This case is coming for final hearing on 27.02.2015 in the presence of Sri V.H.M.Patro and Sri V.V.Bhaskar Kumar Advocates for Complainant and of Sri Sanapala Karuna and Smt. Sanapala Sailaja Advocates for Opposite Parties 1 & 3 and 2^nd opposite party appear in person and having stood over till this date, the Forum delivered the following:

: O R D E R :

(As per Sri V.V.L.Narasimha Rao, Honourable Member on

behalf of the Bench)

1.       The complainant filed the present complaint before this Forum on 23.09.2013 under Section-12 of Consumer Protection Act and requested the Forum to direct the opposite parties;

i)       to pay policy amount of Rs.1,00,000/- along with benefits.

ii)       to pay interest at 24% on Rs.1,00,000/- policy amount from the date of death of the deceased (30.08.2010) i.e., complainant’s father.

          iii)      to pay compensation of Rs.30,000/- for causing mental agony

          iv)      to pay costs for legal expenditure.

2.       The brief facts are as follows: The Complainant submits that his father has obtained life insurance policy from 1^st opposite party located at Anakapalli and the 2^nd opposite party is the Corporate Office of the Insurance Company located at Mumbai and the 3^rd opposite party is corresponding office for the 1^st opposite eparty.  The policy which was obtained by the complainant’s father vide No.17694619 will be valid from 10.08.2010 to 10.08.2020.  In the said policy, the complainant is the nominee.  At the time of taking policy, the complainant’s father is aged about 54 years and he is doing petty business for his livelihood at Tumpala Village at Anakapalli Mandal.  On 27.08.2010 complainant’s father suffered with fever, vomiting and motions and he approached RMP Doctor K.Rameshbabu at Tumpala Village admitted as out-patient and took treatment all of a sudden he died on 30.08.2010.  After obtaining the death certificate of his father on 08.11.2010 he informed the same to the 1^st opposite party and requested for settlement of the claim.  The 1^st opposite party gave claim form and advised the complainant to fill up and the same has to be sent to opposite parties 2 & 3 also.  As per the advise of the 1^st opposite party, the complainant sent the claim form to 1^st opposite party and the same was intimated to opposite party No.3 on 16.12.2011.  There upon the 3^rd opposite party sent a letter to the complainant to send the documents for processing the claim.  Finally, on 30.01.2012 the 3^rd opposite party sent a letter to the complainant repudiating the death claim stating that as the complainant’s father was aged about 74 years at the time of submission of proposal and his age was wrongly mentioned as 54 years in the said policy, the policy amount could not claim.  The complainant raising objections sent a letter to the 1^st opposite party on 03.02.2012 and waited for response.  Even after receiving the letter from the complainant has not came forward to settle the claim the complainant has filed the present complaint against the opposite parties 1 to 3 alleging deficiency of service on the part of them and sought for relieves. 

3.       Notices were sent to opposite parties 1 to 3.  The opposite parties filed their counter denying the averments of the complainant made in the complaint.  The opposite parties stated that after receiving the letter for settlement of the claim from the complainant and after receiving the documents, at the time of investigation, it was found that the deceased life assured (DLA) i.e., complainant’s father was aged about 74 years, which was reflected in the ration card.  As per the policy terms and conditions, the policy will not be covered for the persons who have aged about 65 years.  The complainant’s father intentionally suppressed the said fact and mentioned his date of birth i.e., 10.06.956.  The valid proof of his age i.e., ration card reveals the actual fact and basing upon the said documents itself, the said complaint is liable to be dismissed under Section-26 of Consumer Protection Act.  The complaint is not maintainable either on the law or upon the facts.  Hence, as the complainant’s father has suppressed the actual fact of his age it was revealed as per his ration card, the complaint is not maintainable and is liable to be dismissed. 

4.       Along with counter, the opposite parties has relied upon the 9 case laws. 

1)      Satwant Kaur Sandhu Vs New India Assurance Company Ltd., IV(2009) CPJ 8 SC which relies to the issue of the suppression of facts and thereby the complaint was dismissed. 

2)      1996(6) SCC 428 United India Insurance Co. Ltd., Vs. MKJ Corporation which was related to the issue of non-disclosure of the facts.

3)      2000(2) SCC 734 Modern Insulators Ltd., Vs. Oriental Insurance Co. Ltd., which is related to the non-disclosure of the facts.

4)      AIR 1972 Ori 158 between Kirtan Sahu Vs.Thakur Sahu and others, which is related to the case of insurance claim, wherein, it was held “the electoral roll prepared under the representation of the people act is admissible in evidence without the author thereof and the person supplying the information being examined in the case”. Observing LIC Vs Rambabu Gupta, Patna State Commission Judgment, “as the policy was obtained with concealment of the actual age of the insured and there was premature death claim, it was held as policy was obtained by fraud.  The LIC is not liable to pay the amount to the nominee”.

5)      AIR 1971 A.P. 41 LIC of India Vs. B.Chandravathamma (APHC) it was related to the issue of the policy wherein, the policy has not revealed the actual age. 

6)      2003(3) CPJ 172 NC State of Punjab Vs. Smt.Asharani, 1(2009) 212 National Commission, Life Insurance of India Vs Balbir Kaur, II(2008) CPJ 156 LIC Vs. Smt.Piari Devi & others, III(2008) CPJ 226 Life Insurance of India Vs. Radhika Devi it was held that mis-representation and non-disclosure of the material fact.  The complaint is liable to be dismissed. 

7)      AIR 1992 (Delhi) 197 M/s Seemax Constructions Pvt. Ltd., Vs. SBI which is related to the suppression of the material facts.

8)      AIR 1994 SC 853 S.P. Chenngalvarya Naidu Vs. Jagannath which is related to the insurance claim, wherein, it was held that, it is fraud on the court and the guilty party liable to be throw out at any stage. 

9)      1194 CPJ 245 Bam Dev Vs United India Insurance Co., Ltd., which is related to the repudiation of the claim and it was held that there is no deficiency of service on the part of the insurance company.

5.       Observing the pleadings of both sides, the Forum has framed the following points for consideration.

i)       Whether there is deficiency of service on the part of the opposite parties.

ii)       To what relief?

6.       The Complainant filed his evidence affidavit and on his behalf Exhibits A1 to A11 were marked.  The opposite parties filed evidence affidavit and on their behalf Exhibits B1 to B8 were marked.  Both the parties have submitted their written arguments as well as oral arguments. 

At the time of arguments, the complainant has submitted four case laws in support of his claim. R.P.No.370/2007 between Life Insurance Corporation of India Vs Gopal Singh decided on 28.01.2011, F.A.No.649/2013 against CC.No.6/2013, FA NO.136/2013 between Bajaj Allianz Life Insurance Company Ltd., & others Vs T.Rama Rao, F.A.NO.1027/2013 between Bajaj Allianz Insurance Company Ltd., & another Vs..Ramu & 2 others (AP State Commission). 

7.       Point Nos.1 & 2: The present complaint is filed by the complainant aggrieved by the Repudiation letter submitted by the opposite parties with regard to the death claims of the Insurance Policy NO.17694619. The opposite parties’ version is that the complainant’s father has suppressed his age and mentioned his date of birth as 10.06.1956.  At the time of enquiry, after receiving the claim form from the complainant it was found through the ration card of the complainant’s father that his age was 74 years and thereby as per the terms of the LIC as the persons about 65 years cannot claim insurance policy, the opposite parties have rightly repudiated the claim of the complainant and there is no deficiency of service on their part.  Ex.A1 is the insurance policy NO.17694619 which is obtained by the complainant’s father which is valid from 10.08.2010 to 10.08.2020.  The same insured for the said policy is Rs.1,00,000/- and he has paid the installment amount of Rs.11,330.33p.s to the opposite parties for obtaining the policy.  In the said policy, the complainant’s name is mentioned as nominee.  Ex.A2 and B4 are the same documents.  Ex.A2 is the death certificate issued by the Panchayat Secretary, Tummapala Village which discussed that the complainant’s father P.Apparao died on 30.08.2010.  Ex.A3 is the document dated 24.01.2011 i.e., letter submitted to the Reliance Life Insurance Co., Mumbai by the complainant for claiming the insurance policy amount by enclosing policy copy and death certificate of his father.  Ex.A4 and Ex.A5 are the letter submitted by the complainant for settlement of the insurance claim by submitting policy copy and death certificate of his father.  Ex.A6 is the letter dated 16.12.2011 submitted by the 1^st opposite party to the complainant to provide the claim Form-B, medical reports regarding death summary and previous medical records.  Ex.A7 is the repudiation letter given by the opposite party No.1 for repudiating the claim of the complainant on the ground that the complainant’s father age is 74 years which was reflected through the ration card at the time of investigation.  Ex.A8 is the postal receipt. Ex.A9 is the courier receipt. Ex.A10 is the letter dated 03.02.2012 served to the 1^st opposite party to settle the insurance claim.  Ex.A11 is the claim form A submitted by the complainant to the opposite parties dated 19.08.2011. Ex.B1 is the proposal form for the insurance policy and report of Sri K.V.Narasimha Murthy confronting the information given in the proposal form No.2022481.  The self-declaration of age of complainant’s father, consent to pay extra premium form dated 08.08.2010, ID proof of complainant’s father and the certificate confronted by Dr.K.V.Narasimha Murthy with regarding to the age of the complainant’s father are marked as Ex.B2.  Ex.B3 is the Policy Schedule of the Insurance Policy obtained by the complainant’s father.  Ex.B5 is the Death Claim Intimation with regarding to the claim of the complainant.  Ex.B6 & B7 are the report given by the investigator with regarding to the claim for policy No.17694619.  The Repudiation Letter of 1^st opposite party along with medical prescription, Family members’ details and ration card of complainant’s father were marked as Ex.B8. 

 8.      In the present complaint, though the opposite parties have issued the policy No.17694619 after the death of complainant’s father and receiving the claim form i.e., Ex.A11, the opposite parties have repudiated the claim of the complainant as per Ex.A7 stating that the complainant’s father is aged about 74 years and as per the terms of the LIC policy, his father is not entitled for taking the policy and also as he has suppressed his age and wrongly mentioned his date of birth as 0.06.1956, the claim of the complainant will be repudiated rightly as per the law.

9.       Now observing the Ex.B1 policy Form in the column ‘age proof’, it seems that the opposite parties have collected the notarized document confronting the age proof.  The Sales Manager Moral Hazard Report dated 06.08.2010 which was given prior to issuing the policy by Sri K.V.Narasimha Murthy E No.70058641 it seems the Sales Manager is confronting the entire averments mentioned in the proposal form No.2022481.  The date of birth mentioned in the proposal form No.2022481 and in the self-declaration of age submitted by the complainant’s father is same i.e., 10.06.1956 and the age of the complainant’s father at the time of taking the policy is 54 years.  The self-declaration age certificate was given by the opposite parties vide notarized document.  The complainant’s father has also paid extra amount for the policy towards age extra premium confronted in the letter dated 08.08.2010 by the proposal form No.2022481.  In the proposal form it was clearly mentioned that the complainant’s father has paid Rs.11,462/- to the opposite parties towards insurance policy premium.  Ex.B3 policy schedule for the policy NO.17694619 reveals that the age was verified.  In the column “age verified” it was mentioned as “Y” is equal to YES.  Ex.B2/B4 death certificate confronts complainant’s father died on 30.08.2010.  In the Ex.B6 & B7 i.e., the report of the investigator reveals that the investigator has collected the Aarogyasri Card of the insured person which sows that his age is about 70 years as on 2008.  The ration card enclosed along with Ex.B8 reveals that the complainant’s father’s age is about 35 years as per the ration card and in the said ration card there is no date mentioned to prove that was the date of ration card was issued.  But in this matter, the opposite parties are relying upon the ration card only, alleged that the complainant’s father is aged about 74 years, hence we cannot consider the ration card as a collusive proof.

10.     Observing the case law R.P.No.370/2007 of National commission, wherein, in the said case, it was held that no authenticity can be given to the ration card.  Even observing the ration card copy furnished by the opposite parties, as there is no date mentioned on it, on which date it was given to the complainant’s father.  We cannot come to conclusion that ration card is a proper document. 

11.     As seen from Ex.B1 proposal form and the sales manager report it reveals that the sales manager himself confronted the entire averments mentioned in the proposal form NO.2022481.  With regarding to the age fact, when the complainant’s father has submitted a notarized document to prove his date of birth as 10.06.1956 confronted by the Ex.B2 Doctor Certificate confronting the ID proof and address proof of the complainant reveals that after going through the ID pro0of and address proof confronted by the medical doctor, the sales manager has given a report confronting the entire averments mentioned in the proposal form as correct. 

12.     When the opposite parties while issuing the policy observing Ex.B2 documents i.e., age declaration of complainant, ID proof along with age proof an attested by a medical doctor which was certified by the sales manager of the opposite parties relies insurance company the opposite parties cannot go back with a wrong plea that the complainant’s father has gave wrong date of birth and also they cannot come to conclusion that the complainant is not entitled for the insurance claim.

13.     The case Law 2014(3)CPR 178 (NC), Manager Bajaj Allianz Co. Ltd., Vs. M/s Raj Kumar, it was held that “Usually the authorized member of the Insurance Company examined the insured assists the fitness and after complete satisfaction, then only the policy will be issued.  Therefore, the opposite party is wrong in repudiating the claim of complainant”. Though the opposite parties has relied upon the 9 case laws mentioned supra in Para NO.4 observing the confrontation of the sales manager of the opposite parties dated 06.08.2010 prior to issuing the policy it itself reveals that the sales manager has gone through the entire averments perfectly and has given the clearance certificate for issuing the policy and thereafter the policy is issued to the complainant’s father.  So at this juncture, the opposite parties cannot come with a plea that the complainant’s father is aged about 74 years and claim can be repudiated. 

14.     Observing the entire facts and circumstances of the case along with Ex.A2/B4, Ex.A2 to A5, Ex.B5 policy schedule for policy No.17694619 enclosed with Ex.B3, Ex.B2 documents related to the fact which was confronted and verified as “Y” in the policy schedule. So, we are of conclusive opinion, that there is deficiency of service on the part of opposite parties for repudiating the claim of the complainant stating that the complainant’s father is aged about 74 years.  Also the opposite parties cannot go back for repudiation of the claim at a later stage.  Hence, as the repudiation of the claim is illegal on the part of the opposite parties.

15.     The opposite parties are directed to refund Rs.1,00,000/- (i.e., policy amount) along with interest at 12% p.a. from 16.12.2011 i.e., Ex.A6 till realization.  As interest is awarded to the complainant, he is not entitled for compensation and only entitled for costs for the legal expenditure for an amount of Rs.5,000/- to be paid by the opposite parties 1 to 3 jointly and severally.

          Accordingly, point Nos.1 & 2 are answered.

16.     In the result, the complaint is allowed in part.  The opposite parties 1 to 3 are jointly and severally liable to pay an amount of Rs.1,00,000/- to the complainant at 12% p.a. from 16.12.2011 till realization.  The opposite parties are jointly and severally liable to pay an amount of Rs.5,000/- towards legal expenditure to the complainant. 

Dictated to the Shorthand Writer, transcribed by her, corrected and pronounced by us in the open Forum on this the 16^th day of March, 2015.

                Sd/-                                                                           Sd/-

          President (FAC)                                                              Member      

District Consumer Forum-I                                                                           Visakhapatnam

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:

Exhibits Marked for the Opposite Parties:

                Sd/-                                                                           Sd/-

          President (FAC)                                                              Member      

District Consumer Forum-I                                                                           Visakhapatnam

//VSSKL//