Date of filing:16.12.2013
Date of Disposal:13.10.2014
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: ANANTHAPURAMU
PRESENT:- Kumari Y.H.Prameela Reddy, M.A., LL.B., President
Sri S.Niranjan Babu, B.A.,B.L., Male Member
Monday, the 13th day of October, 2014
C.C.NO.62/2014
Between:
A.Lakshmi Devi,
W/o Late Adi Andhra Honnurappa,
D.No.4-57, S.C.Colony,
Kanaganapalli Village & Mandal,
Ananthapuramu District. …. Complainant
Vs.
Life Insurance Corporation of India,
Rep. by its Branch Manager,
Branch Office –II, Subash Road,
Ananthapuramu. …. Opposite Party
This case coming on this day for final hearing before us in the presence of Sri A.Nagarjuna Reddy, Advocate for the complainant and Sri T.Viswanath, Advocate for the opposite party and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:
O R D E R
Sri S.Niranjan Babu, Male Member:- This complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986 against the opposite party claiming a sum of Rs.2,50,000/- towards the sum assured and interest @24% P.A. from the date of death of the deceased till the date of realization and also to award costs of the complaint.
2. The brief facts of the complaint are that: - The complainant’s husband Late Adi Andhra Honnurappa has obtained an insurance policy bearing No.65194800 from the opposite party during his life time with effect from18.05.2009 to 18.05.2039. Subsequently the complainant’s husband died on 30.08.2009 and the policy was in force as on the date. After the death of her husband the complainant being the nominee preferred a claim with the opposite party along with necessary documents for the sum assured. Later the opposite party has addressed a letter dt.07.01.2011 asking the complainant to visit their office and to submit further requirements. Accordingly the complainant visited their office and furnished the necessary documents. The opposite party remained silent with regard to settlement of the claim. Then the complainant addressed a letter dt.09.03.2013 reminding the opposite party about her claim as the opposite party has failed to settle her claim. The opposite party has committed deficiency of service inspite of repeated demands made by the complainant. Then the complainant got issued a legal notice dt.27.06.2013 for which the opposite party has sent a repudiation letter dt.15.07.2013. The complainant having no option filed this complaint against the opposite party claiming a sum of Rs.2,50,000/- with interest @24% P.A. from the date of death of her husband till the date of realization.
3. Counter filed by the opposite party stating that it is true that the deceased Adi Andhra Honnurappa has taken an insurance policy namely New Bima Gold (which covers accident benefit) under table and term No.179-20-10 and the premiums to be paid on monthly basis. The opposite party submitted that the complainant is a nominee for the said policy. Further as per the proposal form submitted by the deceased Adi Andhra Honnurappa as per the statements and replies to question No.11 (A to E,I & J) and signed at the foot of the said proposal form declaring that all his said statements regarding his health and also other particulars form the basis contract of insurance, if any untrue averments were to be found in his statements the contract of insurance shall be absolutely null and void that all the amounts paid in respect thereof shall stand forfeited to the opposite party. The opposite party submitted that basing on the statement of the deceased the opposite party in good faith has accepted the risk on his life and issued an insurance policy for a sum assured of Rs.1,00,000/- under “ New Bima Gold Policy(which covers accidental benefit). As per the complaint the deceased life assured died on 30.08.2009 and as the death claim has come within three months from the date of issue of the policy, the claim was treated as an early claim and an investigation was conducted by the opposite party in order to know the reasons for the death of the deceased life assured. And in course of investigation the opposite party came to know that the deceased life assured was suffering from chest pain, fever, ulcer and leg injury since 2005 itself and he was taking treatment for the above said ailments regularly by availing sick leaves from 23.12.2004 to 18.08.2009 from his office i.e., Andhra Pragathi Grameena Bank, Ananthapuramu as he was working as messenger in the said branch. Basing on the Xerox copy of letter dt.11.07.2007 issued by Dr.V.Narayanappa relating to treatment for viral fever to the deceased is also considered and repudiated the claim of the complainant for suppression of material facts. Hence there is no deficiency of service on the part of the opposite party and they are not liable to pay any amount as claimed by the complainant.
4. Basing on the above pleadings, the points that arise for consideration are:-
1. Whether there is deficiency of service on the part of the opposite party?
2. To what relief?
5. In order to prove the case of the complainant, the complainant has filed his evidence on affidavit and marked Exs.A1 to A7 documents. On behalf of the opposite party, the opposite party filed evidence on affidavit and marked Ex.B1 to B4 documents.
6. Heard both sides.
7. POINT NO.1:- The counsel for the complainant submitted that the complainant’s husband Late Adi Andhra Honnurappa has obtained an insurance policy bearing No.65194800 from the opposite party during his life time with effect from18.05.2009 to 18.05.2039 and the sum assured is Rs.2,50,000/- including accident benefit and the complainant is the nominee to the said policy. The counsel for the complainant submitted that subsequently the complainant’s husband died on 30.08.2009 and after the death of her husband the complainant being the nominee i.e., the present complainant made a claim along with necessary documents to the opposite party. Later the opposite party has addressed a letter dt.07.01.2011 asking the complainant to visit their office to submit further required documents. Accordingly the complainant visited the office of the opposite party and furnished the necessary documents. The counsel for the complainant submitted that the opposite party remained silent without settling the claim of the complainant. Then the complainant addressed a letter dt.09.03.2013 reminding the opposite party about her claim as the opposite party has failed to settle her claim. The counsel for the complainant contended that as the opposite party failed to settle the claim of the complainant under the above policy and caused deficiency of service to the complainant hence, they are liable to pay the sum assured under the policy along with interest @24% P.A. The counsel for the complainant contended that inspite of repeated demands made by the complainant there was no proper reply from the opposite party. Then the complainant got issued a legal notice dt.27.06.2013 for which the opposite party sent a letter dt.15.07.2013 repudiating the claim of the complainant with untenable grounds. The counsel for the complainant contended that the complainant is entitled for the benefits under Consumer Protection Act and the failure of the opposite party in not settling the claim is nothing but deficiency of service. Hence they are liable to pay the sum assured along with interest @24% P.A.
8. In support of his contention he has relied upon the following decisions:
1. I (2014) CPJ 36 (NC) National Consumer Disputes Redressal Commission, New Delhi between Meena Devi Versus Director General/Additional Director General and another.
2. 2010 (2) CPR 375 Delhi State Consumer Disputes Redressal Commission, New Delhi between The Oriental Insurance Company Limited Versus Parveen Maggo.
3. CPJ 2012-1-84 National Consumer Disputes Redressal Commission, New Delhi between Tarlok Chand Khanna versus United India Insurance Company Limited.
4. CDJ 1996 SC 547 Supreme Court of India between B.V.Nagaraju versus Oriental Insurance Company Limited.
9. The counsel for the opposite party submitted that the complainant’s husband has taken an insurance policy for a sum of Rs.1,00,000/- under New Bima Gold Policy (which covers accident benefit) from the opposite party under table and term No.179-20-10. The counsel for the opposite party submitted that the present complainant was shown as the nominee in the proposal form and declared that he was in good health at the time of submitting the proposal form. Further the counsel for the opposite party contended that the replies to question No.11 (A to E,I & J) the deceased has signed at the foot of the said proposal form declaring that all his above statements regarding his health and other particulars form the basis contract of insurance and agreed therein that, if any untrue averments were to be found in his statements the contract of insurance shall be absolutely null and void that all the amounts paid in respect thereof shall stand forfeited to the opposite party. The counsel for the opposite party submitted that basing on the statements and declaration in the above said proposal form dt.17.05.2009 in good faith the opposite party has accepted the risk on his life and issued a policy for sum assured of Rs.1,00,000/- under “ New Bima Gold Policy(which covers accidental benefit). The counsel for the opposite party submitted that the deceased life assured Adi Andhra Honnurappa died on 30.08.2009 within three months from the date of issue of the above policy. Hence the claim of the complainant was treated as an early claim and an investigation was conducted by the opposite party to know the reasons for the death of the deceased life assured Adi Andhra Honnurappa. And in course of their investigation the opposite party came to know that the deceased life assured was suffering from chest pain, fever, ulcer and leg injury since 2005 itself and he was taking treatment for the above said ailments regularly by availing sick leaves from 23.12.2004 to 18.08.2009 from his office i.e., Andhra Pragathi Grameena Bank, Ananthapuramu where he was working as messenger. The counsel for the opposite party contended that the deceased life assured Adi Andhra Honnurappa was availing sick leave from his office and the same was not mentioned in the proposal form at the time of taking the policy. The counsel for the opposite party argued that the deceased life assured Adi Andhra Honnurappa knowing well about taking the sick leave on the ground of ill-health has not disclosed the said information to the opposite party and suppressed the material fact about his ailment and obtained the insurance policy which amounts to cheating. Further the counsel for the opposite party argued that the answer given by the deceased life assured in the proposal form clearly establishes that the deceased has intentionally mislead the opposite party to issue the policy by suppressing the material fact that he has taken sick leave for his ailment. The counsel for the opposite party contended that if the deceased life assured has mentioned the details of his health condition without suppressing the fact then the opposite party might not have issued a policy in favour of the deceased. The insurance contract between the complainant and the opposite party shall become null and void and all the amounts paid to the opposite party by the deceased shall stand forfeited as per condition No.5 of the insurance policy as follows:
Forfeiture in certain events:- In case the premiums shall not be duly paid or in case any condition herein contained or endorsed herein shall be contravened or in case it is found that any untrue or incorrect statement is contained in the proposal, personal statement, declaration and connected documents or any material information is withheld, then and in every such case but subject to the provisions of section 45 of insurance Act,1938, whenever applicable, this policy shall be void and all claims to any benefit in the virtue hereof shall cease and determine and all moneys that have been paid in consequence hereof shall belong to the corporation, excepting always in as far so relief is provided in terms of privileges herein contained or may be lawfully granted by the corporation.
10. The counsel for the opposite party argued that the insurance is a contract entered into with at most good faith and as the deceased life assured mislead the insurer by suppressing his ailment and treatment for them by availing sick leave hence the contract was declared as void abinitio. Further the counsel for the opposite party argued that the opposite party has rightly repudiated the claim of the complainant as there was suppression of material facts by the deceased life assured at the time of taking the policy. Hence there is no deficiency of service on the part of the opposite party and they are not liable to pay any compensation as claimed by the complainant.
11. After hearing the arguments of both sides and perusing the documents it is an admitted fact that the complainant’s husband has taken an insurance policy from the opposite party and the sum assured under the policy is Rs.1,00,000/- as per the policy with a rider of rupees sum assured Rs.1,00,000/- in case of accidental death. The contention of the complainant is not considered because the deceased life assured has taken the policy on 18.05.2009 and died on 30.08.2009 as per the complaint i.e., within three months after taking the policy. As the claim was an early claim the opposite party has made an investigation into the cause of death of the deceased and in their investigation the opposite party came to know that the deceased life assured has taken sick leave number of times from 23.12.2014 to 18.08.2009 from his office i.e., Andhra Pragathi Grameena Bank, Anantapur where he was working as messenger and this is established by the document Ex.B3 which is issued by the Andhra Pragathi Grameena Bank, Anantapur.
12. As contended by the opposite party that the deceased life assured has not disclosed his health condition in the proposal form with fairness and obtained the policy fraudulently from the opposite party by suppressing the fact that he has availed sick leave from his working place number of times. The fact remains that the deceased has willfully withheld the material fact of taking sick leave and taken the policy from the opposite party. The complainant relied on the decision I (2014) CPJ 36 (NC) National Consumer Disputes Redressal Commission, New Delhi where in it was observed that the superior officer of the life assured has certified that as per the medical examination of the deceased life assured he was in medical category AYE/Shape-I which means that as per the last medical examination conducted by the Army authorities, the deceased Shishpal at the time of obtaining the insurance policy was in sound health, but in the present case there is no such certificate issued by the higher authorities of the deceased life assured hence the said decision does not suit to the present case. Another decision 2010 (2) CPR 375 Delhi State Consumer Disputes Redressal Commission, New Delhi is with regard to the medic-claim hence the same is not suitable to the instant case and another decision CPJ 2012-1-84 National Consumer Disputes Redressal Commission, New Delhi the said decision is also with regard to medi-claim, hence the said decision does not suit to the instant case and another decision CDJ 1996 SC 547 Supreme Court of India also does not suit to the present case as it is with regard to the claim of the vehicle but not with regard to the life insurance.
13. The decision filed by the opposite party IV (2008 CPJ 187 (NC) Wherein it was observed that willfully suppressing any material fact at the time of taking the policy and the deceased life assured died within five months of taking the policy but whereas in the instant case the deceased life assured died within three months after taking the policy which is similar to that off the present case and another decision National Consumer Disputes Redressal Commission, New Delhi Revision petition NO.2148/2012 wherein in the questions in the proposal form the deceased life assured has answered.
| Questions | Answers |
11(d) | Are you suffering from or have you ever suffered from ailments pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system? | No |
11(h) | Do you use or have you ever used alcoholic drinks, narcotics, or any other drugs? | No |
11(i) | What has been your usual state of heath | Good |
In the present case also the deceased life assured has answered negatively in the proposal form for question No.11(A to E,I & J) which clearly shows that the deceased life assured knowing well that he was suffering from some ailment did not disclose intentionally for wrongful gain from the opposite party and suppressed the material fact at the time of taking the policy. Hence we are of the view that the opposite party has rightly repudiated the claim of the complainant and there is no deficiency of service on the part of the opposite party. In the above circumstances the opposite party is not liable to pay the sum assured under the policy to the complaina.t
14.POINT NO.2 – In the result, the complaint is dismissed without costs.
Dictated to Steno, transcribed by him, corrected and pronounced by us in open Forum this the 13th day of October, 2014.
Sd/- Sd/-
MALE MEMBER, PRESIDENT
DISTRICT CONSUMER FORUM, DISTRICT CONSUMER FORUM,
ANANTHAPURAMU ANANTHAPURAMU
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
ON BEHALF OF THE COMPLAINANT: ON BEHALF OF THE OPPOSITE PARTY
-NIL- -NIL-
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Ex.A1 Photo copy of the policy bearing No.651949800 issued by the opposite party in favour of the deceased Adi Andhra Honnurappa
Ex.A2 Letter dt.07.01.2011 issued by opposite party to the complainant.
Ex.A3 Letter dt.09.03.2012 submmittd by the complainant to the opposite party.
Ex.A4 Postal acknowledgement signed by the opposite party.
Ex.A5 Office copy of the legal notice dt.27.06.2013 got issued by the complainant to the opposite party.
Ex.A6 Postal acknowledgement signed by the opposite party.
Ex.A7 Repudiation letter dt.15.07.2013 issued by the opposite party to the counsel for the complainant.
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE EPARTY
Ex.B1 Original proposal form submitted by the deceased Adi Andhra Honnurappa to the opposite party.
Ex.B2 Original policy bearing No.651949800 issued by the opposite party in favour of the deceased Adi Andhra Honnurappa.
Ex.B3 Sick leaves relating to deceased Adi Andhra Honnurappa issued by the Andhra Pragathi Grameena Bank, Anantapur.
Ex.B4 Photo copy of Medical certificate dt.11.07.2007 relating to the deceased Adi Andhra Honnurappa issued by Dr.V.Narayanappa.
Sd/- Sd/-
MALE MEMBER, PRESIDENT
DISTRICT CONSUMER FORUM, DISTRICT CONSUMER FORUM,
ANANTHAPURAMU ANANTHAPURAMU
