Karnataka

Belgaum

CC/72/2015

Sharad W Desai - Complainant(s)

Versus

The Chief Manager Life Insurance Corporation Of India - Opp.Party(s)

P K Bagi

08 Feb 2017

ORDER

                

ADDITIONAL  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BELAGAVI

C.C.No.72/2015

 

                       Date of filing: 10/02/2015

 

                                                                  Date of disposal:08/02/2017

 

P R E S E N T :-

 

	(1)	Shri. A.G.Maldar, B.Com,LL.B. (Spl.) President.
	(2)	Smt.J.S. Kajagar, B.Sc. LLB. (Spl.)  Lady Member.

 

 

COMPLAINANTS      -

1.         2.

Shri.Sharad S/o Wamanrao Desai, Age: 56 Years, Occ: Nil, R/o: 490, Old Bus Stand Road, Khanapur, Tq: Khanapur, Dist. Belagavi.     Smt.Sharmistha W/o Sharad Desai, Age: 52 Years, Occ: Household Work, R/o: 490, Old Bus Stand Road, Khanapur, Tq: Khanapur, Dist. Belagavi.                                 (Rep. by Sri.P.K.Bagi, Adv.)

 

- V/S -

 

OPPOSITE PARTY  -

The Chief Manager, Life Insurance Corporation of India, City Branch No.1, Songolli Rayanna Road, Belagavi-590001.                     (Rep. by Sri.V.M.Deshpande, Adv.)

 

JUDGEMENT

 

By  Shri. A.G.Maldar, President.

 

 

1.      This is a Complaint filed by the complainants under Section 12 of the Consumer Protection Act, 1986 (herein after referred to as Act) against the Opposite Party (in short the “Op”) directed to pay Rs.13,00,000/- together with accrued benefits on the policies to the complainants and award the cost of the proceedings and any other reliefs.

 

2.      The facts of the case in brief are that;

 

 

          It is case of the complainants that, the complainants deceased son had taken Insurance Policies from OP and the details of polices particulars are as below.

Sl. No.	Policy No. & Date of Commencement.	Table & Premium Paying Term	Sum Assured	Due Date & Mode of Payment	Installment Premium Payable	Proposal No.& Date
01	669340045 28.05.13	149/77/28	100000	28.02.2041 Quarterly	Rs.905	1959 31.05.13
02	669340046 28.05.13	149/77/29	100000	28.02.2042 Quarterly	Rs.865/-	1960 31.05.13
03	669340047 28.05.13	149/77/30	100000	28.02.2043 Quarterly	Rs.827/-	1961 31.05.13
04	669340048 28.05.13	149/77/31	100000	28.02.2044 Quarterly	Rs.792/-	1962 31.05.13
05	669340049 28.05.13	149/77/32	100000	28.02.2045 Quarterly	Rs.760/-	1964 31.05.13
06	669340050 28.05.13	149/77/33	100000	25.02.2046 Quarterly	Rs.730/-	1965 31.05.13
07	669340051 28.05.13	149/77/34	100000	25.02.2047 Quarterly	Rs.702/-	1966 31.05.13
08	669340052 28.05.13	149/77/35	100000	25.02.2048 Quarterly	Rs.676/	1967 31.05.13
09	669340054 28.05.13	149/77/36	100000	25.02.2049 Quarterly	Rs.651/	1969 31.05.13
10	669340055 28.05.13	149/77/37	100000	25.02.2050 Quarterly	Rs.652/	1970 31.05.13
11	669340057 28.05.13	149/77/38	100000	25.02.2051 Quarterly	Rs.631/	1971 31.05.13
12	669340058 28.05.13	149/77/39	100000	25.02.2052 Quarterly	Rs.611/	1972 31.05.13
13	669340059 28.05.13	149/77/40	100000	25.02.2053 Quarterly	Rs.591/	1973 31.05.13

 

After taking the above said policies, the insured Shailendra Desai died on 15.02.2014 and further the Post Mortem Report of deceased Shailendra. The opinion given by the Doctor that, “Cause of Death is due to Asphyxia as a result of Hanging”. The deceased Shailendra was unmarried and the Compt.No.1 is the Father and Compt.No.2 is the Mother of the deceased insured Shailendra.

 

          It is further case of the complainants that, after the death of insured Shailendra, the nominee complainant.No.1 who is father of deceased insurer and the complainants are the legal heirs of the deceased insurer who are entitled for the policy amount and further the complainants gave an application to the Op insurance company and requested to pay the above said policies amount together with benefits. But, the OP gave reply to the said application dtd:24.12.2014 and stated that, “Since the Life Assured Committed Suicide on 15.02.2014 which is within one year from the date of commencement of risk under the above said policies i.e. 28.05.2013. Hence, Nothing Is Payable, under the terms and condition of the said polices.

 

          It is further complainants contended that, the act of the Op rejecting the claim of the complainants by denying the payment of the policy amount on the ground of suicide clause in the policy, the OP is making illegal gain for itself which is against the public policy, equity and justice. Therefore, the complainants have suffered heavy loss and damage and sustained mental agony. Hence, the complainants have constrained to file this complaint.

 

3.      After receipt of said notice, the OP appeared through his counsel and resisted the claim of the complainants that, the complainants have filed this complaint in violation of the provisions of Sec.11 of the C.P. Act and is not permissible. Therefore, the Hon’ble Forum has no pecuniary jurisdiction to entertain this complaint and denied all allegations made out in the complaint about deficiency of service in rejecting the claim under these policies and further the Op submitted that, the life assured submitted a proposal on 31.05.2013 to the OP Insurance Company for taking 15 insurance policies on his name of Rs.1,00,000/- each and all commencing from 28.05.2013 for a different term/year and further the life assured submitted another proposal dtd:31.05.2013 with dating back as 28.05.2013 for taking 10 insurance policies on his name for Rs.1,00,000/- each and all commencing from 28.05.2013. On the basis of the personal information filled in the proposal form by the proposer viz, his age, occupation, income, health and habits etc., the insurer/opponent proceeded upon confidence that, the contents in the proposal form were true and material to be relied and not misled on any circumstances and with this belief the underwriter/opponent accepted the proposal and issued the 25 policies being the Complainant No.1 father of the life assured is the nominee.

 

          It is further case of the Op that, on 22.12.2014 the complainants gave an application to the OP Insurance Company intimating the death of the life assured and produced relevant document and informed in his application that, the Life Assured died on 15.02.2014 by committing “SUICIDE” and the suicide is as a result of hanging and requested to settle the claims under the policies and further the Police investigated the incident and filed the charge sheet by registering the case under UD No.04/2014 on 15.02.2014 and finally stated that, the death of the life assured is a case of suicide and further the claims of the complainants under all these 25 policies were rejected by the OP in view of death of Life Assured due to Suicide within one year of the policy and stating that, Nothing is Payable. Therefore, the OP has not committed any deficiency of service in rejecting the claim. Hence, the Op has prayed for dismissed the complaint.

 

 

4.      Both the parties have filed their affidavits in support of their case, the documents produced on behalf of the complainants which are marked as Ex.P-1 to Ex.P-33, as against this, the OP produced 09 documents which are marked as Ex.R-1 to Ex.R-9, for sake of our convenience, we have marked P & R series. Heard the argument on both sides.             

 

Now, on the basis of these facts, the following points are arise for our consideration:

 

1. Whether the complainants have proved that, there is deficiency of service on the part of Op in repudiation of claim of the complainants?

 

2. What order?

 

 

5.      Answer to the above Points:-

 

1.  Negative.

 

2.  As per final Order.

 

 

R E A S O N S:-

 

6.      Point No.1: After perusing the evidence of both parties and written version, the case of the complainant that, the complainant.No.1 & 2 are father and mother of deceased son, son had taken Insurance Policies from OP.  After taking the policies, the insured Shailendra Desai died on 15.02.2014. The opinion given by the Doctor regarding the death of deceased shailendra   “Cause of Death is due to Asphyxia as a result of Hanging”.

 

          It is further case of the complainants that, after the death of insured Shailendra, the nominee complainant.No.1 who is father of deceased insurer and the complainants are the legal heirs of the deceased insurer who are entitled for the policy amount and further the complainants gave an application to the Op insurance company and requested to pay the respective policies amount together with benefits. Thereafter, the OP gave reply to the said application dtd:24.12.2014. In reply Op stated that, “Since the Life Assured Committed Suicide on 15.02.2014 which is within one year from the date of commencement of risk i.e. 28.05.2013. Hence, Nothing Is Payable, under the terms and condition of the respective polices.

         

           The case of the OP is that, the claim under these policies that, the life assured submitted a proposal on 31.05.2013 to the OP Insurance Company for taking 15 insurance policies on his name of Rs.1,00,000/- each, the said policies risk commencing from 28.05.2013 for a different term/year. The life assured submitted another proposal dtd:31.05.2013 with back date as 28.05.2013 for taking 10 insurance policies on his name for Rs.1,00,000/- each and the said policies risk commencing from 28.05.2013. On the basis of the personal information filled in the proposal form and the insurer/opponent proceeded upon confidence that, the contents in the proposal form were true and material to be relied and with this belief the underwriter/opponent accepted the proposal and issued the 25 policies to the deceased insured.

 

          The main contention of the OP that, The Clause-6 of the policy conditions and privileges forbids the death claim under the policy in case of suicide of the life assured within one year of the policy. The insurance policy is a contract between the insurer and the insured and the disputes/claims under the policy shall be decided within its terms and conditions. The policy shall be void if the life assured commits suicide (Whether sane or insane at the time) at any time on or after the date on which the risk under the policy has commenced but before the expiry of one year from the date of commencement of risk under the policy and the LIC will not entertain any claim by virtue of this policy condition. For that proposition of law, the counsel of the OP has relied a Revision Petition No.4412/2009 of National Consumer Disputes Redressal Commission, New Delhi, Wherein, the Hon’ble National Commission observe that, the Insurance Company on ground of the life assured having committed suicide within one year of the purchase of the policies. The District Forum considered the report of investigation of the police, the case of the complainant is dismissed by holding that, it is to be a case of suicide by the life assured.  

          The Counsel of the complainants have not put forth a valid and good grounds to establish that, the complainants are entitled to get the insured amount and the Op repudiate their claim by issuing repudiating letter is amount to deficiency of service. Even, the Counsel of the complainants have not produced any citation or any law of provisions that, within one year of suicide, the complainants are entitled to insured amount of deceased, admittedly the deceased insured has died within one year of the policies,  moreover the complainants counsel merely stating that, he has paid insured amount and at the time of death the insurance is existing/policies are inforce, it is not sufficient to hold that, insurer are liable to pay the insured amount in view of death of Life Assured due to Suicide within one year of the policy.

 

           

Looking to the fact and circumstance of the case, we have observed that, the complainants have not at all proved their case by showing material and cogent document in respect of deficiency or negligence of service on the part of the OP. Therefore, in our considered view, the complainants have failed to prove the alleged deficiency on the part of OP. So, looking from any angle the complainants can’t claim compensation from the Op/Insurance Company and when there is no deficiency on the part of the Op and repudiation made by the OP is justifiable. Accordingly, we answer this Point negative. Hence, we proceed to pass the following;

 

 

O R D E R

 

For the reason discuss above, the complaint filed by the complainant U/s 12 of the C.P. Act – 1986 is here by dismissed.

 

No order as to costs. 

 

 

           

(This order is dictated to the Stenographer, transcript edited, corrected and then pronounced in the open forum on this 08^th day of February, 2017).

 

Sri. A.G.Maldar,     President.

Smt. J.S. Kajagar,    Lady Member.