Karnataka

Gadag

CC/29/2015

Neelavva.H.Beedanal - Complainant(s)

Versus

The Chief Manager, Kotak Mahindra Old Mutual Life Insurance Ltd. - Opp.Party(s)

C.V.Hiremath

01 Oct 2016

ORDER

JUDGEMENT DELIVERED BY

SMT.C.H.SAMIUNNISA ABRAR, PRESIDENT:

The complainant has filed this Complaint against the Opposite Parties (herein after referred in short as OPs) u/s 12 of Consumer Protection Act, 1986 alleging deficiency in service against OPs. 

 

2.    The brief fact of the case is that the Complainant is the wife of the deceased policy holder Hanamantappa Beeganal. The Complainant’s husband had availed a tractor loan from OP No.2 and 3, for the security of the same the OP No.2 and 3 insist the husband of the Complainant to get insurance policy from OP No.1. On the advice of the OP NO.1 and 2 and husband of the Complainant got on insurance policy “KOTAK COMPLETE COVER PLAN” Policy on 19.02.2014 bearing the policy No.CC 000023 (F1).

 

3.      On 04.03.2014, the husband of the Complainant expired due to severe heart attack the same has been intimated to the OP No.1. The Complainant approach OP No.3 personally and produce the death certificate and succession certificate to process the death claim, the OP NO.3 demanded to execute an affidavit, the Complainant on believing the words of OP, the Complainant executed an affidavit to claim the benefit of the policy, at the same time the OP No.3 taking the undue advantage of illiteracy of the Complainant the OP No.2 take signature on the same blank paper and assured the Complainant that the document may be submitted to higher authority for clearing of loan amount.

 

4.      The OP NO.1 intimated the Complainant that the claim of the Complainant is rejected stating that the insured had withheld the material and fail to disclose true and correct declaration of goods health.

 

5.      Further, the Complainant stated the her husband was in good health at the time of getting the policy and he was not hospitalized for treatment of pulmonary tuber clauses chronic in any hospital and alleged that the document produced by the OP a created and manipulated to discard the claim. Hence, the Ops have committed negligence and deficiency in service, further the Complainant prayed to order OP No.1 to pay the loan amount of OP No.2 and 3 and to direct the OP NO.2 and 3 to issue a clearance to the Complainant and to pay compensation of Rs.2,00,000/- and litigation charges and any other reliefs as the Forum deems fit.

 

6.      The Forum received a Complaint and heard on admission. The notices were ordered as such OPs appeared through their advocate and filed their Vakalat and Written Version.

 

Brief facts of the Written Version of OP No.1:

The OP No.1 has have denied the averments made in the Complaint and stated that the Complaint is false and frivolous and vexatious. Further the OP NO.1 stated that the Complainant had failed to demonstrate any deficiency on part of OP. The claim of the Complainant was repudiated on the basis of intentional non-disclosure of material fact and false declaration made in the declaration of good health by the insured (deceased). He was suffering from pulmonary tuber clauses much prior availing said insurance cover. Thus the diseased had intentionally made a false declaration to OP No.1 regarding his health.

 

7.      Further the OP had denied that any signature on bond paper has been obtained from the Complainant, the repudiation of the claim had been informed the Complainant through a letter dated: 26.09.2014 and the value amounting Rs.770.94 was transferred to the Complainant account. Further, the OP stated that he had not committed any deficiency in service and pray to dismiss the Complaint against OP NO.1 with cost.

 

    8.   Brief fact of Written Version of OP No.2 and 3:

          The OP NO.2 and 3 have completely denied the averment made in the Complaint. Further they had stated that OP No.2 and 3 have just to explain the benefit of insurance cover, but its not mandatory for sanctioning of vehicle loan and further submitted that insurance policy was issued by OP No1 and the OP No.2 and 3 are not responsible for repudiation of insurance claim. The insurance contract was between OP No.1 and the husband of the Complainant.

 

9.      Further, OP No.2 and 3 have admitted that the Complainant had personally approached OP No.3’s Office and shown Death Certificate and Succession Certificate and demanded for viewer of a loan amount. Further OP No.3 has denied that he had demanded to execute the affidavit and blank paper or assure the same to submit the higher authorities. So, OP had submitted that OP NO.2 and 3 have no role to play in the claim of the Complainant hence Ops have prays to dismiss the Complaint against the OP NO.2 and 3.

 

10.   On the back ground of the above said pleadings, the Complainant himself examined before this Forum as CW-1 and got marked the documents as EX C1 to C4. The documents are as follows:

1)  EX C1 Office copy of the notice,

2)  EX C2 Letter to the Complainant from OP No.1,

3)  EX C3 Letter from the OP No.1,

4)  EX C4 Death Certificate of Hanamantappa Beedanal.

         

On the other hand, OP No.1 executed a Power of Attorney to one Bheemappa S/o Govindappa working as an Associate Business Developing Manager at Kotak Mahindra and got marked the documents as EX OP1 to OP10. The documents are as follows:

 1)  EX OP1 Authorization Letter

2)  EX OP2 Resolution copy of Kotak Mahindra,

3)  EX OP3 Declaration of Good Health,

4)  EX OP4 Admission Record,

5) EX OP5 Discharge Summary,

6) EX OP6 Investigation Report,

7) EX OP7 Affidavit of Investigated,

8) EX OP8 to OP10 Letters from OP No.1

9) EX OP10 Repudiation Letter from OP No.1

 

11.    On the basis of above said pleadings, oral and documentary evidence, the following points arises for adjudications are as follows:   

1.   2.   3.	Whether the Complainant proves that there was deficiency in service on the part of the OPs?   Whether the OP No.1 is proves that repudiation is justified?   Complainant is entitled for the reliefs as sought?
4.	What Order?

 

Our Answer to the above Points are:-

Point No.1 – Negative,

Point No.2 – Affirmative,

Point No.3 – Negative,

Point No.4 – As per the final order.

                

R E A S O N S

12.    POINT NO.1 to 3:  Since all the points are inter-link and identical, we proceed with all the points together.

 

13.   The Complainant filed a Complaint against the Ops alleging that the Ops made deficiency in service the specific case of the Complainant is that the husband of the Complainant had insured with OP No.1. After the death of the Complainant’s husband the Complainant claiming with OP No.1 repudiate the claim stating the reason that material fact had been suppressed by the insured (as related in the Complaint).

 

14.    The Complainant husband availed a tractor loan from the OP NO.2 and 3 before sanctioning the loan the OP No.2 and 3 instead the husband of the Complainant to take a Kotak complete cover policy from OP NO.3 for the security of the loan.

 

15.    The OP NO.2 and 3 have completely denied this fact and stated that OP No.2 and 3 have no role to play in the claim process of the policy.   

 

16.    The husband of the Complainant had availed a policy on 19.02.2015 by giving a declaration of goods health, but immediately after 15 days of policy insurance i.e. on 04.03.2014 the husband of the Complainant died and Complainant claims the insurance amount from OP NO.1. The controversial points in this Complaint is that the Complainant says that her husband Hanamantappa Beedanal was died due to severe heart attack, the OP No.1 says that the deceased insured was suffering from Practical Tuber Clauses (P.T.B.) which is an pre-existing decease which had been intentionally not disclosed at the time of the policy instead he had given a declaration of goods health.

 

17.    After scanning the document No.6 and 7 which has been filed by the OP No.1 it clearly speaks that they had conducted and investigated by the appointing an Investigator and submitted a report the insured was suffering from P.T.B. which is an pre-existing decease, in this support, the admission record of college of Medical Science, Sattur, Dharwad and Discharge Summary of the same hospital which are marked as EX OP4 and OP5 which are clearly speaks that the deceased Hanamantappa insured was admitted for nearly 07 days from 07.02.2014 and diagnosis that he was suffering from P.T.B. treated and discharged on 14.02.2014. The insured got an insurance policy on 19.02.2014 i.e. just after five days discharged from the Hospital and died on 04.03.2014 by this, it is very much clear that the Complainant husband was suffering from P.T.B. by this it is clear that deceased insured was suffering from pre-existing decease and he had not disclosed to the insurer and give a false declaration of good health by suppressing the material fact. Health Policy was treated as in valid and un enforceable as per the terms and conditions of the policy. Hence, repudiation of the claim is justified since the Complainant is not liable for any relief. Hence we answer the Point No.1 and 3 are in negative and Point No.2 is in affirmative. On the above findings, we relied upon Citation I (2005) CPJ 670 (NC) Hon’ble National Consumer Disputes Redressal Commission, New Delhi (Life Insurance Corporation of India V/s Mamta) the important points reads as hereunder:

           “Consumer Protection Act, 1986 – Sections 2 (1) (g), 21 (b) – Insurance (Life) – Death claim – Suppression of pre-existing disease – Violation of policy condition – Claim repudiated – Alleged deficiency in service – District Forum dismissed Complaint – State Commission allowed appeal – Hence revision – Doctors were informed at the time of admission that patient had a history of diabetes mellitus for the last five years and was on insulin for the last three years – Concealment of material fact regarding previous ailment by life assured – Repudiation justified – Impugned order set aside”.

 

  18.     POINT NO.4: For the reasons and discussion made above and findings on the above points, we proceed to pass a following:  

//ORDER//

1. The Complaint is hereby dismissed.
2. No order as to costs.
3. Send the copies of this order to the parties free of cost.

 (Dictated to the Stenographer, transcribed by him, corrected and then pronounced by me in the Open Court 01^st day of September, 2016)

 

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