DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTAPUR.
PRESENT: - Sri C.Thyagaraja Naidu, B.Sc., B.L., President
Smt.S.Lalitha, Member, M.A., M.L.,
Sri S.Niranjan Babu, B.A., B.L., Male Member
Tuesday, the 30th day of November, 2010
C.C.NO.83/2010
Between:
Sandeep
S/o G.Yerri Swamy, minor
through his appointee G.Indiramma
H.NO.9-3-268/a,Indranagar
Uravakonda,
Anantapur District. … Complainant.
Vs.
1. The Manager,
Shriram Life Insurance Co. Ltd.,
Rayadurg,
Anantapur District.
2. The Divisional Manager,
Shriram Life Insurance Co. Ltd.,
10-3-206, M/4, II floor,
Opp. Krishna Reddy House,
Reddy and Reddy Colony
Tirupati, Chittoor District.
3. The General Manager,
Shriram Life Insurance Co. Ltd.,
3-6-478, 3rd floor, Anand Estate
Liberty Road, Himayatnagar
Hyderabad – 500 029. … Opposite Parties.
This case coming on this day for final hearing before us in the presence of Sri N.Lakshmi Prasad, advocate for the complainant and Sri N.R.K.Mohan and Sri A.Suresh Kumar, advocates for the opposite parties 1 to 3 and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:
O R D E R
Sri C.Thyagaraja Naidu, President: - This complaint has been filed by the complainant under section 12 of Consumer Protection Act, 1986 against the opposite parties 1 to 3 to direct them to pay a sum of Rs.85,000/- which includes Rs.75,000/- towards assured amount in the policy and Rs.10,000/- towards mental agony with costs of the complainant.
2. The brief facts of the amended complaint are that: -The complainant is the nominee of the policy, minor appointed by G.Yerri Swamy, policy holder, who obtained the policy Shri Plus from the opposite party-company. The complainant is represented by his appointee G.Indiramma. G.Yerri Swamy the policyholder obtained Insurance Policy Shri Plus from the opposite parties with policy term of 15 years for an assured amount of Rs.75,000/- with the annual premium of Rs.10,000/- by keeping his son namely Sandeep, minor as nominee through appointee by name G.Indiramma by submitting requisite application form through its Branch Office in Rayadurg by paying annual amount of Rs.10,000/- to the opposite parties. There upon the opposite parties issued policy covering letter dt.12-07-2008 to the policy-holder G.Yerri Swamy with Policy No.LN080800113792 with ID No.SANJ0107197702 through 2nd opposite party. The policy-holder G.Yerri Swamy died on 27-10-2008 and the said fact has been intimated to the opposite parties and in pursuance of the same, the opposite parties supplied concerned claim forms in which the appointee submitted the claim with requisite documents as called upon by the opposite parties to the 3rd opposite party, but the opposite parties repudiated the claim without any just cause or justification. There upon the complainant through appointee got issued legal notice dt.12-01-2010 through her advocate to which the 3rd opposite party gave reply notice dt.16-02-2010 in order to evade the payment of assured amount stating that the opposite parties repudiated the claim of the complainant on the ground that the life assured was suffering with severe health problems and also wrongly declared his age. This amounts to deficiency of service. Hence, the complainant having no other go has filed this complaint against the opposite parties to direct them to pay the assured amount of Rs.75,000/- and Rs.10,000/- towards mental agony with costs of the complaint.
3. The 1st opposite party filed counter and contended that this opposite party is not proper and necessary party to the complaint filed by the complainant. This opposite party is service providers by collecting the premium amount on behalf of Shriram Life Insurance Co. Ltd., and forwarding the proposal forms/claim forms to the concerned Division/Head Office of Shriram Life Insurance Company, which is the proper party which has issued the policy. For convenient and effective service to the customers and being one of the sister concern company of Shriram Group, this opposite party is providing services to the Shriram Life Insurance Co. Ltd., which is having its Registered Office at 3-6-478, Anand Estates, III Floor, Liberty Road, Himayatnagar, Hyderabad and having its Divisional Office at Tirupati. The complainant had failed to file the complaint against proper and necessary party for the relief claimed under the complaint. Hence, this opposite party is not answerable for the allegations mentioned in the complaint. Therefore, the complaint filed by the complainant against this opposite party is liable to be dismissed.
4. The 2nd opposite party filed a memo adopting the counter filed by the 1st opposite party.
5. The 3rd opposite party filed counter and contended that at the time of taking the policy in question, the deceased/policy-holder was supplied with one proposal form and requested to fill the same with correct details with regard to his health condition, habits and pre-diseases if any as per the questionnaire of the proposal form. Basing on the information filed by the deceased policyholder the opposite party has accepted the risk on the life of deceased policy-holder and issued the subject policy in all good faith. In the month of December, 2008 the complainant has informed to the Branch Office, Shriram Chits, Rayadurg, which is the sister concern company of Shriram Life Insurance, the life assured has died on 22-10-2008 due to jaundice . Upon receipt of such information, the company through its investigation has personally handed over the concerned claim forms A,B & C to the appointee under the policy and requested her to submit proper filled in claim forms with all other required documents to process the death claim. The complainant has not submitted the claim forms within the stipulated period, this opposite party has issued reminder on 27-01-2009 and another reminder on 16-02-2009. In response to the same, the appointee has submitted filled in claim forms A,B & C. Upon careful perusal of the claim forms A & C it has become to their notice that as on the date of the death, the deceased life assured was aged 40 years and the same was wrongly mentioned by the life assured in the proposal form at the time of taking of above policy. Upon perusal of the claim form-B it is revealed that the life assured was having pre-health problems before applying the above policy. Against the column of primary cause of death, the doctor has revealed it as Cirrhosis of Liver and Secondary Cause of Death as severe Jaundice and hepatic failure and he was having the above ailments since 3 months before his death. Further, the doctor has revealed that he had treated the life assured on 07-07-2008 for severe vomiting and fever and also revealed that he is a regular medical attendant to life assured since one year and the same were confirmed during the investigation. It is clear that the deceased has not disclosed regarding his pre-health conditions and correct age while applying for the present policy with this opposite party. The non-disclosure of the said facts are nothing but intentional and to have undue advantage of the policy benefits. Since the deceased life assured has concealed material facts with regard to his age proof and health condition while taking the above policy through letter dt.28-02-2009 this opposite party has intimated the complainant that the policy claim has been repudiated and treated the matter as closed. This opposite party denied the other averments mentioned in the complaint and contended that the complaint filed by the complainant is liable to be dismissed with costs.
6. Considering the above pleadings, the points that arise for consideration are:
1. Whether there is deficiency of service on the part of the opposite parties 1 to 3? If
so whether the complainant is entitled in respect of the amount claimed in the
complaint as prayed for from the opposite parties 1 to 3?
2. To what relief?
7. To prove the case of the complainant, the evidence on affidavit of the complainant and additional evidence on affidavit of the complainant has been filed and marked Exs.A1 to A5 documents. On behalf of the opposite parties 1 to 3 the evidence on affidavit of the 3rd opposite party has been filed and marked Exs.B1 to B15 documents.
8. Heard both sides.
9. POINT NO.1: - It is an admitted fact that the deceased policyholder G.Yerri Swamy obtained Insurance Policy Shri Plus from the 3rd opposite party bearing No.LN080800113792 and the policy commences from 12-07-2008, the term of the policy is 15 years, the date of maturity is 12-07-2023 and the assured amount is Rs.75,000/- and installment payable yearly of Rs.1,0,000/-. It is also an admitted fact that the deceased policyholder has nominated the complainant Sandeep, who is minor by the date of taking the said policy. It is also an admitted fact that after obtaining the said policy, the deceased policyholder G.Yerri Swamy died on 27-10-2008 and thereafter G.Indiramma is appointee of the nominee minor Sandeep submitted claim forms to the opposite parties 1 to 3 for payment of the amount under Insurance Policy. The opposite parties repudiated the claim of the complainant on the ground that the deceased Policy-holder G.Yerri Swamy in the proposal form had wrongly mentioned his age as 31 years instead of actual age of 40 years and that the deceased Policyholder G.Yerri Swamy has suppressed his previous ailments at the time of submitting the proposal form on 27-06-2008.
10. The evidence on affidavit of the 3rd opposite party is that the deceased policyholder at the time of submitting the proposal form he has wrongly mentioned his age as 31 years instead of mentioning his age as 40 years, the said age disclosed by G.Indiramma appointee of the minor complainant and further in the claim form Ex.B10 it is mentioned that the deceased policyholder was suffering with Cirrhosis of Lever, severe jaundice and hepatic failure as a result he died and further it is mentioned that since 3 months prior to his death, he was suffering with the said disease and that the deceased died on 22-10-2008. Thus the deceased suppressed the said material facts of his ailment in the proposal form under Ex.B1. Therefore, the repudiation of the claim of the complainant by the 3rd opposite party is justified and that therefore, the complaint filed by the complainant is liable to be dismissed with costs.
11. Except the said oral evidence on affidavit of the 3rd opposite party the opposite parties 1 to 3 have not filed any documentary proof to show that the life assured was admitted in any hospital for treatment with regard to his ailments Cirrhosis of Lever and severe jaundice prior to 27-06-2008.
12. As seen from Ex.B10 claim forming column 5 (c) relates to question how long had he/she been suffering from this disease before his/her death. The answer given to the said question is since 3 months. The deceased died on 22-10-2008 as per Ex.B4 Death Certificate issued by the Secretary, Grama Panchayat, Uravakonda, Anantapur District. Considering the fact mentioned in Ex.B10 that the deceased died 3 months prior to his death, it goes to show that since 22-07-2008 the life assured has been suffering with the above said ailment. Whereas the proposal form submitted by the deceased was on 27-06-2008, which is much earlier to the ailment suffered by the deceased as mentioned in the claim form Ex.B10. Even if Ex.B10 is taken into consideration, the facts mentioned in the said claim are correct; it goes to prove the fact that by the date of submission of proposal form under Ex.B1 by the life assured, he was not suffering with any ailment. Therefore, the question of suppression of his ailment by the deceased as mentioned in Ex.B10 by the complainant cannot be accepted.
13. Further even assuming that the deceased has wrongly mentioned in the proposal form Ex.B1 that his age as 31 years instead of mentioning his age as 40 years that cannot be taken into consideration because the premium fixed under Insurance Policy Ex.B2 is yearly Rs.10,000/-, the sum assured is Rs.75,000/-, date of commencement of policy is 12-07-2008 and the date of last premium is 12-07-2022. Therefore, the premium fixed under Ex.B2 is for a period of 15 years. The opposite parties have not placed any material to show that if the policy holder had mentioned his age as 41 years in the proposal form and if he has taken 15 years policy the premium would be more than Rs.10,000/- as fixed under Ex.B2. When the premium payable by the life assured does not change with the age of advancement, therefore, the contention of the opposite parties that the deceased policy-holder wrongly mentioned his age as 31 years instead of 40 years cannot be taken into consideration so as to repudiate the claim of the complainant by the opposite parties.
14. Therefore, on considering the said facts and circumstances, we have no hesitation to come to conclusion that the repudiation of the claim of the complainant by the 3rd opposite party is not justified and that therefore, the opposite parties 1 to 3 are jointly and severally liable to pay to the complainant a sum of Rs.75,000/- towards assured amount under Ex.B2 policy with interest @ 12% p.a. from the date of notice under Ex.B13 i.e. 12-01-2010 till the date of realization. Since the complainant is awarded interest hence, awarding amount claimed under mental agony does not arise. Accordingly, this point is answered.
15. POINT NO.2: - In the result, the complaint filed by the complainant is allowed and the opposite parties 1 to 3 are jointly and severally liable to pay a sum of Rs.75,000/- to the complainant with interest @ 12% p.a. from the date of notice Ex.B13 dt.12-01-2010 till the date of realization with costs of Rs.3,000/-. The said amount shall be payable by the opposite parties 1 to 3 to the complainant within one month from the date of this order.
Dictated to the Steno, transcribed by him, corrected and pronounced by us in open Forum this the 30th day of November, 2010.
MALE MEMBER LADY MEMBER PRESIDENT
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR ANANTAPUR.
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
ON BEHALF OF THE COMPLAINANT: ON BEHALF OF THE OPPOISITE PARTIES:
-NIL- - NIL-
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Ex.A1 – Photo copy of Deposit Acknowledgment Receipt dt.27-06-2008 issued by the
opposite parties to the deceased G.Yerri Swamy.
Ex.A2 - Photo copy of Insurance Policy bearing No.LN080800113792 issued by the opposite
parties in favour of the deceased G.Yerri Swamy.
Ex.A3 - Photo copy of repudiation letter dt.28-02-2009 issued by the 3rd opposite party to the
appointee G.Indiramma.
Ex.A4 - Office copy of legal notice dt.12-01-2010 got issued by the complainant to the opposite
Parties 1 to 3.
Ex.A5 - Reply letter got issued by the 3rd opposite party dt.16-02-2010 to the counsel for the
Complainant.
EXHIBITS MARKED ON BEHALF OF THE OPPOSTE PARTY NO.3
Ex.B1 - Original Proposal for Unit Linked Insurance dt.27-06-2008 submitted by the
deceased G.Yerri Swamy to the 1st opposite party.
Ex.B2 - Insurance Policy bearing No.LN080800113792 issued by the 3rd opposite party
in favour of the deceased G.Yerri Swamy.
Ex.B3 - First Premium Receipt issued by the 3rd opposite party to the deceased G.Yerri
Swamy.
Ex.B4 - Letter submitted by the appointee G.Indiramma to the 1st opposite party.
Ex.B5 - Photo copy of Death Certificate relating to G.Yerri Swamy issued by the Panchayat
Secretary, Grama Sachivalayam, Uravakonda, Anantapur District.
Ex.B6 - Letter submitted by the appointee G.Indiramma to the 1st opposite party.
Ex.B7 - Letter dt.27-01-2009 issued by the 3rd opposite party to the appointee G.Indiramma.
Ex.B8 - Letter dt.16-02-2009 issued by the 3rd opposite party to the appointee G.Indiramma.
Ex.B9 - Claim Statement dt.10-02-2009 submitted by G.Indiramma to the opposite parties.
Ex.B10 - Medical Attendance Certificate dt.19-01-2009 issued by Dr.Chowdary, Kumudua
Clinic, Uraakonda.
Ex.B11 - Certificate of Identity & Burial Cremation issued by the Sarpanch, Grama
Sachivalayam, Uravakonda, Anantapur District.
Ex.B12 - Repudiation letter dt.28-02-2009 issued by the 3rd opposite party to the appointee
G.Indiramma.
Ex.B13 - Office copy of legal notice dt.12-01-2010 got issued by the complainant to the
opposite parties 1 to 3.
Ex.B14 - Reply letter dt.16-02-2010 issued by the 3rd opposite party to the counsel for the
Complainant.
Ex.B15 - Investigation Report on Death Claim dt.06-01-2009 submitted by G.Rama Murthy,
Insurance Surveyor, Hyderabad to the opposite parties.
MALE MEMBER LADY MEMBER PRESIDENT
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR ANANTAPUR.
