BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Smt. S.Nazeerunnisa, B.A., B.L., Lady Member, President (FAC),
And
Sri.M.V.R.Sharma, B.A., Member
Wednesday the 17th day of June, 2015
C.C.No.114/2014
Between:
P.Satyanarayana,
S/o P.Venkata Subbaiah,
Aged 60 Years, Business,
D.No.8-1-19/1, T.B. Road,
Allagadda Town-518 543,
Kurnool District. …Complainant
-Vs-
1. The Divisional Manager,
Life Insurance Corporation of India,
Jeevan Prakash, P.B.No.10,
College Road, Kadapa-516 004.
2. The Branch Manager,
Life Insurance Corporation of India,
P.B.No.5, H.No.284/24,
Station Road, Nandyal-518 502,
Kurnool District.
3. The Zonal Manager,
S.C. Zonal Office,
Life Insurance Corporation of India,
Saifabad, Hyderabad-500 063. …OPPOSITE PARTIES
This complaint is coming on this day for orders in the presence of Sri.Y.Jaya Raju, Advocate for complainant and Sri.L.Hari Hara Natha Reddy, Advocate for opposite parties 1 to 3 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. S.Nazeerunnisa, Lady Member)
C.C. No.114/2014
1. This complaint is filed under section 11 and 12 of Consumer Protection Act, 1986 praying:-
- To direct the opposite parties to pay the insurance claim with respect to the policy bearing No.6528822704 (Jeevanmitra Triple Cover Policy) with sum assured Rs.2,00,000/- with auxiliary benefits.
- To pay the insurance claim with respect to the policy bearing No.655802951 (Wealth Plus Policy) with sum assured Rs.50,000/- with auxiliary benefits.
- To grant future interest at 24% per annum on the above said policies from the date of the filing this complaint.
- To pay a sum of Rs.1,00,000/- towards mental agony suffered by the complainant and also pay Rs.10,000/- towards costs of the complaint.
And
- To grant such other relief which the Honourable Forum deems fit and proper in the circumstances stated in the complaint and in the interest of justice.
2. The case of the complaint in brief runs as follows:- The complainant is the father of Late P.Nagendra Kumar. P.Nagendra Kumar insured his life with opposite parties and obtained two policies from opposite party No.2 at Nandyal, under (Jeevan Mithra Triple Cover Policy) bearing No.652822704 with its date of commencement from 28.05.2001 for the sum assured of Rs.2,00,000/- with annual premium of Rs.7,036/- and second policy under (Wealth Plus) bearing No.655802951 with its date of commencement from 08.05.2010 for a sum assured of Rs.50,000/- along with auxiliary benefits with single premium of Rs.40,000/-). The insured died by accidental drowning on 30.10.2013. The complainant being the nominee informed opposite party No.2 about his death and claimed the benefits under the above two policies. The complainant submitted all the relevant documents along with original certificates of policy of Insurance issued by opposite party No.2. Opposite party No.1 repudiated the claim on 28.07.2014, on the ground that the insured committed suicide due to mental disorder and therefore the accidental benefits were rejected as per the terms and conditions of policy. The complainant got issued legal notice dated 04.09.2014 to all the opposite parties and requested them to settle the claim of the complainant. But the opposite parties did not respond to give any reply. The Insured was hale and healthy at the time of taking of policy and he was working as Soft Ware Engineer in united Health Group, Hyderabad. Due to his personal problems he gave up his job. His previous attempt to commit suicide was not because of mental disorder but due to his personal feelings. The insured death by drowning is purely accidental and not by committed suicide. The rejection of claim by opposite parties is illegal and in violation of the principle of natural justice. There is a deficiency of service on the part of opposite parties and caused mental agony to the complainant. Hence this complaint.
3. Opposite party No.1 filed written version and same was adopted by opposite parties 2 and 3. It is stated in the written version that the complaint is neither just nor maintainable in law or on facts. The opposite party No.2 denied the allegations that the Insured obtained two policies covering the accidental benefits and the insured died by accidental drowning and the policies were issued to him on verification of his mental health condition. It is admitted that the deceased life Assured has taken two policies No.6528822704 for sum assured of Rs.2,00,000/- and another policy No.655802951 for the sum assured of Rs.50,000/-. The insured nominated his mother P.S.Lakshamma under 1st policy and nominated his father P.Satya Narayanna under the 2nd policy. It is further submitted that the Insured found dead on 30.10.2013 Kasinathal Gani Gunthala situated near Allagadda town. The Allgadda police registered a complaint in Crime No.150/2013 under section 174 of Cr.P.C. According to Post Mortem Report the death is due to drowning. On investigation, the police come into conclusion that the insured died due to his unsoundness and he committed suicide by drowning. Hence the police dropped further action in this case. The claim of complainant with regard to above two policies bearing Nos.652822704 and 655802951 other than accidental benefits is already settled by the opposite parties and the amount is paid to the nominees. The opposite parties repudiated the accidental benefits as per the policy conditions in para 10 (b) (IV) of policy bond. The corporation shall not be liable to pay the accidental benefits in case of the injury or death be caused by intentional self injury, attempted suicide, insanity or immortality or whilst the life assured is under the influence of intoxicating liquor, durg or narcotic. The mother of insured is not added as complaint though she is the nominee under the policy bearing No.652822704. There is no deficiency of service on the part of opposite parties. Hence the complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to Ex.A12 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to Ex.B12 are marked and sworn affidavit of opposite party No.1 is filed.
5. Both sides filed Written Argument.
6. Now the points that arise for consideration are:
- Whether there is deficiency of service on the part of opposite parties?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINTS i and ii:- Admittedly the deceased insured obtained two policies, from opposite party No.2, 1st policy bearing Nos.652822704 for an assured sum of Rs.2,00,000/- with its date of commencement 28.05.2001, and 2nd policy bearing No.655802951 for an assured sum of Rs.50,000/- with its date of commencement 08.05.2010. The said two policies in original are marked as Ex.B8. The complainant is the nominee under the 2nd policy No.655802951. The deceased insured nominated his mother P.S.Lakshamma under 1st policy No.652822704. The insured died by drowning on 30.10.2013. Ex.A5 is the Death Certificate issued by Registrar of Births and Deaths, Nagara Panchayat, Allagadda, Kurnool District. The Allagadda P.S. Registered a complaint in Crime No.150/2013 dated 30.10.2013. The photo copy of F.I.R., is marked as Ex.A7. The copy of Inquest Report is marked as Ex.A8 dated 30.10.2013. The copy of Final Report filed by the S.I. of Police, Allagadda is marked as Ex.A9. The Family Member Certificate in original issued by Thasildar, Allagadda, Kurnool District is marked as Ex.A6. It is the case of the complainant that the complainant submitted claim under the two said policies by furnishing all the relevant documents to opposite party No.2. The opposite party No.2 forwarded the same to opposite party No.1. The opposite parties repudiated the claim under Ex.A1 dated 12.06.2014 stating that the insured was suffering from mental disorder and he committed suicide by drowning. So the accidental death benefits were rejected by opposite party No.1 but it is only accidental death by drowning. The complainant got issued legal notice under Ex.A10 dated 04.09.2014, Postal Receipts Ex.A11 and Postal Acknowledgements Ex.A12. Ex.A2 is the endorsement of Postal Letter dated 12.06.2014. Ex.A3 is the Status Report of 2nd Policy, Ex.A4 is the Renewal Receipt dated 20.12.2012 in 1st policy No.652822704. Though the opposite parties received notice under Ex.A12 they did not either to give reply or settled the claim of the complainant it amounts to deficiency of service on the part of opposite parties.
8. It is the case of opposite party No.1 that the insured obtained above said two policies bearing Nos.652822704 for an assured sum of Rs.2,00,000/- 655802951 for an assured sum of Rs.50,000/- deceased insured nominated his mother P.S.Lakshamma under the 1st policy and he is nominated his father of the complainant P.Satya Narayanna under the 2nd policy. The deceased insured committed suicide due to his mental disorder, there is no possibility of falling into the quarry pit water accidentally. The claim of complainant with regard to above two policies is already settled other than accidental benefits. The amount is paid to the nominees (i.e.,) the complainant and his wife received the amount towards full and final settlement of the claim under both the policies. The relevant discharge vouchers pertaining to policy No.652822704 (Ex.B1 to Ex.B3) and 655802951 (Ex.B4 to Ex.B6) are marked. Ex.B7 is the Repudiation Letter dated 12.06.2014. The opposite party No.1 rightly repudiated the claim in regard to accidental benefits as per the policy condition and privileges, enumerated in para 10 (b) (IV) of Policy Bond. The policy bonds are marked as Ex.B8 and Ex.B9 is the policy terms and conditions. Ex.B10 is the letter addressed to Sub Divisional Policy Officer by Allagadda S.I. of Policy. The final report marked as Ex.B11 dated 14.02.2014 and Ex.B12 is the proceedings of Sub Divisional Police Office, Allagadda dated 22.12.2013.
The learned counsel appearing for complainant contended that the deceased Nagendra Kumar is a MCA post graduate and Soft Ware Engineer and due to personal reasons he has given up his employment and due to his personal problems previously he attempted suicide. The complainant never stated that his deceased son committed suicide either in Ex.B11=Ex.A9 does not disclose that the insured committed suicide. It was case of death due to drowning which in all probability must be accidental. The repudiation of claim is illegal.
The learned counsel appearing for the opposite party No.1 argued that the contract of Insurance is a contract utmost good faith and the deceased Life Assured committed suicide in violation of terms and condition the policy. On police investigation and final report Ex.A9=Ex.B11 clearly shows that the deceased committed suicide, even as per the complainant statement to the police the death of the deceased is only due to mental disorder. Therefore the opposite party No.1 repudiated the accidental benefits under Ex.B7=Ex.A1 dated 12.06.2014. There is no deficiency of service on the part of opposite parties. It is further argued that this complaint is filed without adding the mother of the deceased Life Assured, who is nominee under the policy bearing No.652022704 as a party to the complainant. Hence this complaint is bad for non joinder of necessary party and the same is not maintainable and liable to be dismissed.
9. Admittedly the deceased Insured obtained two above said policies bearing Nos.652822704 and 655802951 from opposite party No.2 for an assured sum of Rs.2,00,000/- and another for Rs.50,000/-. The Insured nominate his mother P.S.Lakshamma in policy bearing No.652822704 and his father P.Satya Narayanna under the policy bearing No.655802951, and the insured died by drowning on 30.01.2013. The complainant informed the opposite parties and submitted claim form and the opposite parties settled the claim in above said policies and paid the assured amount with vested bonus amount of Rs.7,39,600/- under the policy bearing No.652822704 to the nominee (i.e.,) P.S.Lakshamma and further paid the amount with interest bonus of Rs.86,569/- under the policy No.655802951 to the complainant as a nominee. The complainant and his wife received the said amount towards the full and final settlement of the claim under the above two policies and executed discharge voucher No.D201320141000443 are marked as Ex.B1 to Ex.B3 and Ex.B4 to Ex.B6 No.D20132014000430. The dispute is with regard to accidental benefits which were rejected by the opposite parties. According to the complainant the death of insured is accidental but the version of opposite parties is that the insured committed suicide due his mental disorder. As seen Ex.B1 to Ex.B6 it is evident that the opposite parties settled the claim of the complainant and his wife in the month of November 2013 and rejected the accidental benefits under Ex.B7=Ex.A1 dated 12.06.2010. As per Ex.A7 FIR in Crime No.150/2013, and Inquest Report Ex.A9 final report and Ex.B12 it revealed that the deceased insured discarded his job and residing with his parents and three or four times the deceased attempted to commit suicide for which the complainant shown the deceased before the doctors but there is no change over his attitude. As per the policy conditions and privileges enumerating in para 10 (b) (IV) Ex.B9 of policy bond “The corporation shall not be liable to pay the accidental benefits in case the injury or death caused by international self injury attempted suicide-insanity-or immorality or whilst the Life Assured is under the influence of intoxicating liquor, drug or narcotic”. We persued all the material available on record we hold that there is no independent evidence on record to show that the insured died by drowning accidentally and on the other hand the corporation already paid the amount to the complainant and his wife under the above said policies as per their entitlement and they have accepted the said amount towards full and final settlement without any protest. Hence the complainant is not entitled for any further amount under accidental benefits. The insured died on 30.10.2013 when the complainant made in claim to opposite parties. The opposite parties settled the claim on 16.11.2013 and 20.11.2013 itself and rejected the accidental benefits. The deceased insured nominated his mother P.S.Lakshamma under the policy bearing No.652822704. The insured mother is not added as a complainant in the above complaint. We consider all facts and circumstances and material placed on record we are of the view that there is no deficiency of service on the part of opposite parties and the complainant is not entitled for any accidental benefits under the above policies.
10. In the result, the complaint is dismissed without costs.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 17th day of June, 2015.
Sd/- Sd/-
MEMBER PRESIDENT (FAC)
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of exhibits marked for the complainant:-
Ex.A1 Repudiation Letter dated 12.06.2014.
Ex.A2 Endorsement of the postal department of the effect that the said
letter dated 12.06.2014.
Ex.A3 Status Report with respect to the Policy bearing No.655802951 dated 05.08.2014.
Ex.A4 Renewal Premium Receipt dated 20.12.2012.
Ex.A5 Death Certificate issued by Registrar of Births and Deaths, Nagara Panchayat, Allagadda, Kurnool District.
Ex.A6 Family Member Certificate issued by Thasildar, Allagadda.
Ex.A7 F.I.R. in Crime No.150/2013 dated 30.10.2013 of Allagadda Town Police Station.
Ex.A8 Inquest Report dated 30.10.2013.
Ex.A9 Final Report filed by the S.I. of Police, Allagadda.
Ex.A10 Office copy of Legal Notice dated 04.09.2014.
Ex.A11 Postal Receipts (Nos.3).
Ex.A12 Postal Acknowledgements (Nos.3).
List of exhibits marked for the opposite parties:-
Ex.B1 Claim Cheque Covering Letter dated 20.11.2013 addressed to the Nominee under the policy bearing No. 652822704
Ex.B2 Claim payment Voucher dated 20.11.2013.
Ex.B3 Discharge Voucher.
Ex.B4 Claim Cheque Covering Letter dated 16.11.2013 addressed to the Nominee under the policy bearing No.655802951.
Ex.B5 Claim payment Voucher dated 16.11.2013.
Ex.B6 Discharge Voucher.
Ex.B7 Repudiation Letter dated 12.06.2014.
Ex.B8 Policy Bond bearing No.652822704 and 655802951.
Ex.B9 Policy terms and conditions of accident benefits related with death of deceased life assured.
Ex.B10 Letter addressed to sub Divisional Police Officer, Allagadda by S.I. of Police.
Ex.B11 Final report dated 14.02.2014.
Ex.B12 Proceedings of Sub-Divisional Police Office, Allagadda dated
22.12.2013.
Sd/- Sd/-
MEMBER PRESIDENT (FAC)
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