Per Sri A. Hazarath Rao,  President:-

            The complainant filed this complaint u/s 12 of the Consumer Protection Act seeking the insured amount of Rs.6,72,500/- together with interest @12% p.a.,; Rs.50,000/- as compensation and Rs.10,000/- towards costs.

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

            One Pudhota Gnana Sundara Raju i.e., father of the complainant took five insurance policies amounting to Rs.6,72,500/- vide policy Nos. 1) LN100700138784 dated 17-09-07 for Rs.75,000/-, 2) LN100800138558 dated 24-09-08 for Rs.60,000/-, 3)LN100800073492 dated 28-04-2008 for Rs.3,12,500/-, 4) LN100800092285 dated              23-06-08 for Rs.37,500/- and 5) LN100800214613 dated 28-12-08 for Rs.1,87,500/- from the opposite party nominating his wife Mary Ramana.   Subsequent to taking the above policies the insured suffered from cancer and died on 29-12-09 due to cancer.   The nominee Mary Ramana also died on 07-08-10.    The said Mary Ramana during her life time executed a registered will on 03-08-10 bequeathing all the policy amounts to the complainant held up with the opposite parties besides the amount covered by fixed deposit receipts.   The complainant after the death of his mother Mary Ramana on                   14-09-10 in writing made an application to the opposite party requesting it to pay the amount covered by the above policies.   The complainant further requested the 1^st opposite party to substitute his name in the debenture certificate and subordinated debt certificates bearing Nos. 50376637, 10583084 to 10583086 in place of his mother.   The 1^st opposite party substituted the complainant’s name in the above certificates.   But the opposite parties did not choose to pay the amount covered by the said insurance policies.  The complainant got issued notice to the 1^st opposite party on 20-01-12 demanding payment of assured amount as they did not respond to the demands made by the complainant orally and in writing.   The 1^st opposite party though received notice neither gave reply nor paid the amount.   The conduct of the opposite parties in keeping the matter pending amounted to deficiency of service.   The complainant suffered physically and mentally by the above conduct of the opposite parties.   The complaint therefore be allowed.

3.    The contention of opposite parties in brief is hereunder:

            The complaint is barred by time as filed two years after the death of the life assured.   The life assured intentionally and fraudulently suppressed material information regarding his health condition and fraudulently obtained the questioned policies without giving any scope for proper assessment of risk and the above policies are void abi nitio. The complainant has not submitted any claim form till today.   The only nominee i.e, Pudhota Mary Ramana submitted claim form-A along with claim forms.  The said nominee in claim form submitted that the assured died due to heart attack.   The complainant on 14-09-10 wrote a letter to the opposite parties intimating the death of the nominee and also the will said to have been executed by the nominee.   In order to process death claims succession certificate from competent court of law is required.    The opposite parties on 23-06-10, 07-07-10 and 23-07-10 required the claimant to submit biopsy reports.  Neither the complainant nor his mother submitted the same.   The opposite parties on 22-10-10 informed the complainant requiring him to furnish biopsy reports of the insured and succession certificate from competent court of law.   As the complainant failed to submit the same till today there is no deficiency of service on the part of opposite parties.   After the death of nominee all legal heirs of the insured are entitled to receive the assured amount.   Even according to the will the assured has two sons.   Therefore the present complaint is not maintainable without succession certificate from a competent court of law.   The complaint therefore may be dismissed with costs.      

4.    Exs.A-1 to A-11 on behalf of the complainant and Exs.B-1 to B-19 on behalf of opposite parties and Ex.X-1 were marked.

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

1. Whether the complaint is in time?

2. Whether the complainant alone is entitled to receive the insured amount?

3. Whether the opposite parties committed deficiency of service?

4. Whether the complainant is entitled to compensation?

5. To what relief?

6.    POINT No.1:-     The life assured taking the policies in question (Exs.A-1 to A-5) were not in dispute.  The death of the assured on 29-12-09 (Ex.A-6) and the nominee on 07-08-10 (Ex.A-7) under the questioned policies is also not in dispute.   Ex.B-16 revealed that the nominee Mary Ramana submitted claim application on 21-03-10 duly attested by Village Revenue Officer, Dhammalapadu along with medical attendance certificate.   The opposite parties relied on Exs.B-11 to B-15.   The opposite parties did not file either the postal receipt or acknowledgement of the addressee of Ex.B-11, B-12 and B-15 letters.   For Ex.B-13 letter dated 23-07-10 the opposite party not only filed postal receipts but also acknowledgements.   The nominee Mary Ramana on 26-07-10 received copy of Ex.B-13 letter dated 23-07-10 as seen from Ex.B-14 postal endorsements.   Before giving reply to Ex.B-13 letter the said nominee breathed her last on 07-08-10.   The complainant addressing a letter on 14-09-10 along with copy of registered will dated 03-10-10                (Ex.A-8) to the opposite parties is not in dispute.   It is not the case of the opposite parties that it repudiated the claim.

7.   On the other hand, under Ex.B-15 dated 22-10-10 the opposite parties required the complainant to furnish biopsy report of the insured and succession certificate from court of law.   It can therefore be said that the claim is pending with the opposite parties.   The complainant relied on the decisions reported in Rama Avathar Agarwal vs. Oriental Insurance Company Limited 2006 (3) CPJ 148 and Praveen Shekh vs. LIC and another 2006 (1) CPJ 53 (NC).    

8.   Relying on the judgment of Supreme Court rendered in Kandimalla Raghavaiah and company vs. National Insurance Company Limited 2009 CTJ 950 (SC) the National Consumer Disputes Redressal Commission in Lakshmi Bhai and others vs. ICICI Lombard General Insurance Company Limited and others 2011 (4) CPR 64 (NC) held: 

                            “The cases where such payment is not made, would fall in one of                                                the following categories—

1).  Where no claim is made either with nodal officer or the Insurance Company, within 2 years of date of death such claims shall be barred by limitation.

2).  Cases where claim is made to nodal officer or nodal officer has forwarded the claim to Insurance Company or claim has been directly filed with Insurance Company within 2 years of the death and the claim has remained undecided. In such a case the cause of action will continue till the day the Respondent/insurance Company pays or rejects the claim.

3). In a case where the Respondent/insurance company rejects the claim, the cause of action arises again from the date of such rejection.

            In view of the above decision of the National Consumer Disputes Redressal Commission in Lakshmi Bhai and others vs. ICICI Lombard General Insurance Company Limited and others 2011 (4) CPR 64 NC the above decisions relied on by the complainant need not be looked into.   As the claim is neither repudiated nor settled,              we are of the view that the complaint is in time and answer this point in favour of the complainant.

9.  POINTS 2&3:-   Each company is a separate legal entity as rightly contended by the opposite parties.   Settling of claims by sister concerns of the opposite parties in respect of other claims of complainant will not make the opposite parties to adopt the same view.   The said contention of the complainant is devoid of merit.   Ex.A-9 is the copy of legal notice dated nil issued by the complainant to the opposite parties.   Ex.A-9 did not reveal that he made a claim with the opposite parties. 

10.       The complaint revealed that the insured died due to cancer.   In Ex.B-16 claim form it was mentioned that the insured died due to heart attack.   The complainant contented that the opposite parties themselves filled the columns.  As Ex.B-16 was attested by Village Revenue Officer and the medical attendant’s certificate was witnessed by Sri G. Sivaramakrishna, PMP, Turakapalem, the said contention of the complainant is devoid of merit.  

11.       The decisions relied on by the complainant reported in Harjit Kaur vs. State Bank of India 2009 (1) CPJ 193 is not applicable to the facts of the case as the assured and the nominee are not co-depositors.

12.   Another decision relied on by the complainant reported in Life Insurance Corporation of India vs.  Padmavathi and another 007 (2) CPJ 389 is also not applicable as the nominee died pending settlement of claim.

13.  Burden is on the opposite parties to prove that the assured suppressed material facts regarding his health as rightly contended by the complainant.  In United India Insurance Company Limited vs. Anumolu Rama Krishan 2012 CJ 890 (NC) it was held                  “Even if respondent was suffering from these diseases which admittedly do not occur overnight, it is both possible and plausible that he was unaware of it since these can be ‘silent disease’ and a person suffering from them may not even be aware until the condition aggravates and over symptoms appear.”  

14.  To discharge their burden the opposite party summoned case sheet from St. Joseph’s General Hospital, Guntur wherein he was admitted on 29-11-09 and was discharged on 23-12-09 (Ex.X-1).    As seen from 1^st page of Ex.X-1 the deceased was suffering from lung cancer.   No where in Ex.X-1 it was mentioned that the deceased was suffering from lung cancer earlier to 29-11-09.  The opposite parties also failed to produce any medical evidence earlier to 29-11-09 or prior to taking the policy.       

15.  In Life Insurance Corporation of India vs. Rekha Pardasani 2012 (2) CPJ 41 held that:

                         “The insurance company is suppose to verify all the facts mentioned in the proposal form before issuing the policy.   Even otherwise with the fast growing business competition among the insurance companies unhealthy practices develop to get maximum benefits and profits.   It is not a case of a businessman, trader or an educated employed person but that of a common poor man.  He puts in hard earned small savings in such schemes with a hope and aspiration that in case of accident or death he or his family shall get some immediate financial assistance but in most of the cases he is left cheated when his claim is rejected with just a stroke of pen that he concealed some material facts at the time of signing proposal form or the claim was not properly submitted before the Insurance Company.  This apart the agent of the company is required to explain all the details and conditions of the insurance policy sought by the customer.   A common man is not supposed to know all the niceties and technicalities of law.   Once accepting the premium and having entered into an agreement without verifying the facts, the Insurance Company cannot wriggle out of the liability merely by saying that the contract was made by misrepresentation and concealment.  The insurance policies should not be issued and repudiated in such a casual mechanical manner.   The policy entails the liability on both sides.   It is rather exploitation of the customer and more or less fraud on the public.   Such practice should be strongly deprecated.”    

16.  The opposite parties failed in proving that the assured suppressed material facts regarding his health condition intentionally and knowingly.   It can therefore be said that the assured intentionally did not suppress material facts regarding his health condition while taking policies.   The complainant is not a nominee under the questioned policies.   On the other hand, the complainant is one of the sons of the assured and nominee as seen from Ex.A-8 will.   Ex.A-8 is the registered will dated 03-08-10 executed by the nominee of the questioned policies in favour of the complainant.   In Life Insurance Corporation of India vs. Padmavathi and another 2007 (2) CPJ 389 it was held:

“No doubt a nominee is only a trustee or agent on behalf of all the legal representatives.  But so far as the insurance company is concerned, its obligation is only to the nominee and once payment is made to the nominee its responsibility under the policy would cease and it is not answerable to any of the legal representatives.”

17.   It is the contention of the opposite parties that it required the complainant to produce succession certificate from competent court.   A nominee under insurance policies is a trustee for other legal heirs.   Therefore a nominee under insurance policies can execute a will in respect of her share only.          

18.     The assured died leaving behind him, his wife (nominee) and two sons namely the complainant and another son Praveen as seen from Ex.A-8.    The complaint as well as affidavit of the complainant was silent regarding where about of his brother Praveen and when wife of Praveen obtained divorce.   Under Ex.A-8 the complainant is entitled to the share of his mother in Exs.A-1 to A-5.  The learned counsel for the complainant during the course of arguments submitted that award may be passed to half share of the complainant and regarding other half share subject to production of necessary certificate.   The complaint as well as affidavit of the complainant was silent regarding religion of the assured/insured to apply the law of inheritance/succession that too in the absence of proper and necessary parties.   In the absence of religion of the assured/insured the shares of legal heirs cannot be computed and as such the above request of the complainant cannot be looked into.   The complainant did not file certified copy of order under which his sister-in-law obtained divorce from Court.  The complainant therefore in our considered opinion is not entitled to claim the entire amount covered by Exs.A-1 to A-5.   It is for the complainant to produce appropriate certificate be it declaratory or in some other form to claim the share of his brother Praveen.    For want of those material particulars in our considered opinion the opposite parties cannot be in a position to settle the claim of the complainant. The complainant did not approach proper Forum to stake claim in respect of his brother’s share even after knowing the contention of the opposite parties.  Under those circumstances, the complainant’s claim is not proper.   The complainant himself is deficient in our considered opinion in not producing proper certificates to the opposite parties in respect of his brother’s share (Ex.B-8).    It can therefore be said that the opposite parties did not commit any deficiency of service.  We therefore answer these points against the complainant.

19.  POINT No.4:-   In view of above findings the complainant is not entitled to any compensation.   We therefore answer this point also against the complainant.

20.  POINT No.5:-   In view of above findings, in the result the complaint is dismissed without costs.

 Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 29^th of January, 2013.

          MEMBER                                                                                  PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant  :

For opposite parties :         

By the Forum:

                                                                                                                         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.