BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Sri.Y.Reddappa Reddy, M.A., L.L.M., President,
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Thursday the 23rd day of April, 2015
C.C.No.109/2014
Between:
J.P.Venkata Reddy,
F/o Late J.P.Varalakshmi,
S/o Late J.P.Basi Reddy,
Hindu, aged about 61 Years,
H.No.5/466, Near Water Tank,
Hanuman Nagar, Adoni-518 301,
Kurnool District. …Complainant
-Vs-
1. The Branch Manager,
LIC of India, D.No.20/451,
Naketha Building, 1st Floor,
Near New Bus Station,
Adoni-518 301.
2. The Senior Divisional Manager,
LIC of India, Divisional Office,
Post Box No.10, College Road,
Kadapa-516 004. …OPPOSITE PARTIES
This complaint is coming on this day for orders in the presence of Sri.P.Siva Sudarsha, Advocate for complainant and Sri.Ch.Joga Rao Advocate for opposite parties 1 and 2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member,)
C.C. No.109/2014
1. This complaint is filed under section 11 and 12 of Consumer Protection
Act, 1986 praying:-
- To pay the assured amount of Rs.1,00,000/- with interest at the rate of 24% per annum along with profits and bonus.
- To pay Rs.25,000/- towards the compensation for causing mental agony and hardship.
- To pay costs of this complaint.
- To pass any other order or orders that are deem to be fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as follows:- The complainant is the father of Late.J.P.Varalakshmi @ T.Varalakshmi. On 24.06.2008 J.P.Varalakshmi insured her life with opposite parties for an assured sum of Rs.1,00,000/- under the policy bearing No.655069086. On 01.01.2009 J.P.Varalakshmi died, due to Heart Attack. The complainant made a claim to opposite parties being the nominee under the policy. On 16.05.2012 the opposite party No.2 sent a letter to the complainant by requesting him to send the occupation and complete address of the husband of deceased, but the complainant had no contacts with him and his whereabouts is not known to the complainant after the death of his daughter and the same was intimated to opposite parties through letter dated 02.06.2012, and requested them to settle the claim of the complainant. The complainant approached the opposite parties and personally requested them to settle the claim, but they did not respond. On 23.07.2013 the opposite party No.2 repudiated the claim, on a false ground that the deceased/insured suppressed the material fact regarding her pregnancy at the time of taking policy. But the insured died due to Heart Attack. There is a deficiency of service on the part of opposite parties and caused mental agony to the complainant.
3. Opposite party No.1 adopted the written version of opposite party No.2. Opposite party No.2 filed written version stating that the complaint is maintainable neither in law nor on facts of the case. It is barred by limitation. It is admitted that the opposite parties issued policy bearing No.655059086 in favour of the complainant for an assured sum of Rs.1,00,000/- with its date of commencement of risk from 24.06.2008 under the plan and terms of 193/20 and opted to pay premium under yearly mode and the complainant is the nominee under the policy. It is submitted that the claim under the said policy has arisen within 7½ months from the date of policy, the claim was treated as an early claim and conducted investigation. During the course of investigation, it was found that the life assured/deceased had given birth to a female child on 08.11.2008 at Padmavathi Meternity Hospital, Adoni, and the opposite parties obtained birth certificate of her female child. The life assured had intentionally not disclosed the same as she was pregnant at the time of taking policy. The deceased being fully aware of her pregnancy deliberately given declaration in the proposal form that she was not pregnant and this amount to non disclosure of material fact which would have been disclosed by her. Hence the claim was repudiated on valid grounds. There is no deficiency of service on the part of opposite parties. The complaint is liable to be dismissed.
4. On behalf of the complainant filed Ex.A1 to Ex.A6 are marked and sworn affidavit of complainant is filed. On behalf of the opposite parties filed Ex.B1 to Ex.B7 are marked and sworn affidavit of opposite parties are filed.
5. Both sides filed written arguments.
6. Now the points that arise for consideration are:
- Whether the complaint is barred by period of limitation?
- Whether there is deficiency of service on the part of opposite parties?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINT No.i :- Admittedly the deceased J.P.Varalakshmi @ T.Varalakshmi took the policy from opposite party No.2 through opposite party No.1 under Ex.B2=Ex.A1. Ex.B2=Ex.A1 is the policy copy. The insured died on 01.01.2009 due to Heart Attack. The complainant being the nominee submitted claim to opposite parties and opposite party No.2 repudiated the same on 23.07.2013 under Ex.A6=Ex.B7. It is the case of opposite parties that the complaint is not filed within the period of limitation under section 24 (a) of Consumer Protection Act, 1986 the period of limitation to file a complaint before the District Forum is two years from the date on which the cause of action has arisen. In the present case the insured died on 01.01.2009. The Insurance Company repudiated the claim on 23.07.2013 and the complaint is filed on 17.09.2014. The cause of action arisen from the date of repudiation of claim. Hence the complaint is well in time and it is not barred by period of limitation.
8. POINTS ii and iii:- Admittedly on 24.06.2008 the opposite parties issued Money Plus LIC policy bearing No.655059086 in favour of the deceased J.P.Varalakshmi for an assured amount of Rs.1,00,000/- with its annual premium of Rs.10,000/- under a term and plan of Rs.193/20 under Ex.B2=Ex.A1 and the complainant is the nominee under the policy. The insured died on 01.01.2009. Ex.A2=Ex.B6 is the death certificate issued by Registrar of Births and Deaths, Adoni Municipality, Kurnool District, dated 03.01.2009. It is the case of complainant that being the nominee the complainant submitted Claim Form to opposite parties and opposite party No.2 sent a letter dated 16.05.2012 to the complainant by requesting to sent the address and occupation of deceased husband, it is marked as Ex.A3. The complainant in reply letter dated 02.06.2012 intimated that after the death of her daughter (Insured) his son-in-law married to another girl and living with her at Hyderabad and his whereabouts is her known to him it is marked as Ex.A4. Though the complainant personally requested opposite parties to settle the claim, the opposite party did not take steps to settle the claim. Therefore the complainant sent a letter dated 02.06.2013 to insurance OMBUDSMAN and requested him to take step to be settle the claim but there was no response from him. At last on 23.07.2013 under Ex.B7=Ex.A6 the opposite party No.2 repudiated the claim, on the ground that the insured/deceased suppressed the material fact with regard to her pregnancy at the time of taking policy. But she died due to sudden Heart Attack. It is the case of opposite party No.2 that she was pregnant at the time of submitting the proposal form and she did not disclose this fact in that proposal form, had she disclosed her pregnancy, the opposite parties would not have considered the proposal for insurance. The proposal form is marked as Ex.B1 dated 24.06.2008. Ex.B2 is the policy copy. Ex.B6 is the death certificate of insured. Ex.B3 is the affidavit given by the complainant before notary stating that J.P.Varalakshmi @ T.Varalakshmi as mentioned in death certificate Ex.B6 is one and the same person. Ex.B4 is photo copy of House Hold Card of the complainant. Ex.B7 is the repudiation letter dated 23.07.2013. It is further case of opposite party no.2 that during the course of investigation, it was found that the deceased life assured had given birth to a female child on 08.11.2008 at Padmavathi Maternity Hospital, Adoni. Ex.B5 is the Birth Certificate of female child of insured issued by Registrar of Births and Deaths, Adoni Municipality, Kurnool District. The deceased/insured had given birth to female child within 4½ months from the date of policy. As the insured violated the terms and conditions of the policy. Thus the opposite parties are not liable for payment of insurance benefits and the opposite party No.2 repudiated the claim on valid grounds. The learned counsel appearing for the complainant contended that the deceased/insured was not a pregnant lady either at the time of taking policy or at any time. The birth certificate is false and created for the purpose of this case. The opposite parties did not examine any person to prove the same and there is no nexus between alleged pregnancy and cause of death (Heart Attack). He relied on decision in F.A.No.695/2004 Maharastra State Consumer Dispute Redressal Commission, Mumbai, Life Insurance Corporation of India -Vs- Smt.Chhaya Hanmayya Ghante, where in it was held that life assured died due to Jaundice and insured was suffering from Fibrosis Alveolitis. There was no nexus between cause of death and ailment from which he was suffering previously. The facts of the above case are applicable to the present case on hand.
9. Admittedly the deceased/insured obtained policy bearing No.655059086 for an assured amount of Rs.1,00,000/- under Ex.B2=Ex.A1 and the complainant is the nominee under the policy, and the opposite party No.2 repudiated the claim of the complainant under Ex.B7. The opposite parties alleges that the insured was pregnant at the time of taking policy and on 08.11.2008 she had given birth to a female child at Padmavathi Maternity Hospital, Adoni, Ex.B5 is the Birth Certificate of a female child of insured. The deceased suppressed the material fact with regard to her pregnancy in the proposal form. Admittedly the life assured died on 01.01.2009 due to Heart Attack. If the insured died at the time of giving birth to a child (delivery) then there was a nexus of alleged pregnancy and cause of death, but in the instant case the insured died due to Heart Attack approximately fifty three days after her alleged given birth of child (delivery) therefore there was no nexus of alleged pregnancy and cause of death. Though the complainant sent a letter and requested several times to opposite parties to settle the claim. The opposite parties did not respond either to gave reply or settle his claim. We consider all the material available on record and in the light of above decision we hold that there is a deficiency of service on the part of opposite parties by kept pending the claim of complainant for about three years and at last repudiated in the year, 2013. Due to the negligent attitude of opposite parties, the complainant suffered mental agony.
10. POINT No.iv:- The complainant prayed for an assured amount of Rs.1,00,000/- with interest at 24% per annum and compensation of Rs.25,000/- for mental agony. Basing on the material placed on record facts and circumstances of the case. We are of the view that being the nominee under the above policy the complainant is entitled for an assured amount of Rs.1,00,000/- along with benefits with interest at 9% per annum from the date of repudiation letter dated 23.07.2013 and further entitled Rs.10,000/- for mental agony.
11. In the result, the complaint is partly allowed directing the opposite parties jointly and severally liable to pay an assured amount of Rs.1,00,000/- with death benefits with interest at 9% per annum from the date of repudiation i.e., on 23.07.2013 to till the date of realization and further direct to pay compensation of Rs.10,000/- towards mental agony and Rs.1,000/- as costs of the case. The time for compliance is one month from the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 23rd day of April, 2015.
Sd/- Sd/-
LADY MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Policy bearing No.655059086.
Ex.A2 Photo copy of Death Certificate of Deceased Life Assured (J.P.Varalakshmi).
Ex.A3 Photo copy of Letter dated 16.05.2012 from opposite party No.2 to complainant.
Ex.A4 Office copy of Reply Letter dated 02.06.2012 from complainant to Insurance Company along with postal receipt.
Ex.A5 Office copy of Letter dated 02.06.2012 from complainant to opposite party No.2 along with postal receipt.
Ex.A6 Repudiation Letter dated 23.07.2013.
List of exhibits marked for the opposite parties:-
Ex.B1 Proposal Form dated 24.06.2008.
Ex.B2 Policy bearing No.655059086.
Ex.B3 Affidavit of the complainant.
Ex.B4 Photo copy of House Hold Card of complainant.
Ex.B5 Birth Certificate issued by Registrar of Birth and Death, Adoni Municipality, Adoni, Kurnool District.
Ex.B6 Death Certificate of Deceased Life Assured (J.P.Varalakshmi).
Ex.B7 Repudiation Letter dated 23.07.2013.
Sd/- Sd/-
LADY MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties :
Copy was made ready on :
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