State Consumer Disputes Redressal Commission
The Branch Manager, Life Insurance ... vs Guna Simhachalam, S/O.Ramulu, Tekkali ... on 12 September, 2013
BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD F.A.No.87/2013 against C.C.No.31/2012, District Forum,Srikakulam. Between: 1.The Branch Manager, Life Insurance Corporation of India, Opp: Government Junior College, Main Road, Narsannapeta, through the authorised signatory T.K.Balkrishna, S/o.Thirupalappa, Age :58 years, Occ: Asst.Secretary (L & HPF), South Central Zonal Office, Saifabad, Hyderabad. 2. Life Insurance Corporation of India, Rep. by its Divisional Manager, Near RTC Complex, Visakhapatnam, through its authorised signatory T.K.Balkrishna S/o.Thirupalappa, Age : 58 years, Occ:Asst. Secretary (L & HPF) , South Central Zonal Office, Saifabad, Hyderabad. ...Appellants/ Opp.parties 1 & 2 And Guna Simhachalam, S/o.Ramulu, Age:40 years,H.No.1-52, Dharma Neelapuram village, Ravivalasa Post, Naupada R.S., Tekkali Mandal, Srikakulam District. ... Respondent/ Complainant Counsel for the Appellants : M/s. K.Venkatesh Gupta Counsel for the respondent : M/s.T.Tejeswara Rao QUORUM: SRI R.LAKSHMI NARASIMHA RAO,HONBLE MEMBER
AND SRI S.BHUJANGA RAO, HONBLE MEMBER.
THURSDAY, THE TWELFTH DAY OF SEPTEMBER, TWO THOUSAND THIRTEEN.
Oral Order: (Per Sri S.Bhujanga Rao, Honble Member *** This appeal is directed against the order dt.06.07.2012 of the District Forum, Srikakulam in C.C.No.31/2012. The appellants are the opposite parties and the respondent herein is the complainant in C.C.No.31/2012.
For the sake of convenience, the parties are described as arrayed in the complaint.
The complainant filed the Consumer Complaint in C.C.No.31/2012 seeking direction to the opposite parties to pay the policy amount of Rs.1 lakh together with interest at 24% p.a. from the date of death of the insured Guna Jyothi till the date of realisation, to pay Rs.20,000/- towards compensation for causing mental agony and hardship and Rs.5000/- towards costs of the litigation.
The brief case of the complainant as set out in the complaint is that his sister by name Guna Jyothi insured her life with the opposite party no.1 corporation on 15.12.2009 for a sum of Rs.1 lakh by showing the complainant as nominee. On 29.1.2011, the insured died while getting treatment at Community Health Centre, Tekkali. She paid the premiums regularly, without fail, till her death. Immediately, the complainant intimated the death of his sister to the opposite party no.1 and as per the requirements of the opposite party no.1, the complainant submitted all the relevant documents to opposite party no.1, but the opposite party no.1 has not settled the claim of the complainant till the date of filing of the complaint. Thus, both the opposite parties committed gross negligence and there is deficiency in service on the part of the opposite parties. Hence the complaint.
Opposite party no.1 resisted the complaint by filing the written version denying the material allegations made in the complaint and contended that the deceased life assured is unmarried, mentally disabled lady and was receiving physically handed capped allowance of Rs.500/- per month. The deceased life assured had wilfully not disclosed the said fact and thereby the opposite party corporation issued policy for assured sum of Rs.1 lakh. Further, the occupation of the deceased was mentioned as agricultural labour with yearly income of Rs.60,000/- under question no.5 in the proposal form dt.15.12.2009 and basing on the said false answers given by the deceased policy holder, the opposite parties corporation issued policy with utmost good faith. That the deceased life assured was not maintaining sound mind at the time of proposal and is not eligible for insurance coverage. The complaint is bad for non joinder of the parents of the deceased. The complaint is pre mature, as the opposite parties are processing the claim and verifying the bonafides of the claim. As such, the complaint is not maintainable either on law or on facts and is liable to be dismissed.
During the course of enquiry, before the District Forum, in order to prove his case, the complainant filed his evidence affidavit and got marked Exs.A1 to A5. On behalf of the opposite parties corporation, its administrative officer, L & HPF Department M.Vittal Rao filed his evidence affidavit and got marked Exs.B1 to B7.
Upon hearing the counsel for both the parties and on consideration of the material on record, the District Forum while dismissing the complaint, directed the opposite parties to pay the insured amount to the parents of the deceased with benefits.
Aggrieved by the said order, the appellants/opposite parties preferred the above appeal urging that the order of the District Forum is contrary to law, opposed to evidence on record and probabilities of the case. That the District Forum ought to have seen that the policy was obtained by suppressing the fact that the deceased life assured suffering from mental disorder and drawing the pension of Rs.500/-, from the Government and that the District Forum ought to have seen that since the deceased insured knowingly and wilfully suppressed her health condition at the time of taking the policy, the policy itself is void and the appellant corporation has legally repudiated the claim. The appellants/opp.parties corporation finally prayed to set aside the impugned order of the District Forum and to dismiss the complaint in C.C.No.31/2012.
We heard the counsel for both the parties and perused the entire material placed on record.
Now the point for consideration is whether the impugned order of the District Forum is vitiated for misappreciation of fact or law?
The contention of the counsel for the appellant corporation is that since the claim is an early claim, the appellant corporation conducted enquiry and came to know that the deceased life assured was suffering from mental disorders and drawing pension from the Government by the time of taking the policy and obtained policy by suppressing the same and hence the appellant corporation repudiated the claim. The counsel for the appellant corporation further contended that it is well settled principle of law that the contract of insurance is based on the principle of Ubberimafide and since the deceased insured knowingly and wilfully suppressed her health condition, at the time of taking the policy, the policy itself is void and this appellant corporation has legally repudiated the claim of the complainant. Therefore, the impugned order of the District Forum is not sustainable under law and is liable to be set aside and the complaint is to be dismissed.
It is an admitted fact that Guna Jyothi the deceased herein insured her life with appellants corporation on 15.12.2009 for a sum of Rs.1 lakh by showing the complainant as her nominee and that the life assured died on 29.01.2011.
According to the complainant, the insured died due to high fever, while getting treatment at the Community Health Centre, Tekkali. This fact is also not disputed by the opposite party Life Insurance Corporation of India.
The sole and main contention of the appellant corporation is that the deceased life assured was suffering from mental disorders and drawing pension from the Government by the time of taking the policy and obtained the policy by suppressing the same and as such, the policy itself is void and the appellant corporation is legally justified in repudiating the claim of the complainant. In order to prove the same, the appellant corporation filed Exs. B5 to B7.
Ex.B5 is the copy of the letter dt.18.11.2011 addressed by the opposite party no.2 to the Project Director, DRDA, Srikakulam requesting to provide the information regarding the details of physically handicapped pension details under I.D.No.57525, the details of nature of ailment/physically challenged problem along with copy of the physically handicapped certificate produced by Guna Jyothi, the deceased for getting the benefit, the date on which the pension started and how much pension was paid to her per month, under RTI Act,2005. The Project Director, DRDA, Srikakulam under Ex.B6 letter provided information that Gunajyothi, daughter of Ramulu is the pensioner, the nature of disability is O.H.50% and the pension amount paid is Rs.500/- per month. Under Ex.B6 letter, the Project Director, directed the M.P.D.O., Tekkali to furnish the date on which the pension of Guna Jyothi was sanctioned and copy of the physically handicapped certificate of the said pensioner, directly to opposite party no.2. Under Ex.B7 letter dt.02.02.2012, the Manager of opposite party no.2 requested the Mandal Parishat Development Officer, Tekkali to furnish them the date of sanction of pension along with copy of the physically handicapped certificate relating to Guna Jyothi. From these documents, it appear that the deceased life assured Guna Jyothi was physically disabled and was drawing Rs.500/- pension per month, from the Government. These documents do not show that the deceased life assured was suffering from the mental disorders and for that she took pension from the Government. As seen from Ex.B4, the copy of the Election Card, the Government recognised the life assured as a voter and issued original of Ex.B4 voter identity card. As seen from Ex.B2 Form, no column is provided in the proforma, to furnish physical disablement of the applicant. Therefore, the deceased life assured cannot be found fault with, for not furnishing the information in Ex.B2 proforma, regarding his physical disablement. Under these circumstances, even if she failed to disclose her physical disablement, it does not amount to suppression of her disablement, because the physical disablement cannot be kept secret as the same is clear to naked eye of one and all.
Admittedly, the agent of the appellant corporation collected the information, from the deceased life assured and filled Ex.B2 form. Therefore, the agent of the appellant corporation must have noticed the physical disablement of the deceased life assured at the time of filling of Ex.B2 form. The appellant corporation did not adduce any evidence to show that the deceased life assured was suffering from mental disorders prior to and after obtaining the subject policy by her, from the appellant corporation.
In view of the aforesaid facts and circumstances, we are of the considered view that the appellant corporation failed to establish that the deceased life assured was suffering from mental disorders by the date of Ex.B1 policy and thereafter till her death and that the deceased life assured suppressed his mental disorder and obtained Ex.B1 policy from the appellant corporation. Therefore, the appellant corporation is not justified in rejecting the claim of the complainant. The complainant submitted his claim to the appellant corporation, along with required documents and admittedly the appellant corporation neither allowed nor rejected the claim till the date of filing of the complaint, even after receiving the original of Ex.A4 legal notice got issued by the complainant to the opposite parties. Under these circumstances, the opposite parties cannot be heard to say that the complaint filed by the complainant is pre mature.
Having regard to the above facts and circumstances, it is established that there is negligence and deficiency in service on the part of the appellant corporation in not settling the claim and rejecting the same without valid grounds. Therefore, we do not find any grounds, much less valid grounds, to set aside the impugned order of the District Forum.
Admittedly, the complainant is a nominee of the deceased life assured as per Ex.B1 policy. Therefore, he is entitled to receive the assured sum from the insurance company and then pay to the legal heirs of the deceased. Therefore, the District Forum ought to have directed the opposite parties to pay the assured sum to the complainant directing the complainant to pay the assured sum received from the appellant corporation to the legal heirs of the deceased life assured i.e. parents of the deceased.
In the result, the complaint in C.C.No.31/2012 is allowed, directing the opposite parties, to pay the assured sum to the complainant and the complainant is directed to pay the sum received by him from the insurance company, to the legal heirs of the deceased life assured i.e. the parents of the deceased.
Subject to the above modification of the impugned order, the appeal is dismissed, but in the circumstances of the case without costs.
MEMBER MEMBER Pm* Dt. 12.9.2013