BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC. 5/2013.
THIS THE 6th DAY OF DECEMBER 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 :- Smt. Rabiya Begum W/o. Late Kaleem @
Kaleema Pasha, Major, Occ: Fruit Merchant, R/o. Maski By-pass Road, Lingasugur, Tq. Lingasugur, Dist: Raichur.
//VERSUS//
RESPONDENTS :- 1. The Branch Manager, LIC of India,
Branch Office, Station Road, Raichur.
2. The Divisional Manager, LIC of India,
Divisional Office, Station Road, Raichur.
Date of institution :- 21-01-2013.
Date of disposal :- 06-12-2013
Complainant represented by Sri. M. Mallangouda, Advocate.
Respondent Nos. 1 & 2 represented by Sri. Munna Kumar, Advocate.
ORDER
By Sri. Prakash Kumar, President:-
The complaint is filed by the complainant against the Respondents U/sec. 12 of Consumer Protection Act 1986.
2. The complaint in brief is that the complainant is the legally wedded wife of Kaleem @ Kaleema Pasha who was a fruit merchant. He had obtained a LIC policy named New Janaraksha Plan with accident benefit for assured sum of Rs.5,00,000/-. The complainant is the nominee to the said policy. The complainant’s husband Kaleema died on 09-10-2010. Therefore the complainant made claim with the Respondent for payment of the amount assured under the policy for which the Respondents did not respond. Therefore the complainant got issued legal notice to the Respondent No-2 for which reply was given stating that the complaint received from Advocate on behalf of their client are not admissible. Thereafter they repudiated the claim stating that deceased had mis-represented the information regarding his date of birth at the time of effecting the assurance with them. However the Respondents have made payment of policy amount to the complainant in respect of another policy bearing No.660807587 of her husband for sum assured of Rs.1,00,000/- without any objections with regard to date of birth of the policyholder. The attitude of the Respondents amounts to deficiency in service on their part. Therefore the complaint seeking reliefs as prayed for.
3. The Respondents appeared through their counsel and filed written version stating that the complaint filed by the complainant is neither maintainable in law nor on facts. The facts stated in the complaint are not correct. One Kaleema had taken the policy No. 660807587 for Rs.1,00,000/- and another policy No. 664385493 for Rs.5,00,000/- respectively. After receiving the death intimation the Respondents have processed the death claim and came to know that the deceased life assured mis led the Respondents’ corporation by producing false school certificate as age proof. Since the death of life assured is very early from the date of commencement of the 2nd policy investigation was conducted by the Respondents’ Insurance Company which revealed that school certificate produced for getting insurance for sum assured Rs.5,00,000/- is fake one. The Head Master of the school has given a letter to that effect stating that such student has not at all studied in that school. The admission number, the year of the admission and name of the student mentioned in the certificate does not find any entry in their register. As per the under writing rules of the Respondents’ corporation the proposer who is not having standard age proof such as school certificate can take maximum insurance of Rs.2,00,000/- only. In the instant case the deceased life assured with a fraudulent intention has fabricated the school certificate and availed the insurance of Rs.5,00,000/-. Therefore the Respondents rightly repudiated the claim under the 2nd policy. An opportunity was given to approach the Zonal Claims Review committee and complainant approached the same and the committee going through all the records has upheld the decision of the repudiation. The first policy No. 660807587 was taken on 28-03-2001 for Rs.1,00,000/- by self declaration of date of birth as 01-06-1973. This was well within the permissible limits of under writing rules and hence death claim was settled under the said policy. The policy in question 664385493 was availed by producing fake school certificate as age proof. This shows the fraudulent intention of the deceased life assured. The Respondents believing statements made in the proposal form and declaration made by the deceased life assured has granted the insurance of Rs.5,00,000/-. The contract of insurance between the insurer and the insured is made in utmost good faith and suppression of material information at the time of submission of proposal for insurance would justify the repudiation of claim by insurer. Therefore the complaint is liable to be dismissed with heavy cost.
4. Complainant to prove her case filed her 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 their case filed their affidavit evidence which is marked as RW-1 & RW-2 and relied on six documents which are marked as Ex.R-1 to Ex.R-6.
5. Arguments heard on both sides.
6. The points that arise for our consideration are:
1. Whether the complainant proved deficiency in service on the part of the Respondents against her.?
2. Whether the complainant is entitled for the reliefs prayed for.?
3. What order?
7. 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 :-
8. The Respondents repudiated the claim of the complainant to pay the amount assured under the life insurance policy obtained by her husband from their insurance company only on the ground that deceased life assured misled the Respondents’ corporation by producing false school certificate as his age proof. It is not at all the contention of the Respondents that the deceased life assured had given false date of birth. The date of birth mentioned by the deceased life assured in the proposal form Ex.R-1 as on 01-06-1973 was accepted by the Respondents. The contention of the Respondents is that as age proof the school certificate produced by the deceased life assured was fake one. However what is to be observed is that on perusal of the said school certificate produced by the Respondents the copy of which is marked as Ex.R-4 it was found obtained and produced by the agent of the Respondents’ Insurance Corporation by name Smt. K.Mangala.V.Katti. As her seal and signature is found on it. The said document does not show that it was produced by the deceased life assured. The said agent of the Respondents’ Insurance Corporation who produced the school certificate is none other than the said agent of the Respondents’ Insurance Corporation itself. The same was accepted by the Respondents’ Insurance Corporation as age proof of the deceased life assured. Therefore they cannot contend that the said school certificate was produced by the deceased life assured as proof of his age and it is fake one. The said document being produced by the agent of the Respondents’ Insurance Corporation they only have to be made responsible, if the said school certificate is fake one. To say that school certificate was fake one the Respondents relied on a letter said to have been given by the Head Master of the said school to the Respondents’ Insurance Corporation stating that no students had enrolled in their school any time as described in Ex.R-4 school certificate. But to prove the same the Respondents have not produced evidence of the school Head Master who issued the letter of Ex.R-3. Besides this on the basis of the same date of birth i.e, on 01-06-1973 accepting the same the Respondents had issued another policy in favour of the deceased life assured which was for Rs.1,00,000/- and the amount assured under the said policy was settled by the Respondents’ Insurance Corporation in favour of the complainant after the death of the deceased life assured. This is admitted by the Respondents in their written version. That being the case now the Respondents are estopped from contending that the deceased life assured had produced the fake school certificate in support of his date of birth. This shows that the Respondents’ Insurance Corporation just to avoid the payment of amount assured under the policy found out a created ground and repudiated the claim made by the complainant which is not sustainable in the eye of law. The Respondents’ Insurance Corporation should have settled the claim of the complainant. However they on false and untenable ground refused to settle the claim. This amounts to deficiency in service on their part. Accordingly this point is answered in the affirmative.
POINT NO.2:-
9. As the complainant has proved deficiency in service on the part of the Respondents’ Insurance Corporation they are liable to pay compensation for the same to the complainant along with the amount assured under the policy 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:-
10. 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.5,00,000/- towards policy amount from Respondents’ Insurance Corporation.
The complainant is also entitled to recover interest at the rate of 6% p.a. on total sum of Rs.5,00,000/- from the date of the complaint till realization of the full amount.
The complainant is also entitled to recover sum of Rs.20,000/- towards deficiency in service from the Respondents’ Insurance Corporation.
The complainant is also entitled to recover sum of Rs.1,000/- towards cost of the proceedings from the Respondents’ Insurance Corporation.
Respondents are 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 Forum on 06-12-2013)
Smt.Pratibha Rani Hiremath Sri. Gururaj Sri. Prakash Kumar
Member. Member. President,
District Consumer Forum Raichur. District Consumer Forum Raichur. District Consumer Forum Raichur.
