State Consumer Disputes Redressal Commission
Birla Sun Life Insurance Co. Ltd. vs V. Ramesh on 16 December, 2011
BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
BANGALORE
BEFORE THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE.
DATED THIS THE 16TH OF DECEMBER 2011
PRESENT
HONBLE
JUSTICE MR.K. RAMANNA : PRESIDENT
SRI A.M.
BENNUR :
MEMBER
SMT. RAMA
ANANTH : MEMBER
Appeal No. 3516/2010, 3761/2010 & 4417/2010
Appeal NO.
3516/2010
(Filed on 19.08.2010)
1. Max New york Life
Insuance Co. Ltd.
Dr. Jha Marg, Okhla
New
Delhi 110 020
2. The Branch Manager,
M/s. Max New York Life Insurance Co. Ltd.,
Office at Sree Yerritata Complex, Opp:
Petrol Bunk
Sanjay Gandhinagar
Infantry Road, Bellary
(By Sri/ Smt. Manmohan P.N.)
Appellant
OPs before the DF in C.C. No. 147/2009
Appeal No.
3761/2010
(Filed on 01.09.2010)
1. Birla Sun Life
Insurance Co. Ltd.
Registered Office,
6th Floor, Vaman Centre,
Makhwana
Road,
Off: Andheri-Kurla Road,
Near Marol Naka, Andheri East,
Mumbai 400059
2. The Branch Manager,
Birla Sun Life Insurance Co. Ltd,
Branch at Main Road, Parvathinagar, Near Hero
Honda Showroom, Bellary-583101
Both
the appellants are rep. by
Head(Legal),
M/s. Birla Sun Life insurance Co. Ltd., Registered Office
One
Indiabulls Center,
Tower-1,
15th and 16th Floors,
No.841,
Senapathi Bapat Marg, Elphinstone
Road, Mumbai 400013
(By
Sri/Smt R.
Rajagopalan)
Appellants
OPs before the DF in C.C. No. 161/2009
Appeal No.
4417/2010
(Filed on 18.10.2010)
1. M/s Bajaj Allianz
Life Insurance Co. Ltd., GE Plaza, Airport
Road,
Yerwada, Pune
2. The Branch Manager
M/s Bajaj Allianz Life Insurance Co. Ltd., Opp.
Cosmopolitan Club, Double Road,
Bellary.
Rep.
by Mr.Anup Kumar Verma, State Operations Manager.
(By Sri/Smt Geetha
Raj)
V/s
Appellant
OP before the DF in
C.C. No.
148/2009
V.
Ramesh
S/o.
V. Satyanarayana,
R/o.
374, Ulenur Block-2
Gangavathi
Taluk, Koppal Dist.
(By Sri/Smt V. Jamalludin)
Respondent
Complainant before the
DF in C.C. No. 147/ 2009,
161/2009 & 148/2009
O R D E R
SRI. A.M. BENNUR, MEMBER These are the three appeals filed under Section 15 of the Consumer Protection Act 1986 by the respective OPs with respect to complaint No. 147/2009, 161/2009 and 148/2009 on the file of District Consumer Forum, Bellary being aggrieved with the order dated 23.06.2010. As Complainant is common in all the three complaints and the consumer dispute raised, relief claimed being identical, though OPs are different insurance companies in order to avoid the repetition of the facts, multiplicity of reasoning, in the interest of justice all these three appeals are heard together and disposed of by this common order.
The brief facts of the cases put forth by the Complainant in all the three complaints are as under:
2.
That his mother Smt. Varalakshmi got insured her life with the OPs in complaint No. 147/2009 sum assured is Rs. 5,00,000/-, in compliant No. 161/2009 sum assured is Rs. 8,00,000/- and complaint No. 148/2009 sum assured is Rs. 6,00,000/-. According to the Complainant his mother was prompt in making payment of the premium.
But unfortunately, she died on 07.04.2009 due to Cardiac Arrest at Community Health Centre, Karatagi. He immediately intimated the OP about the death of his mother and sought for settlement of the insurance policy as he is the nominee under the said policy. But some how OP repudiated the said claim on flimsy reasons and grounds holding that his mother died very well prior to submission of the proposal i.e. on 04.02.2009 in a road traffic accident and his claim is fraud and baseless. The said repudiation is unjust and improper.
Under the circumstances Complainant felt deficiency in service. Accordingly, filed the complaint.
3. On appearance OPs filed their version. The defence set out by the OPs in all the three complaints though they are different insurance companies, but it is almost one and the same. All the three insurance companies have contended that there is a fraud committed by the Complainant. There is suppression of material fact. Though Complainant is aware of death of his mother on 04.02.2009 in collusion with some of the insurance company agents and other interested parties managed to submit the proposal, paid the premium and got the policy. Then, when one woman by name Varalakshmi died due to Cardiac Arrest on 07.04.2009 he made the claim. Varalakshmi who alleged to have died of heart attack is not the mother of the Complainant. But, the mother of the Complainant died long back i.e. on 04.02.2009 itself. It is revealed through their investigation.
Hence, repudiation is made by them is just, proper and after due application of mind. Complaints are devoid of merit. Among these grounds OP prayed for dismissal of the complaints.
4. Then the litigating parties led their evidence and after hearing arguments the DF was pleased to allow the said complaints vide its order dated 23.06.2010. Being aggrieved by the same now these appellants have come up with these appeals on the following grounds.
The grounds of appeals in all the appeals are almost identical, that the DF has not appreciated the facts and circumstances of the case in a proper and perspective manner. The reasons assigned, conclusions arrived at, inferences drawn and findings recorded are opposed to law, facts and probabilities of the case. There is a proof that the mother of the Complainant died on 04.02.2009 itself in a road traffic accident. Varalakshmi who alleged to have died due to cardiac arrest on 07.04.2009 is not the mother of the Complainant. There is a proof that Complainant has suppressed certain material fact while submitting the proposal and also played fraud on the insurance companies.
Insurance company trusted the information given by the Complainant in good faith. But, Complainant mis-utilised it with a malafide intention. Though all these facts are proved and established by the insurance companies some how DF failed to take note of the same and erroneously held that there is deficiency of service on the part of OP. If the said order is not set aside it will be the appellants who will be put to greater hardship and prejudice. Among these grounds appellants prayed for allowing the appeals.
5. Arguments are heard.
6. In view of the above said facts the points now that arises for our consideration in these appeals are as under:
1.
Whether the impugned orders under the appeals are unjust and improper?
2. If so, whether it calls for interference from this commission?
3. To what order?
7. We have gone through the pleadings of the parties, both oral and documentary evidence, impugned order under appeal, grounds urged in the appeal memos and the arguments advanced. In view of the reasons given by us in the following paragraphs, our findings on Point No.1 is affirmative, Point No. 2 is affirmative and Point No. 3 as per final order.
REASONS
8. The Complainants mother Smt. Varalakshmi submitted proposal to the respective OPs and obtained the insurance policies. The fact of issuance of the insurance policy and the sum assured therein is not at dispute. It is further contended by the Complainant that his mother Varalakshmi died on 07.04.2009 due to Cardiac Arrest. Hence, he being nominee under all the three policies issued by the different insurance companies namely the appellants he prayed for settlement of claim. But his claim was repudiated. Hence, Complainant felt deficiency of service.
9. On the other hand it is specific defence of the insurance companies that the mother of Complainant by name Vottikutti Varalakshmi died on 04.02.2009 in a road traffic accident. So this Varalakshmi who submitted proposal and took the policy is not the mother of the Complainant. Before submission of the proposal itself mother of the Complainant died. So Complainant with a malafide intention cheated, practice fraud on the OPs in collusion with some of the agents of the insurance companies as well as with other interested persons. We find there is substance in the defence set out by the OP because it finds support from the related public documents.
10. Soon after the accident a complaint was lodged to the jurisdictional police wherein it is not only the Vottikutti Varalakshmi died but 4 more persons died in the said accident. Case was registered, FIR was submitted. Then the inquest proceedings were held under Section 174 of the CRPC, at that time the statement of this Complainant was recorded wherein he categorically admitted that his mother died in the accident and identified her body also.
Then the post mortem was conducted.
Even in the post mortem report also it was confirmed that the mother of the Complainant died due to sever injuries. Charge sheet is also filed. The Doctor who conducted post mortem examination has also given his statement. All these public documents like FIR, Charge sheet, Post mortem report, inquest report have been lost sight by the DF.
11. Not only that soon after said fatal road accident a news appeared in the local newspapers. Even the newspaper also discloses how many people died in the said fatal accident and amongst those who suffered severe injuries names were mentioned. This Complainants school leaving certificate discloses his name as Vottikutti Ramesh S/o. Sathyanarayana and Vottikutti Varalakshmi W/o. Sathyanarayana is the person who died in the said accident. So prima-facie there is a proof that mother of the Complainant died in the said road traffic accident on 04.02.2009 where as proposal was submitted subsequently by one Varalakshmi suppose to be the mother of the Complainant who died due to heart attack on 07.04.2009.
12. As could be seen from the so called proposals the proposal for Rs. 5,00,000/- in complaint No. 147/2009 was submitted on 19.03.2009 and proposal with respect to complaint No. 148/2009 was submitted on 14.02.2009 and with respect to complaint No. 161/2009 proposal was submitted on 23.03.20o9 i.e. within a span of hardly about one month three proposals were submitted with different insurance companies that too seeking coverage of insurance for more than 5 to 8 lakhs. Whether the said so called Varalakshmi whom the Complainant now claims to be his mother was in a position to pay the said huge premium which runs in thousands what is her income, avocation and what is the avocation and income of this Complainant is not known. It is not a small premium. It runs in thousands. So in the absence of basic proof that the present Varalakshmi had the capacity to pay the premium we dont think in ordinary course of time she would have opted for three policies of three different insurance companies. If the Complainants mother really interested to get life assured she would have taken the policy from one and same insurance company.
There was no need to knock the door of three different insurance companies. All these facts and deeds of the Complainant speaks loudly about the malafide intention.
13. In our view Ops are successful in showing there is a fraud committed by the Complainant and there is suppression of material fact. Before submitting the so called proposal the death of his natural mother was well within his knowledge and this present Varalakshmi who alleged to have died on 04.02.2009 is highly doubtful that she is the mother of the Complainant. The DF has failed to appreciate all these existing facts and circumstances and wrongly placed its reliance on some of the reports submitted and statement recorded etc. The appellants are successful in showing that the impugned order is erroneous, suffers from legal infirmity, unsustainable in law and suffers from error apparent on the face of record requiring our interference. We find some illegality and irregularity committed by the DF in allowing the said complaints. There is no merit in the complaints filed. Accordingly, we answer point No. 1 and 2 and proceed to pass the following:
ORDER All these three appeals No. 3516/2010, 3761/2010 and 4417/2010 are allowed. The impugned order passed by the DF Bellary in compliant Nos. 147/2009, 161/2009 and 148/2009 dated 23.06.2010 is hereby set aside. All the three complaints are dismissed. No order as to costs.
The deposit if any made by the insurance companies before this commission is ordered to be returned to the insurance companies after appeal time is over.
Keep original order in appeal No. 3516/2010 and copy to be placed in other two appeals.
PRESIDENT MEMBER MEMBER CV*