DISTRICT FORUM :: KADPA Y.S.R DISTRICT
PRESENT SRI P.V. NAGESWARA RAO, M.A., LL.M., PRESIDENT
SRI S.A. KHADER BASHA, B.Sc., MEMBER.
Monday, 23rd May 2011
CONSUMER COMPLAINT No. 18/ 2011
Kalluru Obula Reddy, S/o Pulla Reddy,
aged about 55 years, Hindu, Residing in
Vemula Village and Mandal, Kadapa District. ….. Complainant.
Vs.
1) M/s Bajaj Allianz Life Insurance Co. Ltd.,
Syndicate Bank Insurance Division, 18th cross,
1st floor, Malleshwaram, Bangalore – 560055, Rep. by its
Regional Manager.
2) M/s Bajaj Allianz Life Insurance Co. Ltd.,
Registered and Head Office, GE Plaza, Airport road,
Yerrawada, Pune – 411006, Rep. by its Manager.
3) M/s Bajaj Allianz Life Insurance Co. Ltd., 7 Road,
Kadapa city, Rep. by its Branch Manager. ….. Respondents.
This complaint coming on this day for final hearing on 13-5-2011 in the presence of Sri M. Suresh Kumar, Advocate for complainants and Sri D.V.S. Prasad, Advocate for Respondents and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per P.V. Nageswara Rao, President),
1. Complaint filed under section 12 of the Consumer Protection Act 1986.
2. The brief facts of the complaint are as follows:- The Complainant’s son by name Kalluru Pulla Reddy had a Life Insurance Policy with Respondents bearing No. 0029852763, dt. 30-11-2006 for an assured sum of Rs. 2,00,000/- with annual premium of Rs. 5,000/- and Pulla Reddy paid first installment of premium of Rs. 5,000/- on 8-11-2006 and R3 had issued a receipt to that effect. The Complainant was the nominee under the policy. While so K. Pulla Reddy died due to heart attack on 5-10-2007. Being the nominee, the Complainant was entitled to the assured sum together with benefits including interest thereon. On the date of death of Pulla Reddy the policy was inforce. After the death of Pulla Reddy the Complainant issued a notice through the advocate to R3 on 30-7-2009 to settle the claim of the deceased policy holder. After receipt of the notice a reply was sent requesting the Complainant to send the claim form along with Photostat copies of I.D proof and Bank account passbook. Further it was stated that the claim would be sent to the head office for processing. The Complainant had not received any letter from R3 but a letter was received by the Advocate of the Complainant without any claim form. Immediately the advocate sent reply to R3 on 26-8-2009 that the R3 had not enclosed any claim form and requested the R3 to send the claim form. Again on 4-11-2009 Advocate for the Complainant sent another notice explaining the facts about sending of the passbook as required by R3 and requested the R3 to send the same to Head Office. On 25-2-2010, the R3 sent a letter to the Complainant stating that his son had not paid premium due on 8-11-2007 within grace period of 30 days and hence, the policy was lapsed as on the date of death i.e. 29-12-2007. The policy holder died on 5-10-2007 and the policy was not lapsed as on the date of death. Thus the Respondents committed deficiency of service under the C.P. Act.
3. The Respondents sent Rs. 601/- vide letter dt. 25-2-2010 while rejecting the rest of the claim which was illegal and unjust. Thus the Complaint was filed for Rs. 2,00,000/- towards policy and Rs. 1,00,000/- towards damages for deficiency of service totaling Rs. 3,00,000/- with interest @ 18% p.a. from the date of death of the policy holder i.e. 5-10-2007 till payment with costs.
4. The Respondents 1 & 2 filed a counter denying the complaint and its averments. The complaint was barred by limitation. The Complainant’s son obtained the policy issued by R1 and the premium was yearly premium. The policy holder died on 29-12-2007 as per death certificate and the claim ought to have been lodged before two years from the date of death of the life assured and the complaint was filed on 6-11-2010 which was beyond the period of limitation. Therefore, the complaint was not maintainable and was liable to be dismissed. The delay in filing the complaint should be decided as preliminary issue before deciding the case on merits. The life assured obtained a policy through Andhra Pragathi Grameena Bank, Alavalapadu Branch and the premium was paid through the said branch including the proposal form and so the complaint was bad for non – joinder of necessary party. The life assured suppressed his health condition and obtained the policy as if he was hale and healthy. The life assured was suffering from Neuro problem and other diseases and was given treatment at National Institute of Mental Health and Neuro Sciences,Bangalore since 1999 and also at Visakapatnam and Hyderabad. Suppression of health condition would amount to playing fraud with the Respondents company. The death of the policy holder was on account of complications that arose in his health condition and it was not a natural death as alleged. The policy holder was unmarried because of his health conditions and was 33 years old as on the date of death. The policy was taken with annual premium and there was 30 days grace period for payment of annual premium from the date of expiry of the original period. If the premium was not paid after 30 days grace period the policy would be cancelled automatically and there was no liability on the Respondents to pay the death benefits in case of death of the life assured. In the present case the policy was issued on 9-11-2006 and the renewal of premium ought to be paid on or before 3-11-2007 and as renewal premium of Rs. 5,000/- was not paid, even after grace period, the policy was lapsed and the Complainant had no right to claim the policy amount. As the life assured died on 29-12-2007 it was beyond the grace period. In case the policy holder was alive as on the date of renewal the premium and even after completion of 30 days grace period and in spite of non-payment of renewal premium the policy would be lapsed. Thus the Complainant was not entailed for the assured sum of Rs. 2,00,000/- under the policy. The premium of Rs. 5,000/- along with D.D together with proposal form was received by R1 through A.P. Grameena Bank, Alavalapadu branch and the policy was family gain policy and under the conditions, in case of lapsed condition of the policy the fund value had to be paid in case of any claim. It was not correct that Pulla Reddy died on 5-10-2007 before expiry of the first premium. The death certificate disclosed that he died on 29-12-2007 after lapse of grace period. The Complainant had not intimated the death of the policy holder to any one of the Respondents and it was the first time that the death of the policy holder was informed to the Respondent by way of notice to R3 on 30-7-2009. The R3 had not received the premium nor issued the policy. But however, after receipt of the documents forwarded the same to R2 for settlement of the claim and the policy was in lapsed condition. The fund value of Rs.601/- by way of cheque No. 1102309 on Axis bank was paid to the Complainant. The R3 was not a necessary party. The R1 received the premium and issued the policy and R2 had settled the claim and so the forum had no jurisdiction. Thus the complaint may be dismissed with costs.
5. On the basis of the above pleadings the following points are settled for determination.
i. Whether there is any negligence and deficiency of service on the part of the respondents?
ii. Whether the complainants are entitled to the relief’s as prayed for?
iii. To what relief?
6. On behalf of the complainant Ex. A1 to A10 were marked and on behalf of the Respondents Ex. B1 to B4 was marked. The Complainant filed written arguments also.
7. Point Nos. 1 & 2. The Complainant’s son by name K. Pulla Reddy had a policy by name Bajaj Allianz New Family Gain policy No. 0029852763 for assured sum of Rs. 2,00,000/- on 8-11-2006 with annual premium of Rs. 5,000/- and the first premium was paid to R1. The first premium receipt was Ex. A1. The policy was not filed by the Complainant. The Complainant was the father of the policy holder and was the nominee to the policy holder. Though the Complainant had not filed the original policy the Respondents filed a Photostat copy of the proposal from in which the nominee was the father by name Obula Reddy, who was the present Complainant and more over the policy holder was an un-married person, aged about 33 years. While so, the policy holder died on 29-12-2007 as per attested true copy of death certificate issued by the Panchayat Secretary, Vemula Mandal, Kadapa District under Ex. A10. In the Complaint the Complainant mentioned that the date of death of Pulla Reddy was on 5-10-2007. So the Complainant had not given the correct date of death as 29-12-2007 in the complaint, though he filed Ex. A10. After the death of the policy holder Pulla Reddy, the Complainant as father and nominee issued a notice on 30-7-2009 claiming the assured sum with all benefits. It was sent to R3. The office copy of the notice dt. 30-7-2009 was Ex. A3 and the R3 sent reply dt. 01-8-2009 under Ex. A2 requesting to submit the claim form along with I.D proof and copy of Bank account passbook and R3 informed the Advocate of the Complainant that on receipt of the same the completed forms would be forwarded to the Head Office. Again on 20-8-2009 the Complainant got issued a notice to R3. The office copy of the notice was Ex. A4. Ex. A5 was another office copy of notice dt. 4-11-2009. Under Ex. A4 it was mentioned that the claim forms have not been received. Under Ex. A5, the Complainant sent the Photostat copy of death certificate, family members certificate to R3 and also Photostat copy of first premium receipt and option letter and Photostat copy of S.B.A/c passbook. Ex. A6 and Ex. A7 were postal acknowledgement cards. On 25-2-2010 under Ex. A8 the Respondents refunded the fund value of Rs. 601/- under the policy by way of cheque No. 110239 drawn on Axis bank dt. 16-2-2010 on the ground that the premium due on 8-11-2007 was not paid within grace period of 30 days and the policy was in lapse condition as on date of death on 29-12-2007. The Complainant filed Ex. A9 Photostat copy of cheque for Rs. 601/- sent by the Respondents towards refund of fund value.
8. As per Ex. A10 the policy holder Pulla Reddy died on 29-12-2007. The first premium under Ex. A1 was paid on 8-11-2006. The next premium should be paid by 8-11-2007 or on 8-12-2007 within grace period of 30 days. By the date of the 2nd premium to be paid on or before 8-11-2007 or within the grace period of 30 days by 8-12-2007, the policy holder Pulla Reddy was alive and his death was on 29-12-2007. Though Pulla Reddy was alive he had not paid the 2nd premium either within the period or within the 30 days grace period. Therefore, the policy was lapsed. However, the Respondents paid Rs. 601/- towards fund value of the policy under Ex. A8. It was received by the Complainant and so the Complainant filed Ex. A9 a Photostat copy of cheque.
9. The policy holder suppressed his health condition in the proposal form filed by the Respondents under Ex. B1 to question No. 14 (b) and 14 which disclosed that the health condition of the policy holder was good and he had no other illness. But the Respondents filed a Photostat copy of the Residents report issued to Pulla Reddy by National Institute of Mental Health and Nuero Sciences, Bangalore (Psychiatry, Neurology and Neurosurgery) under Ex. B2. In Ex. B2 it was mentioned that the policy holder Pulla Reddy was wandering, assaultive, shouting, abusive, excessive smiling. Ex. B3 was Photostat copy of O.P. tickets, dt. 17-6-99, 19-3-99 & 11/8 issued by National Institute of Mental Health and Nuero Sciences, Bangalore. Ex. B4 was out patient ticket dt. 7-8-2002 issued by A.P. Vaidya Vidhana Parishad in which Dr. K. Rajasekhar Reddy, Area Hospital, Pulivendula, Kadapa referred Pulla Reddy to Psychiatrist, Govt. General Hospital, Tirupati. Thus the policy holder Pulla Reddy was not in good health and was suffering from Neuro diseases since 1999. The proposal form for the policy under Ex. B1 was given to the Respondents on11-10-2006. Therefore, even by the date of Ex. B1 the policy holder Pulla Reddy was sick person and his health condition was not good since seven years prior to the proposal date. It was not disclosed but suppressed to the Respondents. It would amount to suppressing of material facts to which the Complainant as nominee of the deceased policy holder was not entitled to any amount including sum assured with other benefits. There was no deficiency of service on the part of the Respondents. Hence, the points are answered accordingly.
10. Point No. 3 In the result, the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 23rd May 2011
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Respondent : NIL
Exhibits marked for Complainant : -
Ex. A1 First premium receipt dt. 8-11-2006 issued in favour of Pulla Reddy.
Ex. A2 Letter from R3 to Sri K. Gopal Reddy, Vemula Post & Mandal, Kadapa
District with copy to Complainant’s advocate, dt. 01-8-2009.
Ex. A3 Office copy of notice from Complainant’s advocate to R3, dt. 30-7-09.
Ex. A4 Office copy of notice from Complainant’s advocate to R3, dt. 20-8-09.
Ex. A5 Office copy of notice from Complainant’s advocate to R3, dt. 4-11-09.
Ex. A6 Postal acknowledgement card.
Ex. A7 Postal acknowledgement card.
Ex. A8 Letter from R3 to Complainant, dt. 25-2-2010.
Ex. A9 P/c of cheque bearing No. 110239, dt. 16-2-2010 for Rs. 601/-.
Ex.A10 T/c of death certificate issued by Panchayat Secretary Vemula.
Exhibits marked for Respondents: -
Ex. B1 P/c of proposal form, dt. 11-10-2006.
Ex. B2 P/c of Resident’s report issued by National Institute of Mental Health
& Neuro Sciences, Bangalore.
Ex. B3 P/c out patient tickets, dt. 17-6-99, dt. 19-3-99 and dt. 11-8-
Ex. B4 P/c out patient ticket, dt. 7-8-2002.
MEMBER PRESIDENT
Copy to :-
1) Sri M. Suresh Kumar, Advocate for complainant.
2) Sri D.V.S. Prasad, Advocate for Respondents.
1) Copy was made ready on 2) Copy was dispatched on
3) Copy of delivered to partie
B.V.P.
