BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
F.A.No.136 OF 2013 AGAINST C.C.NO.21 OF 2012 DISTRICT FORUM SRIKAKULAM
Between:
- Branch Manager,
Bajaj Allianz Life Insurance Co.Ltd.,
Main Road, Opp. To Harisankara Theatre
Kasibugga, Srikakulam District - Bajaj Allianz Life Insurance Co.,Ltd.,
rep. by its Managing Director, Regd.& Head Office
at GE Plaza, Airport Road, Yerwada Pune-006
Appellants opposite parties
A N D
Sri Talla Rama Rao S/o Simhadri
R/o Marripadu Village, Yerramukkam Post
Via Baruva, Mandasa Mandal
Srikakulam District-001
Counsel for the Appellants Sri Srinivas Karra
Counsel for the Respondent Sri A.Rama Rao
QUORUM: SRI THOTA ASHOK KUMAR, HON’BLE MEMBER
AND
SRI S.BHUJANGA RAO, HON’BLE MEMBER
MONDAY THE TWENTY THIRD DAY OF JUNE
TWO THOUSAND FOURTEEN
Oral Order (As per Thota Ashok Kumar, Hon’ble Member)
***
1. The opposite parties are the appellants. For convenience sake the parties as arrayed in the complaint are referred to hereunder.
2. The brief facts of the complaint are that the complainant’s mother Talla Appalamma during her life time obtained Life Insurance Policy bearing number 0202565737 for sum assured of 1,00,000/- from the second opposite party-insurance company. The complainant’s mother died on 31.05.2011 due to jaundice. Thereafter, the complainant lodged claim with the opposite party-insurance company. The opposite party repudiated the claim on the ground that the complainant’s mother while submitting the proposal suppressed the material facts but infact there is no such suppression of material facts. The complainant got issued registered notice on 9.1.2012 to the opposite parties but in vain and hence filed the complaint before the District Forum.
3. The opposite party-insurance company resisted the case contending that the life assured had availed the policy under “Bajaj Allianz Unit Gain Policy “for a sum assured of Rs.87,000/- only on payment of annual premium of Rs.10,000/-. The life assured suppressed the material facts regarding his age, while obtaining the policy. The investigation revealed that the deceased suppressed her correct age and produced fake ration card as age proof for availing the policy by understating her age by 12 years. The investigator of the opposite party obtained ration card and according to it the life assured was 57 years as on the date of death. Not only that as per voter ID Life Assured was 64 years old as on date of death. The insured under declared his age by 12 years and as such the insurance policy is void abinitio and that the repudiation was justifiable as per the terms and conditions of the policy and thus prayed to dismiss the complaint.
4. The second opposite party was set exparte.
5. The complainant, in support of his case filed affidavit and marked Ex A1 to A5 documents. On behalf of the first opposite party-insurance company, its Branch Manager filed affidavit and the opposite parties did not choose to file any documents. The opposite parties filed FAIA No.69 of 2013 in this appeal to receive document and the same was allowed marking the documents as Exs.B1 to B4.
6. The District forum allowed the complaint directing the opposite parties to pay 1,00,000/- with interest @ 9% per annum together with costs of 2,000/-.
7. Aggrieved by the order of the District Forum, the opposite party- insurance company filed the appeal contending that the insured did not disclose his correct age at the time of taking the insurance policy and he obtained the insurance policy by submitting a fake ration card. The policy hodler mentioned her date of birth in the proposal form as 24.05.1966 suppressing her correct date of birth and thus prayed to allow the appeal and set aside the impugned order.
8. Heard both side counsel with reference to their respective contentions.
9. The points for consideration are:
- Whether the repudiation of the insurance claim by the
appellant is not justified thereby constituting
deficiency in service?
2. To what relief?
10. POINT NO.1 : The issuance of the insurance policy and the death of the insured are not disputed. The opposite party-insurance company repudiated the claim on the ground that the insured suppressed her correct age and submitted fake ration card at the time of submitting the proposal. The deceased life assured submitted proposal form on 17.01.2011 for obtaining life insurance policy and she mentioned her date of birth as 24.05.1966 and her age as 44 years. The opposite party accepted the age of the deceased insured as 44 years and issued the subject policy. Admittedly the deceased is an illiterate and she affixed her thumb impression in the proposal form. There is no dependable evidence from the side of the opposite party that the contents of the proposal form and the answers said to have been given by the life assured were read over and explained to her and that having understood the same she affixed her thumb impression in token of acceptance of the said contents. When the contents are in foreign language and also the proposer is an illiterate it is the bounden duty of the insurance company to establish that the mind of the proposer accompanied the contents of the said proposal form and that she duly affixed her thumb impression after knowing the details mentioned in the proposal form. The opposite party did not produce evidence in the said context and therefore basing on the information mentioned in the proposal form it is not desirable to believe that the deceased life assured suppressed her age and obtained the subject policy fraudulently knowing fully well that it was false.
11. The Hon’ble Supreme Court in Mithoolal Nayak vs. LIC of India reported in AIR 1962 SC 814 held that there were three conditions for the application of second part of Section 45 of insurance Act and they are as under:
“(a) the statement must be on a material matter or must
suppress facts which it was material to disclose,
(b) the suppression must be fraudulently made by the
policy holder and
(c) the policy holder must have known at the time of
making the statement that it was false or that it
suppressed facts which it was material to disclose.”
12. In view of the of the said judgment of the Hon’ble Supreme Court also it is not desirable to hold that the deceased life assured deliberately and fraudulently made false statement with regard to her age. It is common knowledge that agents in order to improve the business of the insurance company take active role in filing up the contents of the proposal form and obtain signature or thumb impression of the poorly educated persons and illiterates them and therefore no credence need to be given for the contention of the opposite party that the deceased life assured had given wrong declaration regarding her age as 44 years at the time of submitting the proposal. Basing on Ex.B2 photostat copy of household card the opposite party contended that age of the deceased was shown as 45 years at the time of issuance of policy but when the complainant submitted the death claim documents the company had investigated the claim and found that her age was 57 years as on the date of death. Except the contents that age as 40 years the other details of Ex.B2 are not at all legible and readable and there is no dependable evidence from the side of the opposite party that it is true and genuine document. Merely because it is endorsed on such Photostat copy that original verified by the person who attested it the same is not helpful for the opposite party to say that there is suppression of material fact regarding her age by the deceased life assured. It is common knowledge that when enumerators come to seek information for enrolling the voters and also for preparing ration card etc., only approximate age will be described by the inmates of the house and sometimes the enumerators themselves mention approximate age of the inmates and therefore household card and voter IDs are not at all conclusive proof to decide the correct age of the deceased life assured and therefore Ex.B3 is also not helpful for the opposite party. Thus the contention of the opposite party that the deceased life assured suppressed her real age and obtained subject policy fraudulently for wrongful gain etc., could not be appreciated in its favour.
13. As seen from the proposal form copy Ex.B1 sum assured is 87,000/- neither the complainant nor the opposite parties submitted copy of insurance policy. However in the counter filed by the opposite party they specifically pleaded that the policy was issued for an assured sum of 87,000/- only on payment of annual premium amount of 10,000. It is has not been controverted by the complainant by filing rejoinder and stating that in fact it was issued for 1,00,000/- In the absence of such a document it is believed that the policy was issued only for 87,000/- and not for 1,00,000/- claimed by the complainant. In such circumstances order of the District Forum directing the opposite parties no.1 and 2 jointly and severally to pay 1,00,000/- to the complainant is not sustainable and the same is liable to be reduced to 87,000/-. However, the rate of interest @ 9% per annum from the date of claim till realization and costs of 2,000/- remains unchanged. Thus the order of the District Forum is modified.
14. In the result the appeal is allowed in part by modifying the order of the District Forum directing the opposite party to pay 87,000/- insured amount with interest @ 9% per annum from the date of claim till realization and also costs of 2,000/-. There is no separate as to the costs of the appeal. Time for compliance four weeks.
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Dt.23.06.2014
కె.ఎం.కె.*
Appendix of evidence
Exhibits Marked
For opposite parties
Ex.B1 Copy of proposal Form
Ex.B2 Copy of Ration Card
Ex.B3 Copy of Household Card
Ex.B4 Copy of letter dated 26.08.2011
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