BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, B.L., LADY MEMBER
M.V.R. SHARMA, B.A. MEMBER
Friday, 27th February 2015
CONSUMER COMPLAINT No. 60 / 2014
Smt. A. Nagakumari, W/o late Subbarayudu,
aged 50 years, Hindu, Residing at D.No. 42/347-180,
A.W. Road, Simhapuri Colony, Kadapa city. ….. Complainant.
Vs.
1. The Branch Manager,
Life Insurance Corporation of India,
Branch Office, R.S. Road, Kadapa.
2. The Divisional Manager, L.I.C of India,
Divisional Office, Arts College Road, Kadapa City.
3. The Zonal Manager, L.I.C of India,
South Central Zonal Office, Secretariat Road,
Hyderabad – 500 463. …… Opposite parties.
This complaint is coming before us for final hearing on 18-2-2015 and perusing complaint and other material papers on record and on hearing the arguments of Sri C.K. Bramhaiah, Advocate for complainant and Sri G.V. Raghava Reddy, Advocate for opposite parties and the matter is having stood over for consideration this day, the Forum made the following:-
O R D E R
(Per Sri M.V.R. Sharma, Member),
1. This Complaint is filed under section 12 of the Consumer Protection Act 1986 requesting this forum to direct the Opposite parties:-
(a) To pay Rs. 4,50,000/- with vested bonus under three policies with interest @ 24% p.a. from the date of death of the insured till date of payment.
(b) To pay Rs. 50,000/- towards compensation for causing mental agony and physical strain.
(c) To pay cost of the complaint.
2. The averments of the complaint in brevity are that her husband late Subbarayudu, was insured his life with the Opposite parties (for short herein called as O.P) company for an assured amount of Rs. 2,00,000/- under policy No. 656395146 commencing from 28-7-2011, Rs. 2,00,000/- under policy No. 655308676 commencing from 22-9-2010 and Rs. 50,000/- under policy No. 652268508 commencing from 28-10-1999 the total he insured his life an assured amount of Rs. 4,50,000/-. The said policies were continued by the deceased Subbarayudu by paying premium periodically.
3. The complainant further stated that her husband suddenly died on 4-2-2012 at his residence. The complainant intimated the same to O.P.1 in the capacity of wife and nominee and claimed insurance amount under the above three policies, but the O.P.2 repudiated the claim of the complainant and sent a letter of repudiation on 15-12-2012, after that she received repudiation letter from O.P.2 she appealed OP.3 decision of O.P.2. But the O.P.3 uphold the decision of the O.P.2 and send a letter dt. 12-4-2014 through O.P.2 and also stated that her husband was hale and healthy and not suppressed any material information with regard to his health. Hence, this complaint.
4. The O.P.1 filed counter and O.P.2 and 3 adopted the same.
5. The O.P.1 stated that he admitted that the Deceased Life Assured (for short herein called as DLA) taken three policies from this O.P. The O.P.1 also stated that the complainant is put to strict proof, that the DLA suddenly died on 4-2-2012 at his residence and also denied the repudiated claim with false grounds is not correct. The 1st policy was lapsed and it was revived on 20-9-2010 and other policies were taken on 22-9-2010 and 28-7-2011.
6. It is further stated that the policies were repudiated on the ground that the DLA revived 1st policy and obtained other 2 policies fraudulently by suppressing material facts with regard to his health that the life assured was suffering with chronic Kidney disease and taken treatment for the same prior to revival of the 1st policy itself. The expenditure incurred for his treatment was claimed by the DLA and got reimbursement by his employer i.e. APSRTC. Hence, the DLA concealed the material fact information which is within the knowledge and obtained polices with entering into a contract. Therefore, the contract of insurance is void. Therefore, the Hon’ble forum may be pleased to dismiss the complaint with costs.
7. To prove his case the complainant filed an affidavit along with documents which are marked as Exs. A1 to A3 and the Opposite parties to disprove their case filed documents which are marked Exs. B1 to B12 by consent.
8. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is eligible for compensation as prayed by her?
- Whether there is negligence or deficiency of service on the part of opposite parties?
- To what relief?
9. Point Nos. 1 & 2. The contention of the complainant is that her husband late Subbarayudu, had insured his life with Opposite parties company with three policies for an amount of Rs. 4,50,000/-. On 4-2-2012 the DLA died at his residence and the complainant intimated the same in the capacity of wife and nominee and submitted the claim for aforesaid three policies to the O.P1. But O.P.2 repudiated the claim on 15-12-2012 on false grounds and she appealed to O.P.3 the decision of O.P.2 but O.P.3 also uphold the decision of O.P.2 and send a letter, dt.12-4-2013 through O.P.2.
10. Per contra O.P.1 admitted that the DLA had taken three policies. 1st policy was lapsed and revived on 20-9-2010 and the other two policies were taken on 22-9-2010 and 28-7-2011 and also contended that the DLA was suffering with chronic Kidney disease and underwent treatment for the same prior to the revival of 1st policy itself. The expenditure incurred for his treatment was claimed by the DLA and got reimbursed by his employer i.e. APSRTC.
11. In the present case on hand no dispute that the complainant’s husband late Subbarayudu, assured his life with opposite parties company for an assured amount of Rs. 2,00,000/- under policy No. 656395146 commencing from 28-7-2011, Rs. 2,00,000/- under policy No. 655308676 commencing from 22-9-2010 and Rs. 50,000/- under policy No. 652268508 commencing from 28-10-1999. The total he insured his life for an assured amount of Rs. 4,50,000/-. As seen from Ex. A1 it is issued by the office of Kadapa Municipal Corporation, the DLA died on 4-2-2012 at his residence. But the complainant not disclosed the reason of death in the complaint and she intimated the same in the capacity of wife and nominee and claimed insurance amount. As seen Ex. A2 and A3 repudiation letters issued by O.P.2 and 3 stating that the DLA was not in good health condition and was suffering with chronic kidney disease and taken treatment in a hospital i.e. prior to the date of proposal.
12. The contention raised by the complainant that the O.P’s repudiated the claim in negligent manner without applying mind and her husband was hale and healthy and not suppressed any material information with regard to his health. As seen Ex. B3 essentiality certificate issued by consultant of Nephrologist Global Hospitals, Hyderabad, the DLA underwent treatment for chronic kidney disease from 24-2-2009 to 5-4-2010 and the DLA taken reimbursement from the employer i.e. APSRTC, which was incurred by him for Rs. 16,029/- towards medicines.
13. As seen from Ex. B9 i.e. policy bond of the DLA bearing No. 656395146 commenced from 28-7-2011 and Ex. B10 policy bond of the DLA bearing No. 655308676 commenced from 22-9-2010. The DLA was suffering with chronic kidney disease from 24-2-2009 even prior to the above said policies obtained by him. The DLA knows about his disease that he was suffering with chronic kidney disease but concealed the said factum which is within his knowledge but obtained policies for wrongful gain suppressing his ill health. Therefore, the opposite parties is right in repudiating the claims of policies dt. 28-7-2011 and 22-9-2010. However, the opposite parties cannot repudiate the claim of policy bearing No. 652268508, dt. 28-10-99 for Rs. 50,000/- as no suppression facts of health by the policy holder and complainant is entitled for that policy amount from opposite parties.
14. As per the above discussion we hold that the complainant not established deficiency in service of the Opposite parties. Hence, opposite parties are not liable to pay compensation, to the above said two policies. Accordingly, points 1 & 2 are answered.
15. Point No. 3 In the result the complaint is allowed in part, directing the opposite parties to pay Rs. 50,000/- (Rupees fifty thousand only) towards policy No. 652268508 with vested bonus and also pay Rs. 1,000/- (Rupees one thousand only) towards cost of the complaint to the complainant, within 45 days from the date of receipt of the order. The rest of the claim of the complainant is dismissed.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 27th February 2015
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Opposite parties : NIL
Exhibits marked for Complainant: -
Ex.A1 Death certificate of deceased Subbarayudu issued by Municipal Corporation, Kadapa, 18-10-2012.
Ex.A2 Letter of repudiation Dt. 15-10-12 three in number issued by Respondent no.2
Ex.A3 Letter dated 12-4-2013 uphold the decision of the 2nd respondent by Zonal Manager/Respondent no.3 issued by the O.P. No.2.
Exhibits marked for Opposite parties: -
Ex.B1 Claim repudiation letter Dt. 15-10-2012 under policy no.652268508.
Ex.B2 Claim repudiation letter Dt. 15-10-2012 under policy no.656395146.
Ex.B3 Claim repudiation letter Dt. 15-10-2012 under policy no.655308676
Ex.B4 Letter Dt. 12-4-2013 addressed to A. Nagakumari informing about the decision of ZO claim review committee.
Ex.B5 Letter Dt. 4-7-2012 addressed to the Chief Manager, LIC, BO, Kadapa by Deputy Chief Personnel Manager, APSRTC, Kadapa along with Office Order and Medical Bills.
Ex.B6 Personal statement regarding health dated 20-9-20101 subm9tted by the DLA at the time of revival of his policy no.652268508 (original).
Ex.B7 Proposal Form dated 20-8-2011 under policy no.
656395146 (original).
Ex.B8 Proposal Form dt. 20-8-2011 under policy no.655308676 (original)
Ex.B9 policy bond bearing no. 656395146 (original).
Ex.B10 policy bond bearing no.652268508 (original).
Ex.B11 policy bond bearing no.655308676 (original).
Ex.B12 Proposal form for policy dt. 28-10-1999.
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri C.K. Bramhaiah, Advocate for complainant.
- Sri G.V. Raghava Reddy, Advocate for Opposite parties.
B.V.P.
