons for Judgement no.705/04 in the said Summary Suit as reproduced above in the said order passed by Hon’ble Justice S.H.Kapadia. Hence we do not feel the need to go in to the certificate & affidavit issued by the said Dr. Paresh Lakdawala stating that deceased was unsound mind & was under his treatment for 9 to 10 yrs. We are of the view that the Opposite Party has tried to fill in the lacuna by bringing in the certificate and affidavit of the said psychiatrist Dr. Paresh Lakdawala that Mr.A.P.Naringrekar was suffering from Manic Depressive Psychosis since last 9-10 years and was taking treatment for the said disease from him on the basis of the observations reproduced above made by his lordship Justice S.H.Kapadia in the order dated 26/08/1996 We fail to understand why the Legal Heirs of Mr.A.P. Naringrekar did not produce the said certificate and affidavit of the said psychiatrist in the Hon’ble Mumbai High Court in support of their said contention. As our view it was within the knowledge of the said legal heirs of late Mr.A.P.Naringrekar that he suffered from no disease i.e. manic-depressive psychosis. Even otherwise on perusal of the said certificate only the name Avinash is written on the said prescription and no mention of the surname is there on the said prescription. Secondly it is highly inconceivable that a patient i.e. late Mr.A.P.Naringrekar who was allegedly taking treatment for 10-15 years from the said psychiatrist Dr.Paresh Lakdawala no other records except a single prescription dated 22/03/1991 standing in the name of one Mr.Avinash has been produced. The other question which arises in our mind is that can a person suffering from Maniac Depressive Psychosis i.e. of unsound mind work as a typist cum clerk in a bank which requires mental activity ? It is learnt from reliable sources that this disorder is a type of bi-polar disorder arising out imbalance in the brain & the answer to the said question therefore, would be simply No, as banking in our view requires a lot of mental activity and no unsound person can do the same. It is also pertinent to note that at one end the Opposite Party in their written arguments in para no.4 have stated that they learnt about late Mr.A.P.Naringrekar being of unsound mind during the enquiry conducted by the Enquiry Officer and on the other hand state that they learnt about late Mr.A.P.Naringrekar being of unsound mind from the prescription given by his legal heirs Therefore, from the overall appreciation in our opinion this appears to be an after thought on part of the Opposite Party as copies of orders passed by the Hon’ble High Court were served upon them. Further even the claim enquiry report relied upon by the Opposite Party at Exhibit –“3” does not support the case of the Opposite Party as by no stretch of imagination from the said claim enquiry which was conducted by the Opposite Party it could be concluded that the insured late Mr.A.P.Naringrekar was of unsound mind. Further it is also pertinent to note that the document i.e. employees certificate of Dena Bank has been submitted to the Opposite Party by the legal heirs of late Mr.A.P.Naringrekar in response to the question as to when deceased first complain of illness which caused his immediate absence before death and the symptoms complained of, the response of Dena Bank clearly states that it is not applicable. Further the leave record as given by the Dena Bank to the Opposite Party for the period of 1990-1991 indicates that the late Mr.A.P.Naringrekar only took 8 days of privilege leave and no medical certificate was given to Dena Bank. So in our view section 45 of the Insurance Act as contended by the Opposite Party would not be applicable to the present fact and circumstances It is also pertinent to note that the insured died on 30/4/92 & Claim Enquiry was conducted some time in 1993 as seen from the report it was latest to be submitted by 16/08/1993 & repudiation of claims was done on 18/7/06 which is reflected from Exhibit –“7” to the written statement. The Opposite Party is trying to mislead and confuse regarding the dates of claim and repudiation just to cover up its deficiency. However, from Exhibit –“7” to the written statement it is clear that the repudiation of the claims was 18/07/2006. IRDA has prescribed a mandatory period of 6 months for allowing the claim or repudiating the same. In our view doing none would itself amount to deficiency in service on part of the Opposite Party.
12) It is the contention of the Opposite Party that the insured deceased Mr.A.P. Naringrekar had answered the questions while filling the proposal form No. 891755972
Questions Answer
17(a) What has been your usual state of health Good
18. Have you ever suffered from or are you suffering from
(e) Paralysis, insanity, epilepsy, fits of any kind or nervous break
Down or any other disease of the brain or the nervous system ? No
20. Have you consulted a medical practitioner, within the last five years No
For any ailments requiring treatment for more than a week ?
21. Have you remained absent from place of your work on grounds of
Health during the last five years ? No
22.(a) Did you ever have any operation, accident or injury ? No
(b) Have you ever had an electrocardiogram, X-Ray or screening, blood
urine or stool examination ? No
(c) Have you ever been in any hospital, asylum, or sanatorium for
check-up. No
24. Give name and address of your usual medical attendant. No one
in particular
The Opposite Party states that the answer to above were false as they have evidence and reasons to believe that the proposer had prior to taking the policies he was suffering from Manic Depressive Psychosis and taking treatment from Psychiatrist for 9/10 years.
13) Firstly it is pertinent to note that Mr.A.P.Naringrekar had died on 30/04/92 (as admitted in para no.4 & 5 of written statement & written argument of the Opposite Party respectively) and the death claim was lodged on 25/06/1992 by the brother of the insured as the claim was a early death claim within 7 months from the issuance of the policy a mandatory inquiry was initiated by the Opposite Party in 1993. It is also pertinent to note that Opposite Party in W.A in para no.4 contends that while going through the report of the Inquiry officer to conducted inquiry, it was observed that life assured has been taking treatment for maniac depressive psychosis for many years duly evidenced by the old prescription of one Dr.Lakdawala, the Psychiatrist dated 22.03.1991. On perusal of the said claim enquiry report at Exhibit-“3” to the written statement of the Opposite Party there is not a whisper regarding the insured suffering from manic-depressive psychosis On the contrary the report says that the late Mr.A.P.Naringrekar was healthy and had sober habits and was keeping good health and was not unsound mind nor had sought any treatment from any medical practitioner. It is pertinent to note that the Claim Inquiry Report at Ex-‘3’ to the written statement in the column nos.2 of the said report states that late Mr.A.P.Naringrekar was healthy and had sober habits with no sort of deformity, columns nos.7,8 are statements of the neighbours stating that the insured was very friendly and his office colleagues remarked that he was a sincere and efficient worker and the general state of the life assured was good and sound through out and Column nos. 10 states that Mr.A.P.Naringrekar was found lying behind his neighbouring building after the neighbours rushed the spot following allowed thud noise. It was rumored in the area that the accident occurred as Mr.Avinash was on the edge of the terrace trying to adjust to his T.V. aerial. It was also learned that Mr.Avinash had lots of debts to be settled and there is suspicion of suicide in this case. Answer to column No.11 states that deceased left his residence approximately 1 hrs before the accident. Answer to column No.12 states that usually he had no particular medical practitioner to be attended, medical treatment not applicable. Column No.13 states that the diseased was not suffering from any illness or injury as stated above prior to the date of commencement revival of this policy answer to the said column is no not applicable. Column 14 states that whether any Inquest or any postmortem examination was made in connection with the death answer mentioned is yes, details not available. Column No.15 states that whether the deceased was ever admitted in hospital, if so name and case number should be stated answer is no. Column No.18 talks about any prior treatment given to the deceased the history details whether any advise sought by special consultant, the date, when the disease of which the life assured died was first suspected or diagnosed answers mentioned to all these said questions were non applicable. Column No.21 states If the particulars given by any other doctors indicate that some of the doctors had been consulted, give name and address of such doctor/s and obtain particulars of his/her their treatment in writing ? Answer to the said question is nil. Column No.26 states that whether the disease has availed any sick leave or any other kind of leave on the ground of health any time during the period of 3 years before the commencement/revival of the policy, etc. and whether doctor who had given the certificate had treated the decease and whether he is having the relative records and whether deceased was regular in attendance ? Answer to the said question at column no.26 is given by Mr.Pandya, Br.Manager, Dena Bank, Peddar Rd. Branch. As per his knowledge the deceased rarely availed of any leave and he was very sincere and good worker and further he would be able to supply the copies of his leave record only if they are sought in writing by the personal department. Answer to column no.27 states that late Mr.A.P.Naringrekar was service with Dena Bank since last 7 years or more. It is pertinent to note that all the above inquiry was done at the behest of the Opposite Party and the claim enquiry report submitted to the Opposite Party no way support its contention that the late Mr.A.P.Naringrekar was unsound mind. Therefore, it can be safely concluded that late Mr.A.P.Naringrekar was of sound mind with no untoward habit and his death occurred due to a accident. Therefore it can concluded that the questions answered by the insured late Mr.A.P.Naringrekar while availing the Opposite Party policies were true & correct there was no material suppression regarding he suffering from manic-depressive psychosis since last 9-10 years at the time of availing insurance and further even if the said questions in the proposal form were answered falsely it would be of no consequence as death of late Mr.A.P.Naringrekar occurred due to an accident and not due to the said disease which the Opposite Party alleged the late Mr.A.P.Naringrekar of having and suppressing prior to availing the policy.
14) Even if assuming for the sake of arguments that the insured late Mr.A.P.Naringrekar was suffering from manic depressive psychosis and was under the treatment of said psychiatrist for last 9-10 years prior to proposing the policies. It is pertinent to note that it is the contention of the Complainant that Mr.A.P.Naringrekar died in an accident and the police report says to even the Claim Enquiry Report at Ex-“3” to the W.S says so, so also the Opposite Party in para 5 and 4 of their written statement have stated that the corporation also called for the particulars in respect of cause of death and other details but there is no whisper regarding the cause of death of late Mr.A.P.Naringrekar. It appears that the Opposite Party is trying to suppress the cause of the death of late Mr.A.P.Naringrekar. The Complainant contends that the Police Report also says that Mr.A.P.Naringrekar died in an accident. It is also pertinent to note that post mortem was conducted on the insured Mr. A.P.Naringrekar which would establish the cause of death & which the Opposite Party is ceased of as indicated in the Claim Enquiry Report at Ex-“3”in column no.14 and further all the relevant papers were supplied to the Opposite Party by the legal heirs of the insured. Therefore it can be said that Opposite Party being fully aware of the cause death of said insured has tried to side track the cause of death of the said insured. It is further pertinent to note that not a whisper regarding the same is mentioned though admittedly details & particulars in respect of the cause of death were called and to suppress the actual cause of death the said issue has being given colour to it that it was a suicide case, however, there is no evidence to that effect. It is pertinent to note that Opposite Party has no where refuted the contention of the Complainant that the death of Mr.A.P.Naringrekar was not due to an accident. Hence, it can be said that the claim in the present case arose out of the accident of the Insured late Mr.A.P.Naringrekar and not out of any sickness/illness arising from Maniac Depressive Psychosis as alleged by the Opposite Party. Therefore, it can be said that there is no nexus between the cause of death from which the claim arose and had the case being so that the insured was suffering from Maniac Depressive Psychosis as no claim arose out of the said disease the claim cannot be rejected on the said ground even if assuming that the deceased insured had suppressed that he was suffering from Manic-Depressive Psychosis. Therefore, it can be said that since the insured late Mr.A.P.Naringrekar had an accidental death no nexus to any previous ailments, if any suffered by the proposer even if concealed while availing the insurance i.e. proposal of insurance would justify the Opposite Party in taking the stand of repudiating the claim for suppression ofpre-existing disease. However, in view of the above discussion it can be safely concluded that the late Mr.A.P.Naringrekar was of sound mind. The Complainant in support of the said contention that there is no nexus between alleged disorder and death of the insured has produced & relied upon the judgement passed by our Hon’ble State Commission in the case of LIC V/s .Mrs.Pushpa Balkrishna Payar, the judgement passed by the Hon’ble Supreme Court in the case of LIC V/s. Asha Goel reported in 2001 2 SCC 160 & the same in our view are squarely applicable to the case in hand. We are therefore of the view that the Opposite Party is on one or the other pretext is trying to defeat the legitimate claim of the Complainant as beneficiary under said orders passed by the Hon’ble High Court and coming out with lame and flimsy excuses despite being in contempt for non compliance of the order dated 09/12/2004. therefore, we finds substantial force and truth in the contentions raised by the Complainant and feel that the contentions raised by the Opposite Party are false and frivolous and are totally devoid of merit and therefore, we are inclined to reject the same.
15) The judgments produced & relied by the Opposite Party which are reproduced below are not applicable in our view to the present facts and circumstances of the case in hand.
i) II(1992) CPJ493(NC)
(ii) 1997 (1) CPR 40
(iii) 1997(1) CPR42
iv) NATIONALCONSUMER DISPUTES REDRESSA,NEW DELHI life Insurance Corporation of India & Anr. –Appellants Gowri &Ors. Respondents first Appeal No.163 of 1993 Decided on 10.10.1994
16) We are of well considered view that it highly deplorable that the Opposite Party has no respect for the rule of law and has a high handed approach & consider itself above the law & therefore have been in continuous contempt for flouting the several orders passed by the Hon’ble Mumbai High Court. well as the orders passed in the 3 Contempt Petitions filed by the Complainant & further for raising the malafide issue of suppression by insured that he was suffering from manic-depressive psychosis prior to availing the said policies though the same issue had already been adjudicated upon by the Hon’ble Mumbai High Court long back which was within the knowledge of the Opposite Party. It is pertinent to note that the Complainant learnt that the claim had being repudiated on 18/07/2006 when a reply was filed by the Opposite Party in the Contempt Petition No.61/2007 as forwarded by its Advocate letter dated 24/09/2007 where the said repudiation letters dated 18/07/2006 were annexed as exhibits to the Opposite Parties reply therefore the question of limitation would not arise in the present case as the present complaint has been filed on 25/08/2008 within 2 years from the cause of action.
17) In view of the above discussion, it is rather shocking to see the modes, methods, tricks and tactics adopted by the Opposite Party to defeat the legitimate rights of the Complainant under the said policies as beneficiary. We condemn the attitude and approach adopted by the Opposite Party and feel that the Opposite Party is clearly deficient in service. We do not have the slightest doubt in our minds that the Complainant has gone through immense mental agony & till date going through the same as the Complainant was drawn into long drawn litigation right from the year 2004 till date and was so much so constrained that to have his grievances redressed he had to knock the doors of this forum & we therefore feel that the Complainant should be compensated for the same to achieve the need of justice. Hence, we pass the following order :
O RD E R
1.Complaint no.158/2008 is allowed in following terms.
2.Opposite Party is directed to pay an amount of Rs.1,00,000 (Rs.One Lac Only) to the Complainant @ 9 % from 15/12/03 until realization.
3.Opposite Party is directed to pay compensation to the tune of Rs. 15,000/- (Rs.Fifteen Thousand Only) towards mental agony and torture, etc. to the Complainant.
4.Opposite Party is directed to pay Rs.5,000/- (Rs.Five Thousand Only) towards cost of litigation to the Complainant.
5.Opposite Party is directed to comply with this order within 4 weeks from the receipt of the copy of this order. In case of failure to pay aforesaid amount within stipulated period, then the Opposite Party shall be liable to pay interest on Rs.1,00,000/- @ 18 % p.a. until realization of entire amount to the Complainant.
6.Certified copies of this order be furnished to the parties.
