This complaint having come up for final hearing before us on 01.07.2015 on perusal of the material records and on hearing the arguments of Thiru.N.K.Shanmugam, the counsel for the complainant and Thiru. M.G.Rajamohan, the counsel for the 1st opposite party and Thiru.S.Manickavel Pandiyan, the counsel for the 2 and 3rd opposite parties and subsequently having been set exparte and having stood before us for consideration, till this day the Forum passed the following
By President, Thiru..P.G.Rajagopal, B.A.B.L.,
This complaint is filed by the complainant u/s 12 of the Consumer Protection Act 1986.
2) The gist of the complaint filed by the complainant is that one Thiru.Sekar, the husband of the first complainant and the father of the 2nd and 3rd complainants took Life Insurance policy No. NP091200090186 with the 2nd opposite party and paid the first premium amount from out of the chit amount received by him from the chit transaction with the first opposite party, the period of policy was 15 years and the next due date for the payment of premium was 28.03.2013 as per the letter sent by the 2nd opposite party on 17.04.2012. The said Sekar had another life insurance policy in policy No. NP091100069087 for the sum of Rs. 1,00,000/- and the premium amount was Rs. 10,192/-. The said Sekar died at 11.45 A.M on 02.04.2012 and the complainants as legal heirs of the deceased policy holder sent their proposal forms claiming the policy amount under the said two policies. The earlier policy No.091200090186 had been repudiated by the second opposite party by their letter dated 30.08.2012 and when the complainants filed an appeal before the 3rd opposite party, the Internal Claims Review Committee, the said committee also confirmed the order of repudiation rejecting the claim of the complainants. The deceased Sekar died of sudden Heart attack and he had not suppressed any material facts in the proposal form as alleged by the opposite parties in the repudiation letter. Further the proposal form was filled up only by the agent of the second opposite party and the diabetes of the policy holder was not the reason for the heart attack causing his death. Therefore the repudiation of the earlier policy by the second opposite party is sheer deficiency of service and they have not given any reply with respect to the 2nd policy No. NP091100069087 till date which is also deficiency of service on their part. The complainant therefore prays for an order to direct the second opposite party to pay the policy amount of Rs. 5,00,000/- and Rs.1,00,000/- due under the said insurance policies No. NP 091200090186 and NP091100069087 respectively with interest from the date of their claim application and also pay a sum of Rs.3,00,000/- towards compensation of their mental agony caused to them.
3) The first opposite party filed his written version. The 3rd opposite party was represented by his counsel Thiru.S.Manickavel Pandiyan who undertook on 11.03.2013 the date of first hearing of this complaint, to file vakalath for opposite party-2 also; but despite several adjournments the said counsel had not filed vakalath for opposite party-2 and written version was also not filed for opposite party-3 and in consequences thereof on 12.06.2014 the 2nd and 3rd opposite parties were set exparte.
4) The gist of the written version filed by the 1st opposite party is that they have nothing to do with the insurance policies claimed by the complainant in as much as they are only dealing with the chit transaction and the deceased Sekar was a subscriber with them in a chit group for the value of Rs.5,00,000/- and on 12.02.2012 in the 9th auction he auctioned the chit for Rs.3,00,000/- and deducting expenses of Rs. 250/- in the prize money on 06.03.2012 the opposite party gave a cheque No.1223 drawn on the City Union Bank, Kumbakonam for Rs. 2,37,750/- and another cheque No. 1224 for Rs.50,000/- on 05.03.2012 drawn in favour of the second opposite party at the request of the said Sekar to be paid towards his premium amount for his life insurance policy with the second opposite party. Therefore, the first opposite party has nothing to do with the claim amount under the said two policies mentioned by the complainants except issuing the cheque for Rs.50,000/- towards the premium amount in favour of the second opposite party. The first opposite party has nothing to do with the said life insurance policy taken by the deceased Sekar with the second opposite party. The first opposite party has therefore to be exonerated from the complaint.
5) The 3rd complainant has filed his proof affidavit reiterating all the averments made in his complaint and filed 11 documents which are marked as Ex.A.1 to Ex.A.11.The first opposite party filed his proof affidavit in support of his defense and filed two documents which are marked as Ex.B.1 and Ex.B.2.Written arguments have been submitted by the 3rd complainant and the 1st opposite party.
6) The points for Determination are:
1) Whether there is any deficiency of service on the part of the opposite parties?
2) Whether the complainant is entitled to any relief? If so to what relief?
7)POINT NO.1: The main allegation of the complainant is that the deceased Sekar, the husband of the first complainant and the father of the 2nd and 3rd complainants took two policies with the 2nd opposite party one for Rs.5,00,000/- and he paid the first premium and the due date for the payment of the next premium is 28.03.2013 and he had another policy for Rs.1,00,000/- the premium amount being Rs. 10,192/- and the due date for the payment of the next premium was 28.03.2013. But the policy holder died on 02.04.2012 owing to sudden heart attack and the 2nd and 3rd opposite parties have repudiated their claim for the policy amount under the earlier policy for Rs.5,00,000/- on the ground that the deceased policy holder wrongly gave an information as if he was not suffering from diabetes in the proposal form and the deceased policy holder did not give any false information or suppressed any material facts and the proposal form itself was filled up by the agent of the second opposite party and the said diabetes was not the reason for the heart attack causing the death of the deceased policy holder. The repudiation is done by the 2nd and 3rd opposite parties wantonly in order to evade their liability to pay the amount to the complainants and further they have not given even a reply with respect to the another policy for Rs.1,00,000/- and thus they have committed deficiency of service and are liable to pay the policy amount as well as the compensation as claimed by them in the complaint.
8) The main contention of the first opposite party is that he has nothing to do with the life insurance policies issued by the 2nd opposite party and his company deals with chit transaction and the deceased Sekar was a subscriber to the chit conducted by them for Rs.5,00,000/- and the Sekar took the chit for Rs. 3,00,000/- and the sum of Rs.50,000/- was as per his request transferred to the second opposite party towards premium for his life insurance scheme. Apart from that the first opposite party has nothing to do with the claim of policy amount made by the complainants. Therefore the first opposite party has to be exonerated from the complaint.
9) As far as the first opposite party is concerned it is true that they are only the company dealing with only chit transaction and has nothing to do with the issue of life insurance policies to the deceased Sekar. Ex.B.1 shows that the Sekar was a subscriber to a group of chit for the value of Rs.5,00,000/- and at the 9th auction he won the prize money of Rs.3,00,000/- bidding the amount for Rs.2,00,000/- and Ex.B.2 is the letter given by the said Sekar requesting the first opposite party to pay from out of the prize money, to pay Rs.50,000/- towards the premium for the life insurance policy with the second opposite party. Though the first and second opposite parties belong to the same group of company, the first opposite party is only dealing with the chit transaction having a separate registered office at a particular address and the second opposite party is the company dealing with issue of life insurance company having separate office at a different address. Therefore, the first opposite party has only given a cheque in favour of the second opposite party towards the first premium amount for the life insurance policy issued by the second opposite party to the deceased Sekar who won the prize money in the chit auction held by the first opposite party. Therefore the first opposite party has nothing to do with the claim of the complainants or their repudiation of the second opposite party. Since he belongs to the same group of company the first opposite party seems to have been added as a formal party and there is no deficiency of service on the part of the first opposite party.
10) On the side of the complainants Ex.A.1 is the letter sent by the 2nd opposite party to the deceased Sekar on 17.04.2012 informing that his proposal was accepted and the policy pack was despatched to him. It is stated that his policy No. NP091200090186 issued on 31.03.2012 had been discharged to him and the first renewal premium of Rs.49,946 will be due on 28.03.2013. Ex.A.9 is another renewal premium notice sent to the deceased policy holder Sekar for the policy No.NP091100069087 informing that the due date for the payment of premium is 11.05.2012 and the premium amount to be paid is Rs. 10,192/-. Ex.A.4 is the death certificate of the policy holder and it has revealed that the policy holder died on 02.04.2012 at Anbu Hospital, Kumbakonam. Therefore it is very well proved that the policy holder died when the policy was in force and before the expiry of the due date for the payment of the premium. Ex.A.2 is the renewal reminder notice dated 23.05.2012 sent by the 2nd opposite party to the deceased policy holder. Ex.A.3 is the certificate given by the Anbu Hospital stating that the cause of death of the deceased policy holder at 11.45 am on 02.04.2012 was sudden cardiac arrest. Ex.A.5 is the legal heir certificate issued by the Tahsildar, Kumbakonam stating that the complainants are the surviving legal heirs of the deceased policy holder. Ex.A.6 is the letter of repudiation dated 30.08.2012 sent by the second opposite party to the first complainant the nominee under the policy. Ex.A.7 is the representations dated 01.10.2012 made by the first complainant to the 3rd opposite party by way of an appeal against the order of repudiation of the second opposite party. Ex.A.8 is the letter of the third opposite party dated 09.10.2012 upholding the decision of repudiation of the first opposite party. Ex.A.10 is the voucher made for the payment by the second opposite party to the complainant. Ex.A.11 is only the current months due intimation given by the first opposite party to the deceased Sekar in connection with his chit transaction with him.
11) As per the Ex.A.6 even though the 2nd opposite party has repudiated the claim of the complainants on the ground that the deceased policy holder suppressed the fact of his having diabetes by answering negative for the related question No.25 in the proposal form and as he had not disclosed the pre health ailment of diabetes their claim is repudiated as the policy itself has become a void one. But the 2nd and 3rd opposite parties have not filed their objections to the allegation made in the complaint before this Forum and they have been set exparte therefor. In such circumstances the contention of the complainant that the deceased Sekar had only subscribed the signature in the proposal form and all the contents were filled up by the agent of the 2nd opposite party only and further the said Sekar suddenly died of heart attack and his ailment of diabetes is not the immediate reason for the death of the deceased policy holder. The very failure on the part of the 2nd and 3rd opposite parties to appear before this Forum and file their objections gives an inference to this Forum that the allegations made in the complaint are true as they are not refuted by the opposite parties. Further it is quite probable and believable that diabetes is not the immediate cause for the death of the deceased policy holder as a person having high level of cholesterol or Hypertension could also have to die of consequential heart attack and therefore the repudiation of the claim of the complainants by the second opposite party is neither reasonable nor valid and it is nothing but their deficiency of service and the repudiation of the 2nd opposite party as well as the upholding of the said repudiation by the 3rd opposite party is nothing but sheer deficiency of service on their part.
12) POINT NO.2:- In the result, the complaint is allowed in part. The 2nd opposite party is directed to pay the sum of Rs.5,00,000/- (Rupees five lakh only) the policy amount under the policy No. NP091200090186 and Rs.1,00,000/-(Rupees one lakh only) the policy amount under the policy No. NP091100069087 with interest at the rate of 12% per annum from 02.04.2012 the date of death of the policy holder till the date of payment and the opposite parties 2 & 3 are directed to pay jointly or severally the sum of Rs.2,00,000/-(Rupees two lakh only) towards compensation for the mental agony of the complainants owing to their deficiency of service. The 2nd opposite party is directed to pay the said policy amount to the complainants within 45 days from the date of this order failing which the said policy amount shall carry further interest at the rate of 18% per annum from the date of this order till the date of its payment. The opposite parties 2 and 3 are also directed to pay the compensation amount to the complainants within 45 days from the date of this order, failing which the said amount shall carry an interest at the rate of 12% per annum from the date of this order till the date of its payment. The opposite parties 2 and 3 are further directed to pay jointly or severally the sum of Rs.3000/- (Rupees three thousand only) to the complainants towards the cost of this litigation. The complaint as against the first opposite party is dismissed.
This order was dictated by me to the Assistant, transcribed by her and corrected and pronounced by me on this 15th day of July 2015.
MEMBER -I PRESIDENT
List of documents on the side of the complainant:-
Exhibits | Date | Description |
Ex.A.1 | 17.04.2012 | Letter sent by the 2nd opposite party to the deceased Sekar. |
Ex.A.2 | 23.05.2012 | Renewal reminder notice dated 23.05.2012 sent by the 2nd opposite party to the deceased policy holder S.Sekar.. |
Ex.A.3 | 22.06.2012 | Xerox copy of the certificate given by the Anbu Hospital stating the cause of death of the deceased policy holder. |
Ex.A.4 | 19.04.2012 | Xerox copy of the Death certificate of deceased Sekar. |
Ex.A.5 | 25.05.2012 | Xerox copy of the legal heir certificate issued by the Tahsildar, Kumbakonam. |
Ex.A.6 | 30.08.2012 | Letter of repudiation of the claim sent by the second opposite party to the first complainant . |
Ex.A.7 | 01.10.2012 | Xerox copy of representations made by the first complainant’s by way of an appeal against the order of repudiation of the second opposite party before the Internal Claims Review Committee, Hyderabad. |
Ex.A.8 | 09.10.2012 | Letter of the Internal Claims Review Committee of the Shriram Life Insurance Company Limited upholding the decision of repudiation of the first opposite party. |
Ex.A.9 | 11.05.2012 | Another renewal premium notice sent to the deceased policy holder Sekar for the policy No.NP091100069087 |
Ex.A.10 | 04.05.2011 | Payment voucher made by the first opposite party to the complainant. |
Ex.A.11 | 05.05.2012 | Current months due intimation given by the first opposite party to the deceased Sekar. |
List of documents on the side of the Opposite parties :
Exhibits | Date | Description |
Ex.B.1 | 12.2.2012 | Sekar was a subscriber to a group of chit for the value of Rs.5,00,000/- and at the 9th auction he won the prize money of Rs.3,00,000/- bidding the amount for Rs.2,00,000/-. |
Ex.B.2 | 05.03.2012 | Letter given by the deceased Sekar to the first opposite party. |
MEMBER -I PRESIDENT