BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 28/2012.
THIS THE 7th DAY OF DECEMBER 2012.
P R E S E N T
1. Sri. Pampapathi B.sc.B.Lib. LLB PRESIDENT.
2. Sri. K.H. Sri Ramappa, B.A.LLB. MEMBER.
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COMPLAINANT :- Shakshawali S/o. isaq Sab Age: 25 years, Occ:
Business, R/o. Near Kort Sab house, Basava Reddy Galli, Maski, Tq. Lingasugur, Dist: Raichur.
//VERSUS//
OPPOSITE PARTIES :- 1. Mrs. Roopa R. Hiremath, Agent, C/o. Shriram
Life Insurance Company Ltd., Branch Sindhanoor, No. 6-1-2995, Kustagi Road, Dist: Raichur.
2. The Asst. General Manager, Shriram Life
Insurance Company Ltd., # 3-6-478, Anand Estates, 3rd floor, Liberty Road, Himayatnagar, Hyderabad, 500 029 (AP).
CLAIM : For to award an amount of Rs. 2,90,000/- with
death benefits of the policy of late Isaq Sab, to pay an amount of Rs. 50,000/- towards deficiency in service and cost of Rs. 10,000/- with other reliefs, as deems fit to the circumstances of this case.
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Date of institution :- 13-04-12.
Notice served :- 04-05-12.
Date of disposal :- 28-09-12.
Complainant represented by Sri. T.M. Swamy, Advocate.
Opposite No-1 Ex-parte.
Opposite No- 2 represented by Sri. Yadavendra Katti, Advocate.
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This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.
JUDGEMENT
By Sri. K.H. Sri Ramappa, Member:-
This is a complaint filed by complainant Shakshawali against opposite Shri Ram Life Insurance Company Ltd., U/sec. 12 of Consumer Protection Act seeking direction to the opposite to pay assured sum of Rs.2,90,000/- under the Insurance policy, and also claimed compensation towards mental agony and litigation expenses.
2. The brief facts of the complainant’s case are that, the complainant is the son of Isaq sab who obtained the Insurance policy bearing No. LN 051000025421 with opposites for sum assured of Rs. 2,90,000/- and paid yearly premium of Rs. 30,000/- for a term of 10 years and submitted proposal. Accordingly the admitting the proposal opposites to issue policy through letter dt. 15-09-2010 along with policy schedule premium receipt etc., and the complainant is the nominee of the said policy. it is the further case of the complainant that, the policyholder has suffered from chest pain on 12-12-2010 immediately he was hospitalized at Annapurna Nursing Home, Maski, and he passed away on the same day due to heart attack and death was intimated to the opposites. Further, claimed made by the complainant by furnishing all required documents and requested for the settlement of the claim. But opposite No-2 repudiated the claim of the complainant on flimsy grounds stating that, the life assured had suppressed the actual age and same was not disclosed at the time of submitting the proposal. Further, the complainant alleged that, opposite No-1 after satisfying the particulars and documents submitted by the proposal on 26-06-2010 as endorsed the same on the proposal form and recommended the opposite No-2 for acceptance of the proposal and issuance of the policy to the policyholder. Hence now opposite No-2 cannot turn down the claim of the complainant on the flimsy ground by relying the voters list of the policyholder the age determination and opposite parties have failed to collect school records etc., if any with regard to proof of age at the time of acceptance of policy. The complainant further contended that, the policyholder has not suppressed is actual age, as his knowledge and the opposite parties have issued policy on 15-09-2010 after satisfying the particulars and documents submitted by the life assured on 26-06-2010. hence repudiation made by the opponent No-2 is unlawful without any basis and it cannot be sustained under law and even the amounts offered to pay to the complainant is very meager and acts of the opposites nothing but deficiency in service, negligence and unfair trade practice and complainant is entitled for 100% death benefits with interest under the policy. On these grounds the complainant prayed for allowing the complaint with a direction to the opposite parties to pay sum assured of Rs. 2,90,000/- with benefits and interest under the policy and also prayed for compensation of Rs. 50,000/- towards harassment and Rs. 10,000/- towards the cost of the proceedings.
3. Opposite No-1 Insurance agent of Opposite No-2 remained Ex-parte. Opposite No-2 Insurance Company Sri. Ram life Insurance Company Ltd., appeared in this case through its Advocate filed its written version by contending that, the Isaq sab who is the son of the complainant submitted a proposal for insurance on 26-06-2010 to the opponent company proposing for Sri. Ram Shri Vikas II unit Link Plan policy. Based on the statements and declarations made in the proposal form by the life assured the opponent company issued a policy bearing No. LN 051000025421 with opposites for sum assured of Rs. 2,90,000/- and receiving yearly premium of Rs. 30,000/- for a term of 10 years. Further opponents admitted that, on 13-01-2011 the complainant has submitted the death claim to the opponent company intimating said demise of life assured on 12-12-2010. The opponents further contended that, as the death of life assured within a short period of taking the policy, and internal investigation was carried the investigator collected voters list and in which the date of birth of life assured was recorded as 70 years which it was evident that, the life assured had fraudulently suppressed his correct age at the time of singing the proposal form and proposal was accepted based on the answers, statements and declarations provided by the life assured and if the life assured had disclosed old age then the age mentioned in the proposal form the opposites would not have accepted risk on the life of the policyholder and would not have issued subject policy to him, and as per the terms and conditions of the policy in case it is found that, any untrue or in accurate or if any matter that might influence the terms of this proposal is not disclosed the contract shall be absolutely null and voild and all premiums so far paid in respect of this contract shall stand forfeited to the company and nothing is payable under the policy. On the grounds of misrepresentation and suppression of material facts at the time of affecting the policy by the life assured, opponents company had repudiated the claim of the complainant vide its letter dt. 13-10-2011 by explaining reasons to the complainant. Under these circumstances the opponents submitted that, no cause of action had arose to file this complaint and there was no deficiency in service on their part and present complaint is not maintainable and deserves to be dismissed with cost.
4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that:
1. Whether the complainant proves that, there is a deficiency in service on the part of the opponents in repudiating his claim.?
2. What order?
5. Our findings on the above points are as under:-
(1) In affirmative.
(2) As discussed in the body of this judgement and as noted in the final order.
(3) In-view of the findings on Point Nos. 1 & 2, we proceed
to pass the final order for the following :
REASONS
POINT NO.1 :-
6. To prove the facts involved in these two points, affidavit-evidence of the complainant was filed, who is noted as PW-1. The documents Ex.P-1 to Ex.P-15 are marked and closed his side. Opposite No-1 is placed Ex-parte. Opponent No-2 has filed affidavit-evidence as RW-1. Documents marked at Ex. R-1 to R-6 and closed its side.
7. On the material placed by the parties on record and the argument advanced by the counsels appeared for the parties it is evident that, the complainant is the son of Isaq Sab S/o. Imam Sab who opted the Sri. Ram Shri Vikas II unit Link Plan policy bearing No. LN 05100025421 with opponents for sum assured of Rs. 2,90,000/- and paid yearly premium of Rs. 30,000/- which will be matured on 15-09-2020. On admitting the proposal submitted by the life assured and complainant is the nominee of the said policy. The policyholder died due to sudden heart attack on 12-12-2010 during the currency of the policy. As a nominee the complainant had made claim along with necessary documents with opponents. But opponent No-2 has repudiated his claim by its letter dt. 30-10-2011 on the ground of misrepresentation of his age and policyholder fraudulently has not disposed the correct age and suppressed the material facts by explaining reasons. Similar contentions have been put forwarded at length in its written version. The main ground urged by the opponent No-2 is that, the life assured was the old aged of 70 years as per Ex.R-6 voter list which collected from the concerned authority from the investigator who appointed by the opponent No-2 Company and mentioning the wrong age in the proposal life assured obtained the policy. We perused the voter list Ex.R-6 which obtained on 01-01-2011. The date of proposal is on 07-07-2010 and the birth date mentioned in the policy as on 01-01-1955, which clearly establishes that, the life assured age was 55 years at the time of proposal and at the time of obtaining the voter list from the concerned authority the life assured was died. The opponents have not placed affidavit of the investigator and the villagers to confirm the correct age of life assured. Opponent No-1 who is the agent has not filed his affidavit to clarify his correct age. The voter list is only to find out if the person was major or not and to cast his vote. The voter list cannot be treated as a conclusive proof of actual age mentioned therein of the person. On such evidence the opponent could not come to the conclusion that, the actual age of life assured at the time of taking the policy was stated to be 70 years and the voter list cannot be relied upon as conclusive proof of age. The complainant has produced copy of discharge voucher for fund value which clearly established that, the opponent company has made offer to pay fund value of Rs. 18,106/- to the complainant on the repudiation of policy and called upon the complainant to submit the same with signature and attestation. But no explanation by the opponent that, on what basis and authority they have offered to pay the fund value to the complainant. It means that, the opponent No-2 had admitted the validity of the age giving by the life assured. Besides the counsel appeared for the complainant has relied a decision of the Hon’ble National Commission reported in: II 2011 CPJ at page 249 NC, wherein it has categorically held that, suppression of age by insurer is not considered as a suppression of material facts by confirming order of the District Forum. It is important to note that, heart failure is sudden and same was not chronic. It is well settled law that, once the insurance company accepted the age of life assured they has no right to repudiate the insurance claim by alleging age given to be different than that. It is also settled law that, once the policy was issued in the name of policyholder and same was accepted, a duty cast on the insurance company to settle the claim after received the death intimation, the denial of genuine claim will undoubtedly defeat the very purpose of taking the insurance cover. In case of death before the end of policy term sum assured or value of the units whichever is higher in the life assured’s unit account is payable to the nominee as per the terms of the policy at Ex.R-3 as quoted at the head notes of Benefits of payable. It means the opponent NO-2 is liable to pay sum assured of the policy with benefits to the nominee who field this complaint. Under these circumstances and on the ration laid down by the Hon’ble National Commission, we are of the considered view that, the claim has been repudiated on the basis of whimsical and self contradictory grounds without verifying the legal aspects and there is a deficiency in service on the part of the opponent No-2 and opponent No-2 is liable to pay sum assured of the policy with benefits to the complainant and also liable to pay compensation of Rs. 5,000/- towards the hardship, inconvenience and mental agony, Rs. 2,000/- towards the cost of the proceedings. Opponent No-1 is the agent of the opponent No-2 and the complainant was not alleged deficiency in service on the part of the opponent No-1 and the complaint deserves to be dismissed against the opponent No-1 as the claim repudiated by the opponent No-2 and no deficiency in service on the part of the opponent No-1. Hence we answered Point No-1 in affirmative and proceed to pass the following order
ORDER
The complaint filed by the complainant U/sec. 12 of C.P. Act is partly allowed with cost.
The opponent No-2 is order to pay Rs. 2,90,000/- with benefits under the policy bearing No. LN 051000025421 with interest at 9% p.a. from the date of the repudiation of the claim till its realization.
Opponent No-2 is directed to pay Rs. 5,000/- towards the hardship, inconvenience and mental agony, Rs. 2,000/- towards the cost of the proceedings.
Complaint is dismissed against the opponent No-1.
Granted six weeks time to the opponent No-2 to comply the above said sum.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 07-12-12)
Sri. K.H. Sri Ramappa Sri. Pampapathi,
Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur.
