This case is coming for final hearing on 05.12.2014 in the presence of Sri Adari Apparao Advocate for the Complainant and of Sri Sanapala Karuna & Smt.Sanapala Sailaja Advocates for Opposite Parties and having stood over till this date, the Forum delivered the following:

 O R D E R :

(As per Smt. K.V.R.Maheswari, Honourable President(FAC) on

behalf of the Bench)

1.       The case of the complainant is that her husband Sri Peela Ramunaidu during his life time took a Life Insurance Policy from opposite parties bearing Policy No.C160512661 for an amount of Rs.3,49,300/- and at the time of issuance of the said Insurance Policy to the insured the said insurance company name was Tata AIG Life Insurance Company Ltd.  Subsequently, the said insurance company name was changed as Tata AIA Life Insurance Company Ltd.  The date of commencement of risk to the said policy from 11.07.2011 and the complainant is shown as nominee in that policy.  While so, on 22.05.2012 the said Ramunaidu came to their house with sun’s stroke and he took rest on that night and next day morning i.e., 23.05.2012 he suffered with suffocation and unconscious then, he immediately shifted to Vijaya Hospital, Anakapalli and the doctor stated that the insured died i.e., brought dead. 

2.       The complainant stated that she informed the same to 1^st opposite party through registered post on 30.06.2012, on receipt of intimation from the complainant, the opposite parties’ person came to the complainant’s house on 24.07.2012 and enquired about the death of the insured and took statement of the complainant as well as the neighbours and also received required documents from the complainant.  The Complainant personally approached the 2^nd opposite party in the first week of August, 2012 and submitted the original bond, death certificate, filled claim form, treatment details and all other required documents, but there is no response from the opposite parties.  After that the complainant contacted the 2^nd opposite party by way of telephone and requested them to settle the claim.  The investigator of the opposite parties came to the house of the complainant for some more documents and they were submitted to the investigator.  On 27.09.2012 the complainant received letter from Claims Department to submit income proof, original driving license and alterative age proof.  Then on 08.11.2012 the complainant send all those documents along with covering letter to 1^st opposite party.  But there was no response from the opposite parties, then finally on 20.11.2012 the complainant issued a legal notice to the 1^st opposite party, but there was no response from the opposite parties and intentionally avoiding to pay the claim amount to the complainant which clearly shows their deficiency of service and irresponsible acts of the opposite parties by denying the claim amount, the complainant suffered from mental agony and financial hardship.  Hence, this complaint to direct the opposite parties;

a) to pay claim amount of Rs.3,49,300/- with interest at 24% p.a.

b) to pay Rs.50,000/- towards compensation besides costs.

3.       On the otherhand, the opposite parties filed its counter and denied the allegations mentioned in the complaint and pleaded that the complainant filed his complaint with malafide intention and there is no cause of action and not maintainable under law and also there is no negligence on behalf of the opposite parties.  The opposite parties pleaded that DLA at the time of making the said proposal misrepresented his age which amounts to suppression of material facts at the time of filling and signing the proposal form, based on which the said policy was issued.  As per “National Commission in the Executive Director (mktg.) Life Insurance Corporation of India Vs. Yogendra Prasad Singh Revision Petition No.692 of 2006 wherein, an insurance company was offered to the deceased who at the time of taking the policy stated his date of birth to be 18.10.1950 and he expired after paying only the third premium and a claim was lodged by his son, after enquiry the opposite parties found that the complainant who is the son of DLA was born on 01.05.1954 as per school records and to this effect the Government Head Master of Government High School, Harnaut, Nalanda produced the Hon’ble National Commission judgment wherein it was held that the deceased had not disclosed the correct date of birth and had withheld material information, hence repudiated the claim is justified”. 

4.       The complainant should go through the terms and conditions mentioned in the application and must be aware of them which are in the policy at the time of filling the proposal form and he would have minimum knowledge of the matter, consequently, it could not be believed that he had simply put his signatures on different proposal forms without understanding the contents of the relevant items and the plea of the insured that he was not aware of the requirement to give correct answer about the contents of the answers given cannot be accepted.  Thus non-disclosure of the material fact by the complainant is a sufficient ground for the dismissal of the said complaint who submitted wrong information regarding his age at the time of submission of application.  After that it came to know that there was an age discrepancy at the time of filling the application.

5.       The opposite parties stated that the proposal form was signed by DLA on 07.07.2011 after understanding all the terms and conditions of the policy and the same was issued for an amount of Rs.3,49,360/- for which annual Modal Premium amounting to Rs.49,900/- was proposed to be paid annually on for a term of 5 years and the DLA also signed on declaration and authorization on the application and the DLA was mentioned his date of birth as 20.08.1952 at the time of signing the application form.  As per the clause, pertaining to mis-statement of age and sex wherein it is stated that the policy is issued at the age and sex shown on a policy information, if the age or sex misstated then the company reserve right.  Believing upon the contents of the proposal form, the said policy was issued to DLA on receipt of premium.  The opposite parties also intimated the premium due date and the renewal of the premium amount to the DLA but he failed to make payment and again on 28.08.2012 the DLA was intimated by the opposite parties vide intimation letter dated 24.08.2012.  On 06.07.2012 the opposite parties received the death claim intimation as mentioned that DLA suddenly died on 23.05.2012.  Upon receipt of the claim intimation as per its procedure the opposite parties conducted the investigation and during the course of investigation, it was established that DLI has mis-stated his age in the said proposal form and found that the document on driving license which was submitted by the DLA at the time of filling the application and the same was evident from the office of the Regional Transport Officer, Rajahmundry, EGDT dated 25.02.2013, wherein it was stated that they have not issued any driving license to Sri P.Ramunaidu bearing No.DLRAP105148442002. 

6.       Further it was found that according to the ration card DLA was 55 years in the year 2008 which means that DLA was 58 years in the year 2011 i.e., at the time of application whereas as per the Voter ID the year of birth of DLA was in the year 1943 i.e., 68 years in the year 2011.  Because of the said facts and circumstances the opposite parties repudiate the claim of the complainant on the ground that the correct age of the DLA was beyond the insurable age for the product and as per the said facts and circumstances it was revealed that there is gross discrepancy and the complainant in order to extract the monies from the opposite parties is acting fraudulently.  Hence, the repudiation by the opposite parties because of the suppression of material facts by the complainant and also by DLA at the time of filling the proposal form and made false representation.  As such the opposite parties on 14.03.2013 repudiate the claim of the complainant.  But being the customer centric organization the opposite parties refunded the amount of Rs.44,028.32p.s. as account value vide cheque bearing 061422 dated 12.03.2013. Thus, the opposite parties do not hold any liability under the said policies as the life insurance contracts are contracts “uberrimae fides”  where observance of utmost good faith is enjoined on the parties to the contract, i.e., they must disclose all material facts in respect of the risk to be covered by the insurance.  Hence, as per Consumer Unity & Trust Vs CMD reported in 1991(I) CPJ 1 SC wherein, the Supreme Court of India held that where there is no deficiency of service or negligence on the part of the insurance company, then it would not be liable for any loss etc., which is caused to the consumer.  Hence, as the complainant failed to make out a prima facie case against the opposite parties, the complaint is to be dismissed with costs.

7.       At the time of enquiry, the complainant filed evidence affidavit along with documents which are marked as Exhibits A1 to A10.  On the other hand, the opposite parties filed its counter, evidence affidavit and no documents are marked on their behalf, as they filed photo copies and failed to file even attested copies.  Both the parties filed their written arguments and heard both the counsels who reiterated their versions.

8.       As per Ex.A1 i.e., photo copy of the policy document dated 11.07.2011 is not in dispute.  Ex.A2 is the Certificate issued by Dr. R.Nookeswara Rao dated 28.05.2012 wherein it mentioned that DLA was brought to Hospital on 23.05.2012 at 7.30a.m with a complaint of sunstroke and on examination there is no pulse, BP and no respiration, then the doctor came to diagnosis that “he was already died”.  Ex.A3 is the death certificate of DLA died on 23.05.2012 and date of registration is 24.05.2012.  Ex.A4 is the Death intimation letter issued by the complainant to 1^st opposite party on 30.06.2012.  Ex.A5 is the statement of the complainant which was submitted to the investigator on 24.07.2012.  Ex.A6 is the Pending memo-1 issued by the opposite parties’ claim department mentioned that “the policy is pending and for necessary documents like income proof, original driving license, alternate age proof.  If the above requirement has already been submitted please ignore this reminder”.  Ex.A7 is the covering letter issued by the complainant to 1^st opposite party on 08.11.2012 stating that all the necessary documents were already submitted to opposite parties when their representative visited her house.  Ex.A8 is the postal receipt of Ex.A7 dated 08.11.2012.  Ex.A9 is the Legal notice issued by the complainant to the opposite parties on 20.11.2012.  Ex.A10 is the postal receipt of Ex.A9. 

9.       The version of the complainant is that even after death intimation of DLA was informed to the opposite parties they failed to settle the claim amount and that too the complainant submitted all the necessary documents to the investigator who appointed on behalf of opposite parties and also to the opposite parties.

10.     The version of the opposite parties is that the complainant at the time of filling the proposal form, misrepresented his age and it was found to be false and fabricated and the same was evidenced by a letter obtained from the office of the Regional Transport officer, Rajahmundry, East Godavari District.  Wherein, they stated that they have not issued any such driving license to Sri P.Ramunaidu but that document, which was relied by the opposite parties has not filed the original copy or attested copy, hence it was not marked as Exhibit.  But at the time of oral arguments, the complainant stated that if DLA lived in Visakhapatnam, why the opposite parties obtained letter from Rajahumdry, RTO Office regarding confirmation of his driving license? 

11.     The other plea of the opposite parties is that according to ration card, the DLA was 55 years in the year 2008 which means the DLA was 58 years at the time of filling of application and as per Voter ID he was 68 years at the time of application.  But the opposite parties failed to substantiate these pleas regarding the discrepancy in the age of DLA by filing any documentary evidence.  Mere contention regarding the age of DLA is not enough, the  opposite parties have to prove its contention by filing any documentary evidence to look into and to decide the matter.  Hence, at the time of filling the proposal form, the age mentioned by the DLA in that proposal form is 55 years and the date of birth is 18.06.1955 and to specify that it is also mentioned that for address proof the driving license was submitted by the DLA.  But the opposite parties not even file that attested copy of driving license.  Simply, the opposite parties filed the photo copy of driving license without attestation by the authorized officer and the same was not marked as Exhibit.  The opposite parties paid Rs.44,028.32p.s. to the complainant on 12.03.2013 i.e., after filing of complaint and the same was received by the complainant towards part payment.

12.     The Opposite parties relied upon a decision Life Insurance Corporation of India Vs. Yogendra Prasad Singh Revision Petition No.692 of 2006 decided on 14.05.2009 by the National Commission, Wherein, insurance company came up with school record of DLA’s son to know the date of birth of DLA.  Where, the son’s date of year is 1954 but the DLA mentioned his date of year as 1950.  Hence, the National Commission decided the matter relied upon documentary evidence.  But here in this case, the opposite parties’ contention is not substantiated by any documentary evidence to prove that, the age mentioned by the DLA at the time of filling of proposal form is not correct.  That too, on receipt of claim intimation along with necessary documents from the complainant, the opposite parties did not issue any repudiation letter by showing the reasons why they are not going to settle the claim amount which clearly shows the deficiency in service on the part of the opposite parties.  Hence, the opposite parties are liable to pay the claim amount of Rs.3,49,300/- after deduction of Rs.44,028.32p.s which was already paid by the opposite parties on 12.03.2013 by way of cheque to the complainant, then the amount comes to Rs.3,05,271.68p.s. and the opposite parties have to pay this amount to the complainant with 9% interest from the date of legal notice i.e., 20.11.2012 to the complainant.  The opposite parties neither settle the claim amount nor repudiate the same and the complainant is in dark regarding her claim amount which clearly shows deficiency of service on the part of the opposite parties and because of acts of opposite parties, there is no doubt that the complainant being widow woman suffered so much mental agony and financial hardship, hence the opposite parties are liable to pay the compensation of Rs.5,000/- besides costs. 

          Accordingly, this point is answered.

13.     In the result, the complaint is allowed directing both the opposite parties to pay Rs.3,05,271.68p.s. with 9% interest per annum from 20.11.2012 to the complainant within three months, failing which to pay the same with 12% interest till the date of payment. The opposite parties are further directed to pay Rs.5,000/- towards compensation besides costs of Rs.2,000/-.

  Dictated to the Shorthand Writer, transcribed by her, corrected and pronounced by us in the open Forum on this the 18^th day of December, 2014.

      Sd/-                                                                                                Sd/-

Member                                                                 President (FAC)

                                                                   District Consumer Forum-I 

                                                                             Visakhapatnam

Consumer Complaint No:41/2013

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:

Exhibits Marked for the Opposite Parties:

       Sd/-                                                                                               Sd/-

Member                                                                  President (FAC)

                                                                   District Consumer Forum-I

                                                                             Visakhapatnam

//VSSKL//