Karnataka

Kolar

CC/49/2015

Narayanaswamy .C s/o Chowdappa - Complainant(s)

Versus

M/s Life Insurance Corporation of India - Opp.Party(s)

V.Sridhar

15 Mar 2016

ORDER

Date of Filing: 16/10/2015

Date of Order: 15/03/2016

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, D.C. OFFICE PREMISES, KOLAR.

 

Dated: 15^TH DAY OF MARCH 2016

PRESENT

SRI. N.B. KULKARNI, B.Sc., LLB,(Spl.)    …….    PRESIDENT

SRI. R. CHOWDAPPA, B.A., LLB               ……..    MEMBER

SMT. A.C. LALITHA, BAL., LLB         ……  MEMBER

CONSUMER COMPLAINT NO :: 49 OF 2015

1) Sri. Narayanaswamy C,

S/o. Chowdappa,

Major in Age,

Now residing at, Urigili Village,

Sugatur Post,

Kolar Tq. & District.

 

2) Sri. Nandan Kumar. N,

S/o. C. Narayanaswamy,

Aged About 19 Years,

R/at. Urigili Village,

Sugatur Post, Kolar Tq. & District.

 

 (Rep. by Sriyuth. V. Sridhar, Advocate)               ….  Complainants.

 

- V/s -

M/s. Life Insurance Corporation of

India, Kolar Branch,

Antaraganga Road,

KOLAR-563 101.

 

(Rep. by Sriyuth. Sama Rangappa, Advocate)        …. Opposite Party.

-: ORDER:-

BY SMT. A.C. LALITHA, MEMBER

01.   The complainant No.1 having submitted this complaint Under Sections 11 & 12 of the Consumer Protection Act, 1986 (hereinafter referred in short as “the Act”) against OP has sought issuance of directions to OP to make payment of the policy vide No.364128085 of insurer Smt. N.Vinodha along with interest @ 12% per annum from the date of service of legal notice, till its realization and any other reliefs as the Forum to deem fit.

 

02.   The facts in brief:-

(a)    It is contention of the complainant No.1 that, his wife late Smt. Vinodha was the Life insurance policy (Non-medical) holder bearing No.364128085 issued on 28.12.2010 for a sum of Rs.1,25,000/-.

 

(b)    It is contended that, late Smt. Vinodha his wife being a policy holder deposited premiums till 2014 without any dues.  And on 13.09.2014 his wife insurer was admitted in R.L Jalappa Hospital, Kolar, with fever and died on 23.09.2014. 

 

(c)    Further it is the case of complainant No.1 that, he submitted all relevant records to OP along with a claim form for settlement.  And the OP was repudiated his claim on 30.03.2015 on flimsy grounds, and advised him to consult Zonal Office, Hyderabad.

 

(d)    It is contended that, while obtaining the policy, his wife deceased Smt. Vinodha, was told by the agent of the OP company that, the policy is non-medical policy, so, the previous medical history is not necessary.  And thus she only signed to the form and rest of things the agent was filled by himself.  Thus, there was no nexus for her cause of death and her part medical history.  In spite of settle the claim the OP repudiated claim hence deficient in service.  And the policy was taken about 3 years back, the statutory period for refund of the premium paid to the OP also completed without any dues.

(e)    It is contended that, the complainant No.2 was the nominee under the said policy.  And that the OP was silent in settling the matter.  And that, being aggrieved by this act of OP, he got issued legal notice through his counsel on 17.08.2015 for which, OP had replied on 04.09.2015 through their counsel by repudiating claim on medical grounds for a non-medical policy.  Thus OP rendered deficiency in service.

 

(f)     It is contended that, the cause of action arised on 23.09.2014 i.e., the date of death of Smt. N. Vinodha, wife of the complainant No.1 and 30.03.2015 date of repudiation of claim, and on 17.03.2015 i.e., the date of issuance of legal notice to OP and the date of service of the same and reply notice from OP.

 

(g)    It is contended that, the complainant is the resident of Kolar Taluk and OP branch office is at Kolar town, with in jurisdiction of the Hon’ble Forum and also the complaint is in time.

 

(h)    It is contended that, along with complaint enclosed a copy of LIC premium paid receipt, death certificate of Smt.N.Vinodha and letter dated: 30.03.2015, office copy of legal notice with postal acknowledgement.  So contending, the complainant has come up with this complaint seeking the above set-out reliefs.

 

03)   In response to the notice issued with regard to the case on hand, OP has put in his appearance through his said learned counsel and submitted written version.

 

(a)    The main contention of the OP is that, the insurer Smt. Vinodha had suppressed the facts of her previous deceases, because of suppression of facts the claim was rejected.  And that, OP was not deficient in rendering the service.  So contending dismissal of the complaint has been sought.

 

(04)  The complainant No.1 on 08.12.2015 has submitted his affidavit evidence and on behalf of the complainant following Xerox copies of documents have been submitted:-

(i)       Aadhar Card of N. Nandakumar

(ii)      Marks card of N. Nandakumar

(iii)   

         

(05)  The learned counsel for complainant has submitted the below mentioned Xerox copy of citation.

i) AIR 2001 Supreme Court 549

 

(06)  On 03.03.2016 the learned counsel for complainant brought complainant No.2 on record as necessary party by filing necessary application.

                       

(07)  On 19.01.2016 the learned counsel appearing for OP has submitted affidavit evidence and submitted Xerox copies of following documents:-

(i) LIC Bond along with terms and conditions

(ii) Proposal Form of the said Policy

(iii) Certificate of hospital treatment

(iv) Death Certificate

 

(08)  Both counsel appearing for complainant and OP has submitted written argument.  And heard the oral arguments of both the learned counsels.

 

(09)  Therefore the points that do arise for our consideration in this case are:-

1. Whether the repudiation of the claim by the OP would amount to deficiency in service?

 

2.   If so, to what relief the complainant is entitled?

 

3.  What order?

 

(10)  Findings of this District Forum on the above stated points for the following reasons are:-

 

POINT 1:     In the Affirmative

 

POINT 2:     the complainants are entitled for matured policy amount of Rs.1,25,000- along with compensation of Rs.5,000/- together with interest @ 9% pa from 16.10.2015 being the date of complaint till realization with costs of Rs.3,000/-.

 

POINT 3:     As per final order for the following:-

 

REASONS

POINT NO.s. 1 & 2:-

(11)  To avoid repetition in reasonings and as these points do warrant common course of discussion, the same are taken up for consideration at a time. 

 

(a)    The contention of OP is on suppression of pre-illness of insurer Smt. N. Vinodha the claim form submitted by the OP itself clearly discloses that, this policy is non-medical policy. 

(b)    Insured was almost illiterate so also she coming from rural background, while accepting the policy it is bounden duty of an agent/insurance company, medical examination was necessary for issuance of policy.  Without medical examination policy could not have been issued by OP.  OP has not placed any record to substantiate that at the time of issuance of policy the required medical tests were not carried-out and deceased was found suitable for obtaining policy.  Now repudiating under this fact thus OP has deficient in service.

(c)    The deceased was died due to fever and the policy is of non-medical policy, hence repudiation as suppression of pre-illness has no relevance at this juncture deceased.

(d)    When the complainant No.1 being appointee approached this OP for claim on 30.03.2015, the OP instead of settling the matter ordered to approach Zonal Office, Hyderabad mercilessly this act of OP towards its customer merely leads to rash negligence.

(e)    There is substantial principle enunciated in the citation submitted by the learned counsel for the complainant in AIR 2001 Supreme Court 549 which is thus:-

(B) Insurance Act (4 of 1938), s. 45 – Life Insurance Corporation Act (31 of 1956), S. 30 – Repudiation of claim by insurer – Merely on grounds that deceased had withheld correct information regarding his health at time of effecting insurance with corporation – Not proper – Matter of repudiation of policy should not be dealt with in a mechanical and routine manner but should be one of extreme care and caution.”

 

 

When it is evident from the document on record that, the said policy is of non-medical policy and the insurer was died due to fever and while accepting and issuing of policy the OP without being conducting any medical examination, was accepted policy and after full payment of premiums repudiation on this fact which is irrelevant to this non-medical policy and thus OP should negligence in rendering service.

 

(f)     For the reasons and findings mentioned above we hold that, there is deficiency in service on the part of the OP in repudiating the claim, though all the premiums were deposited by the policy holder.  Therefore in our view the complainant is entitled to policy amount.

(g)    Hence we allow the complaint of the complainant and direct the OP to pay a sum of Rs.1,25,000/- to the complainant No.2 nominee Sri. N.Nandan Kumar along with compensation of Rs.5,000/- together with interest at the rate of 9% per annum over the matured sum from 16.10.2015 being the date of the complaint till realization.

POINT 3:-

(12)  In the result, we proceed to pass the following:-

ORDER

01.   For foregoing reasons this complaint stands allowed with cots of Rs.3,000/- as hereunder:-

(a)    The complainant is held entitled to recover Rs.1.25,000/- being the maturity value of the insurance policy bearing No.364128085 along with compensation of Rs.5,000/- together with interest @ 9% per annum over the matured sum from 16.10.2015 the date of complaint till realization for to be recovered from OP.

 

(02)  Send a copy of this order to both parties free of costs.

 

(Dictated to the Stenographer in the Open Forum, transcribed by him, corrected and then pronounced by us on this 15^th DAY OF MARCH 2016)

 

 

 

 

MEMBER                             MEMBER                 PRESIDENT