BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 43/11.
THIS THE 17th DAY OF NOVEMBER 2011.
P R E S E N T
1. Sri. Pampapathi B.sc.B.Lib. LLB PRESIDENT.
2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.
3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER
*****
COMPLAINANT :- Mallanna S/o Veerbhadrappa,
Age 40 years, Occ: Agri,
R/o. H. No. 45 at hullur village,
Po: Hullur Tq: Sindhanoor Dist; Raichur.
//VERSUS//
OPPOSITE PARTY :- The Branch Manager,
BAJAJ ALLIANZ LIFE INSURANCE
CO LTD Near ICICI Bank at Sindhanoor
Dist: Raichur
CLAIM :- Settlement of Death claim in view of
deficiency of service.
Date of institution :- 13-06-11.
Notice served :- 28-06-11.
Date of disposal :- 17-11-11.
Complainant represented by Sri. Basavaraj G.Y. Advocate.
Opposite Party represented by Sri. Avinesh Tharanath, Advocate.
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This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.
JUDGEMENT
By Sri. Gururaj, Member:-
This is a complaint filed by one complainant Mallanna S/o. Veerabhadrappa against Opposite Branch Manager, Bajaj Allianz Life Insurance Company Ltd., Sindhanoor Dist: Raichur, U/sec. 12 of Consumer Protection Act, for to direct the opposite to pay an amount of Rs. 1,00,000/- towards policy amount along with interest at the rate of 2% p.a. and Rs. 50,000/- as damages expenses mental shock agony etc., along with other benefits of policy in question.
2. The brief facts of the complainant’s case are that, that the mother of the complainant had insured her life with the Respondent under policy No. 0127637766 for sum of Rs. 1,00,000/- and the premium amount was payable by her is at Rs. 10,000/- p.a. The policy holder late Smt. Amaramma W/o. Veerabhadrappa died on 15-10-09 on the death of the policyholder the complainant being the nominee of said policy has surrendered the said policy and by furnishing the relevant applications, copies etc., has requested the Respondent the settled the death claim benefits of said policy. But the Respondent instead of settling the death claim to the tune of Rs. 1,00,000/- along with its benefits but the claim has been declined through letter dt. 01-09-10 which are totally contrary and arbitrary to the terms of policy. It is further case of the complainant that, immediately after the receipt of the said letter he approached the said Respondent and requested for to settle the policy amount and benefits to which is entitled as per the policy for which the Respondent postponed and dragged the matter on one or the other pretext by giving untenable reasons. The complainant thereupon got issued the legal notice on 03-05-11 calling upon the Respondent to settle the claim, but in spite of service of said notice the Respondent neither come forward to settle the policy amount nor replied to the said notice, the act and tendency of the Respondent clearly goes to show that, it is totally contrary, arbitrary and deficiency of service for which the complainant sustained mental shock, agony and incurred heavy loss. Therefore, he has sought for the relief as prayed in the complaint.
3. Opposite Insurance Company appeared in this case through its Advocate, filed written version by contending that, the complaint filed by the complainant is abuse of the process of the Hon’ble Forum, it is devoid of any material substances, the complainant has approached this Forum with malifide intention only to get illegal monetary benefits, and he has suppressed material facts, therefore he is not eligible for any claim from this opposite life Insurance Company and sought for dismissal of the complaint. Further it has contended that, the voter ID Card of the insured was forged and her age was manipulated and same can be pursued from the photo copy of the two voter ID cards produced by the complainant. As per the first ID card issued on 25-09-95 her age on dt. 01-01-94 she was 45 years but another ID card submitted by the insurer at the time of buying the policy states that, she was 38 years as on 01-01-2005 she has under stated her age by almost 20 years to the Respondent. The age as per the ration card issued to the deceased in the year 2006 clearly states that, her age is 50 years vis-à-vis the photo copy of the voter ID card of the complainant as on 01-01-2005 39 years. As such there is no possibility for the deceased to be less then 55 years in 2005 because a lady can conceive and give birth only after she completed 16 years. Wherein the another voter ID card of the complainant submitted by the deceased for non standard age proof she submits that, her age as on 01-01-2005 was 38 years as such there is absolutely no possibility of just one year between the mother and her son.
Further it is contended that, the claim verification report wherein a relation of the deceased/insured by name Basangouda and neighbor Gundappa, friend Basavaraja and complainant’s wife Laxmi states that, mother of complainant was suffering from Asthma and breathlessness which was not disclosed by the deceased/insured to the opposite party. As such the insured/deceased is guilty of suppression of material facts, which would have made her in eligibility for any insurance more specifically that off Respondent, therefore the claim of the complainant is not sustainable in the eyes of law and in gross violation of the terms and condition of the contract between the deceased and the opposite company, as such the claim of the complainant needs to dismiss. Hence sought for dismissal of the complaint with exemplary cost punitive damages.
4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that:
1. Whether the complainant proves that, there is a deficiency in service on the part of the opposite, as alleged.?
2. Whether the complainant is entitled for the relief’s as prayed in his complaint.?
3. What order?
5. Our findings on the above points are as under:-
(1) In affirmative.
(2) In affirmative.
(3) In-view of the findings on Point Nos. 1 & 2, we proceed
to pass the final order for the following :
REASONS
POINT NO.1 & 2:-
6. In order to prove the facts involved in these two points, affidavit-evidence of the complainant was filed, he was noted as PW-1. Documents Ex.P-1 to Ex.P-5 are marked. On the other hand affidavit-evidence of one Sri Sharanabasappa, Branch Manager of Respondent Insurance Company was filed he was noted as RW-1. Five Documents as Ex.R-1 to Ex.R-9 are marked. Heard the arguments of the opposite counsel, the counsel for the complainant remained absent on the date when the case was posted for arguments. Hence we have taken it has no arguments to be advanced from the complainant side.
7. Admittedly the mother of the complainant has got policy bearing No. 0127637766 for a sum of Rs. 1,00,000/- on the premium of Rs. 10,000/- p.a. and the complainant is the nominee for the said policy. Further it is admitted that, the policyholder by name Amaramma W/o. Veerabhadrappa i.e, mother of the complainant was died on 15-10-09, after her death the complainant has moved claim petition before the opposite and same was repudiated.
8. We have gone through the pleadings of the parties and documents. It is the case of the complainant that, after the death of his mother by name Amaramma W/o. Veerabhadrappa i.e, life assured moved claim form for the death claim under the policy bearing No. 0127637766 for a sum of Rs. 1,00,000/-. But same was repudiated by the opposite. On the other hand, it is the case of the opposite that, the life assured late Amramma was submitted forged document in the form of the voter ID card in order to establish her age at the time of taking the policy and suppressed the material facts regarding her decease, which is illegal and contrary to the terms and conditions of the policy. The opposite in support of their case, they have relied upon the documents filed under Ex.R-1 to Ex.R-9.
9. As per the opposite pleadings and their documents the following points are arising for our consideration are as under:
1. Whether, the deceased was obtained the policy by submitting forged ID card in order to prove her age, as contended by the opposite.
2. Whether, the deceased was suppressed the material facts regarding her pre-existing decease.
On first point is concerned, we have perused Ex.R-1 i.e, the proposal form which was filled by the one Sharanappa Hullur wherein, the age of the deceased life assured was shown as 42 years and same was supported by the witness and the said proposal form was also signed by the in-charge officer of the opposite. From this it is very clear that, she was 42 years at the time of obtaining the policy. Further on perusal of voter ID card produced under Ex.R-3 the age as on 01-01-1994 it was 45 years and as per Ex.R-4 as on 01-01-2005 38 years. No doubt from these three documents the age of the deceased was very much difference from one document to another and it is also proved that, the age of the deceased as per Ex.R-4 and the age of the complainant as per Ex.R-4(1) i.e, ID card of the complainant was difference by one year as on 01-01-2005.
It is not the case of the opposite that, the deceased has obtained the policy at the age barred time, fixed for to obtaining the policy. If we have considered two ID cards of the deceased, no doubt one is given in the year 1994 and another one in the year 2005. The ages are shown as 42 and 38 years respectively. No doubt, there is a lot of difference in ages and more particularly the age of 1994 ID card is more than the age of 2005 ID card.
10. It is worth vile to note here that, both the ID cards produced before this forum are xerox copies neither the complainant nor the OP have produced the original ID cards more particularly when the Ops relaying upon those documents and questioning in their originality he has to prove that, one of the ID card is manipulated or forged one with all authoritative evidence. Here the OP has not produced any documents to show that, the alleged documents i.e. ID produced under Ex R-4 is forged one. The author of the said documents is one and signature of the competent authority is same in both ID Cards. Under such circumstance and since they are the xerox copies we cannot come to the conclusion that, which is false and which is correct. No doubt the originals have been called for the complainant only after the filing of the complaint, and appearance of the op. But the op has not made any efforts to call for such ID cards, when they have written a letter dated 13-08-2010 through which they have called some other documents from the complainant. But the complainant has not produced the same when it has been called before the forum. This inability by the complainant is just may be not availability of the same. This facts was supported by the Ex R-7 i.e. statement of one Laxmi wife of complainant. Where in she has clearly stated at para No. 2 of the said statement as “£À£Àß CvÉÛ ªÀÄvÀÄÛ CªÀgÀ ªÀÄUÀ£ÀzÀÄ ªÀÄ®ètÚ JA§ÄªÀªÀgÀzÀÄ E§âgÀzÀÄ ºÀÄnÖzÀ ¢£ÁAPÀzÀ ¸Ànð¦üÃPÉÃlÄUÀ¼ÀÄ AiÀiÁªÀÅzÀÄ E¯Áè ” further it worth wile note here that, the said Ex- R-7 is the document produced by the OP, it cannot be discarded without any contradictory proof. Under such circumstance we do not find how the OP has obtained xerox copies of the ID card produced under Ex R-3, R-4 & R-4 (1).
Further Op in their version contended that, the attested ID card was produced by the deceased life assured at the time of obtaining the policy, but signature on the ID card alleged to be attested by life assured and signatures on the proposal form i.e. Ex-R-1 are appears to be different. Under such circumstance the version of the OP cannot be believed as life assured was submitted false/forged document while availing the policy in question.
11. Further on perusal of Ex R-3(1) i.e. consent letter for to collect extra premium under the head “ To whom so ever it may concerned ” it shows that, no standard age proof has been produced by the life assured. It means it clearly speaks that, at the time of obtaining the policy no documents including ID card regarding age is concerned have been produced by the life assured. If at all she has produced alleged ID card under Ex R-4 then the question of giving such letter shown under Ex R-3 (1) will not arise. Hence under such circumstance, the document filed by the Op itself under Ex R-3 (1) further proves that, no ID card was produced at the time of obtaining the policy as contended by the OP. Viewing from any angle, the OP has failed to prove that, the complainant mother i.e. life assured has obtained the policy by submitting forged documents, hence the point No. 1 is goes in favor of the complainant and against the OP.
12. It is worthwhile to note here that, the opposite party neither they have made any efforts to get the evidence of the witnesses who have present and signed the proposal form along with the deceased at the time of obtaining the policy to so that, the deceased was produced alleged ID card. Further, the opposite has also not produced any documents to show that, the deceased was obtained the policy by producing manipulated document and he has made any complaint before the competent authority to prove that, the alleged ID cards was manipulated one. The OP through Ex P-2 i.e. letter dated 13-08-2010 has called the complainant to produced 3 documents but no where in the said letter Op called for the ID cards in order to get verify or confirm about their originality. This fact is further clearly goes to show that, the OP up to 13-5-2010 they were intended to settled the claim, but ultimately they have raised un wanted objections about the ID card and intentionally refused the claim. If at all they are firm in their opinion about the forged document, then once again the question will come before us that, what has prevented them to call the ID cards along with other documents through Ex P-1. This act also creates lot of doubts about their attitude. Hence the ground on which the claim has been repudiated is nothing but contrary, arbitrary and against the terms of the policy as contended by the complainant.
13. Further the Op is trying to prove their case, by comparing the photos produced under Ex R-5 and Ex R-6 with alleged ID cards as the ID cards were not matching with the age of the ID card and age on the face of photos. When the credibility of the ID cards is under dark, then their comparison with the photos which are not supported by the negatives is nothing but searching of the black cat in dark room. Hence under such circumstance the efforts of the OP are once again nothing but beating of the dead horse. Hence we have rejected the version of the op in this regard.
14. The second point whether, the deceased was suppressed the material facts regarding her pre-existing decease is concerned, no doubt the OP has raised this question only in the written version but not repudiated the claim on this ground, in the repudiation letter dated 01-09-2010 produced under Ex P-1, no where it has mentioned that, the claim has been repudiated on the ground of suppression of material facts regarding the pre existing decease, further it is worth vile to note here that, in their investigation / claim verification report produced under Ex R-8 it has mentioned that, OP company enquiring authority enquired with the neighbor hood, Panchayath, relatives, friends, complainant and doctors etc., and came to know that, the life assured was suffering from asthma and ulcer and died due to that, but no statement or affidavit evidence and medical reports are not made available before this Forum. Further it reveals that, the cause of death is as chest pain but not due to Ulcer or Asthma as contended by the OP. This is clearly goes to show that, the cause of death is not due to the said decease, and there is no any evidence to show that, the chest pain was due to Asthma or Ulcer. Under such circumstance the OP contention in this regard holds no good. The claim verification report cannot be accepted unless otherwise same is proved by proper evidence. Their own repudiation letter is contrary to the said verification report. The duel version of the Op creates lot of doubts, hence under such circumstance the rejection of the claim cannot be accepted, and contention in this regard is rejected.
15. Hence from viewing from all the angles, the repudiation of the claim by the Op through letter dated 1-9-2010 is nothing but a contrary and arbitrary. Since the insurance company hold responsibility of proving his case, but absolutely failed in this regard. We do not find any merits in the contention of the opposite that, it has rightly repudiated the claim of the complainant on the contrary it follows that, the opposite has wrongly repudiated the claim without any basis hence, we find that there is a gross deficiency of service of the opposite in repudiating the claim, therefore for all these reasons the above points No-1 & 2 are answered in the affirmative.
16. The complainant in his complaint has claimed the policy amount of Rs. 1,00,000/- and also interest at the rate of 2% p.a. Rs. 50,000/- as damages, expenses, mental shock etc., and cost of the proceedings. In view of our conclusion and findings on above points 1 & 2 the complainant is entitled for policy amount of Rs. 1,00,000/-. As regards to damages etc., are concerned the claim of the complainant is heavy and excessive hence we granted Rs. 6,000/- including cost of the litigation and deficiency in service. Complainant is entitled to recover interest at the rate of 9% p.a on total amount of Rs. 1,06,000/- from the date of complaint till realization of full amount.
POINT NO.3:-
17. In view of our findings on Point Nos. 1 & 2, we proceed to pass the following order:
ORDER
The complaint filed by the complainant is allowed in part.
The complainant is entitled to recover Rs. 1,00,000/- towards policy amount
The complainant is also entitled to recover Rs. 6,000/- towards deficiency in service and cost along with damages etc., complaint is entitled to recover interest at the rate of 9% p.a on total sum of Rs. 1,06,000/- from the date of this complaint till realization of full amount.
The opposites are directed to pay the above said awarded amount with interest within six weeks from the date of receipt of this order.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 17-11-11)
Smt.Pratibha Rani Hiremath, Sri. Gururaj Sri. Pampapathi,
Member. Member. President,
Dist.Forum-Raichur. Dist-Forum-Raichur Dist-Forum-Raichur.
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