Andhra Pradesh
Chittoor-II at triputi
CC/82/2016
Vani Sree, D/o. T.Venugopal, W/o. M. Geeta Anand - Complainant(s)
Versus
Sundaram Finance Limited, by itsAuthorised signatory, - Opp.Party(s)
G.Guru Prasad
27 Dec 2017
ORDER
Filing Date:-31-08-2016 Order Date: 27-12-2017
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, CHITTOOR AT TIRUPATI.
Present: - Sri. M. Ramakrishnaiah, President
Smt. T. Anitha, Member
WEDNESDAY, THE TWENTY SEVENTH DAY OF DECEMBER, TWO THOUSAND AND SEVENTEEN
C.C.No.82/2016
Between
- Mrs. Vani Sree, Hindu, aged 35 years,
D/o. T. Venugopal, W/o. M. Geetha Anand,
Formerly at 5-386F, Polisettigaripalli,
Damalacheruvu Mandal, Presently at
6-269 / 8, Dwaraka Nagar, Opp. Rice Mill,
Peruru Panchayat, Tirupati.
- Mendri Geetha Anand, S/o. M.Venkatappa
Hindu, aged 42 years, H/o. complainant No.1
Formerly at 5-386F, Polisettigaripalli,
Damalacheruvu Mandal, Presently at
6-269/8, Dwaraka Nagar, Opp.RiceMill
Peruru Panchayat, Tiruapati. … Complainants 1 & 2
And
- Sundaram Finance Limited, by its
Authorized Signatory, 2/89, 1st Floor
Srinivasapuram, Tiruchanur Road,
Tirupati.
- Sundaram Finance Limited, by its
Authorized Signatory, 21, Patullos Road,
Chennai – 600 002.
- The Chief Manager/Claims Department,
Kotak Mahendra and Old Mutual Life
Insurance Ltd., 4th Floor, Vinay Bhavya
Complex, 159-A, CST Road, Kalina
Santacruz (East), Mumbai – 400 098. … Opposite parties
This complaint coming on before us for final hearing on 07.12.2017 and upon perusing the complaint, written arguments of the complainant a opposite party and other relevant material papers on record and on hearing of Sri.G.Guruprasad, counsel for the complainant and Sri. K.Ramanarayana Reddy, counsel for the opposite party no. 1 and 2 and opposite party no.3 is remained exparte having stood over till this day for consideration, the Forum made the following.
ORDER
DELIVERED BY SMT. T. ANITHA, MEMBER
ON BEHALF OF THE BENCH
This complaint is filed under Sections 12 and 14 of the Consumer Protection Act, 1986, complaining the deficiency in service on part of the opposite parties and prayed this forum to allow the complaint by directing the opposite parties 1 to 3 jointly and severally to refund the amount paid by the complainant no.2 (as a guarantor) of Rs.6,53,509/- (6,81,737 – 28,228) as the entire loan amount subsequent to the death of the member on 04.09.2014 to be paid by the insurer opposite party no.3 to the policy holder/opposite party no.1 and 2 and to pay Rs.2,000/- towards compensation and Rs.2,000/- towards legal expenses.
2. The brief facts of the case are: the opposite parties 1 and 2 are the financiers having branch office at Tirupati and head office at Chennai. And the opposite party no.3 is the insurance company extended complete cover group plan to the members of the Sundaram Finance.
The complainant further submits that her father T. Venugopal availed loan for the purchase of vehicle Chevrolet Tavera bearing registered no.AP03-TV-1575 from opposite party no.1 of Rs.8,50,000/- on 05.07.2014 and the complainant no.2 is stood as a guarantor and the total loan amount has to pay along with interest is Rs.9,83,118/- which is repayable in 35 installments commencing from 10.08.2014 to 10.06.2017 while so, the opposite party no.3 extended life insurance cover to Sundaram financier i.e. opposite party no.2 under kotak complete cover group policy bearing no.CC.No.000038 which was designed for the members of Sundaram finance referred as a policy holder.
The complainant further submits that her father T. Venugopal who took loan from Sundaram finance was also protected under credit term plan to the loan taken by him. In the event of death of any member, the claim amount is payable under the policy to Sundaram financiers to the extent of loan outstanding is rest by the opposite party no.3 and as per the benefit terms of the policy the claim amount subject to the maximum loan outstanding on the date of the death of the member would be paid. The said benefits shall be payable to the nominee i.e. the complainant no.1 as per coverage under the policy conditions by the insurer i.e. opposite party no.3.
The complainant further submits that her father died on 04.09.2014 while taking treatment in SVIMS hospital, Tirupati. By the date of the death her father paid first installment of Rs. 28,228/- on 08.08.2014 and the balance of loan outstanding is Rs.9,54,890/- to Sundaram financiers i.e. opposite party no.1 and 2. However the complainant no.2 being the guarantor was asked to pay the further amount, hence he paid a sum of Rs.6,81,737/- including the first instalment of Rs.28,228/- by 30.08.2016. The complainant no.1 submits that being the nominee of Mr. T. Venugopal she submitted her claim to the opposite party no.2 on 31.03.2015, they in turn forwarded the claim to the opposite party no.3, but the claim was repudiated on the ground that the member T. Venugopal was suppressed his previous ailment i.e. he is suffering with Chronic Liver Disease with Portal Hypertension with Splenomegaly, prior to the signing of the declaration of good health on 05.07.2014. He intentionally withheld the material information from the company and failed to disclose true and correct facts in the declaration of good health form. The complainant further submits that as per the policy terms the membership form cum declaration of good health is required by the insurer, if the member is not able to provide satisfactory evidence of good health, the insurance cover shall be declined. It is further seen as per clause-3 under documentation the member may be required to compulsorily undergo medical test and submit to the insurer in the membership form cum declaration of good health as provided in the policy. Hence it is deemed that the good health declaration form (DOGH) was duly obtained from the member T. Venugopal after thorough medical test which is compulsory as per the terms of the policy. After collecting the necessary premium, the certificate of insurance bearing CC.000038 A019700 under loan ID JO11500173 was issued to him through the opposite party no.1 Tirupati branch.
The complainant further submits that being the nominee she sought for information under RTI Act on 14.06.2016 from the opposite party no.2 and requested them to furnish the copy of DOGH along with medical test report as laid down under clause 3(b) & 3(c) of the policy but they failed to furnish the required information which is nothing but deficiency in service. As there is no reasonable ground to repudiate the claim of the complainant no.1, she again sent a rejoinder on 27.07.2016 with a request to reconsider the death claim of the member, but there is no response from the opposite parties, hence she filed the present complaint.
3.The opposite parties 1 to 3 came in to appearance and written version of opposite party no.1 was filed along with the adoption memo of opposite party no.2. The counsel for the opposite party no.3 filed the vakalat and failed to file the written version even after granting several adjournments. As the opposite party no.3 did not choose to file the written version even after the statutory period of 45 days for filing written version, hence opposite party no.3 called absent and set exparte.
In the written version the opposite party no.1 denied the allegations mentioned in the complaint and further submits that the father of the complainant no.1 T. Venugopal has approached the second opposite party with a request to extend loan facility for the purchase of the Chevrolet Tavera Vehicle. Accordingly, the second opposite party sanctioned loan of Rs.8,15,000/- and entered in to a loan agreement on 05.07.2014 and agreed to pay the loan of Rs.9,83,118/- which includes principal 8,15,000/- with interest of Rs.1,68,118/-. The opposite party no.2 further submits that, they availed group insurance cover under kotak complete cover group plan policy no. F18 which proves life cover to the borrowers of the second opposite party if opted by the customers of them. Accordingly the borrower T. Venugopal opted for life insurance cover with a policy UIN107NPI84V02 which is group insurance plan designed for the customers of second opposite party. At the request of the said T. Venugopal the op no.2 collected documents from T. Venugopal including declaration of good health and forwarded the same to the opposite party no.3. And the 3rd opposite party has issued insurance certificate to the 2nd opposite party and they in turn forwarded it to the T. Venugopal and also as per the documents submitted by the insured one T.Kanthamma who is the mother of the complainant no.1 was stood as a nominee of the insured. The opposite party further submits that the complainant no.1 has intimated the death of her father to them and submitted necessary documents and they have transmitted the same to the 3rd opposite party. And the 2nd opposite party intimated to the complainant no.1 that one T.Kantamma was the original nominee mentioned in the policy but the complainant informed that her mother T.Kanthamma was already expired and requested them to submit her claim to the 3rd opposite party and accordingly they have submitted the claim of the complainant no.1 to the 3rd opposite party on 07.02.2015.
The opposite party no.1 further submits that they have received the letter from the opposite party no.3 on 31.03.2015 by repudiating the claim of the complainant no.1 on the ground that the member of the policy T. Venugopal having knowledge of his ailment, he has suppressed the material information about his health condition and submit the declaration of good health form to the second opposite party and he failed to disclose true and correct facts in the declaration of good health form. The opposite party further denied the allegations mentioned in para 9 of the complaint and further stated that they received a letter dt:14.06.2016 from complainant no.1 requesting to furnish copy of the declaration of the good health and other documents submitted by the member T. Venugopal to the 3rd opposite party through the second opposite party, but they are unable to furnish the copies of the said documents as those documents are in the custody of the third opposite party. Hence non - furnishing of documents which are not in the custody of them does not amount to deficiency in service as alleged by the complainants. The opposite party further stated that the policy was issued by the 3rd opposite party to the insured, this opposite party and second opposite party has no business in the said policy and it is purely between the member of the policy and the 3rd opposite party. The complainants are unnecessarily impleaded them as the parties and also further stated that, the complainants are not consumers of this opposite parties hence there is no deficiency in service on part of them as they properly forwarded the claim to the opposite party no.3 and there is no deficiency in service on part of them towards the complainants and the complaint is liable to be dismissed.
4. The complainant no.1 M.Vanisree filed her evidence on affidavit and Ex.A1to A21 were marked on behalf of the complainants. On behalf of the opposite parties 1 and 2 one Mr.Prasad KVSRK S/o. Gurunatha Sasthry, Branch Manager filed Mrs.Sundaram Finance Ltd of Tirupati filed his evidence on affidavit and no documents were marked on behalf of them. Both complainants and opposite party no.1 and 2 filed their Written arguments and oral arguments were heard.
5. Now the points for consideration are:
(i) Whether there is any deficiency in service on part of the opposite parties
towards the complainant?
(ii) Whether the complainant is entitled to the reliefs as prayed for?
(iii) To what Relief?
6. Point No:-(i). there is no dispute regarding the loan taken by the complainant’s father from opposite parties 1 and 2 and same was admitted by them and also there is no dispute regarding the policy issued by the opposite party no.3 to the members who availed loan from the opposite parties 1 and 2 and same was admitted by the opposite parties 1 and 2 and also there is no dispute that the complainant no.2 is stood as a guarantor for the loan taken by the member T. Venugopal. The main contention of the complainant is her father one T. Venugopal availed loan of Rs.8,15,000/- for the purchase of vehicle Chevrolet Tavera bearing registration No. AP03-TV-1575 and the above said loanRs.9,83,118/- includes principal of Rs.8,15,000 + interest 1,68,118/- is repayable in 35 installments commencing from 10.08.2014 to 10.06.2017. Accordingly, he paid the first instalment of Rs.28,228/- and unfortunately he died on 04.09.2014 while taking treatment in SVIMS hospital, Tirupati. The complainant no.2 who is a guarantor paying the amount regularly which is due under the loan account.
The complainant further submits that her mother T. Kanthamma whose name was mentioned in the nominee column was pre-deceased to the death of her father on 16.12.2012. Hence, being a legal heir to the estate of her father, she submitted her claim to the opposite parties 1 and 2 and in turn they forwarded the claim to the opposite party no.3. The opposite party no.2 by their letter dt:31.3.2015 intimated to the complainant the claim was repudiated on the ground of suppression of previous ailments such as chronic liver disease with portal hypertension with splenomegaly by the date of taking the policy and he signed in the declaration of good health form on 05.07.2014 and had undergone treatment in pursuance of the same and despite of the complete information of his medical condition the member intentionally withheld the material information with the insurance company and failed to disclose true and correct facts in declaration of the good health form.
In this regard the counsel for the complainant stated that as per the terms of the policy under Clause3(c) the member may be required mandatorily to undergo medical test and submit to the membership form and declaration of good health as provided in the insurance policy. So, it is deemed that the good health declaration form was duly obtained from the member after thorough medical test which is compulsorily and mandatorily as per the terms of the policy. The counsel for the complainant further stated that there is no material on record to show that the deceased member T. Venugopal deliberately concealed or failed to disclose his ailments in declaration of good health form. Hence the complainant no.1 sent rejoinder on 15.09.2016 to reconsider her claim but the opposite parties gave reply dt:10.10.2016 stating that the medical tests were not carried out in each and every policy in a group insurance and the contract of insurance is based on declaration of good health certificate given by the member and sent the copy of declaration of good health certificate for reference under Ex: A16. And also in the said document the nominee name is mentioned as T.Kanthamma who is pre-deceased on 06.12.2012 by the date of the death of the T.Venugopal in this regard the complainant no.1 filed death certificate under Ex:A17 dt:16.12.2012. The counsel for the complainant submits that the opposite parties without complying the conditions of policy terms about conducting the medical test on the member they would not have issued the policy, they cannot escape from their liability by saying that the policy was obtained by misrepresentation by suppressing material facts. Though the contract of insurance is based on the principles of good faith, it is the duty of the insurance company to verify the facts in the declaration of good health certificate before issuing the policy but in this case the opposite party accepted the premium and issued the policy and in order to evade their liability they repudiated the claim which is nothing but deficiency in service on part of them.
The counsel for the opposite parties 1 and 2 stated that the borrower T. Venugopal collected insurance policy forms and other material and after filling up the said forms he handed over to the 2nd opposite party and the 2nd opposite party forwarded to the same to the 3rd opposite party after receiving the documents the 3rd opposite party issued the insurance certificate. The counsel for the opposite party no.1 stated that they received the claim of the complainant no.1 through the second opposite party and same was forwarded to the third opposite party. The counsel for the opposite party no.1 stated that the complainant is not the consumer of the opposite party no.1 and 2 as the policy was issued by opposite party no.3 and also stated that the member T. Venugopal obtained insurance cover fraudulently, dishonestly and by misrepresentation. The contract of insurance is based on foundation of utmost good faith i.e. principle of Uberimafides. The insured has to maintain and observe good faith while entering in to the insurance contract with the insurance company. If the insured failed to disclose true and correct material facts to the insurer or gives any false declaration to that effect, the cover obtained by the insured stands vitiated and the insured or any person claiming under policy is not entitled for any benefits under the said policy. In the present case, the insured was suffering from chronic liver disease with portal hypertension with splenomegaly prior to availing insurance cover. He intentionally concealed said fact to the insurance company in order to get wrongful gain further the insured has mislead the opposite party no.3 in to believing that he was medically fit to avail said insurance cover by giving false declaration in the declaration of good health. Hence the complaint is liable to be dismissed.
After perusing the records and evidence placed by the both opposite parties 1 and 2 there is no dispute regarding the loan taken from the opposite party no.1 and 2 and also there is no dispute regarding the policy taken by the member who availed loan from opposite party no.1 and 2 from opposite party no.3. The main contention of the complainant is after the death of her father T.Venugopal on 04.09.2014 while taking treatment in SVIMS hospital, Tirupati and she submitted her claim as a legal heir of the deceased to the opposite parties and same was repudiated on the ground that the insured suppressed the ailments which he suffered prior to taking of the policy. Under Ex:A21 death summary issued by SVIMS it was clearly mentioned that the insured is having chronic liver disease with portal hypertension AKI, lower limb cellulitis, septic shock respiratory failure on MV support which clearly shows that the member T.Venugopal is a chronic liver patient and hypertensive patient prior to taking of the policy and also the complainant stated that the name T.Kanthamma was mentioned as nominee who was pre-deceased of the death of insured T.Venugopal hence as a legal heir for the estate of her father, the complainant submitted her claim, but in order to prove her contention she is the sole legal heir of the insured and also she has not filed any document such as family member certificate, succession certificate to prove the same, in the absence of any documentary proof, we cannot consider that she is the sole legal heir of the deceased T.Venugopal. Hence the complainant failed to prove her case that she is the sole legal heir of the insured and also the insured was hale and healthy by the date of taking the policy i.e. 05.07.2014. Hence the complainant failed to prove her case with cogent evidence. Hence in the absence of documentary proof we cannot not held deficiency in service on part of the opposite parties towards the complainant. Hence this point is answered against the complainant
7. Point(ii):- As the point no.1 is discussed against the complainant the question of entitlement would not arise.
8.Point (iii):- In the result, the complaint is dismissed. No Costs.
Dictated to the stenographer, transcribed and typed by her, corrected and pronounced by me in the Open Forum this the 27th day of December, 2017.
Sd/- Sd/-
Lady Member President
APPENDIX OF EVIDENCE
Witnesses Examined on behalf of Complainant/s.
PW-1: M. Vanisri (Chief Affidavit filed).
Witnesses Examined on behalf of Opposite PartY/S.
RW-1: Mr. Prasad KVSRK (Chief Affidavit filed).
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT/s
Exhibits (Ex.A) | Description of Documents |
Photo copy of household card of T. Venugopal issued by MRO Pakala. | |
Photo copy of Aadhaar Card bearing No.7388 9090 7113 of T. Venugopal. | |
Photo copy of registration of the vehicle bearing No.AP03-TV-1575 in favour of T.Venugopal. Dt: 21.07.2014. | |
Photo copy of Motor insurance certificate cum policy schedule issued by Oriental Insurance Company in favour of T.Venu Gopal. Dt: 03.07.2014. | |
Photo copy of death certificate of T. Venu Gopal issued by Tirupati Municipality. Dt: 11.09.2014. | |
Photo copy of Intimation of death of T. VenupGopal to the customer care officer claims department, Kotak Mahindra Old Mutual Life Insurance by M. Vanisri. | |
Photo copy of Repudiation of death claim of Mr. T. Venu Gopal by opposite party No.3 addressed to Sundaram Finance (O.P.No.2) along with copy of certificate of Insurance. Dt: 31.03.2015. | |
Photo copy of letter by O.P.No.2 to Mr.T. Venugopal. Dt: 28.12.2015. | |
Office copy of Letter to the O.P.No.1 by complainant No.1 seeking certain information under R.T.I Act along with postal order for Rs.20/-. Dt: 14.06.2016. | |
Photo copy of statement of transaction issued by Sundaram Finance from 05.07.2014 to 14.06.2016. Dt: 14.06.2016. | |
Photo copy of rejoinder to opposite parties 1 to 3 with postal delivery certificate. Dt: 27.07.2016. | |
Statement of transactions for the period from 05.07.2014 to 31.08.2016 of account showing the total amount paid and balance towards the loan availed by T. Venu Gopal issued by O.P.No.1. Dt: 31.08.2016. | |
Reply letter from O.P.No.2 to regd. Legal notice Dt: 27.07.2016 sent on behalf of complainant No.1 stating that they have no concern with regard to the policy benefits issued by O.P.No.3. Dt: 25.08.2016. | |
Reply to legal notice dated 27th July, 2016 sent on behalf of complainant No.1 furnishing the relevant expert of declaration of good health by the member Mr. T.Venu Gopal and other details of the policy conditions and not liable to pay the insurance coverage to Mr T. Venu Gopal. Dt: 01.09.2016. | |
The rejoinder of complainant No.1 to O.P.No.3 with reference to their reply Dt: 01.09.2016 and copy marked to O.P.No.1 and 2 Sundaram Finance. Dt: 15.09.2016. | |
Another letter from O.P.No.3 to complainant No.1 subsequent to previous letter Dt: 01.09.2016 enclosing the copy of declaration of Good Health Certificate in respect of T.Venugopal etc. Dt: 10.10.2016. | |
Death Certificate in original in respect of T. Venu Gopal who died on 16.12.2012 issued by Registrar, Births and Deaths, Damalacheruvu Gram Panchayat. Dt: 20.09.2014. | |
Photo copy of Demand notice to venu gopal issued by O.P.No.1 Sundaram Finance Limited Branch at Tirupati. Dt: 12.10.2016. | |
Reply to O.P.No.1 by complainant No.2 in reference to the demand notice Dt: 12.10.2016 to venu gopal and also the guarantor M.Geetha Anand to pay Rs. 3,07,954/- towards outstanding loan amount for which he paid under receipt Dt: 14.10.2016 for Rs.56,200/- issued by sundaram finance of O.P.No.1. Towards two installments due by them. Dt: 15.10.2016. | |
Photo copy of Letter to the O.P.No.3 informing the stage of the case against them before the District Forum along with copy of complainant as required by them. Dt: 26.10.2016. | |
Cause death of T.Venu Gopal issued by the SVIMS Authority. Dt: 06.09.2017. |
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTY/s
-NIL-
Sd/-
President
// TRUE COPY //
// BY ORDER //
Head Clerk/Sheristadar,
Dist. Consumer Forum-II, Tirupati.
Copies to: 1. The Complainants.
2. The Opposite parties 1 to 3.
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