State Consumer Disputes Redressal Commission
Smt. Hema Agarwal, vs 1. Life Insurance Corporation Of India, ... on 22 March, 2018
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL FORUM Telangana First Appeal No. FA/1277/2013 ( Date of Filing : 23 Dec 2013 ) (Arisen out of Order Dated 20/11/2013 in Case No. CC/47/2012 of District Hyderabad-II) 1. Smt. Hema Agarwal, W/o. late Mukesh Kumar Agarwal, Aged about Years, Occ: House Maker, R/o. H.No.21-7565, Kokharwadi, Charkaman, Ghansi Bazar, Hyderabad. ...........Appellant(s) Versus 1. 1. Life Insurance Corporation of India, Rep. by its Branch Manager, At H.No.23-1-71, 1st Floor, Moghalpura, Near Chrminar Telephone Exchange Hyderabad-500 002. 2. 2. Smt. G. Sunitha, Agent of Life Insurance Corporation of India, Bearing agency No.01037804, At 21-7-761, Opp High Court Post Office, Ghansi Bazar, Hyderabad. ...........Respondent(s) BEFORE: HON'BLE MR. JUSTICE B. N. RAO NALLA PRESIDENT HON'BLE MR. Sri. PATIL VITHAL RAO JUDICIAL MEMBER For the Appellant: For the Respondent: Dated : 22 Mar 2018 Final Order / Judgement STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA : At HYDERABAD FA 1277 of 2013 AGAINST CC No. 47 of 2012, DISTRICT FORUM - II, HYDERABAD Between : Smt. Hema Agarwal, W/o Late Mukesh Kumar Agarwal, Aged about years, Occ :House maker R/o H.No. 21-7-565, Kokharwadi, Charkaman Ghansi Bazar, Hyderabad ..Appellant/complainant And Life Insurance Corporation of India, Rep. by its Branch Manager, H.No. 23-1-71, 1st floor, Moghalpura, Near Charminar Telephone Exchange Hyderabad - 500 002. Smt. G. Sunitha, Agent of Life Insurance Corporation of India, Bearing Agency No. 01037804, At 21-7-761, Op High Court Post office, Ghansi Bazar, Hyderabad ( R2 set exparte, Hence not necessary in appeal).. Respondent/complainant Counsel for the Appellant : M/s.Megha Rani Agarwal. Counsel for the Respondents : Sri Hari Rao Lakkaraju for R-1 R2 - served. Coram : Honble Sri Justice B. N. Rao Nalla ... President And Sri Patil Vithal Rao ... Member
Thursday, the Twenty Second Day of March Two Thousand Eighteen Oral order : ( per Hon' ble Sri Justice B.N.Rao Nalla, Hon'ble President ) ***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the complainant praying this Commission to set aside the impugned order dated 20.11.2013 made in CC No. 47 ;of 2012 on the file of the DISTRICT FORUM - II, Hyderabad.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainant, in brief, is that her husband obtained LIC's Jeevan Tarang Policy (T.No. 178) bearing No.645784306 for the assured sum of Rs. 9,90,000/- commencing from 24.11.2009 through the second opposite party agent disclosing him his previous insurance policy and she is the nominee and subsequently her husband died on 10.08.2010 due to heart attack. When she submitted the insured claim, she received a letter dated 19.02,2011 from the first opposite party repudiating the claim on the ground her husband suppressed his previous policy at the time of filling the proposal form and advised to make representation to the Zonal Manager. She informed the opposite parties that the policy form was filled by the second opposite party when her husband gave all particulars and the previous policy was not suppressed. Then on 03.03.2011, she received letter from the first opposite party to submit requisite documents towards settlement of the claim, but, however she received another letter dated 08.08.2011 from the Zonal office upholding the repudiation decision of the Divisional office with an advice to approach Central Office within three months which amounts to deficiency in service. Hence the complaint to direct the opposite parties to pay the insured sum of Rs.9,90,000/- with interest amount of Rs.1,62,030/- along with interest ! 12% pa from 10.08.2010 till filing of the complaint, to pay interst @ 12% pa on Rs.9,90,000/- from the date of the complaint till the date of realization, to pay Rs.50,000/- towards compensation for mental agony etc and costs of Rs.25,000/-.
4). The opposite party no.1 opposed the above complaint by way of written version, while admitting issuance of the policy in question in favour of the husband of the complainant and death of her husband on 10.08.2010 and submission of the claim along with requisite documents by the complainant, contending that the deceased policy holder suppressed previous four policies, altogether, for an amount of Rs.8,00,000/- and gave incorrect answers to question no. 9 in the proposal form dated 14.11.2009 and hence her claim was repudiated. There is no deficiency in service on their part. Hence prayed to dismiss the complaint.
5). The second opposite party agent called absent and hence she was set exparte.
6) During the course of enquiry before the District Forum, in order to prove her case, the complainant filed her evidence affidavit and got marked Ex.A1 to A-8 and the opposite party no.1 filed evidence affidavit and got marked Ex. B1.
7) The District Forum, after considering the material available on record, dismissed the complaint. .
8) Aggrieved by the said order, the complainant preferred this appeal before this Commission.
9). Both sides have advanced their arguments reiterating the contents of the appeal grounds and rebuttal thereof along with written arguments. R2 was set exparte before the District Forum and though, notice was served on the second respondent/second opposite party, he did not choose to contest the matter.
10) The points that arise for consideration are, (i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner? (ii) To what relief ? 11). Point No.1 :
There is no dispute that the husband of the Appellant/complainant obtained policy in question for an amount of Rs.9,90,000/- from the 1st respondent/1st opposite party and the appellant/complainant is the nominee. There is also no dispute that the husband of the appellant/complainant died on 10.08.2010 due to heart attack. There is no dispute that the claim submitted by the appellant/complainant along with requisite documents was repudiated on the ground that the husband of the appellant/complainant suppressed his previous four polices for an amount of Rs.8,00,000/- obtained from the 1st respondent Company.
12). The District Forum, relied on the recent decision of the Hon'ble National Commission reported in Revision petition No. 382 and 383 of 2011 in between Life Insurance Corporation of India Vs. Vidya Devi and Ajay Kumar, dismissed the complaint on the ground that non-disclosure of existence of previous policies is a material suppression, therefore, there is no deficiency in service on their part in repudiating the claim.
13). Now, the point to be determined is, whether the deceased policy holder suppressed his previous four polices and whether the appellant/complainant is entitled to the policy amount in question, if , he had taken policies earlier.
14). Counsel for the appellant/complainant argued that since the first respondent/1st opposite party itself admitted that they obtained the earlier policy of the deceased policy holder as age proof to the present policy, hence the question of material suppression by the deceased policy holder will not arise. On the other hand, Counsel for the respondent Insurance Company argued that the deceased life assured took the present policy for the assured sum of Rs.9.90 lakhs without revealing the fact that he had taken four polices earlier aggregating to Rs.8.00 lakhs, had the deceased disclosed above information, he would have been subjected to thorough medical examination before Third party Administrator (TPA) and special medical reports like ECG would have been called for to ascertain health condition. In support of his contention, counsel for the appellant/complainant relied on Ex.A-7, Merchant Premium Collection Portal, wherein, against the column, 'age (Date of Birth), it was mentioned as " 43 years (02/08/1966) previous policy ". From which, it reveals that the respondent Insurance company mentioned the date of birth of the policy holder, relying on his previous policy. In view of the fact, it can be concluded that the existence of previous policy was known to the respondent Insurance Company and hence there is no suppression of material fact.
15). There is no dispute that the husband of the appellant/complainant obtained four policies prior to the present policy in question. The appellant/complainant contended that it was informed to the second respondent/2nd opposite party, who, filled the proposal form at the time of filling up of the same and hence there was no suppression of the same. However, the second respondent/2nd opposite party did not contest the matter either before the District Forum or before this Commission for the reasons best known to her.
16). It is not the contention of the respondent Insurance company that the deceased life assured suppressed his ailment. The respondent insurance company did not place before us any rule to repudiate the insured claim of the present policy when previous policies were existed. The respondent Insurance Company argued that had the deceased policy holder disclosed his previous policies, he would have been subjected to medical tests to ascertain his health condition. That means, if the previous policies were disclosed, they would ascertain health condition. It explains that they would issue policies on the basis of the health condition. In other words, if the health condition is good, they would have no hesitation to issue further policies. In other words, it can be said that, issuance of the present policy depends upon health condition, but, not on issuance of previous policies. Nowhere, it is stated that the deceased policy holder is suffering from any disease at the time of issuance of present policy in question and that he suppressed the same and for that reason he died. Further, the Insurance company computerized all the policies of the customers and hence if any person sends a proposal for a new policy, the computer would automatically show the other policies of the said person, if any, without any effort. Hence the contention of the 1st respondent Insurance company that the deceased policy holder obtained the present policy in question suppressing previous four policies is ridiculous. From the above circumstances, it can be concluded that taking of previous polices by the deceased policy holder is not a ground to repudiate the claim of the appellant/complainant and that the repudiation of the claim is unjust and it tantamounts to deficiency in service and therefore the appellant/complainant is entitled to the insured amount. The absence of the second respondent/second opposite party agent also supports the contention of the appellant/complainant that her deceased husband informed her about the existence of previous four policies at the relevant time and hence it also infers that there is no suppression of material fact.
17). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, this Commission is of the view that the 1st respondent/1st opposite party Insurance company is liable to pay to the appellant/complainant the insured sum of Rs.9,90,000/- under Jeevan Tarang ( T.No. 178) policy with interest @ 9% p.a from the date of filing of the complaint before the District Forum , i.e., 21.12.2011 till the date of realization, to pay compensation of Rs.10,000/- towards mental agony etc. and costs of Rs.5,000/-. Since the second respondent/second opposite party is only an agent and hence she cannot be made liable for payment of insurance claim keeping in view the prevailing circumstances of the case and therefore the claim against the second respondent/second opposite party is liable to be dismissed.
18). Point No. 2 :
In the result, the appeal is allowed setting aside the order dated 20.11.2013 in CC 47 of 2012 on the file of the District Forum II, Hyderabad and consequently the complaint is allowed in part directing the 1st respondent/ 1st opposite party to pay to the appellant/complainant the insured sum of Rs.9,90,000/- under JeevanTarang ( T.No. 178) policy with interest @ 9% P.A. from the date of filing of the complaint before the District Forum , i.e., 21.12.2011 till the date of realization, to pay compensation of Rs.10,000/- towards mental agony etc. and costs of Rs.5,000/-. Time for compliance four weeks.
The claim against second respondent/2nd opposite party is dismissed.
PRESIDENT MEMBER Dated : 22.03.2018. [HON'BLE MR. JUSTICE B. N. RAO NALLA] PRESIDENT [HON'BLE MR. Sri. PATIL VITHAL RAO] JUDICIAL MEMBER