Complaint presented on:  17.11.2011

                                                                Order pronounced on:  17.05.2016

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,        PRESIDENT

                    TMT.T.KALAIYARASI, B.A.B.L.,           MEMBER II

TUESDAY THE 17th  DAY OF MAY 2016

C.C.NO.204/2011

Mrs.R.Pushpa,

Old No.Q/14, New No.-Q/28,

MMDA Colony, Arumbakkam,

Chennai - 600 106.

                                                                                            ..... Complainant

..Vs..

Date of complaint                                  23.11.2011

Counsel for Complainant                      :Mr.K.Kumaran

Counsel for Opposite parties                   :M/s. M.Shakkira Banu

O R D E R

BY PRESIDENT THIRU. K.JAYABALAN B.SC., B.L.,

          This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.

THE COMPLAINT IN BRIEF:

           The complainant’s son Mr.R.Srinivas submitted a proposal form dated 11.9.2009 along with the requisite premium of Rs.98,219/- paid through Syndicate Bank, Aminjikarai Branch, Chennai to the 2^nd opposite party. The 2^nd opposite party after verifying the proposal form accepted the application of Mr.R.Srinivas and issued Regular Invest Plus policy bearing No. 0134775211 dated 7.10.2009 for the assured sum of Rs.9,90,000/- for the period of 10 years. The policy is the life assured policy and Mr. R.Srinivas has to pay annual premium of Rs.98,219/- every year on or before 6^th of October and the maturity date of policy is on 6.10.2009. The life assured covers the death benefit of Rs.9,90,000/-. The said Mr.R.Srinivas, nominated her mother Mrs. R.Pushpa/complainant as his nominee to receive the death benefit if any unfortunate event happens to him.

2.          The complainant’s son Mr.R.Srinivas had died on 21.11.2009  due to cardiac arrest. Immediately the complainant intimated the death to the opposite parties with relevant claim form and other documents. However the opposite parties without settling the claim repudiated the claim by their letter dated 5.4.2010 for non-disclosure of material facts by the life assured that is he was taking treatment for hypertension with unstable angina for the last 2-3 years or even prior to that. The opposite parties have not relied at any documents with their repudiation that the complainant was suffering from hypertension with unstable angina. Actually the complainant had not suffered with any disease alleged by the opposite parties and he has not suppressed any material facts. Further the said Mr.R.Srinivas took an another policy with the opposite party in policy No. 52806156 for a sum of Rs. 2,50,000/-, nominating his wife and the claim for the said policy settled by the opposite parties in her favour. Therefore there is no reason for rejection of the claim of the complainant, hence the opposite parties committed deficiency in service and therefore after issuing legal notice, the complainant filed this complaint to direct the opposite parties to pay the death benefit, compensation for mental agony with cost of the complaint.

3.   Written Version of opposite parties 1 and 2 in brief:-

          A proposal form for Life Insurance in the name of Mr.R.Srinivas dated 11.9.2009 was received by Bajaj Allianz Life Insurance Company Limited for the plan named as “ Invest Plus”. Along with said proposal form, payment of premium amount for a sum of Rs.98,219/- was received. The proposal form was scrutinized and policy was issued on 7.10.2009 with policy No.0134775211. The deceased has appointed his mother R.Pushpa as his nominee.

4.         The complainant has opted for payment of renewal premium for a 10 years term. Later the opposite parties received a claim requisition letter from the nominee that the insured died on 21.11.2009 and as she is the nominee of the deceased, she claimed the sum assured amount. On the basis of the claim form, review was done for death claim and it was found that the said R.Srinivas has died on 21.11.2009, within 1 month and 14 days of taking the policy. It was also found that insured died due to Massive Myocardial infraction. The medical certificates of R.Srinivas revealed that the said R.Srinivas had history of treatment for hypertension with unstable angina for the last 2-3 years. Hence the claim was repudiated vide letter dated 5.4.2010 stating the reasons for repudiation due to suppression and non-disclosure of material facts while availing the policy. The opposite parties have settled claim for the same deceased in policy No. 52806156, it is submitted that the said policy was not an early claim. The policy duration was 938 days and 3 yearly premiums were paid by the deceased. Hence the claim was accepted and sum assured was settled to the Nominee in that policy i.e. Mrs Narthana Sarayu (wife). But this policy was issued only on 7.10.2009 and the said R.Srinivas died within a short span of 44 days and the policy was taken by non-disclosure of material facts required for any insurance company while underwriting the risk of the proposed. Hence the claim was repudiated for non disclosure of material facts. Therefore the opposite parties pray to dismiss the complaint.

5. POINTS FOR CONSIDERATION:

      1.      Whether there is any deficiency in service on the part of the opposite

              parties 1 and 2?

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

              She is entitled to?

6. Point No.1:-

         The admitted facts of that the complainant’s son Mr.R.Srinivas submitted Ex.B.1, Proposal Form dated 11.9.2009 to the 2^nd opposite party with payment of yearly premium amount, a sum of Rs. 98,219/- for issuing policy in the plan “Invest Plus” and the opposite parties for the scrutinizing his proposal issued under Ex.A.1. Policy dated 7.10.2009 and the said policy, Mr.Srinivas nominated her mother Mrs.R.Pushpa as a nominee. On the death of the insured/R.Srinivas, the nominee is entitled for the death benefit of Rs.9,90,000/- and appropriate sum of Rs. 7583.40 towards Life Insurance premium and the insured R.Srinivas was died on 21.11.2009 and after his death, the complainant made a claim based on Ex.A.1 policy to the opposite parties for the death benefit and however the opposite parties repudiated her claim stated that the deceased was suffering with hypertension with unstable angina for the last 2-3 years or even prior to the policy and for such a suppression of deceased, the opposite parties repudiated the claim under Ex.A.3, letter dated 5.4.2010.

7.         The deceased R.Srinivas not only taken the policy in the case in hand and he had also taken another policy in policy No. 52806156 with the opposite parties nominating his wife and after his death his wife made a claim with the opposite parties and the said claim was honoured by the opposite parties and insured cheque for a sum of Rs. 2,50,000/- in favour of his wife Mrs. Narthana Sarayu. Under Ex.A.4, the complainant contended that when the another claim was settled by the same opposite parties, the opposite parties repudiated the claim is not justified and thereby they have committed deficiency in service.

8.          Ex.A.3 is a repudiation of claim letter of the opposite parties. In the repudiation, the opposite parties have stated that the deceased life assured at history of consultation, treatment of hypertension with unstable angina for the last 2 to 3 years and these facts known to deceased’s life assured were not disclosed in the proposal form dated 11.9.2009 and at these facts have been disclosed, the company would not have covered the risk of policy and the same have unconditioned. Undisputedly the policy holder died on 21.11.2009. His death certificate is marked as Ex.A.2. The opposite parties filed Ex.B.3, medical certificate of cause of death for the deceased R.Srinivas, issued by the Corporation of Chennai. In Ex.B.3, it is clearly stated in the column, the cause of death as Massive Myocardiac Infraction. So even in the document produced by the opposite parties under Ex.B.3, supposed the case of the complainant is that, Mr.R.Srinivas was died only due to cardiac arrest and not due to any other disease. However the repudiation letter in Ex.A.3 stated that the complainant was suffering with hypertension with unstable angina, no proof has been filed by the opposite parties. The complainant also denied that the deceased was now suffering with hypertension with unstable angina at any point of time. Therefore for rejection of the claim made by the complainant that the complainant is suffering with hypertension with unstable angina had not been established by the opposite parties and we hold that the deceased Mr.R.Srinivas was never suffering with the disease as alleged by the opposite party and the deceased Mr.R.Srinivas suffered any disease in Ex.B.1, Proposal form.

9.            The opposite parties stated another reason for rejection of claim is that the other policy was in an existence for the period of 938 days and 3 yearly premiums was paid by the deceased in respect of that policy and where as in the disputed policy, the deceased has paid only one premium and within two months of the commencement of the policy, he had died and therefore he had sustainable. The opposite parties issued Ex.A.1, policy to cover death benefit. When such a policy has been issued the insured person when he died, is inmaterial and this Insurance company has to honour the claim made by the beneficiary and therefore the contention of the opposite parties that for the present policy, the deceased paid only one premium and therefore rejection of claim is sustainable, it cannot be accepted.

10.             In view of the foregoing discussions, it is held that the opposite parties committed deficiency in service in rejecting the claim made by the complainant based on Ex.A.1, Insurance policy. The death benefit assured in Ex.A.1, Insurance policy is that the benefit payable at Rs. 9,90,000/- and the premium payable at Rs.7,583.40 (rounded to Rs. 7,583/- )  towards Life Insurance Premium and for both the amounts, the complainant is entitled from the opposite parties towards her insurance claim. Due to rejection of the claim, the complainant suffered with mental agony is acceptable and for the said mental agony, it would be appropriate to order a sum of Rs.50,000/- towards compensation would be reasonable and apart from that a sum of Rs.5000/- towards litigation expenses to the complainant. Hence the complainant is entitled for the above relief.

           In the result, the complaint is partly allowed and the opposite parties 1 and 2 are jointly or severally ordered to pay a sum of Rs.9,90,000/- towards the death benefit of Mr.R.Srinivas, to the complainant and also to pay a sum of Rs.7,583/- towards Life Insurance Premium amount and also to pay a sum of Rs.50,000/- towards compensation for mental agony besides a sum of Rs. 5000/- towards litigation expenses.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 17^th  day of May 2016.

MEMBER – II                                                               PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES:

Ex.B1 dated  11.09.2009                     Proposal Form

Ex.B2 dated 05.04.2010                      Rejection of claim

Ex.B3 dated 12.03.2010                       Medical certificate of cause  of death                                  

MEMBER – II                                                               PRESIDENT