Karnataka

Chitradurga

CC/93/2016

Kotresh S/o Late Matada Veeraiah - Complainant(s)

Versus

The Manager,HDFC Life Insurance Co Ltd., - Opp.Party(s)

Sri.K.B.Chandrappa

05 Aug 2017

ORDER

COMPLAINT FILED ON:05/10/2016

DISPOSED      ON:05/08/2017

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

 

CC.NO: 93/2016

 

DATED: 5^th AUGUST 2017

PRESENT: - SRI. T.N. SREENIVASAIAH  : PRESIDENT                                   B.A., LL.B.,

                   SRI.N. THIPPESWAMY        : MEMBER

                          B.A., LL.B.,   

……COMPLAINANT/S	Kotresh S/o Late Matada Veeraiah, Age: 23 Years, Agriculturist, K. Bevinahally Village, Bannikodu Post, Harihara Taluk, Davanagere District.   (Rep by Sri.K.B. Chandrappa, Advocate)
V/S
…..OPPOSITE PARTIES	1. The Manager, HDFC Life Insurance Company Limited, I Floor, Old Savitha Bhavan Building, Beside Head Post Office, Holalkere Road, Chitradurga.   Now the Office shifted to Nabhoraj, I Floor, right side portion, 4th main, P.J. Extension, Davanagere.   2. The Claims Manager, HDFC Standard Life Insurance Co.Ltd., 11th Floor, Lodha Excellus, Apollo Mills Compound, N.M. Joshi Road, Mahalaxmi, Mumbai-400 011.     (Rep by Sri.B.S. Shivamurthy, Advocate)

ORDER

SRI. T.N. SREENIVASAIAH:   PRESIDENT

The above complaint has been filed by the complainant u/Sec.12 of the C.P. Act, 1986 for the relief to direct the OPs to pay a sum of Rs.19,50,000/- as compensation of policy admissible amount along with interest at the rate of 24% p.a and such other reliefs.

2.      The brief facts of the case of the above complainant are that, his father namely Matada   
Veeraiah S/o Siddaiah obtained the insurance policy from OP No.1 situated at Chitradurga working under the control of OP No.2.  The policy was issued under the name and style as HDFC Life Click to Protect (Term Policy) policy bearing No.16514874 valid for the period from 26.12.2013 to 26.12.2027 and the policy term is 15 years and the premium was Rs.9,819/- per year.  OP No.1 issued the policy bond in favour of father of complainant covering the risk of the life of the policy holder.  The policy holder has paid two premium.  The first premium was paid on 216.12.2013 and second premium was paid on 13.01.2015.  It is further submitted that, the OPs agreed that, in case of death of policy holder due to natural death or accidental death, the sum assured amount of Rs.19,50,000/- will be paid but, the same has not been paid.  In case of death of policy holder occurred naturally or due to accidentally, the insurance company has to pay the sum assured to the nominee.  The father of complainant Matada Veeraiah was working as an agriculturist and business has obtained the above said policy and made his son as nominee.  The said Matada Veeraiah died on 24.08.2015 due to chest pain at his residence leaving behind his children as his surviving nominee.  After the death of said Matada Veeraiah, complainant has given claim form on 02.09.2015 along with original policy bond, death certificate of his father, bank account statement, Voter ID, Pan Card and other relevant documents to the OPs for settlement of the claim.  OPs have appointed the investigator, the investigator recorded the statement of complainant and collected all the necessary documents but, the OPs have not settled the claim.  Inspite of several requests and demands made by the complainant to settle the claim, but the OPs have drag on the matter to settle the claim on one or the other pretext, thereby the complainant suffered lot and put into great mental agony and financial problem.  OPs assured that, if the policy holder died, the policy amount will be paid to the nominee.  Complainant approached the OPs along with original documents for payment of the policy amount but, the OPs have not settled the claim.  Complainant has submitted the claim form on 02.09.2015 and further submitted requisition letter on 07.12.2015 but, the OPs have repudiated the claim made by him.   The cause action for the complaint arose on 26.12.2015 when the above said policy was obtained by deceased Matada Veeraiah and he was died on 24.08.2015 and when the complainant issued the request letter dated 07.12.2015 which is within the jurisdiction of this Forum.  Therefore, the complainant has respectfully prayed before this Forum to allow his complaint with cost. 

3.      On service of notice, OPs appeared through Sri. B.S. Shivamurthy, Advocate and filed version denying the allegations made in the complaint.  It is further stated that, the complainant has not intimated the death of life assured and not submitted any documents to process the claim.  After the receipt of the notice issued from this Forum, it came to know that, the Life assured was died.  Immediately they contacted the nominee/complainant and collected documents and initiated death claim.  As per the procedure, it is the duty of the nominee to intimate the death of life assured and submit the documents of life assured as well as nominee.  But, the complainant has directly approached this Forum with a malafide intention, therefore the complaint is false, malicious and incorrect and the same is liable to be dismissed.  It is further submitted that, the proposal dated 23.12.2013 was accepted from the deceased Mathada Veeraiah for purchase of policy bearing No.16514874 namely HDFC Life 2 Protect Policy for a sum of Rs.19,50,000/- towards death benefits, the same was accepted on the basis of information provided by the proposer.  Life assured was obtained the policy with a malafide intention to gain illegally from the insurance company.  It is further submitted that, the life assured was a BA graduate and he was well aware of the clause of proposal form and after being convened only he was obtained the policy.  The deceased was disclosed his occupation as an agriculturist, designation as Landlord and annual income as 4 lakhs and nature of work as Supervisory but, he has not produced any documents to show that he was earning Rs.4 Lakhs p.a.  It is further submitted that, the wife of deceased Matada Veeraiah has submitted a letter of objection to Kasturba Hospital, Manipal objecting to provide the medical records to any insurance company or agents.  The complainant has not provided the proper medical documents and the documents which provided by the complainant is insufficient and nothing was disclosed except medicine description.  As per the terms and conditions and IRDA Regulations, it is mandatory and the duty of the proposer to disclose proper details regarding the health, proper income, age and occupation.  It is further submitted that, the insurance is a subject matter of solicitation.  The agents solicits the insurance policies from the proposed customer after briefing him/her on the terms and conditions of the insurance policy.  OP has not received any death claim intimation and the settlement of the claim is subject to the terms and conditions of the policy and provision of Insurance Act.  It is further submitted that, the clause/declaration of the policy document on incorrect information and non-disclosure, wherein it is provided that “your policy is based on the application and declaration which you have made to us and other information provided by you/on your behalf.  However, if any of the information provided is incomplete/incorrect, we reserve the right to vary the benefits, which may be payable and further, if there has been non-disclosure of a material fact then we may treat your policy as void from inception.”

Section 45 of the Insurance Act, 1938 stipulates that, No policy of the life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of policy i.e., from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud.  Provided that in case of fraud, the onus of disproving lies upon the beneficiaries, in case the policy holder is not alive.  Therefore, the OPs have not committed any deficiency in service or unfair trade practice.  In view of the above stated facts prayed for dismissal of the complaint.

         4.       Complainant has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-5 were got marked. On behalf of OPs, one Sri. Kumar B.G S/o Gaviyappa, Assistant Manager (Legal), has examined as DW-1 by filing the affidavit evidence and Ex.B-1 to     B-5 documents have been got marked.  

 

5.      Arguments of both sides heard.

6.      Now the points that arise for our consideration for decision of above complaints are that;

 

(1)  Whether the complainant proves that the OPs have committed deficiency of service in settling the claim made by him and entitled for the reliefs as prayed for in the above complaint?

              (2) What order?

          7.      Our findings on the above points are as follows:-

          Point No.1:- Partly in Affirmative.

          Point No.2:- As per final order.

REASONS

8.      It is not in dispute that, father of the complainant namely Matada Veeraiah S/o Siddaiah obtained the HDFC Life Click to Protect (Term Policy) policy bearing No.16514874 valid for the period from 26.12.2013 to 26.12.2027 by paying premium of Rs.9,819/- per year.  The policy term is 15 years.  OP No.1 issued the policy bond in favour of father of complainant covering the risk of the life of the policy holder.  The policy holder has paid two premium.  The first premium was paid on 26.12.2013 and second premium was paid on 13.01.2015.  The OPs have agreed that, in case of death of policy holder on account of natural death or accidental death, the sum assured amount of Rs.19,50,000/- will be paid.  But, the same has not been paid.  The said Matada Veeraiah was died on 24.08.2015 due to chest pain at his residence leaving behind his children as his surviving nominee.  After the death of said Matada Veeraiah, complainant has given claim form on 02.09.2015 along with original policy bond and other relevant documents to the OPs for settlement of the claim.  OPs have appointed the investigator, the investigator recorded the statement of complainant and collected all the necessary documents.  But, the OPs have failed to settle the claim, thereby the complainant suffered lot and put into great mental agony and financial problem.

9.      In support of his contention, the complainant has filed his affidavit evidence and reiterated the contents of complaint and relied on the documents like Death certificate of Matada Veeraiah marked as Ex.A-1, Ex.A-2 is the letter dated 05.04.2017 issued by the OP with regard Death claim for policy wherein it has been stated that, as per investigation made by the OP that, the life assured had multiple insurance from other insurance companies which was not disclosed in the application dated 23.12.2013.  But, as per the documents produced by the complainant this policy is the earlier policy and remaining policies are obtained by the father of the complainant are subsequent policies.  Therefore, the contention taken by the OP in its version is not acceptable, letter dated 07.12.2015 given by complainant to the OPs with regard to the delay in settling the insurance claim marked as Ex. A-3 and insurance premium paid receipts marked as Ex.A-4 and 5, which shows that, the father of the complainant has paid premiums to the OPs regularly. 

10.    On the other hand, it is argued by the OPs that, the complainant has not intimated the death of life assured and not submitted any documents to process the claim.  After the receipt of the notice issued from this Forum, it came to know that, the Life assured was died.  Immediately they contacted the nominee/complainant and collected documents and initiated death claim.  As per the procedure, it is the duty of the nominee to intimate the death of life assured and submit the documents of life assured as well as nominee.  But, the complainant has directly approached this Forum with a malafide intention.  The proposal dated 23.12.2013 was accepted from the deceased Mathada Veeraiah for purchase of policy bearing No.16514874 namely HDFC Life 2 Protect Policy for a sum of Rs.19,50,000/- towards death benefits, on the basis of information provided by the proposer.  As per the terms and conditions and IRDA Regulations, it is mandatory and the duty of the proposer to disclose proper details regarding the health, proper income, age and occupation.  The insurance is a subject matter of solicitation.  The agents solicits the insurance policies from the proposed customer after briefing him/her on the terms and conditions of the insurance policy.  OPs have not received any death claim intimation and the settlement of the claim is subject to the terms and conditions of the policy and provision of Insurance Act.  The clause/declaration of the policy document on incorrect information and non-disclosure, wherein it is provided that “your policy is based on the application and declaration which you have made to us and other information provided by you/on your behalf.  However, if any of the information provided is incomplete/incorrect, we reserve the right to vary the benefits, which may be payable and further, if there has been non-disclosure of a material fact then we may treat your policy as void from inception.”  Section 45 of the Insurance Act, 1938 stipulates that, No policy of the life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of policy i.e., from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud.  Provided that in case of fraud, the onus of disproving lies upon the beneficiaries, in case the policy holder is not alive. 

11.    In support of its contention, the OPs have filed affidavit evidence of one Sri. Kumar B.G S/o Gaviyappa, Assistant Manager (Legal), has examined as DW-1 by filing the affidavit evidence and reiterated the contents of version and relied on the documents like Statement of Death Claim with respect to policy bearing No.16514874 of Matada Veeraiah marked as Ex.B-1, name declaration of the complainant marked as Ex.B-2, Proposal Form dated 23.12.2013 of Matada Veeraiah marked as Ex.B-3, Investigation report  and claim details marked as Ex.B-4 and Death Claim for policy dated 05.04.2017 marked as Ex.B-5.

12.   On hearing the rival contentions of both parties and on perusal of the documents including the affidavit and documentary evidence, it clearly made out that, the father of the complainant deceased Matada Veeraiah has taken HDFC Life Click to Protect (term policy) policy bearing No.16514874 by paying the premium amount of Rs.9,819/- p.a for the period from 26.12.2013 to 26.12.2027 for a sum assured of Rs.19,50,000/-.  The said policy term is 15 years.  The complainant has paid two yearly premiums as per the premium receipts as per Ex.A-4 and 5.  It clearly shows the father of the complainant was paying the premium amounts regularly.  Such being the case, the father of the complainant died on 24.08.2015.  After the death of his father, the complainant has submitted his claim form for settlement of the insurance amount to the OPs.  But, the OPs have repudiated the claim stating that, the father of the complainant has obtained the policies before taking this policy, the same has been suppressed by the life assured. But the documents produced by the complainant shows that, the remaining policies are the subsequent policies.  The claim made by the complainant with the OPs is the first policy.  Therefore, the contention taken by the OPs is not admissible or acceptable.  The complainant approached the OPs claiming compensation but, the OPs have drag on the matter on one or the other reason.  Therefore, we come to the conclusion that, the repudiation made by the OPs in settling the claim of the complainant itself is a deficiency of service on the part of OPs.  Accordingly, this Point No.1 is held as partly affirmative to the complainant.          

            13.     Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-

ORDER

The complaint filed by the complainant U/s 12 of CP Act 1986 is partly allowed.

It is ordered that, the OPs are hereby directed to pay a sum of Rs.19,50,000/-, the sum assured amount to the complainant. 

It is further ordered that, the OPs are hereby directed to pay Rs.10,000/- towards mental agony and Rs.5,000/- towards costs of this proceeding.  

It is further ordered that, the OPs are hereby directed to comply the above order within 30 days from the date of this order.

 (This order is made with the consent of Member after the correction of the draft on 05/08/2017 and it is pronounced in the open Court after our signatures)         

 

 

                                     

 MEMBER                                                   PRESIDENT

 

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

PW-1:  Complainant by way of affidavit evidence.

Witnesses examined on behalf of OPs:

DW-1:  Sri. Kumar B.G S/o Gaviyappa, Assistant Manager (Legal) of OPs by way of affidavit evidence. 

 

Documents marked on behalf of Complainant:

01	Ex-A-1:-	Death certificate of Matada Veeraiah
02	Ex-A-2:-	Letter dated 05.04.2017 issued by the OP with regard Death claim
03	Ex-A-3:-	Letter dated 07.12.2015 given by complainant to the OPs with regard to the delay in settling the insurance claim
04	Ex-A-4 & 5:-	Insurance premium paid receipts

 

Documents marked on behalf of OPs:

01	Ex-B-1:-	Statement of Death Claim
02	Ex-B-2:-	Name declaration of the complainant
03	Ex-B-3:-	Proposal Form dated 23.12.2013 of Matada Veeraiah
04	Ex.B-4:-	Investigation report  and claim details
05	Ex.B-5:-	Death Claim for policy dated 05.04.2017.

 

 

 

MEMBER                                                            PRESIDENT

Rhr**