This case is coming for final hearing on 25-07-2014 in the presence of Sri M.V.S.Rama Rao, Advocate for the Complainant and Sri Sanapala Karuna Advocate for Opposite Parties called absent and having stood over till this date, the Forum delivered the following.                                                                                                                                             

: O R D E R :

(As per Smt. K.V.R.Maheswari, Honourable President(FAC) on behalf of the Bench)

1. The case of the complainant is that during the life time of deceased Policy holder i.e. Smt.Pathalam Appalakonda took a Life Insurance Policy on 16.02.2011 under Policy Ref.No.004717215 from 1^st Opposite party’s branch and the 1^st Opposite party satisfied with the information furnished by the deceased Life Assured issued Policy after due verification and the complainant is a Nominee. While so the said Pathalam Appalakonda i.e. Life Assured expired on 30.04.2011 due to cardiac arrest. The complainant submitted Claim Form on 4.4.2012 with the Opposite parties and the Opposite party issued a letter on 30.04.2012 stating that the deceased is aged more than what is stated in the policy. Hence, the complainant again claims the Policy amount. The complainant stated that the officials of the Opposite parties are satisfied with the particulars of the deceased and also verified the proof of age by Voter ID Card and more over the deceased was an illiterate as such the Date of Birth will be based only on the basis of ration card and voter ID. Because of Non-settlement of claim by the Opposite party, the Complainant issued a Regd Lawyer’s Notice on 26.05.2012 to all the Opposite Parties and the same were received by them and issued a Reply on 8.8.2012 with false allegations. The action of the Opposite parties in not settling the claim clearly shows the deficiency of service on the part of the Opposite Party. Hence this complaint to direct the Opposite Parties

   a)       to settle the claim amount of Rs.1,20,000/- with 24% interest from the date of filing the complaint

   b)       to pay Rs.50,000/- towards compensation besides costs.

2. On the other hand, the Opposite Parties filed their Counter and denied all the allegations mentioned in the Complaint and pleaded that the complaint does not fall within the definition of a ‘consumer dispute’ under C.P.Act as there is neither any unfair trade practice by the Opposite Party nor any deficiency in service. The claim made by the Complainant was repudiated by the Opposite party for reason of mis-representation of material facts by the Deceased Life Insured at the time of making the proposal. In Kaur Sandhu Vs. New India Assurance Co. Ltd., (2009) 8 SCC 316, has referred the term “Proposal Form” as defined under the Insurance Regulatory and development Authority, 2002 as a “Form” to be filled in by the proposer for Insurance, for furnishing all material information required by the Insurer to decide whether to accept or to decline. The Opposite Party further stated that in Life Insurance Corporation of India V.Yogendra Prasad Singh, R.P.No.692 of 2006, wherein Insurance cover was offered to the deceased who at the time of taking the policy stated his date of birth to be 18.10.1950, when he expired after paying only the third premium and a claim was lodged by his son, the Petitioner set in motion an enquiry with regard to the correct age of the Life assured.

3. The Opposite party came to know that the Complainant was born on 1.5.1954 as per the School records, to this effect a letter dt. 30.11.2000 was produced from the Head Master, Govt High school, Harnaut, Nalanda. The Opposite Party relied upon another Judgement in Life Insurance Corporation of India & Ors Vs. Asha Goel (Smt.) & ‘Anr. (2001) SCC 160, wherein it was held that the contract of Insurance including the contract of life assurance are contracts uberrima fides and every facet of material must be disclosed otherwise there is good ground for rescission of the contract.

4. The non-disclosure of the material facts by the Life assured is a sufficient ground for repudiation and as per Division Bench of Hon’ble Andhra Pradesh High Court in LIC of India Vs. B.Chandravathamma, Air 1971 AP 41 reiterated the same that the proposal, the personal statement and the Life Insurance Policy all contain a special clause putting the Insured on notice that in case of any deliberate misrepresentation, the contract of insurance would become void and the amounts paid there under shall be forfeited. The deceased Life Insured after completely understanding the terms and conditions of the Insurance Product voluntarily applied for an Insurance Policy vide Proposal Form and signed on 16.02.2011 and the daughter of the deceased life insured was proposed nominee for the policy amount of Rs.1,20,000/- which a annual premium amount of Rs.8,130/- for a term of 20 years. The deceased Life Insured mentioned his date of Birth as 15-08-1955 and also submitted consent letter form Non-Standard Proof and the consent letter for declaration of Age for her age proof, wherein he stated that the current age at the time of signing the application is 55 years. Accordingly the Opposite party issued policy which is commencing from 18.02.2011. subsequently on 9.4.2012 the Opposite parties received Death Claim intimation along with along with the Claimant’s Statement and medical attendance certificate and Death Certificate whereby the Opposite Party understand that the deceased Policy Holder died on 30.04.2011 due to Heart attack and in that statement it was mentioned that deceased Life Assured was 57 years of age at the time death.

5. After receipt of the death claim by the Complainant, the Opposite Parties conducted the investigation. As per the version of the complainant, the deceased Life Insured date of birth was 1955 i.e. as 56 years at the time of death and as per the Voter Id card No.KJA1294665, DLI’s age 48 years as on 2003 i.e. DLI’s age was 56 years at the time of death. But during the investigation it was revealed that the complainant submitted another Voter ID No.JZB1094556, wherein it is stated that DLI was 63 years as on 2003. According to that his age was 71 years at the time of death. It was further verified and revealed that Voter ID KJA1294665 which was submitted at the time of application as neither existed in the list nor in the voters list of the village. But JZB1094556 that was matching. The Opposite parties further stated that the DLI was old lady who was beneficiary of old age pension. Thus the DLI submitted a tampered age proofdocument at the time of filing the application form and after the investigation madeby the Opposite Party it was revealed her age was 71 years at the time of death and also revealed that the elder son of DLI was 45 years as on 2006 and currently he is 51 years old and the Complainant’s age is 45 years at present. Hence the age of the DLI was beyond the insurable age as such the Opposite party rejected the claim vide letter dt. 30.04.2012 which is not come under deficiency in service only because of the non-disclosure of the material facts while obtaining the policy. As per B.Chandravathamma Vs LIC of India and others (2008) I SCC 321, hence there is no prima facie case against the Opposite Party as such this complaint has to be dismissed.

6. At the time of enquiry, the complainant filed Affidavit along with documents and also filed Written Arguments and Exhibits A1 to A6 are marked and on the other hand Opposite Party filed its Counter and affidavit and not filed their Written Arguments. Even after giving so many adjournments for marking of documents by Opposite Parties, they filed Photostat copies and they have not come forward for marking of documents. Hence Forum treated no documents on behalf of Opposite Party. Heard both the counsels who reiterated their version.

7. In view of the respective contentions, the point that would arise for determination is:-

   Whether the repudiation of the claim amount by the Opposite Parties is come under deficiency in service on their part, if so can the complainant claim the reliefs prayed for?

8. The issuance of the Policy to the deceased Life Insured under BSLI Vision Plan on dt. 18.02.2011 for an amount of Rs.1,20,000/- and for a period of 20 years as per Ex.A1 is not in dispute. Ex.A2 is the Death Certificate of the deceased Policy Holder issued by Panchayat Secretary is also not in dispute. Ex.A1 & A2 are the Photostat copies. The complainant represented that the Originals were submitted to the Opposite Party to settle the claim amount. Ex.A3 is the Reply sent by Opposite Parties dt.30.04.2012 regarding the repudiation of the Claim, wherein it mentioned that the Life Assured stated her Date of Birth as 15-08-1955 after their investigation, it was established that her age far older than the age declared in the application and her age is beyond insurable age for the plan of insurance, hence they are repudiating their claim. Ex.A4 is the household card of the deceased policy holder, wherein it mentioned the age of deceased policy holder as 50 years as on 29.08.2006. Ex.A5 is the Registered Lawyer’s notice issued by the complainant dt. 26.05.2012, regarding the settlement of claim. Ex.A6 is the Reply issued by Opposite party on 8.6.2012.

9. The main contention of the Opposite Parties is that the age of the deceased policy holder. The deceased policy holder mentioned his date of birth as 15.08.1955 and also submitted non standard proof and the consent letter for declaration of age. The information received by Opposite parties regarding the death claim intimation on 9.4.2012 as the deceased policy holder died on 30.04.2011 due to heart attack. At that time they declared her age was 57 years. After the investigation conducted by the Opposite party as per Voter Card her age was 56 years and at the time of death and after investigation it was revealed by another Voter Card her age was 63 years as on 2003 i.e. 71 years at the time of death. The Opposite Parties took a plea in his Counter that Voter Card bearing No.KJA1294665 was not existed in the list of the village, especially KJA series is not existed but JZB series i.e. Voter Card submitted at the time of death intimation was matching. To strengthen their pleas, the Opposite Party did not furnish any document regarding this.

10. The version of the complainant is that after death of her mother due to heart attack on 30.04.2011, being a nominee the complainant intimated the same to the Opposite party by submitting necessary documents. But they failed to settle the claim amount, moreover issued a repudiation letter on 30.04.2012 and took a plea that the age of the deceased Policy holder is not correct, as she mentioned at the time of taking policy.

11. The Opposite party’s main contention regarding the age of the deceased policy holder. As per their version there is merely 15 years of difference between age stated by the complainant and as per their investigation report. The Opposite party did not file any documents regarding the age of the deceased policy holder but they stated that the DLI is a pensioner. The Opposite party filed some of the Photostat copies and the Forum insisted the Opposite Party for filing attested copies of the documents for marking of those documents and to consider the documents at the time of hearing, but even after giving so many chances, the Opposite Party not come forward to file attested copies of the documents by attesting them with any Authorised person of the Opposite parties.

12. If we assumes that the deceased Life Insured at the time of submission of his policy application her age is wrongly mentioned, but it is to be noted that the time of fill up of the proposal application, the Opposite party verify the date of Birth, address proof etc. and then the persons of the Opposite party took signatures of the Policy holder. If really there is 15 years of difference in the age of the Life Assured definitely any one can came to know about the age of a person if they saw them personally. If this 2 to 5 years age difference, nobody can estimate the age but if it is nearly 15 years difference anybody can know that the age mentioned by the applicant is not correct. But the Opposite Party took signatures in the application by the DLI and collected the age proof details etc but at the time of settlement of claim the Opposite Party took a plea that the age of the DLI of 71 years at the time of death in 56 years. The other plea of the Opposite Party is that the Voter ID Card submitted by the DLI at the time of issuance of policy is differing from ID Card submitted at the time of investigation. But no claim was filed by the Opposite Party regarding discrepancy of the Voter Card and more over their contention is that series KJA was not existed in the list but for that also the Opposite Party not substantiated its plea by filing any documents. The decisions mentioned by the Opposite Party in its counter, regarding those cases the facts are different and it is true that if there is misrepresentation and suppression of material facts who not be there as per the citations mentioned by the Opposite Party. But in this case the Opposite Parties mere contention is not enough to decide the case regarding the age of the DLI, the Opposite Party has to substantiate its plea by filing documentary evidence, but they failed to do so. Hence repudiation of the claim by the complainant is not justified.

13. It is to be noted that absolutely no evidence filed by the Opposite Parties as regarding to the date of birth of Policy holder is wrong, in the absence of any evidence as pleased by the Opposite Party, the Forum came to conclusion as per versions made by both the counsels, the age mentioned by the DLI at the time of taking policy is as per Date of Birth 15.08.1955. Hence the Opposite Parties are bound to pay the policy amount of Rs.1,20,0000/-.

14. The repudiation of the claim by the Opposite Party is clearly shows deficiency in service in rejecting the policy amount during the policy period and it was clearly established by the complainant and hence the Opposite Parties are liable to pay the policy amount. In view of unjust vision to pay the policy amount by the Opposite Parties there cannot be any dispute that the complainant put to mental agony and suffering. In order to compensate it would be just and proper that the Opposite Parties directed to pay Rs.5,000/- towards compensation to the complainant.

15. Accordingly, this point is answered holding that the Opposite Parties are liable to pay Rs.1,20,000/- from the date of complaint i.e. 24.08.2012 with 9% interest p.a. within 3 months failing which to pay the same with 12% interest p.a. till the date of realization.

    9.       In the result, the complaint is allowed directing both the Opposite parties to pay Rs.1,20,000/- (Rupees One lakh twenty thousand) along with 9% interest p.a. from the date of complaint i.e. 24.08.2012 to the Complainant within three months, failing which to pay the same with 12% interest p.a. till the date of realization. The Opposite parties are further directed to pay Rs.5,000/- (Rupees Five thousand) towards compensation besides costs of Rs.2,000/- (Rupees Two thousand).

    Dictated to the Shorthand Writer, transcribed by him, corrected and pronounced by us in the open Forum on this the 31^st day of July, 2014.

     

      Sd/-                                                                                     Sd/-

    Member                                                                          President (FAC)

                                                                                 District Consumer Forum-I

                                                                                           Visakhapatnam

Consumer Complaint No:277/2012

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:

Exhibits Marked for the Opposite Parties:     -NIL-

     Sd/-                                                                                Sd/-

  Member                                                                         President (FAC)

                                                                             District Consumer Forum-I

                                                                                       Visakhapatnam

// GLR //