BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 7/2013.
THIS THE 11th DAY OF OCTOBER 2013.
P R E S E N T
1. Sri. Prakash Kumar B.A. LLB. PRESIDENT.
2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.
3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER.
*****
COMPLAINANT :- Sri. Venkat Rao S/o. Y. Achaiah, age 30 years,
Occ: agri., R/o. Marlanahalli village, Tq. Gangavathi, Dist: Raichur.
//VERSUS//
OPPOSITE PARTY :- The Branch Manager,
Bajaj Alllianz Life Insurance Company Ltd., Near ICICI Bank, Sindhanoor, Dist: Raichur.
Date of institution :- 24-01-2013.
Date of disposal :- 11-10-2013
Complainant represented by Sri. Prasanna Sharma, Advocate.
Respondent represented by Sri. Vishwanath Pattansetty, Advocate.
ORDER
By Sri. Prakash Kumar, President:-
The complaint is filed by the complainant against the Respondent U/sec. 12 of Consumer Protection Act 1986.
2. The complaint in brief is that, the complainant’s father Edlapalli Achaiah insured his life with the Respondent’s Insurance Company for Rs.4,00,000/- & Rs.5,00,000/- for which the premium payable Rs. 20,000/- & Rs. 25,000/- p.a. respectively. The complainant’s father Edlapalli Achaiah died on 02-11-2011. The complainant being the nominee under the policies obtained by his father made claim with the Respondent’s Insurance Company to pay the amount assured under the policies. But the Respondent’s Insurance Company did not settle the claim. Therefore the complainant got issued legal notice to the Respondent calling upon him to settle the claim and on service of the same the Respondent neither settled the claim nor replied to the notice. It was with an intention to deprive the complainant of the amounts assured under the policies issued by the Respondent’s Insurance Company. This amounts to deficiency in service on their part. Once the policy was issued by accepting the amount of premium and having required examination the Respondent is bound to pay the amount assured under the policies and other benefits to the nominee. Hence the complaint seeking reliefs as prayed for.
3. The Respondent filed the written version stating that the averments made in the complaint, except which are specifically admitted are denied as false. All the allegations made in the complaint are false. The complaint is not maintainable either in law or on facts. The complaint is contrary to the contract between the parties. The deceased life assured had not disclosed the fact of his actual age while making proposal, which he was under obligation to mention at the time of applying for the Insurance policy. Had he disclosed the same the company would not have insured the life assured or would have certainly called for more documents and medical tests. The breach of providing information by the assured entitles the insurer to avoid the contract of insurance so long as he can show that the non disclosure induced the making of the contract on the relevant terms. The claim of the complainant was repudiated on the ground of under statement of age by 12 years. The life assured had the knowledge that he had not shown proper age at the time of making proposal to the Insurance Company. Therefore the life assured is guilty of suppression of material facts. The complaint is not bonafide, legal, proper and therefore it deserves to be dismissed on the principle of “Allegatio contra factum non est admittenda” as all the allegations made in the complaint are contrary to the terms and conditions of the policy. The Life Insurance policy issued to the life assured is based on the principles of “Utmost Good Faith” and therefore the assured is under a solemn obligation to make true and full disclosure of the information on the subject which is within his knowledge. When the deceased had knowledge of his particular age and other matters he is obliged to disclose it particularly while answering questions in the proporal form. In case of any inaccurate answers it will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a Contract of Insurance. The contents of para-1 of the complaint are all matters of records and requires no explanation. The averments of Para-2 to 12 are denied as false. After receipt of the death claim the Respondent made investigations through the investigator which revealed that the deceased life assured deliberately concealed his age while making proposal for insurance and availed the policy by suppressing his real age. The voter list checked showed age of life assured as 75 years. Death Register checked with the Village Accountant discloses the age as 75 years. Anganawadi Register showed the age as 70 years. The Sandhya Suraksha Yojana Pension sanction card of the deceased mentioned the age as 65 years. It was sanctioned in the year 2008. The deceased’ wife’s age in the voter card is mentioned as 65 years and the deceased’s daughter Padmavathi as 45 years. From the above investigations and records it was found that, the policyholder had given under statement of his age by 20 years. The policyholder aged around 75 years was having old age problem. Therefore the policyholder made conspiracy and had taken high sum assured policies and in the proposal form the policyholder signed it in English, but Sandhya Suraksha Yojana Identity card shows that he put his thumb impression which is counter signed by the Tahasildar, Karatagi and the PAN Card was taken for the specific purpose of obtaining of insurance with the fake age document. The deceased had violated the condition No. 13 in not disclosing his actual age and played fraud on Respondent’s Insurance Company. Therefore the complaint is liable to be dismissed with cost in the interest of justice and equity.
5. Complainant to prove his case filed his affidavit which is marked as PW-1 and relied on ten documents which are marked as Ex.P-1 to Ex.P-10. The Respondents to prove his case filed one affidavit which is marked as RW-1 and relied on thirty eight documents which are marked as Ex.R-1 to Ex.R-38.
6. Arguments heard on complainant’s side.
7. The points that arise for our consideration are:
1. Whether the complainant proved deficiency in service on the part of the Respondent’s Insurance Company against him.?
2. Whether the complainant is entitled for the reliefs prayed for.?
3. What order?
8. Our answer on the above points are as under:
(1) In the affirmative.
(2) Partly in the affirmative.
(3) As per final order:
REASONS
POINT NO.1 :-
9. The Respondent admitting the issuance of two Life Insurance Policies in favour of the complainant’s father Edalapalli Achaiah on his death repudiated the claim made by the complainant to pay him the amounts assured under the said two policies, he being the nominee under the said policies, on the ground that the deceased life assured had suppressed his age while making proposal for issuance of Insurance policy in his favour with his Insurance Company. It is the case of the Respondent that, the deceased life assured had not disclosed the fact of his actual age while making proposal and the breach of providing true information by him entitles the insurer to avoid the contract of insurance as long as he can show that non disclosure of true information induced the making of the contract on the relevant terms. It is the further case of the Respondent that after receipt of the death claim they made investigations through the investigator which revealed that deceased life assured deliberately concealed his age while making proposal for insurance policies and availed the policies by suppressing his real age. To prove this contention the Respondent produced the copies of voter list, death Register Extract, Anganawadi Letter, and Sandhya Surakasha Yojana Pension Scheme card wherein the age shown are in the range of 65 years and 75 years. The Sandhya Surakasha Yojana Pension Scheme issued by Tahasildar Karatagi is marked as Ex.R-2. Death certificate issued by Anganawadi is marked as Ex.R-3. The voters’ list is marked as Ex.R-4 & Ex.R-7. Out of this Ex.R-2 Sandhya Surakasha Yojana Pension Scheme identity card does not reveal the age of the deceased life assured Achaiah. So the said document is of no use for the Respondent to prove his contention. In Ex.R-3 as on 02-11-2011 the date on which the deceased life assured died the age shown is 70 years. As per Ex.R-4 and Ex.R-7 which are the voters’ list for the year 2012 the age of the deceased life assured was shown as 75 years. Out of these documents Ex.R-4 and Ex.R-7 pertains to 2012 by which time the deceased life assured was already dead he having died in the year 2011. Then how come his name in voters’ list of 2012 is not known. However these documents relied on by the Respondent cannot be considered as fool proof, reliable and authentic documents which proves the real age of the deceased life assured because as per the decision of the Hon’ble National Consumer Disputes Redressal Commission reported in II (2011) CPJ 7 the age given in voters’ list cannot be taken as sure test to determine the exact age of a person. Therefore the age mentioned in the voter list is not conclusive proof of the age of the person concerned. Besides, this there is inconsistency in respect of the age of the deceased between these documents produced by Respondent. This also make these documents unreliable. Likewise much value cannot be attached to other documents produced by the Respondent to prove the age of the deceased life assured as these documents also fall in the same category as that of voters’ list. Therefore on the basis of these documents repudiation of the claim made by the complainant to pay the sum assured under two policies issued in favour of his father amounts to deficiency in service on the part of the Respondent’s Insurance Company. Accordingly this point is answered in the affirmative.
POINT NO.2:-
12. As the complainant has proved deficiency in service on the part of the Respondent’s Insurance Company and that the repudiation made by the Insurance Company to pay the amounts assured under the policies being found baseless, the complainant is entitled for the amount assured under the policies along with interest and cost of the proceedings which shall be as per final order. Accordingly, we answer this point partly in affirmative.
POINT NO.3:-
13. As per order below:
ORDER
The complaint filed by the complainant is partly allowed with cost.
The complainant is entitled to recover sum of Rs.9,00,000/- from Respondent’s Insurance Company.
The complainant is also entitled to recover interest at the rate of 6% p.a. on total sum of Rs.9,00,000/- from the date of the complaint till realization of the full amount.
The complainant is also entitled to recover sum of Rs.1,000/- towards cost of the proceedings from the Respondent’s Insurance Company.
Respondent is given one month time from the date of this order for making payment of the above said amounts.
Intimate the parties accordingly.
(Dictated to the Stenographer, typed, corrected and then pronounced in the open Court on 11-10-2013)
Smt.Pratibha Rani Hiremath Sri. Gururaj Sri. Prakash Kumar
Member. Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur. District Consumer Forum Raichur.
