State Consumer Disputes Redressal Commission
The Branch Manager,L.I.C. Claims ... vs D.Chandran,Managing Director,Nila ... on 30 April, 2015
IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
MADURAI BENCH.
Present: Thiru.A.K.ANNAMALAI,M.A.,M.L.,M.Phil. PRESIDING JUDICIAL MEMBER.
Thiru.M.MURUGESAN, B.Sc., B.Ed., MEMBER.
F.A.No.441/2012
(F.A.No.246/2012 on the file of State Consumer Disputes
Redressal Commission, Chennai.)
(Against the order in C.C.No.165/2010 dated 04.07.2011 on the file of DCDRF,
Tirunelveli.)
THE 30th DAY OF APRIL 2015.
1. The Branch Manager,
LIC Claims Department,
Palayamkottai,
Tirunelveli - 627 002.
2. The Regional Manager,
LIC of India (CRM),
Southern Zonal Office,
Anna Salai, Chennai. Appellants/ Opposite parties 1 & 2
Vs
D. Chandran,
S/o. Deva Nesa Nadar,
Nila Sea Food Private Ltd.,
No.137, Pudurpanidapuram,
Tuticorin - 2. Respondent/Complainant
Counsel for Appellants/Opposite Parties 1 & 2: Mr.K.K. Kannan, Advocate.
Counsel for Respondent/Complainant : Mr.R. Ramasamy, Advocate.
This appeal coming before us for final hearing on 21.04.2015 and on
hearing the arguments of both sides and on perusing the material records this
Commission made the following:
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ORDER
THIRU. A.K.ANNAMALAI, PRESIDING JUDICIAL MEMBER.
1. This appeal is filed by the opposite parties 1 and 2 against the order of the District Forum, Tirunelveli passed in C.C.No.165/2010, dated 04.07.2011, allowing the complaint.
2. The complainant as beneficiary of the Policy, took the insurance policy for her deceased son Arun Prabhu and the policy number is 321150458 during the year 2002 and the maturity amount payable for Rs.12,00,000/- and his son Arun Pirabu who is life assured died on 30.10.2004 by unnatural cause for which a criminal case was registered in crime No.1150/2004 under section 304 IPC by D1 Triplicane Police Station, Chennai and when the complainant claimed insurance amount from the opposite party they have sent a reply on 27.03.2006 asking for certain documents and after sending the same on 25.08.2009, the claim was not considered and thereby a consumer complaint came to be filed claiming for payment of policy amount of Rs.12,00,000/- and also to pay a sum of Rs.5,00,000/- as compensation for mental agony and for costs.
3. The opposite parties denying the allegations of the complainant contended that since the policy holder Arun Prabhu was done to death by way of murder by injecting poisonous substance and since the policy holder being an liquor and drug addict at the time of submitting the policy proposal which was 3 suppressed and thereby as per the terms and conditions of the policy, the claim was not considered and therefore there is no deficiency in service on their part.
5. The District Forum after an enquiry, on the basis of both sides materials allowed the complaint directing the opposite parties to pay the claim amount with 6% interest from the date of complaint till the date of realization and also to pay a sum of Rs.30,000/- as compensation for mental agony and Rs.5000/- as costs.
6. Aggrieved by the impugned order, the opposite parties have come forward with this appeal contending that the District Forum erroneously allowed the complaint without considering the criminal records from the police report and documents relating to the criminal case which would establish the drug addict of the life assured which is suppression of facts and thereby the appeal to be allowed.
7. Both sides have filed their written arguments and on the side of the appellants/opposite parties documents filed before this Commission which were permitted to be marked as Exhibits B1 to B4 as additional evidence.
8. We have carefully considered both sides written arguments and also gone through the documents relied on by the appellants before this Commission by way of additional evidence. It is the admitted case of both sides that the complainant taken the life insurance policy in favour of his son Arun Prabhu during the year 2002 as per the document Ex A1 and subsequently the life 4 assured, policy holder Arun Prabhu was died on 30.10.2004 at Chennai in an unnatural manner for which a criminal case was registered in crime No.1150/2004 under section 304 IPC by the D1 Triplicane Police Station, Chennai. But, in the case of natural death of the policy holder, the Legal Heirs of the policy holder will automatically get the benefits of the policy but in this case, the death was caused due to unnatural circumstances and on perusal of the documents relied on by the appellant before this Commission which are not produced before the District Forum under Exhibits B1 to B4 relates to criminal case registered in this matter in which the investigation and the details of evidence concerned with the case and the judgment in S.C.No.237/2009 rendered by Additional District & Sessions Judge, Fast Track Court-V, Chennai-1 which details discloses that the policy holder Arun Prabhu was drug addict and on the date of crime on 30.10.2004, " Venki @ Venatesan broke open two ampoules (4 ml) of Tidigestic drug and mixed it with a half tablet of Celin in brandy bottle cap and heated the mix with a lighted match stick and after cooling down he had injected the drug on the left hand of Arun Prabhu. He himself reportedly had a dose of one ampoule in the same manner. Arun Prabhu who was found fainted never woke up thereafter. Siva and Chandrasekaran failed in their attempt to wake him up in the morning of 31.10.2004 and called upon Venki @ Venkatasan to the room. He tried in vain his best to resuscitate and retrieve his life and declared that Arun Prabu had kicked his bucket already". From these details furnished by the police in the final report, submitted before 5 the court under Ex B1 and subsequently as per the other documents Exhibits B2 to B4 by way of Forensic report, witness examination and other details, the trial court also believing the version of the police report, the court convicted the concerned Accused as per the judgment copy under Ex B4. Under these circumstances, it is clear that the policy holder was died in unnatural way because of over doses of Tidiestic drugs and also the deceased was in the habit of taking Celin drug tablet. The policy was taken during the year 2002 and death occurred in the year 2004 i.e., after two years and as per the provision under section 45 of the Insurance Act, if any suspicion arose regarding the death of the policy holder even after completion of two years the Insurance Company has got the right to investigate the matter to decide the nature of death and in this case it was established that the policy holder even before the policy proposal submitted was in the habit of taking drugs and thereby the material facts were suppressed in the proposal submitted for the policy and if the facts were not suppressed, the insurance company either would have rejected the policy or allowed the policy with enhanced premium and in those circumstances, we are of the view that the policy holder and proposer have suppressed the material facts and thereby the insurance company is entitled to reject the claim. The insurance company contended that the claim could be decided only in civil court in such cases as per the terms and conditions of the policy. Under the terms and conditions of the policy under Ex A1, in condition No.5, it is mentioned as follows:-
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"Forfeiture in certain events:- In case the premium shall not be duly paid or in case any condition herein contained or endorsed hereon shall be contravened or in case it is found that any untrue or incorrect statement is contained in the proposal, personal statement, declaration and connected documents or any materials information is withheld, then and in every such case but , subject to the provisions of section 45 of the Insurance Act, 1938, wherever applicable, this policy shall be void and all claims to any benefit invirtue hereof shall cease and determine and all monies that have been paid in consequence hereof shall belong to the Corporation excepting always in so far as relief is provided in terms of the privileges herein contained or may be lawfully granted by Corporation."
In this case, it is clear that there was violation of conditions of the policy by suppressing the material facts and thereby we are of the view that the complainant cannot get any benefit from the insurance company on the basis of death of the complainant's son, Arun Prabhu. On perusal of the District Forum order, it is found that since the appellants/opposite parties have failed to file their proof affidavit before the District Forum even though filed their written version and not filed any documents before the District Forum and thereby the District Forum seems to have allowed the complaint on that basis only by relying upon the complainant side documents alone whereas now before this Commission by way of additional evidence by producing documents under Exhibits B1 to B4 the opposite parties have established the cause of death of the policy holder and proved the suppression of material facts and thereby we are of the view that the order of the District Forum is liable to be set aside by allowing 7 this appeal; however, the complainant is entitled to approach the Civil Court in order to settle the dispute with the opposite parties regarding the claim.
9. In the result, the appeal is allowed by setting aside the order of the District Forum, Tirunelveli passed in C.C.No.165/2010, dated 04.07.2011 with liberty to the complainant to approach the Civil court for the settlement of the claim against the opposite parties if so desired. No order as to cost in this appeal.
The Registry is directed to refund the mandatory Fixed Deposit with accrued interest duly discharged in favour of the appellants/opposite parties.
Sd/-xxxxxxxx Sd/-xxxxxxxx M. MURUGESAN, A.K. ANNAMALAI, MEMBER. PRESIDING JUDICIAL MEMBER.
List of documents filed before this Commission by the appellants/ opposite parties in this appeal.
Ex B1 23.01.2008 Copy of Final Report submitted by the Police before the Court Ex B2 17.06.2005 Copy of Forensic Report Ex B3 17.08.2010 Copy of depositions Ex B4 24.09.2010 Copy of judgment in S.C.No.237 of 2009 Sd/-xxxxxxxx Sd/-xxxxxxxx M. MURUGESAN, A.K. ANNAMALAI, MEMBER. PRESIDING JUDICIAL MEMBER.
INDEX: YES / NO TCM/Mdu Bench/Orders- April 2015