A. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD
FA 100 of 2012 against CC 41/2011 on the file of the District Consumer Forum-1, Visakhapatnam.
Between :
01.Shriram Life Insurance Company Ltd
The Divisional Manager
D. No. 1-83-27/1, Plot no. MIG 53
Sector -5, Double Road, MVP colony
Visakhapatnam – 17.
2. Shriram Life Insurance Company Ltd.,
represented by its Asst. General Manager,
Head office, Door No.3-6-478, III floor,
Anand Estate, Liberty Road, Opp. Indian Bank
Himayat Nagar, Hyderabad-500029. .. Appellants & Ops 1 and 2
And
Maddi Jayalakshmi, W/o Maddi late Mohana Rao,
Hindu, aged 42 years, Household duties,
residing at Sambana Veedhi,
Tekkali Town, Mandal
Srikakulam District.. Respondent/complainant
Counsel for the Appellants : M/s. KRR Associates
Counsel for the Respondent : M/s. A. Rama Rao
Coram ;
Sri R. Lakshminarasimha Rao… Hon’ble Member
And
Sri T. Ashok Kumar .. Hon’ble Member
Wednesday, the Twenty Second Day of May
Two Thousand Thirteen
Common Oral Order : ( As per Sri T. Ashok Kumar , Hon’ble
Member )
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1. The appeal in FA 100/2012 was preferred by the complainant in CC 41/2011 on the file of the District forum I, Visakhapatnam. For convenience sake, the parties as arrayed in the complaint are referred to as under:
2. The brief facts of the complaint are that the complainant’s husband, by name,Maddi Madhava Rao, had taken two Shri Plus policies bearing Nos .LN 110600111522 and LN 110700000514 for Rs.3,00,000/- each from the Opposite party on 20.12.006 and paid Rs.10,000/- towards premium for each policy and that the e date of maturity was 28.12.2011. while the matter stood thus, on 31.12.2006, the complainant’s husband, Maddi Madhava Rao, died at around 9.45 AM due to severe chest pain and by that time he was not given the policies by the Opposite parties. After four months thereof, some staff members of the respondents Insurance company came to her house and enquired about reasons for the death of her husband and that she informed that her husband died of chest pain. They obtained her signature and also of her two sons on two white blank papers promising to pay Rs.6,00,000/- covered under the two policies. Despite their promise, the Opposite party sent only draft for Rs.20,000/- dated 26.04.2007 informing that the balance Rs.6,00,000/- would be paid later but failed to do so in spite of many requests and hence she got issued Legal Notice dated 23.12.2008 to the Opposite parties, for which they gave a reply with false and untenable allegations stating that her husband was suffering from prolonged illness before taking of the policies and the said fact was suppressed and is caused great mental agony to them and it amounts to deficiency in service on the part of the Ops and thus she filed this complaint to direct the opposite parties Opposite parties to pay Rs.3,00,000/- covered under insurance policy pertaining to this case and compensation of Rs.50,000/- besides Rs.30,000/- as costs.
3. The 2nd
The complainant is not a consumer. Admitted taking of two policies and that the complainant is the nominee. It is pleaded that on 1.1.2007 when the representatives of the Opposite party gone to the place of the policy holder to handover the policy related documents and to obtain the acceptance of terms and conditions, they came to know the unfortunate death of the policy holder on 31.12.2006 and so the policy documents could not be handedover to the life assured. Since life assured died before receipt of the policy related documents for his acknowledgement and confirmation of terms and conditions of the policies opted by him, the contract of Insurance has become null and void and not enforceable. During the enquiry, this Opposite party came to know that the deceased Life Assured was having pre-health problems relating to heart since long time and this was confirmed by family members. Thus there is suppression of material fact. When enquired by the complainant, the company made it clear to the complainant that since the insured died even before accepting the policy documents there is no concluded contract and there was failure to disclose his pre-health condition and as such the policy amounts cannot be paid. On such clarification, the complainant on 24.04.2007 gave a letter requesting the company to refund the premium amount of Rs.20,000/- towards full and final satisfaction and she will not have any claim on the policy amount. In view of the request by the complainant, which is witnessed by her two sons, the company has considered the matter on humanitarian grounds and refunded the premium amount of Rs.20,000/- towards full and final satisfaction. After lapse of one year eight months, she sent a letter with false and frivolous allegations that a proper reply on 8.1.2009 was given. The complaint after three years after the death of her husband itself would show malafides on the part of the complainant. For this reasons, there is no deficiency in service on the part of Opposite party and the complaint is liable to be dismissed
4. Both sides filed evidence affidavit reiterating their respective pleadings and Ex. A-1 to A5 were marked on behalf of the complainant and Ex. B -1 to B 9 were marked for the OP.
5. Having heard both sides and considering the evidence on record, the District Forum allowed the complaint and directed OPs tois allowed directing the Opposite parties to pay Rs.3,00,000/- being the Policy amount covered under the two policies to the complainant with interest at 9% from 23.12.2008, the date of Legal Notice till the date of payment, excluding Rs.20,000/- already paid towards refund of premium amount. It is further directed the Opposite party to pay compensation of Rs.25,000/-, which shall be paid within one month from the date of this Order, failing which it shall carry interest at 9% from the date of Order (03.11.2011) till the date of payment. The complainant is entitled for costs of Rs.5,000/- from the Opposite party.
6. In fact, in CC 41/2011 the claim is for Rs.3 lakhs covered under SHRI policy bearing IN 110600111522 of the deceased life assured Maddi Madhava Rao but in the operative portion of the order under Appeal originally Rs.6,00,000/- was typed and subsequently as per orders in IA 382/201 dt. 12.12.2011 the said Rs.6,00,000/- has been substituted with Rs.3,00,000/- but the words “covered under the two polices remained as it is. Hence in the circumstances of the case it is understood that the said Rs.3,00,000/- was ordered to be paid in respect of policy aforesaid only.
7. Feeling aggrieved with the said order the unsuccessful OPs filed this appeal on several grounds and mainly contended that the life assured died before receipt of the policy and therefore as per the agreed terms and conditions it became void and unenforceable and that the District Forum did not consider the said aspect and arrived at a wrong conclusion in allowing the complaint and that after getting clarification from the complainant Ops refunded premium amount of Rs.20,000/- to the complainant towards full and final satisfaction and the same was accepted without any protest but the Forum did not appreciate the said aspect and that the deceased policy holder for wrongful gain malafidely did not disclose the material facts and thereby committed breach of ubrimafied contract and that condonation of delay in filing the complaint with a delay of more than one year vide orders in IA 436/2010 is also not justified. It is further contended by the complainant/Ops that the life assured was on regular treatment for the heart related ailments and was having few more policies from other companies and he did not disclose the said aspects in the proposal form and thus violated the terms of contract of insurance which stands on the principle of utmost good faith and thus prayed to allow the appeal and set aside the impugned order.
8. Heard both sides with reference to their respective contentions in detail.
9. Now the point for consideration is whether the order of the District Forum is sustainable ?
10. There is no dispute that thecomplainant’s husband M.Madhava Rao submitted proposal forms for issuance of two Shri Plus policies bearing Nos .LN 110600111522 and LN 110700000514 for Rs.3,00,000/- each from the Opposite party on 20.12.006 and paid Rs.10,000/- towards premium and that the e date of maturity was 28.12.2011 and that he died on 31.12.2006. Opposite parties contention is that as per their norms the policies will be personally handed over to the life assured under his signatures on the acceptance forms, so as to say that the policy holder has received the policies and understood the terms and conditions thereof and that the details printed are true and correct and that in this case after generating the policies on 01.01.2007 the same were sent to the life assured through their representative with a direction them to hand over the said policies the life assured had obtained the signatures on acceptance form but by the time the said representatives went to the house of life assured they came to know that life assured died on 31.12.2006 due to heart related problems and thus they could not hand over the policies. From the said circumstances it is understood that within three days of submitting the proposal form for issuance of the policy the life assured died. There is no much delay in generating the policies because the effective date of policies was 28.12.2006 and the policies were generated on 1.1.2007. In a decision reported in AIR 1984 SC 1014 between LIC of India Vs. Raja Vasireddy Komalavalli Kamba and others the Hon’ble Supreme court of India held that the contract of insurance will be concluded only when the party whom an offer has been made accepts it, unconditionally, and communicates his acceptance to the person making the offer. In this case, there is no dependable evidence from the side of the complainant that the policies were communicated to the life assured before his death and Ex. B5 blank acknowledgment of the policy supports the same and therefore there is acceptable force in the contention of the opposite parties that there is no concluded contract in this case. That apart, there is clinching documentary evidence from the complainant vide Ex. B8 letter dated 23.4.2007 that she made request for refund of premium amount of Rs.20,000/- under two policies. According to the Ops, the said amount was paid to her towards full and final satisfaction vide Ex B9 and that after lapse of one year and eight months she designed the claim with frivolous allegations and that a proper reply was given to her and that the complainant did not dispute receipt of Rs.20,000/- vide CC No. 110 of 2011 on the file of District Consumer Forum, Srikakulam pertaining to FA 727/2012 being disposed of simultaneously with this appeal. However, she denied such she made a request for refund of Rs.20,000/- aforesaid and pleaded that her signatures were obtained on blank papers. She did not establish with any convincing material that on such blank papers her signatures were obtained by Ops. She did not file any complaint before police or concerned court of law alleging the said aspects nor issue notice to the Ops stating that her signatures were so obtained on blank papers. Her conduct of silence till complaint is filed in the said context improbablizes her plea aforesaid. Therefore, the same is not accepted as true,. Ex. B8 discloses that the complainant issued it and her two sons attested it. The Ops did not place any dependable evidence in support of their contention that the deceased was suffering from ailments much prior to the submission proposal form for issuance of the policy. Therefore, the said ground Is not helpful for the opposite parties. In view of the above discussion, we are of the considered view that claim of the complainant is not sustainable either in law or on facts and therefore the impugned order is liable to be set aside by allowing the appeal.
11. In the result, the appeal is allowed setting aside the order of the District Forum. Parties shall bear their own costs of the appeal.
MEMBER
MEMBER
DATED : 22.05.2013
