BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.<br /> <br /> COMPLAINT NO. DCFR. 64/07.<br /> <br /> THIS THE 7th DAY OF MARCH 2008.<br /> <br /> P R E S E N T<br /> <br /> 1. Sri. N.H.Savalagi, B.A.LLB. (Spl) PRESIDENT.<br /> 2. Sri. Gururaj, B.com.LLB. (Spl) MEMBER.<br /> 3. Smt. Pratibha Rani Hiremath,M.A. (Sanskrit) MEMBER.<br /> <br /> *********<br /> <br /> COMPLAINANT :- Smt. Mukramma D/o. Late P. Nagappa & W/o. <br /> Mallesh, Age: 26 years, Occ: Household, R/o. Janatha Colony at & Post; Askihal, Tq. & Dist: Raichur. <br /> <br /> //VERSUS//<br /> <br /> RESPONDENTS :- 1. The Branch Manager, Life Insurance Corporation <br /> of India, Raichur Branch, Hyderabad Road, Near M.G. Stadium Raichur.<br /> <br /> 2. The Senior Divisional Manager, Life Insurance Corporation of India, Raichur Branch, Hyderabad Road, Near M.G. Stadium, Raichur.<br /> <br /> CLAIM :- For direction to pay policy amount of Rs. 3,00,000/- <br /> with interest and along with interest at 24% p.a. from the date of death of policyholder till realization to pay Rs. 50,000/- towards compensation for mental agony and torture and Rs. 10,000/- towards cost of litigation and Rs. 50,000/- towards damages.<br /> <br /> <br /> Date of institution :- 16-08-07.<br /> Notice served :- 02-11-07.<br /> Date of disposal :- 07-03-08.<br /> Complainant represented by Sri. H. Narasappa, Advocate. <br /> Respondent No- 1 & 2 represented by Sri. N.R. Malagi, Advocate.<br /> -----<br /> This case coming for final disposal before us, the Forum on considering the entire material and evidence placed on record by the parties passed the following.<br /> <br /> <br /> JUDGEMENT<br /> <br /> This is a complaint filed U/s. 12 of Consumer Protection Act by the complainant Mukramma against the Respondents- (1) Branch Manager Life Insurance Corporation of India Branch Raichur and (2) Senior Divisional Manager, Life Insurance Corporation of India. The brief facts of the complaint are as under:<br /> <br /> The complainant is the daughter of life assured one late P.Nagappa, a lineman in GESCOM (KEB at Raichur Unit). During his service he had obtained three Insurance policies bearing NO. (1) 661238532 dt. 28-10-01, (2) 661238533 dt. 28-10-01 & (3) 661388362 dt. 09-03-02 for the assured sum of Rs. 1,00,000/- each. The monthly premium was Rs. 660/-, Rs. 600/- & Rs. 348/- for the respective three policies were deducted in the salary of the life assured totaling to Rs. 1,608/- p.m. as the policies were under Salary Saving Scheme. The policyholder had nominated his wife Smt. Mallamma for the 2nd & 3rd policies and the complainant Smt. Mukramma being his daughter was nominated for the first policy. The life assured P.Nagappa died on 27-04-02. After the death of her husband, his wife Mallamma submitted claim application on 13-05-02 for a total claim by filing survival certificate and death certificate. But the Respondents remained silent and not replied thereafter this Mallamma also died on 15-09-02. The matter was unknown to the complainant-Mukramma including the correspondence made by her late mother. Later on she consulted with one Advocate Sri. Somashekhar Hiremath to defend her case in getting the claim benefits who sent a legal notice to the Respondents. Thereafter this Somashekhar Hiremath disappeared from 22-06-06 from Raichur and now his whereabouts are not available. Therefore there was no communication between the complainant and Sri. Somashekhar Hiremath Advocate and the Respondents. Thereafter the complainant personally met the Respondent on several times but they failed to disclose the information Therefore she collected information under Rights to Information Act. According to the information received from the Respondent, the said three policies are repudiated on 15-04-03 itself on the basis of allegation that the insured/deceased did not disclose information at the time of proposal about his health condition and treatment taken by him as he had availed leave on medical grounds and he suppressed material facts. The complainant was shocked to learn about repudiation of her claim by the Respondents on frivolous and unreasonable grounds. In-fact there was no any concealment of material information about the health of her father/policyholder at the time of proposal of insurance. The medical examination conducted by the approved doctor of the Respondent at the time of proposal did not clinically find any diseases on examination of the various organs and found every thing was in normal limits and found no diseases which is leading to cause his death. Therefore the claim is lawful, even though the Respondents rejected her claim meticulously with regard to the merits of the case.<br /> <br /> The life assured was regular customer of Respondents having taken policies on good faith one after another for the benefit of his family members consisting of his wife and daughter. He had not taken any treatment for serious diseases. During the last five years the deceased father of the complainant had taken treatment only for fever, cough vomiting and giddiness from qualified doctors who have given certificate of fitness for attending duties. The life assured has not taken any treatment for any serious diseases and he was unaware of all those things at the time of proposal therefore the proposal form is perfectly in-order and even treatment taken for the disease were not the cause leading to his death. The Respondents have rejected the claim of the complaint without any proof of detailed medical report. The rejection of her claim on false ground amounts to deficiency in service by the Respondents. Hence for all these reasons the complainant has sought for direction to pay policy amount of Rs. 3,00,000/- with interest and along with interest at 24% p.a. from the date of death of policyholder till realization to pay Rs. 50,000/- towards compensation for mental agony and torture and Rs. 10,000/- towards cost of litigation and Rs. 50,000/- towards damages.<br /> <br /> 2. The Respondent No-1 & 2 appeared through counsel and have filed written version contending that the life assured had taken three policies. The complainant is nominee for one policy and Mallamma wife of life assured was nominee for other two policies. The life assured died on 27-04-02. The wife Mallamma and complainant-Mukramma have submitted claim forms on 10-06-02 and claim was processed and they have sent repudiation letter to the complainant and Mallamma on 15-04-03 by registered letters. The letter sent to Mallamma returned undelivered stating that party expired. The repudiation was done on 15-04-03 as such the complaint is barred by limitation the complaint may be dismissed in limine.<br /> <br /> The complainant is not a consumer within a meaning of Consumer Protection Act for the policy bearing No. 661238533 and 661388362 for the Mallamma wife is the nominee as such the complainant Mukramma has no locus standia to claim the policy amount. Without prejudice to their contentions it is submitted that as the life-assured died within short time of six months and one month after taking the above said policy as such Respondent caused enquiry and came to know that the life-assured P.Nagppa had suppressed material facts about his health condition and taking medical leave from his employer as the life-assured working in GESCOM. In the proposal form given at the time of obtaining policy, the life-assured nominee has given wrong answers to question No. 11 (a) to (j) of proposal. But there is proof to show that before he proposed for policy, he had availed leave on medical ground on number of occasions. As per employer’s letter dt. 19-02-03 which is filed herein, the deceased life assured had availed medical leave from 03-05-98 to 15-05-98, 16-08-99 to 20-08-99, 21-08-99 to 31-08-99, 01-09-99 to 30-09-99, 21-04-2000 to 01-05-2000 and from 02-05-2000 to 14-08-2000. The life assured did not disclose these facts in his proposal form, instead he gave false answers to said questions. The basic principles of insurance contract is utmost good faith violated abinitio as late Nagappa had given false answers to the questions in the Proposal Form. Basing on the records after due application of mind and keeping in view of legality of the matter and according to the Insurance Act. the Respondent Corporation has repudiated the said policies and informed the same. The repudiation is as per the contract and declaration given by the deceased life-assured. This Respondent is not liable to claim interest or mental agony or etc., Hence for all these reasons the Respondents have sought for dismissal of the complaint with cost.<br /> <br /> 3. During the course of enquiry the complainant Mukramma has filed her sworn-affidavit by way of examination-in-chief and has got marked (11) documents at Ex.P-1 to Ex.P-11. In-rebuttal the Respondents have filed the sworn-affidavit of its Division Manager by way of examination-in-chief and has got marked (9) documents at Ex.R-1 to Ex.R-9.<br /> <br /> 4. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:<br /> <br /> 1.Whether the complainant is not a ‘consumer’ for the claim of two policy of Late nominee-Mallamma as alleged by the Respondents.?<br /> <br /> 2. Whether the complaint of complainant is time barred as alleged by Respondents.?<br /> <br /> 3.Whether the complainant proves deficiency in service in not <br /> settling her claim under three policies by the Respondents, as alleged.<br /> <br /> 4.Whether the complainant is entitled for the reliefs sought <br /> for?<br /> 5. Our finding on the above points are as under:-<br /> 1) In the Affirmative (against the complainant) <br /> 2) In the Negative. <br /> 3) In the Affirmative only in-respect of complainant’s nominee policy.<br /> <br /> 4) As per final order for the following<br /> <br /> REASONS<br /> <br /> POINT NO. 1 :-<br /> 6. The Respondents Insurance Corporation have contended that the complainant is not a consumer within the meaning of C.P. Act 1986 since for the policy bearing No. 661238533, (2) 661388362 Mallamma the wife of life assured is the nominee and so the complainant has no locus standi to claim the amount under two policy. The Respondents have produced copies of three Insurance Policy Bonds at Ex.R-6, Ex.R-7 & Ex.R-8. The Insurance Bond of policy bearing No. 661388362 at Ex.R-6 another policy Bond of policy No. 661238533 at Ex.R-7, show the name of nominee as Mallamma wife of life assured. The third Insurance Bond of Policy No. 661238532 at Ex.R-8 shows the name of Mukramma (complainant) as nominee being the daughter of life assured. The L.C. for the Respondents submitted that all the three policies have been repudiated and the same has been intimated to the respective nominee Mallamma-Mukramma vide letter dt. 15-04-03 and without prejudice to the contention of limitation, the complainant-Mukramma has no locus standi to claim the two policy amount unless she produces Order from the competent court of law under P & S.C. as per clause shown in the Policy Bonds under the head to “Whom Sum Assured Payable”. Admittedly out of three policies, Mallamma has been shown as nominee for the two policies at Ex.P-6 & Ex.P-7. and this Mallamma is no more. The complainant has filed death certificate of Mallamma at Ex.P.5 showing the date of death of Mallamma as on 15-09-02. As per clause under the head to ‘Whom Sum Assured Payable”, the complainant has to produce Order from the competent court of law under P & S C . The complainant has not produced any Order under P & S C and so she cannot claim policy amount of these two policies and thereby she cannot be a consumer within the meaning of C.P. Act. Hence Point No-1 is answered in the affirmative and consequently her claim under these two policies has to be rejected.<br /> <br /> POINT NO.2:-<br /> 7. The Respondents have contended that they have repudiated the death claim under three policies on 15-04-03 and the same has been intimated to Mallamma and to the complainant-Mukramma respectively by Registered letter on 15-04-03 itself. So the complaint of the complainant is barred by limitation. <br /> It is worthwhile to note here that at the time of filing of this complaint, the complainant has filed an application U/s. 5 of Limitation Act and another application U/s. 24 (A) (2) of C.P. Act with supporting affidavits of the complainant-Mukramma for condonation of delay in filing the complaint. In the supporting affidavits she has sworn to the facts that her father late P.Nagappa died during his service on 27-04-02. Her mother and herself are the nominees for the three polices obtained by her late father. On 13-05-02 her mother Mallamma had applied for claim of the policies after the death of her father, but her mother had not received any reply from the Respondents, and her mother died on 15-09-02. The communication/ correspondence made by her mother is unaware to her and she has not found any documents as the correspondence. Therefore after the death of her parents she contacted with one Sri. Somashekhar Hiremath, Advocate at Raichur but while progress of the correspondence with the Respondents, this Advocate dis-appeared from Raichur on 26-06-06 and still his whereabouts are not known. She has also not received any information or letters from the Respondents, therefore she contacted the present Advocate (Sri. T.Jayappa) who got information from the Respondents through reply notice on 05-06-07. Regarding repudiation of the claim she had not received any information till 05-06-07. The non-filing of the claim petition within earlier period is not intentional but due to her ill-literacy and unawareness of legal process. The delay is about two years four months. She is having good cause and her claim is genuine. If the delay is condoned no harm will be caused to the other side as such it is necessary to allow his application.<br /> <br /> 8. The complainant has contended regarding condonation of delay in Para-4 & 5 of her complaint. So keeping alive the consideration of limitation point, the complaint was admitted for enquiry. The Respondents on their appearance have taken the plea of limitation by contending that the claim is barred by time and so Point No-2 came to be raised.<br /> <br /> 9. The complainant has produced Ex.P-3 the letter dt. 12-06-07 issued by the Manager(Claims) Divisional Office Raichur stating that all the three policies are repudiated on 15-04-03 and the same has been intimated to the respective claimanants by Registered Post and that they have received legal notice from one Sri. Somashekhar Hiremath Advocate on 24-04-06 and they have replied to legal notice vide their letter dt. 23-05-06. The complainant has also produced certified copy of FIR with complaint at Ex.P-10 and Ex.P-10(1) showing the registration of a case in crime No. 136/06 by Sadar Bazar Police Station, Raichur on 27-06-06 on the complaint of Sri. B.P.Hundekarmath Advocate regarding missing/dis-appearance of his son-in-law Sri. Somashekhar Hiremath Advocate from 22-06-06.<br /> <br /> 10. Further the complainant has also filed letter dt. 05-06-07 of the Respondent at Ex.P-7 addressed to her Advocate Sri. T.Jayappa Advocate stating the receipt of his letter dt. 26-05-07 seeking information of the three policies of late P.Nagappa under Right to Information Act 2005 and the matter being under process and necessary information will be communicated shortly. Complainant has filed another letter at Ex.P-8 of Respondent addressed her stating the receipt of the application from Sri. T.Jayappa Advocate under Right to Information Act-2005 seeking information regarding three policies of late P.Nagappa and they have sought her consent/objection if any for disclosing the information sought by Sri. T.Jayappa Advocate. From perusal of Ex.P-3, Ex.P-6, Ex.P-7, Ex.P-8, Ex.P-10 & Ex.P-10(1) it amply shows that the complainant had sought for information regarding her claim through Sri. Somashekhar Hiremath Advocate, whose whereabouts were not known to her owning to his dis-appearance as per the police complaint with F.I.R. at Ex.P-10 and thereafter she engaged another Advocate Sri. T.Jayappa for obtaining information from the Respondent. So these documents support her contention in Para-4 & 5 of her complaint and averments in the affidavit filed in support of her Application filed for condonation of delay.<br /> <br /> 11. The Respondents have produced office copy of the Registered letter dt. 15-04-03 addressed to the complainant-Mukramma at Ex.R-5 intimating repudiation of her claim as on 15-04-03 itself. The L.C. for the complainant submitted that the Repudiation letter dt. 15-04-03 of the Respondent addressed to late Mallamma has been returned un-delivered as payee expired and in this regard he has relied on the copy of the said letter with endorsement produced by Respondent which was got marked for the complainant at Ex.P.11. This letter at Ex.P-11 shows an endorsement as letter returned un-delivered as payee is expired. The Respondents have averred the same in their written version at Para-3. Admittedly the letter Ex.P-11 was produced by the Respondent though it was got marked for the complainant as Ex.P-11. So it follows that the said letter of repudiation was not served on Mallamma. <br /> <br /> 12. The L.C. for the Respondent further argued that the letter of the Repudiation at Ex.R-5 dt. 15-04-03 addressed to complainant-Mukramma has been served on the complainant so her complaint is barred by limitation. On the contrary the L.C. for the complainant submitted that the Respondent Corporation have not produced any evidence to show the service of this Repudiation letter on the complainant-Mukramma and in the absence of the same it cannot be said that letter was served on the complainant especially when the said complainant-Mukramma was residing in her husband’s village at Merchade and she was not residing along with her mother at Askihal Tq. Raichur. From a perusal of Repudiation letter at Ex.R-5 addressed to Mukramma shows similar address like that off Mallamma at Ex.P-11. Of-course the complainant have not produced any evidence to show that at the time of Repudiation letter at Ex.R-5 the complainant-Mukramma was residing in her husband’s village at Merchade and she was not at all residing with Mallamma at Askihal village. Similarly the Respondents have not produced any piece of evidence to show the service of Repudiation letter at Ex.R-5 which was issued by RPAD as could be seen on the very letter at Ex.R-5. Even Respondents have not produced Postal Acknowledgement or Postal endorsement regarding service of said letter on the complainant-Mukramma. In the absence of the same it cannot be said that Ex.R-5 Repudiation letter dt. 15-04-03 was in-fact served on the complainant-Mukramma on 15-04-03 itself. Added to this the circumstances that this complainant had engaged Sri. Somashekhar Hiremath Advocate and subsequently Sri. T.Jayappa Advocate and got information regarding three policies under Right to Information Act from Respondents go to show that she was un-aware of the Repudiation letter of the Respondent. The complainant in Para-10 of her complaint has averred that the cause of action to the complainant to file the complaint arose on 19-06-07 when she received information by the Respondent by RPAD. In Para-5 she has averred that on personal meet by the complainant several times the Respondents failed to disclose the information, therefore she collected information under Right to Information Act and according to information received from the Respondents the above three policies are repudiated on 15-04-03 itself on the basis of allegations of suppression of material facts by the life assured regarding his health. The complainant has produced the letter dt. 19-06-07 at Ex.P-2 addressed to Sri. T.Jayappa Advocate. This letter Ex.P-2 discloses that it is a Reply Letter to the application dt. 26-05-07 sought under Right to Information Act-2005. So all these factors as discussed above go to show that the complainant-Mukramma was not served with Repudiation letter dt. 15-04-03 and she was unaware of the Repudiation of the policy. So it cannot be said that the complaint filed by her is barred by limitation. Therefore Point No-2 is answered in the negative.<br /> <br /> POINT NO.3<br /> 13. In-view of our discussion and finding on Point No-1 regarding rejection of the claim of the complainant in-respect of the two policies bearing No. 661388362 and (2) 661238533 at Ex.R-6 & Ex.R-7, we have to consider the alleged deficiency in service only in-respect of the complainant’s nominee policy bearing No. 661238532 at Ex.R-8 for assured sum of Rs. One Lakh with vested bonus. The Respondents in Para-7 of the written version have contended that the life assured (P.Nagappa) has given wrong answer to the question No. 11 (a) to 11(j) of the proposal form given at the time of obtaining the policy, with regard to his health. As per Employer’s letter dt. 19-02-03 the deceased life-assured has availed leave on medical grounds from 03-05-98 to 15-05-98, from 16-08-99 to 20-08-99, 21-08-99 to 31-08-99 from 01-09-099 to 30-09-99, from 21-04-99 to 01-05-2000 and from 02-05-2000 to 14-08-2000. But the life assured did not disclose these facts in his proposal, instead he gave false answers to the said question. So he has suppressed material facts with regard to his health. The Repudiation letter dt. 15-04-03 at Ex.R-5 shows that the Respondents have repudiated the policy on account of the deceased life assured having with-held correct information regarding his health at the time of effecting the proposal of the assurance. In the proposal for assurance dt. 25-08-01 and the personal statement signed by the deceased assured on 25-08-01 he had answered to question No. 11 (a) (b) (c) as ‘No’ and question No. 11 (i) as ‘Good’ but all these answers are false since the life-assured had availed leave on medical grounds on number of occasions as per the employer’s letter dt. 19-02-03. The Respondents have produced the letter of Employer-Account Officer GESCOM Raichur dt. 3/4-07-2002 by enclosing a Certificate regarding leave availed by its employee-P.Nagappa. The Respondents have also produced the three Proposal Forms at Ex.R-1 to Ex.R-3 duly filled in by the life assured for the three policies. In these proposal forms he has answered to the question No. 11 (a) to 11 (h) in the Negative with regard to his having had consulted with any Medical Practitioner for his ailment requiring treatment for more-than a week and ever been admitted in any hospital for treatment/operation and remained absent from the place of his work on the ground of health for the last five years and suffered or suffering from ailments of Liver, Stomach, Heart, Lung, Kidney, Brain or Nervous system, H.B.P. L.B.P. Diabetes, Cancer, Epilepsy, Hernia, Hydrocele Leprosy etc., which have bodily defect or deformity suffered any accident or injury etc.,<br /> <br /> 14. The L.C. for the complainant submitted that late policyholder P.Nagappa was hail & healthy and was not suffering from any diseases. He further argued that except the statement of leave certificate issued by the employer of life assured, the Respondents have not produced any evidence to show that life assured P.Nagappa was suffering from or had suffered any such disease which resulted in his death, so in the absence of the same the leave statement cannot be as gospel truth regarding suffering of disease by the life assured employee. We find considerable force in this argument. Admittedly the Respondents have not produced any piece of evidence to show that P.Nagappa the life assured was suffering from any diseases as shown in the question No 11 (a) to 11 (c) and the death of said P.Nagappa was nexus to his having suffered any of such disease. In the absence of the same the certificate of leave availment of P.Nagappa issued by his employer cannot be a sole basis to show that P.Nagappa was suffering from any disease which resulted in his death. So it follows that the Respondents have failed to prove that the life assured has suppressed material facts in the proposal form consequently it follows that the Repudiation made by the Respondents amounts to deficiency in service in not settling the claim of the complainant with regard to her nominated policy. Hence Point No-3 is answered in the affirmative only in-respect of complainant’s nominee policy.<br /> <br /> POINT NO.4:- <br /> 15. In view of our above discussion and finding on Point No-1, 2, & 3 we pass the following order.<br /> <br /> ORDER<br /> <br /> The complaint of the complainant is allowed in part.<br /> The claim of the complainant in-respect of two policies nominated in the name of Mallamma is rejected as per fining on Point No-1.<br /> The Respondents shall pay the policy amount in-respect of nominated policy in the name of complainant bearing policy No. 661238532 (vide policy bond Ex.R-8) along with its vested bonus etc., and to pay a global compensation of Rs. 2,000/- (Two Thousand) for mental agony inducing damages and cost of litigation. <br /> The Respondent shall comply this order with in (6) weeks from the date of receipt of copy of this order.<br /> Office to furnish certified copy of this order to both the parties forth with free of cost.<br /> (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 07-03-08)<br /> <br /> Sd/- Sd/- Sd/-<br /> Smt.Pratibha Rani Hiremath, Sri. GururajSri. N.H. Savalagi,<br /> Member. Member. President, <br /> Dist.Forum-Raichur. Dist-Forum-Raichur Dist-Forum-Raichur.<br />