This C.C. is coming on before us for final hearing in the presence of Sri D.Sudhakar Rao, Advocate for the complainant; and of Sri.K.Jagan Mohan Rao, Advocate for opposite parties; upon perusing the material papers on record; upon hearing the arguments and having stood over for consideration this forum passed the following:
ORDER
(Per Sri R. Kiran Kumar, Member)
This complaint is filed u/s.12-A of Consumer Protection Act, 1986 to direct the opposite parties to pay Rs.2,00,000/- towards death benefits of the father of complainant under the policy No.687602994 along with interest accrued thereon, to award damages of Rs.50,000/- for causing mental agony and to award costs.
2. The averments made in the complaint are that the complainant is daughter of late Gandepalli Suryanarayana, who insured his life with opposite party No.1 vide policy bearing No.687602994 at Badrachalam branch office, commencing from 28-3-2006 and the same will be matured on 28-3-2025, for a period of 20 years. At the time of taking the policy, the authorities of opposite party No.1 have verified the health condition of deceased, Suryanarayana by their panel doctors, thereafter issued the policy in his favour. The complainant submitted that her father suffered with severe chest pain and suffered with breath problem on 31-7-2006, immediately he was shifted to Govt. General Hospital, Kakindada and while undergoing treatment, he died on 31-7-2006.
3. It is submitted by the complainant that after the demise of her father, she obtained requisite documents for claiming death benefits of her father, under the above said policy and submitted the same to the authorities of opposites parties on 24-1-2007. The complainant made several rounds to the office of the opposite party No.1 for payment of death claim of her father, but they are postponing the same under one pretext or the other. Vexed with the attitude of opposite parties, the complainant got issued a legal notice on 6-5-2009 demanding the opposite parties to settle the death claim of her father and to pay the assured amount of Rs.2,00,000/- with interest accrued thereon, as per the terms and conditions of the policy herein. Inspite of receipt of notice, on 1-6-2009 the opposite parties gave reply requesting to bear the delay, since it is under process. But they failed to settle the death claim of her father inspite of lapse of one-month time. Hence, the complaint.
4. In support of her complaint, the complainant herself filed affidavit, reiterating the contents of the complaint.
5. On receipt of notice, the opposite parties appeared through their counsel and filed written version, submitted that the father of complainant had obtained insurance policy bearing No.687602994, for sum assured Rs.2,00,000/-, the same was commenced from 28-3-2006. It is further submitted by the opposite parties that on receipt of intimation received by Badrachalam branch office of opposite parties corporation, the above said life assured died on 31-7-2006, since the death of life assured occurred within 4 months of the date of commencement of the policy, treating the claim as EARLY, as per rules of the opposite parties corporation, and investigation was caused into the bonafides of the claim.
6. The opposite parties further submitted that during the investigation, it came to light that the deceased/ life assured had suppressed the material fact of his age and understated the same by 14 years, insurability of a person is decided on the basis of his age, which is the PILLAR of Life Insurance Contract, the age factor has more significance in life insurance than in General Insurance. By believing the study certificate issued by the Manager & Correspondent of Aided Elementary school, Gangolu, which is submitted by the insured, the LIC issued a policy for a sum assured of Rs.2,00,000/-. During the investigation caused into the bonafides of the claim, it is transpired that the name of the above said Aided Elementary school was later on changed as Mandal Praja Parishad School, Gangolu, Dummugudem Mandal of Khammam District and the Head Master of the Mandal Praja Parishad School has stated in their letter dt.7-10-2009 that the above said life assured i.e. Gandepalli Surya Narayana, S/o. Naganna, was not admitted at MPPS, Gangolu as per Admission register and also as per school records. The opposite parties submitted that the letter of Head Master, MPP school Gangolu confirms that the certificate was a fake one.
7. The opposite parties further submitted that as per the case sheet pertaining to IP No.274951 of OCCU/CARD WARD of Govt. General Hospital, Kakinada, which is attested by the Resident Medical Officer of the said hospital, the age of the patient bearing IP No.274951 is shown as 64 years Male and his name as Gandepalli Suryanarayana, which clearly shows that the deceased life assured had suppressed his age by 14 years i.e. produced a fake study certificate showing his age at the time of taking the policy as 50 years as against his actual age of 64 years, so as to obtain a high sum assured life insurance policy on his own life from their corporation. The opposite parties further submitted that the death report in Form No.2, dt.31-7-2006 of Kakinada Municipality, clearly shows the age of the deceased person as Sri Gandepalli Suryanarayana, and his age is shown as 64 years and the IP NO.274951 of Govt. General Hospital, Kakinada exactly tallies with the records of said hospital. After fully applying their collective wisdom and on perusal of evidence on record, have taken a decision to repudiate the claim under the above said policy and communicated the same to the complainant by addressed a letter, dt.10-10-2009. Hence, there is no deficiency of service and prayed to dismiss the complaint with costs.
8. To substantiate the claim, the complainant filed the following documents and the same were got marked as Exs.A.1 to A.8.
Ex.A.1 - Photocopy of death certificate, dt.23-8-2006
issued by Kakinada Municipality.
Ex.A.2 - Copy of policy issued by the opposite party No.1 vide policy
No.687602994 assured for Rs.2,00,000/-, dt.28-3-2006.
Ex.A.3 - Photocopy of death claim application along with affidavit
sent to the opposite party No.2 through opposite party No.1,
dt.24-1-2007.
Ex.A.4 - Office copy of legal notice.
Ex.A.5 - Postal receipts and postal acknowledgment.
Ex.A.6 - Reply notice issued by opposite party No.2, dt.1-6-2009.
Ex.A.7 - Record sheet bearing Admission No.36
Ex.A.8 - Dhruveekarana (certificate) issued by Head Mistress, MPP
School, Gangolu, Dumugudem Mandal, Khammam District.
9. Apart from the above documents, the complainant also filed written arguments.
10. On behalf of the opposite parties, R.W.1, Head Mistress, MPP School, Gangolu was examined, during the evidence of R.W.1, got marked Exs.B.1 and B.2, along with the above documents, the opposite parties also filed Exs.B.3 to 6.
Ex.B.1 - Certificate issued by Head Master, M.P.P. School, Gangolu,
Dummugudem Mandal.
Ex.B.2 - Attested copy of Register of admission,
Ex.B.3 - LIC proposal for insurance.
Ex.B.4 - Study certificate issued by Manager & Correspondent, Aided
Elementary School, Gangolu.
Ex.B.5 - Attested copy of case sheet issued by Govt. General Hospital,
Kakinada.
Ex.B.6 - Attested copy of death intimation informed by Civil Surgeon,
Govt. General Hospital, Kakinada.
11. Upon perusing the material papers on record, now the points that arose for consideration are,
- Whether the assured had suppressed the material facts pertaining to his age mentioned in the proposal form, consequently the complainant is entitled for the claim amount covered under the policy?
- To what relief?
POINT No.1:-
12. It is the case of complainant that her father had obtained insurance policy bearing No.687602994 at Badrachalam branch office, commencing from 28-3-2006 and the same will be matured by 28-3-2025, for a period of 20 years. After satisfying with the report of his health condition issued by the panel of doctors, the opposite party No.1 issued policy and after that her father attacked the severe chest pain and breath problem on 31-7-2006, immediately he was shifted to Govt. General Hospital, Kakindada and while undergoing treatment, he died on 31-7-2006. After the demise of her father, she obtained requisite documents for claiming death benefits, under the above said policy and submitted the same to the authorities of opposites parties on 24-1-2007, but they did not settle and postpone the same under one pretext or the other. Vexed with the attitude of opposite parties, she got issued a legal notice on 6-5-2009 demanding the opposite parties to settle the death claim of her father. On receipt of notice, on 1-6-2009 the opposite parties gave reply requesting to bear the delay, since it is under process.
13. In the written version filed by opposite parties, they submitted that the claim of complainant is an early claim and in their investigation they found that father of complainant produced a fake study certificate vide admission No.36, dt.16-6-1962 regarding his age and understated the same by 14 years.
14. To support their contention, the opposite parties examined R.W.1 and got marked Exs.B.1 and B.2. Ex.B.1 is the certificate issued by Head Mistress, dt.09-12-2010 and Ex.B.2 is the photocopy of admission register bearing No.136 to 698(first page).
15. In the evidence of R.W.1, she deposed that earlier she had worked as Head Mistress at Gangolu from 25-8-2009 to 17-9-2010, on oral request of opposite parties, she issued certificate, Ex.B.1, earlier 1979 their school was under the name of Aided Elementary School and after 1979 it was named as Mandal Praja Parishad School and further deposed that the study certificate shown by the opposite parties has not been issued by their school, the same was confirmed by verification of admission register of the school and certified that it is a fake study certificate. To the surprise, in her cross-examination, she admitted that she had not filed any enquiry report to say that the certificate, Ex.A.8 is a fake one, she is not concerned with regard to the Aided Elementary School and also admitted that she committed a mistake in certifying Ex.B.1 is fake certificate and also stated that Ex.B.2 contains Sl.No.136 onwards, earlier to this record may be somewhere else, but she does not know where it is. From the above evidence of R.W.1 and Ex.B.1 goes contrary to their own plea of opposite parties.
16. Moreover, opposite parties had accepted the age of the father of the complainant is 50 years while issuing the policy, they cannot now turn around and repudiate the insurance claim alleging that the father of the complainant understated his age. The opposite parties panel doctor examined the father of the complainant at the time of taking the policy. The same was observed by the Hon’ble Supreme Court of India in the judgment in P.C.Chako and another Vs. Chairman, Life Insurance Corporation of India and others IX (2007) SLT 533 page, in which the judgment of Hon’ble Calcutta High Court reported as Allianz and stuttgarter Life Insurance Bank Ltd., Vs. Hemanth Kumar Dass AIR 1938, Calcutta 641 in which the Hon’ble Calcutta High Court held as under:
“ It is to be born in mind that this was an insurance by a man who admittedly was, at any rate, at the age of over forty five years. He himself stated that he was fifty-four years. Therefore, the transaction came within the category of those proposals, which require at the outset the furnishing by the proponents of proof of their age. Noot Bnehari Das was required to furnish proof of his age. He produced a horoscope. The horoscope was acted by the company as being sufficient. Therefore, we may take that the company issued the policy upon the footing that they were insuring the life of a man whose age was fifty-four. This is not a case where the proposer says that his age was fifty four and the company merely accepted that statement at its face value and proceeded to issue a policy on that footing and subsequently, either shortly afterwards or a long time afterwards, admitted the age as stated in the policy in accordance with the provisions of Clause 9(2) thereof. This was a case where the whole transaction from the very beginning proceeded upon the basis that the company had satisfied themselves that the proposer was of the age of fifty-four and then issued the policy accordingly. In my view therefore the admission contained in the endorsement at page 3 of the policy is of such a character that the defendants when the policy matured could not be heard to say that the age of the insured was anything different from what he himself had stated it to be in February 1934. It is not necessary that one should apply in terms of the principle of estoppel, because that is merely a rule of evidence. In my view, this matter goes far deeper than that. The question of the age of the deceased was a definite and determining factor in the transaction from the very outset.”
17. Therefore, neither the father of the complainant had understated his age nor the opposite party company can repudiate the claim on its basis. This point is answered accordingly in favour of the complainant.
Point No.2:
18. In the result, the complaint is allowed in part directing the opposite parties to pay Rs. 2,00,000/- (Rupees two lakhs only) covered under the policy bearing No.687602994, together with interest @ 9% P.A. from date of claim i.e. 24-1-2007 till the date of realization and also directed to pay Rs.5,000/- towards costs of the litigation.
Dictated to steno, transcribed by her, corrected and pronounced by us in the open forum, on this 30th day of November, 2011.
PRESIDENT MEMBER
DISTRIC CONSUEMR FORUM,
KHAMMAM
APPENDIX OF EVIDENCE
Witnesses examined for complainant: None
Witnesses examined for opposite parties:
R.W.1 - B.Sukeerthanamma
Exhibits marked for Complainant:
Ex.A.1 - Photocopy of death certificate, dt.23-8-2006
issued by Kakinada Municipality.
Ex.A.2 - Copy of policy issued by the opposite party No.1 vide policy
No.687602994 assured for Rs.2,00,000/-, dt.28-3-2006.
Ex.A.3 - Photocopy of death claim application along with affidavit
sent to the opposite party No.2 through opposite party No.1,
dt.24-1-2007.
Ex.A.4 - Office copy of legal notice.
Ex.A.5 - Postal receipts and postal acknowledgment.
Ex.A.6 - Reply notice issued by opposite party No.2, dt.1-6-2009.
Ex.A.7 - Record sheet bearing Admission No.36
Ex.A.8 - Dhruveekarana (certificate) issued by Head Mistress, MPP
school, Gangolu, Dumugudem Mandal, Khammam District.
Exhibits marked for opposite parties:
Ex.B.1 - Certificate issued by Head Master, M.P.P. school, Gangolu,
Dummugudem Mandal
Ex.B.2 - Attested copy of Register of admission,
Ex.B.3 - LIC proposal for insurance.
Ex.B.4 - Study certificate issued by Manager & Correspondent, Aided
Elementary School, Gangolu.
Ex.B.5 - Attested copy of case sheet issued by Govt. General Hospital,
Kakinada.
Ex.B.6 - Attested copy of death certificate issued by Kakinada
Municipality.
PRESIDENT MEMBER
DISTRIC CONSUEMR FORUM,
KHAMMAM
