Karnataka

Kolar

CC/102/2018

N.Manju , N.Manjunath S/o Narayanappa and Late Rathnamma - Complainant(s)

Versus

The Manager, Life Insurance Corporation of India - Opp.Party(s)

30 Apr 2019

ORDER

Date of Filing: 27.12.2018

Date of Order: 30.04.2019

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, D.C. OFFICE PREMISES, KOLAR.

 

Dated: 30^th DAY OF APRIL 2019

PRESENT

SRI. K.N. LAKSHMINARAYANA, B.Sc., LLB., PRESIDENT

SMT. A.C. LALITHA, BAL., LLB           ……  LADY MEMBER

C.C. NO. 101 OF 2018 IS COMBINED WITH C.C.NO. 102 OF 2018

C.C.NO.101 OF 2018

Sri. Narayanappa,

H/o. Late Rathnamma,

Aged About 53 Years,

Dharmarayanagara ‘A’ Block,

Bangarpet Road,

Kolar-563 101.                                                                 ….  Complainant.

(Rep. by Sri. N. Manju, Advocate)

 

C.C.NO.102 OF 2018

Sri. N. Manju @ N. Manjunath,

S/o. Narayanappa & Late Rathnamma,

Aged About 32 Years,

Dharmarayanagara ‘A’ Block,

Bangarpet Road, Kolar-563 101.                                 ….  Complainant.

(In-person)

 

- V/s -

1) The Manager,

Life Insurance Corporation of India (LIC),

Dr. Rajkumar Road, Behind KSRTC

Bus-stand, Kolar-563101.

(Rep. by Sri. A.V. Ananda, Advocate)

 

2) Sri. Ramalingaiah Shetty P.L,

LIC Agent, Sapthagiri Nilaya,

1^st Floor, Opposite to house of

Ex-President of City Municipality,

Kurubarapet, Kolar-563 101.                                          ….  Opposite Parties.

(In-person)

(In both the above cases OPs are same)

                       

-:COMMON ORDERS:-

BY SRI. K.N. LAKSHMINARAYANA,PRESIDENT

01.   The complainant in the above said two cases filed complaint against the OPs claiming death claim/sum assured amount pertaining to two policies along with interest @ 9% from 01.10.2015 till payment of the sum assured amount and Rs.20,000/- towards mental agony and Rs.5,000/- towards litigation expenses from the OPs.

 

 

02.   The brief facts of the above two cases are that, one Late Smt. Rathnamma was the wife of complainant in C.C. No.101/2018 and mother of complainant in C.C. No.102/2018 and they filed the above said complaints contending that, late Smt. Rathnamma during her life time has taken two insurance policies in C.C. No.101/2018 and two policies in C.C. No.102/2018 and the complainant’s are the nominee for the said policies. 

 

 

02(a).       In C.C. No.101/2018 late Smt. Rathnamma has taken two policies vide No. 361151602 – Money Back – dated: 24.02.2000 for assured sum of Rs.20,000/- and policy No. 698552793 – New Bhima Gold – dated: 11.09.2003 for assured sum of Rs.2,50,000/- and the complainant Sri. Narayanappa is the nominee for the said two policies. 

 

 

02(b).       In C.C. No.102/2018 late Smt. Rathnamma has taken two policies vide No.698552804 – Money Back – dated: 12.09.2013 for assured sum of Rs.1,00,000/- and 364086841 – Jeevan Anand – dated: 05.07.2008 for assured sum of Rs.1,00,000/- and the complainant Sri. N. Manju @ Manjunath is the nominee for the said two policies. 

 

02(c).       The complainants further contended that, the said Rathnamma was died on 30.12.2014 and during her life time she had sugar complaint, the said Rathnamma has not stated anything at the time of taking the said policies and OP No.2 obtained her signature in the said policies and he filled-up the application form and not taken any medical certificates.  During August-2014 the deceased Rathnamma found swelling on her left mouth and she got admitted to R.L. Jalappa Hospital and she was died on 30.12.2014.  On 03.03.2015 they filed application before the LIC Office at Kolar for death claim.  On 25.06.2015 the Head Office at Bangalore had replied stating that, their applications are in progress and the said Rathnamma was suffering from diabetes since from last 06 years as per the death summery report and called them to produce prescriptions and they submitted all the reports.  On 01.10.2015 the Head Office has replied about the rejection of the insurance claim and the complainants are eligible only for paid up value. 

 

02(d).       On 26.02.2016 complainants submitted complaint before the Divisional Office, Bangalore, questioning the negligence of the agent but they refused to accept the claim and directed to contact Ombudsman.  On 17.12.2016 with respect to policy No.361151602 in C.C. No.101/2018 and with respect to policy No.364086841 in C.C. No.102/2018 they sent policy discharge and NEFT form, the complainant filled up the same and returned to them and they sent a sum of Rs.8,387/- in C.C. No.101/2018 and Rs.27,789/- in C.C. No.102/2018 respectively to the complainant’s S.B. account.  The complainants are not satisfied and they approached this Forum and prays to allow the said complaints in the ends of justice and equity.    

 

03.   In both cases the complainants have submitted following 09 documents:-

(i) Copies of 02 LIC bonds – Annexure-A

(ii) Complaint copy addressed to Head Office for rejection of death claim – Annexure-B

(iii) Copy of Policy Discharge & application pertaining to transfer of amount – Annexure-C

(iv) Copy of the Bank pass-book – Annexure-D

(v) Copy of the death certificate of Late Rathnamma – Annexure-E

(vi) Copy of rejection of claim and suggesting to contact Ombudsman – Annexure-F

(vii) Copy of Letter regarding claim was in process – Annexure-G

(viii) Voice record C.D. regarding acceptance of guilty by the agent –Annexure-H

(ix) Copies of the case-law – Annexure-I.

 

04.   After service of notice, the OP No.1 appeared through the counsel in both the cases and filed similar version.  The OP No.1 has contended that, the said complaint is not maintainable either in law or on facts.  The averments made at para-3 of the complaint are partly admitted wherein in C.C. No.101/2018 the sum insured under the second policy is Rs.1,00,000/- and not Rs.2,50,000/- as alleged in the complaint.  The averments made at Para-4 are not known and the averments at para-5 are all false and concocted as this OP No.1 is having proof to show that, the deceased was taking treatment for diabetes mellitus and Hyper Tension from the past 06 years as per the certificate issued by Dr. Balachandra G, along with Lab Reports dated: 08.12.2012 and 04.04.2013 respectively and she was on regular medication.  Later on she was admitted to R.L. Jalappa Research Centre, Tamake, Kolar, from 30.08.2014 to 27.11.2014 and treated for left cheek Malignancy squamous cell carcinoma, Hypertension and Diabetes Mellitus on regular treatment and as per the death summary issued by the R.L. Jalappa Hospital & Research Centre, Kolar, Smt. Rathnamm was admitted with OP No.91220 at EMD Casualty ward on 29.12.2014 and was declared as dead at 12.30 AM on 30.12.2014 due to Malignancy GBS – T4A N3 Mx, Accelerated Hypertension, Type 2 Diabetes Mellitus in DKA (Diabetic Ketoacidosis).  The past disease and treatment taken was well known to the deceased life assured and with an intention to defraud OP No.1 she had taken the insurance policies.  The polices were repudiated on the ground of non-disclosure of material facts as on the date of revival and commencement of the policy.  The policies were revived by suppressing the material facts without following the principle of “Utmost good faith” under insurance contract and hence the same has become null and void.  The policy bearing No.36151602 and 364086841 are eligible for Paid up value of Rs.8,387/- and Rs.27,789/- respectively which was credited to the nominees bank account through NEFT on 24.12.2016.  Under policy bearing Nos. 698552793 and 638552804, the policies have run for 1 year 3 months and any death that occurs within 3 years from the date of commencement of policy or date of revival is treated as an early claim which ought to be investigated and authenticated as per procedure.  Accordingly investigation was conducted and due to suppression of material facts by the life assured the said policies does not acquire any benefit as the same has not run for minimum period of 03 years and nothing was payable under the policy No.698552793 and 698552804.  The claim was further reviewed by the Zonal Office at Hyderabad and upheld the decision of repudiation.  The averment made at para-8 of the complaint is not within the knowledge of this OP No.1.  As there is no deficiency in service on the part of this OP No.1 and as this OP No.1 had settled the eligible claim amount to the nominee’s bank account the said complaint is liable to be dismissed.

 

05.   OP No.2 did not file any version.

 

06.   The complainant in both the cases have filed their respective affidavit evidence and on 12.03.2019 one Sri. V. Narayana, S/o. Vannappa, Manager at Legal & HPF Department, LIC of India, Divisional Office-II, Bangalore, has filed affidavit evidence on behalf of OP No.1 in both the cases with list of 06 documents:-

(i) Certificate issued by the consulting doctor with lab reports consisting of 05 pages – Exhibit-D.1

(ii) Reports & Discharge summary issued by R.L. Jalappa Hospital consisting of 07 pages – Exhibit-D.2

(iii) Copy of repudiation letter dt: 01.10.2015 consisting of 02 pages – Exhibit-D.3

(iv) Copy of personal statement regarding health dt: 06.05.2013 – Exhibit-D.4

(v) Copy of repudiation letter dt: 01.10.2015 – Exhibit-D.5

(vi) Copy of policy bonds – Exhibits-D.3 & D.4.

 

 07.  On 16.03.2019 counsel for OP No.1 has submitted Memo with two citations (i) Revision Petition No.3322/2016, dt: 03.10.2016 between Sunitarani V/s PNB Metlife India Insurance Company Limited, (ii) Revision Petition No.1134/2016, dated: 14.01.2016 between LIC of India V/s. Jyothi Sudhir.

 

08.   On 26.03.2019 complainant submitted written arguments in both the cases and on 12.04.2019 the complainant filed Family Tree issued by Deputy Tahasildar.  Heard arguments of complainant and OP No.1.

 

09.   Now the common points that do arise for our consideration in the above two cases are that:-

POINT NO.1:-  Whether the complainant in

                   C.C. No.101/2018 and C.C.No.

                   102/2018 proves deficiency

                   of service on the part of the OPs?

 

POINT NO.2:-   Whether the complainant in

                   C.C. No.101/2018 and C.C.No. 

                   102/2018 is entitled for the  

                             relief as prayed?

 

POINT NO.3:-  What order?

 

10.   The findings on the above points are that:-

POINT NOs.1 & 2:- Are in the Negative

POINT NO.3:-         As per final order for the

following:-

 

REASONS

11.   POINT NOS.1 & 2:-  These points are taken up together for discussion to avoid repetition of facts and reasonings.  We perused the complaint, version filed by OP No.1, affidavit evidence of the complainant and the OP No.1 and the documents produced by them and the citation relied by the OP No.1 and perused the family tree.  The complainant in the above said two cases are the only legal-heir of the deceased.  On perusal of the pleadings it is an admitted fact about the policies taken by the deceased and the complainants are the nominees of their respective policies.  Both complainant and OP No.1 produced the said polices as per Annexure-A & B and Exhibit-D.3 & D.4 in the above said two cases respectively.  Further there is no dispute regarding paid up value of Rs.8,387/- vide policy No.361151602 in C.C. No.101/2018 and Rs.27,789/- vide policy No.364086841 in C.C. No.102/2018 as per Annexure-D respectively.  The above said amount have been credited to the complainant’s bank account bearing No. 54042409354 in C.C. No.101/2018 and bank account No. 64016621118 in C.C. No.102/2018 by OP No.1 and to that effect the complainants have produced their bank account extract as per Annexure-D in the above cases.  The said amount was credited on 26.12.2016.  The said life assured Smt. Rathnamma was died on 30.12.2014 and the complainants have produced the Death Certificate of the deceased as per Annexure-E.

 

12.   On perusal of Annexure-A and Exhibit-D.3 the life assured has taken policies bearing No.361151602 on 28.02.2000, the sum assured Rs.20,000/- and the maturity date on 28.02.2020 in C.C. No.101/2018 and on perusal of Annexure-A and Exhibit-D.3 the life assured has taken policy vide No.364086841 dated: 05.07.2008, sum assured Rs.1,00,000/- and maturity on 05.01.2029 in C.C. No.102/2018 and the above complainants are the nominees to the said policies.  But before the maturity of the said bonds the life assured by name Smt. Rathnamma was died on 30.12.2014.  Thereafter the complainants approached OP No.1 for seeking death claim and on perusal of the documents and after calling documents from the complainant on 24.12.2016 the OP No.1 has credited the paid up value of the above said policies to the Bank account of the complainant in the above said two cases. 

 

13.   On perusal of the documents produced by OP No.1 the life assured has suppressed the material facts that, the life assured was suffering from Malignancy GBS – T4A N3 Mx, Accelerated Hypertension, Type 2 Diabetes mellitus in DKA (Diabetic Ketoacidosis) and she was died due to the said disease as per copy of the Death Summary under Exhibit-D.2 at page No.5.  On perusal of Exhibit-D.1, the copy of the Medical certificate issued by Dr. Balachandra.G dated: 23.07.2015 it reveals that, the said life assured Smt. Rathnamma was suffering from diabetes mellitus and hypertension for the past 06 years and taken treatment and later on she was admitted to R.L. Jalappa Hospital, Kolar, on 30.08.2014 and discharged on 27.11.2014 for Malignancy Left GBS T4a N3 Mx as seen from Page-3 under Exhibit-D.2 and was on regular treatment and again she was admitted to R.L. Jalappa Hospital on 29.12.2014 and she was died on 30.12.2014 as seen at page-5 under Exhibit-D.2 as the Cause of Death is Malignancy GBS-T4AN3Mx, accelerated Hypertension, Type 2 Diabetes mellitus in DKA. 

 

14.   On perusal of the letter of OP No.1 dated: 01.10.2015 wherein the policy bearing No.361151602 and the policy No.364086841 of the above said complainants respectively were lapsed for non-payment of the premium due on 06/2011 and were revived on 06.05.2013 for full sum assured on the strength of a personal statement of health made by the deceased and she declared that, she has no illness/diseases requiring treatment for a week or more, no history of operation, accident or injury and not undergone ECG, X-Ray, Screening, Blood, Urine or Stool examination and her health condition was good while giving this personal statement.  On perusal of the said personal health statement declaration which clearly discloses that, the life assured has suppressed the material facts about her health condition only to deprive OP No.1 and to get the full sum assured by suppressing the material facts.  Hence as discussed above, the complainants in the above said two cases are not entitled for full assured amount vide policy No.361151602 in C.C. No.101/2018 and policy No.364086841 in C.C. No.102/2018 and are entitled only the paid up value and the said amounts are already paid to the complainants and there is no any deficiency of service on the part of the OP No.1.

 

15.   Now it is relevant to state here that, the life assured deceased was also taken policy bearing No.698552793 and policy No.698552804 and the complainant are nominee in the above said respective cases.  The said policies run for 01 year 03 months and 19 days in C.C. No.101/2018 and the said policy No.698552804 was run for 01 year 03 months 18 days in C.C. No.102/2018 and the life assured was died on 30.04.2014 before maturity of the said policies.  The life assured could not pay continuously the 2^nd and 3^rd.  The life assured was taken the above said policies by suppressing the material facts about her health condition to the utmost on good faith and the complainants are not entitled for any reliefs on the above said two policies as the life assured has not paid three years premium and the complainants could not get the refund of the premium amount paid by the insurance company has already taken risk for the period for which the premium has been paid and refund of any amount by the OP No.1 as prayed by the complainants does not raise.  In this regard we relay citation reported in 1994(1) CPJ 184 of the Hon’ble Gujarat State Commission.  Wherein their lordship has held that, after 1^st premium no other premium paid the insured is not entitled to receive the premium amount.  Here in this case the life assured was died after 01 year 06 months after taking the policy.  Hence the principle of the said citation is attracted to the above said facts.  The complainants are not entitled for any reliefs for the above said two polices.  Hence under these circumstances as discussed above, the complainants have failed to make out any deficiency of service or negligence on the part of the OP No.1 and accordingly, we answer these points are in the Negative.

 

POINT (3):-

16.   In view of the discussions made on Point (1) & (2), we proceed to pass the following:-

ORDER

01.   The complaint filed by the complainant in C.C. No.101/2018 and the complaint filed by the complainant in C.C. No.102/2018 are hereby dismissed.  No order as to costs.

 

02.   The original of this order shall be kept in C.C. No.101/2018 and a copy thereof in C.C. No.102/2018.

 

03.   Send a copy of this order to both parties free of costs.

 

(Dictated to the Stenographer in the Open Forum, transcribed by him, corrected and then pronounced by us on this 30^th DAY OF APRIL 2019)

 

 

   LADY MEMBER                         PRESIDENT