This complaint coming up before us for final hearing on                          28-07-14 in the presence of Sri R.K.S. Murthy, advocate for complainant and of Sri B.S.R.K. Prasad, advocate for opposite parties, upon perusing the material on record, after hearing both sides and having stood over till this day for consideration this Forum made the following:-

O R D E R

Smt T. Suneetha, Member:-    The complainant filed this complaint                      u/s 12 of the Consumer Protection Act seeking directions on the opposite parties to pay the policy amount of Rs.14,68,000/- along with interest from the date of death of the policy holder; compensation of Rs.1,00,000/-, for deficiency of service Rs.1,00,000/- and legal expenses Rs.5,000/-. 

2.   In brief the averments of the complaint are these:

          The complainant Mahankali Sujatha’s father Late Siriveri Venkateswarlu who died in train accident on 28-02-11, during his life time obtained two life insurance policies from the opposite parties under policy Nos.C171389650 and U155403756 on 31-05-09 and  17-06-10 respectively showing the complainant as nominee.  The complainant approached opposite parties with all necessary documents like death certificate of the insured, FIR, Inquest, Post mortem certificate and family member certificate along with claim form for obtaining insurance benefits pertaining to her father.              In the 1^st week of September, 2013 when complainant approached the office of the  1^st opposite party she was informed that her claim was already repudiated by 2^nd opposite party and she was handed over a repudiation letter.  The complainant is the nominee and only legal heir of the deceased and her lawful claim was illegally repudiated by the opposite parties.  The opposite parties repudiation of the claim is not justifiable.  Therefore opposite parties committed deficiency of service in not settling the claim of the complainant.  Hence the complaint.   

3.      The opposite parties filed version and its contents in brief are as follows:

          The deceased Venkateswarlu by the time of entering the policy with the opposite parties was already having the policy with 1^st opposite party.   Without disclosing the material fact the deceased obtained policy from OP2 thereby he committed breach of contract.   As per the norms of the policy if there is any violation on the part of the policy holder the insurer is entitled to repudiate the policy.   It was incorporated in the policy itself.   The insured signed the policy after agreeing to the terms of the policy.   The complainant approached the Hon’ble authority with unclean hands.   The Hon’ble Forum may be pleased to dismiss the complaint with costs.

4.      The complainant and opposite parties filed their respective affidavits. Exs.A-1 to A-15 were marked on behalf of the complainant and Ex.B-1 was marked on behalf of opposite parties.

5.    The points that arose for consideration in this complaint are these:

    1. Whether the opposite parties committed any deficiency in service?

    2.  To what relief?

6.   POINT No.1:-   The allegation of the complainant is that the opposite parties repudiated the claim unjustly.   The opposite parties contended in their version that the complainant non disclosure of the policy obtained from the 1^st opposite party to the 2^nd opposite party is suppression of material fact which amounts to violation of terms and conditions of the policy.

7.    The opposite parties counsel in para 3 of their version contended that  “By the time of entering the policy with opposite parties the deceased Venkateswarlu was already having a policy with OP1.   Without disclosing the material fact the deceased Venkateswarlu took the policy from OP2 thereby he committed breach of contract”.  Where as in the repudiation letter Ex.A-13 it was different.  The following is extracted for better appreciation:

      “The above policy was issued on the basis of the application for insurance dated 15-May-09 on the life of Mr.Mr. Venkateswarlu Siriveri (the “Life insured”).  In the said application signed by the Life Insured, question number 3 of Step 7 had been replied in the negative.  For your reference we are reproducing below the aforesaid questions & the replies there to in the application for insurance.

       Our investigations have established that the Life Insured had applied for substantial insurance cover from multiple life insurers prior to application with our company.  According to our records, such information was not disclosed in reply to the specific questions in the application dated 15-May-09 for the above policy.   After careful evaluation of all facts, documents submitted and circumstances in this case, we have come to the conclusion that the replies to the aforesaid questions in the application form are incorrect.   Had such information been disclosed our underwriting decision would have been different…………….”

8.      The contentions of the opposite parties counsel is in contradiction with the documents filed i.e., application form Ex.B1 and repudiation letter A-13 (table extracted in the above letter).

9.   The opposite parties filed objections through a memo dated                   20-06-14.  The relevant portion is extracted below:  

          The question is extracted from the application form i.e., Ex.B-1 which is as below:  

10.    In the extraction of the application form Ex.B-1 there is no mention about the name of Tata AIG the opposite party herein.   But the opposite party counsel in his objections has mentioned Tata AIG Life Insurance company. 

11.  The opposite parties counsel for the reasons best known to him have presented his narrations in version and objections in contradiction to the documents filed.  

12.  However, in view of the pleadings of the counsel of the opposite parties the Forum opined to discuss the issue basing on the pleadings of the counsel of the opposite parties.   The contention of the counsel of the opposite parties is non disclosure of the policy with 1^st opposite party to the 2^nd opposite party prior to taking the 2^nd policy from the 2^nd opposite party.  The opposite parties counsel filed Ex.B-1 dated 15-05-09 application form of the insured with policy No.C171389650.  The complainant counsel filed the application forms of two policies with policy No. C171389650 dated 15-05-09 and policy No.U155403756 dated                 09-06-10.  In the 1^st policy i.e., C171389650 there is no mention about the other insurance policies in column No.7, where as in the 2^nd policy the insured mentioned about the 1^st policy i.e., C171389650.                          The following is extracted from Ex.A-15.        

Step 1E:

Do you have any existing insurance and/or concurrent application for insurance on your life? Or where you are payor? If the space is insufficient kindly attach separate sheet.

13.    As per the above recorded the insured while taking the 2^nd policy from the opposite parties have disclosed the fact of having policy in the opposite party’s company prior to taking of the 2^nd policy.   Thus the opposite parties committed deficiency of service by repudiating the claim of the complainant unjustly and are liable to pay the complainant the insurance amount of both the policies and compensate the complainant.   This point is answered in favour of the complainant.

14.  POINT No.2:-   The opposite parties repudiated the claim of the complainant unjustly.   Therefore the opposite parties are liable to pay the complainant the insurance amount pertaining to both the policies and compensation.

          In the result the complaint is allowed in part as indicated below:

1. The opposite parties are directed to pay the policy amount of Rs.7,00,000/- (Rupees seven lakhs only) in policy no.C171389650 along with interest @9% p.a., from the date of repudiation till realization to the complainant. 

          2. The opposite parties are directed to pay the policy amount of                                       Rs.3,84,000/- (Rupees three lakhs eighty four thousand only) in                 policy no.U155403756 along with interest @9% p.a., from the                              date of repudiation till realization to the complainant. 

1. The opposite parties are further directed to pay Rs.10,000/- (Rupees ten thousand only) towards compensation to the complainant.
2. The opposite parties are further to pay a sum of Rs.2,000/- (Rupees two thousand only) towards costs of the complaint.    
3. The amounts ordered above shall be paid within a period of six weeks from the date of receipt of the order.

Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 5^th day of August, 2014.

      MEMBER                                                                            PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:   

PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.