State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India, ... vs Fathima @ Anthoniammal, W/O (Late) ... on 26 November, 2008
F BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT PUDUCHERRY WEDNESDAY, the 26th day of November, 2008 First Appeal No.30/2006 Life Insurance Corporation of India, Rep. by its Branch Manager, Pondicherry Branch, Pondicherry .. Appellant/O.P.1 Vs. 1. Fathima @ Anthoniammal, W/o (late) Vidal Sagayanadin, No.14, II Cross, Muthalamman Koil St., Pavaza Nagar, Puducherry. .. Respondent/Complainant 2. Ulrich Vidal, S/o (late) Vida Sagayanadin 3. Miss Karvine Vidal, D/o (late) Vidal Sagayanadin 4. Steven Vidal, S/o (late) Vidal Sagayanadin, Respondents 2 to 4 are residing at No.29, Rue Partrice De La Tourdupink ESC B.S., 75020 Paris, France. Respondents/O.P.s 2 to 4 (On appeal against the order passed by the District Forum, Puducherry in Consumer Complaint No.19 of 2003, dated 19.09.2006) Consumer Complaint No.19 of 2003 Fathima @ Anthoniammal, W/o (late) Vidal Sagayanadin, No.14, II Cross, Muthalamman Koil St., Pavaza Nagar, Puducherry. .. Complainant Vs. 1. Life Insurance Corporation of India, Rep. by its Branch Manager, Pondicherry Branch, Pondicherry 2. Ulrich Vidal, S/o (late) Vida Sagayanadin 3. Miss Karvine Vidal, D/o (late) Vidal Sagayanadin 4. Steven Vidal, S/o (late) Vidal Sagayanadin, Respondents 2 to 4 are residing at No.29, Rue Partrice De La Tourdupink ESC B.S., 75020 Paris, France. Opposite Parties BEFORE: HONBLE JUSTICE THIRU N.V.BALASUBRAMANIAN PRESIDENT TMT. P.V.R.DHANALAKSHMI, MEMBER
FOR THE APPELLANT:
Tvl S.P.Vasudevan, K.Ravikumar And S.Hemalada Anbajagane, Advocates, Puducherry.
FOR THE RESPONDENTS:
Thiru N.Mouraly, Advocate, Puducherry.
O R D E R This appeal is directed against the order of the District Forum made in C.C.No.19/2003, dated 19.09.2006. Challenging the order of the District Forum, Puducherry the present appeal has been filed.
2. The first opposite party namely, Life Insurance Corporation of India, represented by its Branch manager, Pondicherry is the appellant herein. The 1st respondent/complainant has filed a complaint directing the first opposite party to pay Rs.75,000/- to the complainant and to each of the opposite parties 2 and 4 together with interest at 12% p.a. from 18.07.1998 till the date of payment for deficiency in service on the part of the insurer. The husband of the complainant late Vidal Sagayanadin was holding two LI.C policies dated 28.09.1995 and 28.09.1996 for a sum of Rs.1,00,000/- each (one of them with double coverage), and the premiums were periodically paid., The Policy Holder Vidal Sagayanadin died on 18.07.1998. The 1st respondent herein has stated that after the death of her husband, she has approached the appellant for the payment of the assured amount, but, the appellant repudiated the claim by letter dt. 02.05.2000 and subsequently by another letter dated 10.02.2002, the appellant informed the 1st respondent that the competent authority at the zonal office, Chennai admitted the claim and agreed to pay a sum of Rs.45,000/- on ex gratia basis and further directed the first respondent to obtain an order from the Civil Court to get the amount. There was another letter from the appellant dt.3.2.2003 wherein the appellant requested the 1st respondent to obtain necessary permission from the competent court to receive the minors share. The 1st respondent claims that she was an appointee to receive the assured amount on behalf of the minor children as nominees and in the Policy No. 730564968, the amount due was Rs.2.00 lakhs and in the other policy bearing No.730732703, the amount assured was Rs.1.00 lakh. Since there was a repudiation of the claim by the 1st respondent by the appellant herein, the 1st respondent has preferred a complainant in Complaint No.19/2003 on the file of the District forum, Puducherry and in that proceedings, the appellant contested the claim of the respondents on many grounds.
However, the District Forum has passed an order on 19.07.2004 to the effect that the complainant/1st respondent is a consumer and she is entitled to the amount and directed the appellant herein to pay Rs.2,00,000/- payable towards the policy with interest at 18% p.a. along with compensation and costs. The appellant herein has challenged the order of the District Forum in Appeal No.1/2005 and the State Commission by order dt.21.04.2005 recorded a finding to the effect that on the date of the first policy i.e. on 28.09.1995, the first respondent/ complainant was not married to the deceased policy holder and she was not the mother of the minor nominees for whom the first policy was taken. As far as the second policy is concerned, the complainant has signed as an appointee and 3 minors daughters are referred to as nominees and the 1st respondent/complainant cannot be the mother of the three minor nominees since she married the deceased policy holder only after the date of the 1st policy. The Commission found that the three nominees were not impleaded as parties nor the mother of the minor nominees was impleaded as a party. The Commission was not able place much reliance on the decree of the civil court passed on 26.10.1988 and that the complainant cannot claim the entire amount and also it is not open to the complainant to claim the entire policy amount and the repudiation by the appellant was justified as the other legal heirs of the deceased were not parties before the District Forum. The Commission remanded the matter to the District forum for fresh disposal with the following directions:
It is open to the complainant to implead all the legal heirs of the deceased and state the particulars as to the whereabouts of the nominees of the deceased policy holder in the complaint.
It has to be stressed at this stage that the complainant is only one of the legal heirs of the deceased policy holder who can claim a specific share in the estate of the deceased. The District Forum will direct the complainant to implead all the legal heirs of the deceased policy holder and proceed to decide the question whether there is any deficiency in service on the part of the opposite party. It is also open to the complainant to seek any other remedy available to her under law. With the above observations, we are inclined to allow the appeal with direction to the District Forum to dispose of the dispute in the light of the directions contained in the order.
3. After remand, the 1st respondent took steps to comply with the order of the Commission to implead the three minor children as parties and the relief sought for in the complainant is also modified as under:
1) To pay Rs.75,000/- to the complainant and each of the opposite parties 2 to 4, together with interest @ 12% p.a. from 18.07.1998 till date of payment;
2) To pay Rs.1 lakh as compensation for deficiency in service; and
3) To pay Rs.2,000/- towards costs.
In the District Forum notices were sent to the parties and it was held that the service of the notice was sufficient. Despite service of notice, respondents 2 to 4 herein remained absent and they were set exparte. The District Forum held that the 1st respondent/complainant is a consumer and she is entitled to file the complaint as a consumer. The District Forum also held, on the basis of evidence, that there is no nexus between the disease suffered by the 1st respondents husband and the cause of death and there was no connection between the disease in to which he died and the earlier disease for which he was taking treatment and there was no proof on the side of the appellant to correlate the same to justify the repudiation of the claim. The District Forum also found the complainant and the respondents 2 to 4 are the legal representatives of the deceased Midel Sagayanadin and there is no evidence to show that the 1st wife of the deceased was alive or not and in the absence of any evidence, the DF held that the respondents 1 to 4 are the L.R. of the deceased Videl Sagayanadin. As far the first policy in Ex.C1, dt.28.09.1995 is concerned, the District Forum held that the 1st respondent was married to the deceased policy-holder subsequent to the date of the policy and hence she is not entitled to claim any amount. As far as the 2nd policy dt. 28.09.1996 (Ex.C2) is concerned, she was the wife of the deceased policy holder and she is shown as appointee for the minor nominees and the 1st respondent is entitled to receive the share of the respondents 2 to 4. Ultimately, the District Forum allowed the complaint with the following directions:
1) The first opposite party do pay to the complainant the sums due under Exs.C1 and C2 together with interest @ 12% p.a. on the sum assured from 18.07.1998 till realization;
2) The complainant and each of the opposite parties 2 to 4 are entitled to one-fourth share in the sum due under Ex.C2 along with accrued benefits;
3) The complainant is not entitled to any share in the sum due under Ex.C1 and the opposite parties 2 to 4 only are entitled to equal shares each in the sum due under Ex.C1 along with accrued benefits; and
4) The complainant shall deposit the shares of the opposite parties 2 to 4 due under Exs.C1 & C2 in fixed deposit in their respective names and produce the FDRs before this Forum within one month from the date of payment by the first opposite party.
4. Aggrieved by the order of the District Forum, the first opposite party in the complainant has preferred the appeal. The notices were sent to the parties. The notices sent to 1st respondent was served and she is represented by her counsel.
As far the notices to respondent 2, 3 and 4 are concerned, the were sent by registered posts to the address in France and the envelopes containing the notice to the respondents 2 and 4 were returned to the Commission, but, the covers were returned with the endorsement as follows: non reclame (not claimed) But, the registered cover sent to R3 was not returned. A memo has been filed by the counsel for the appellant since the respondents 2 to 4 remained exparte before the District Forum no notice need be sent in the further appeal under Order 41 Rule 14 of C.P.C. Considering the factual situation in this case, we allowed the memo and we held that the service on the respondents 2 to 4 are sufficient and they are set exparte in the proceedings.
5. The point that arises for consideration is: Whether the respondents 1 to 4 are entitled to the amount due under Exs.C1 and C2.
6. We heard Mr. S.P.Vasudevan, learned counsel for the appellant and learned counsel appearing for the 1st respondent. We hold that the District forum was right in holding that the 1st respondent, who was the complainant before the District Forum, is entitled to file a complaint and she is a consumer within the meaning of the Consumer Protection Act, 1986. Mr.S.P.Vasudevan. learned counsel for the appellant vehemently argued that the insured has given a false information regarding health condition for the past five years and even after taking the policies, he was suffering from Pseudo cyst of pancreas for which he had taken treatment in Paris and the repudiation by the appellant corporation was justified. We confirm the finding of the District Forum that none of the documents exhibited by the appellant herein would reveal that there had been any connection between the disease due to which the insured died and the earlier disease for which he was taking treatment and the appellant has failed to correlate the same to justify the repudiation of the claim. It cannot be said that there was suppression of material facts by the insured and the appellant corporation at no point of time repudiated the claim of the claimants on the ground of suppression of material facts regarding the health conditions of the deceased. Accordingly, we confirm the finding of the District Forum as the said finding was arrived at on appreciation of facts and no infirmity has been pointed out to the conclusion arrived by the District Forum. We also confirm the finding of the District Forum that the respondents 1 to 4 are the L.Rs. of the deceased policy holder and there is no evidence that the first wife of the de ceased Sagayanadin is alive as on date.
7. There is no dispute also that the 1st respondent was not married to the deceased policy-holder on the date of the 1st policy, dt.28.09.1995. It has been found that the marriage was subsequently solemnized on 13.12.1995. The Commission has already held that on the date of the first policy i.e. on 28.09.1995, the first respondent was not married to the deceased policy holder and she cannot be the nominee for the three minor nominees for whom the policy was taken.
8. As far as the second policy is concerned, it was taken on 28.09.1996 and on that date, she was the wife of the deceased policy holder, but, as one of the L.R. of the deceased she is entitled to claim a share in the amount due therein. Though she was shown only as an appointee for the three minor nominees. we confirm the finding of the District Forum the 1st respondent is entitled to a share in the 2nd policy amount in Ex.C2. As far as the directions given by the District Forum is concerned, we are of the view that the 1st respondent is not entitled to receive the shares of the respondents 2 ,3 and 4, as she has suppressed material facts in the civil proceedings and she obtained a decree as she filed the suit as against one Alaber, who remained exparte. The 1st respondent has not impleaded the three minor nominees as legal representatives of the deceased, as parties to the suit nor she has impleaded the L.I.C. as party in the suit. She has also filed the complaint earlier before the District Forum claiming the entire amount without impleading the three nominees as parties in the complaint and only on the directions of the State Commission in the order Dt.21,04,2005, the three nominees were impleaded as parties in the complaint. Considering the conduct of the first respondent in the judicial proceedings in more than one forum, we set aside the directions given by the District Forum and we direct that the complainant is entitled only share in the sum due under second insurance policy, Ex.C2 along with accrued benefit and she is not entitled to any share in the sum due under Ex.C1. The respondents 2, 3 and 4 are entitled to equal share in the sum due under Ex.C1 along with accrued benefits and they are also entitled to share in equal proportion in the sum due under Ex.C2 policy along with accrued benefits. The 1st respondent is also entitled to interest @ 12% p.a. on her share in the sum assured in the 2nd policy Ex.C2 from 18.07.1998 till the date of realization.
9. As far as the shares of the respondents 2, 3 and 4 are concerned in both the policies, the appellant is directed to keep their share in its safe custody and if any claim is preferred by the respondents 2, 3 and 4 either jointly or severally they will be entitled to receive the amount with interest at 12 percent per annum from the date of claim petition till this date on being satisfied about their identity and eligibility. to receive the amount and the appellant is directed to pay the amount directly to them. There will be no order as to costs.
10. In the result, the appeal is disposed of as observed above.
Dated this the 26th November, 2008 (N.V.BALASUBRAMANIAN) PRESIDENT (P.V.R.DHANALAKSHMI) MEMBER