Karnataka

Gadag

CC/126/2019

Veerappa S/o Veerbhadrappa Akkishettar alias Gadag - Complainant(s)

Versus

Divisional Manager, Life Insurance Corporation of India Dharwad - Opp.Party(s)

S.K.Patil

31 Dec 2020

ORDER

-::O R D E R::-

 

BY: SMT.C.H.SAMIUNNISA ABRAR, PRESIDENT.

 

1.       The complainant has filed this complaint claiming direction to the OPs to pay policy amount of Rs.16,00,000/- with bonus and interest, Rs.50,000/- towards compensation with cost and such other relief.

-::Brief facts of the case are as under::-

2.       The case of the complainant is that, the complainant is the husband of late Smt. Shanta Veerappa Akkishettara @ Gadada who died on 26.11.2018.  During her life time, the wife of complainant had obtained Jeevan Labha insurance policies from the OPs bearing Policy Nos.(1) 366077656 for Rs.2,00,000/-, (2) 366077657 for Rs.2,00,000/-, (3) 366077658 for Rs.2,00,000/-, (4) 366077659 for Rs.2,00,000/- on 18.07.2016, (5) 366247676 for Rs.1,00,000/-, (6) 366247675 for Rs.1,00,000/- on 26.03.2018, (7) 608237526 for Rs.2,00,000/-, (8) 608237574 for Rs.2,00,000/- on 24.04.2018 and (9) 366077655 for Rs.2,00,000/- on 18.07.2016, in all a sum of Rs.16,00,000/-.  The OPs have issued Policy Bonds in respect of all the above 9 policies.  After the death of his wife, complainant approached and requested OP No.2 office to pay the policy amount with bonus and interest by producing original bonds and allots.  The complainant has a right to get the policy amount with other documents, but till today the OPs did not taken any action regarding the same.  The complainant approached OPs several times for the last six months, but it went in vain.  Therefore, the complainant issued legal notice through his Advocate on 13.08.2019 by way of RPAD.  OP No.1 gave an evasive answer to the said notice on 17.08.2019 denying the claim made by the complainant, which is a negligence and deficiency of service on the part of OPs bonus and interest from the above said policies. The cause of action for this complaint arose on 13.08.2019 when the notice issued by complainant and on 17.08.2019 when the OP issued evasive reply to the notice issued by complainant.   Hence, the OPs are liable to pay an amount of Rs.16,00,000/- with bonus and interest,  Rs.50,000/- towards compensation for negligence and deficiency of service and cost.

3.       Registered the complaint and notice was ordered, as such OPs present before the Forum and filed written version, the contents are as follows.

Written Version of the OPs

The OPs contended that, none of the contents of complaint are either true or admitted, the complaint is false, frivolous and vexatious and the same is not maintainable either in law or on facts, the same is liable to be dismissed in limine.  The present complaint does not fall under the definition of “complaint” as per Sec.2(1)(C) to (iv) of the C.P Act, 1986 and the dispute cannot be called as “Consumer Dispute” as per Sec.2(1)(c) of the Act and hence, the complaint is liable to be dismissed.  It is further submitted that, there is no deficiency of service on the part of OPs and the allegations do not come under the provisions of Sec.2(1)(a) or 2(1)(c) of the Act.  Therefore, this Commission has no jurisdiction to decide the present complaint. 

It is respectfully submits that, as per the complaint, the wife of complainant deceased Smt. Shanta W/o Veerappa Akkishettar @ Gadad had taken 9 policies from OP No.2 under Jeevan Labha Plan.  However, she had taken policies under the plan mention against each policies on different dates other than Jeevan Labh i.e., (1) policy No.366247676 and  366247675 under Jeevan Adhar Plan, (2) Policy No.608237526 under Jeevan Rakshak Plan with date of Risk 25.04.2018 and (3) Policy No.608237574 under New Endowment Plan with date of Risk 27.04.2018.  It is true that, the complainant approached the OPs for settlement of death claim benefits under the above said policies.  The notice was suitably replied on 17.08.2019.  The OPs have admitted the claim under Policy Nos.366077655, 366077656 and 366077657 and prepared to make payments to the nominees.  The claim in respect of other six policies stands repudiated i.e., Policy Nos.608237526, 608237574, 366247676, 366247675, 366077659 and 366077658 had been repudiated and nothing is payable under the said policies.  It is further submitted that, the policy holder revived the policies under medical examination and declaration of Good health on 20.03.2018 and the deceased life assured undergone treatment as outpatient in KLE Cancer Hospital, Belgaum on 29.03.2018 just 9 days after revival of the policies and the complainant has not submitted the medical treatment particulars as desired by the OP and the same was conveyed to the Advocate vide letter dated 17.08.2018 by way of reply.  Therefore there is no deficiency of service on the part of OPs and hence, prayed for dismissal of the complaint.

4.       The complainant has filed his affidavit evidence and filed 06 documents.  The Administrative Officer (L & HPF) of OPs filed his affidavit evidence and 57 documents have been produced.

COMPLAINANT FILED DOCUMENTS AS follows

	Particulars of Documents	Date of Document
C-1 & 2	2 Postal Receipts
C-3	Legal Notice
C-4	Reply to Notice
C-5 & 6	Aadhar Cards

OP FILED DOCUMENTS AS follows

	Particulars of Documents	Date of Document
OP-1	Letter by OPs
OP-2	Status Report
OP-3	History of Premium Transaction
OP-4	Policy Bond
OP-5	Status Report
OP-6	History of Premium Transaction
OP-7	Policy Bond
OP-8	Status Report
OP-9	History of Premium Transaction
OP-10	Policy Bond
OP-11 & 12	Letter by OPs	10.10.2019
OP13	Status Report
OP-14	History of Premium Transaction
OP-15	Policy Bond
OP-16	Status Report
OP-17	History of Premium Transaction
OP-18	Revival Quotation
OP-19	Personal Statement regarding Health
OP-20	Addendum for Female Proponents
OP-21	Form No:DWD/NB/32
OP-22	Medical Examiner’s Confidential Report
OP-23	Letter from OPs
OP-24	Status Report
OP-25	History of Premium Transaction
OP-26	Policy Bond
OP-27	Female Lives Annexure-1
OP-28
OP-29	Proposal for Insurance (Form No.501)
OP-30	Letter by OPs
OP-31	Status Report
OP-32	History of Premium Transaction
OP-33
OP-34	Policy Bond
OP-35	Letter by OPs
OP-36	Status Report
OP-37	History of Premium Transaction
OP-38	Policy Bond
OP-39	Proposal for Insurance
OP-40	Medical Examiner’s Confidential Report
OP-41	Letter by OPs
OP-42	Status Report
OP-43	History of Premium Transaction
OP-44	Policy Bond
OP-45	Proposal for Insurance
OP-46	Death Claim
OP-47	Claimant’s Statement
OP-48 to 54	Case sheet
OP-55	Discharge summary
OP-56	Hospital records
OP-57	Intake Output Chart

 

5.     On the basis of above said pleading, oral and documentary evidence, the following points arises for adjudication which are as follows:

1.       Whether the Complainant proves that, the OPs have     committed deficiency of service and unfair trade practice?

2.       Whether the Complainant proves that, he is entitled for the    relief?         

3.       What order?

6.       Our Answer to the above points are:-

1.  

                     

2.  

 

3. As per the final order.

REASONS

7.       Point No-1 & 2:- Since both the points are identical and interlinked with each other and hence, we proceed both together.   

8.       The complainant has filed this complaint against the OPs stating that, 9 policies have been purchased by the deceased wife of complainant from the OPs during her life time.  Out of 9 policies, 5 policies have been purchased in the year 2016, remaining 4 policies were purchased in the year 2018.  Complainant submits that, out of 9 policies, 6 policies have been repudiated by the OPs stating that, the policy holder was suffering from pre-existing disease i.e., Breast Cancer.  The disputed policies 366077658, 366077659 have been purchased in the year 2016 itself and remaining policies 366247676, 366247675, 608237526, 608237574 purchased in the year 2018.  These are the contention of the complainant claiming for the benefit of these policies from the OPs.

9.       On the other hand OPs filed a written version submitting and admitted that three policies i.e., Policy Nos.366077655, 366077656 and 366077657 are undisputed policies and they are ready to pay the claim amount with respect to the same, the remaining policies are disputed one, the policy No.366077658, 366077659 which have been purchased in the year 2016 itself, but it has been revived in the year 2018 and remaining policies are purchased in the year 2018.  While enquiring about the deceased Smt. Shanta Veerappa Gadada about her health and all those things that, she is suffering from Breast Cancer before purchasing the four policies which have purchased in the year 2016 revived policies also.  Hence, there is deficiency of service on the part of OPs.

10.     On-going through the records on file, it is an disputed fact that, the three policies which have been purchased in the year 2016 are in force but, another two policies which have been purchased in the year 2016, but it was discontinued and unfortunately it has been revived in the year 2018.  We have to discuss deeply about this is that, the policy has been revised on 20.03.2018 before the Medical Officer, he said to be appointed by the OPs themselves and the contention of OPs is that, while filing the personal statement regarding health, the deceased had not revealed the fact that, she is suffering from Breast Cancer.  Moreover, the agent who is appointed by the OPs had sold the three more policies to this deceased in the year 2018.  Whatever it may be, he cannot overlook the defence of OPs stating that, she has not revealed her health condition while purchasing the fresh policies in the year 2018.  On the other hand, we cannot overlook the contention of complainant also that, the policies which have been purchased in the year 2016 i.e., policy No. 366077658, 366077659, which were revised on 20.03.20418.  Ongoing through the records produced before the Commission by the OPs i.e., revival quotation, it speaks that, only two premium amount had not paid by the deceased Smt. Shanta.  Such being the fact, we cannot accept the defence regarding these two policies, merely it was revived in the year 2018, but it was purchased in the year 2016.  Moreover, as per the written version of OPs is that, the policy holder revived the policies on 20.03.2018 and further submits that, the complainant undergone treatment as an outpatient in KLE Hospital on 29.03.2018.  Hence, the policy has been purchased in the year 2016, which cannot be overlooked since the policy has been revived before taking treatment.

11.     Of course, the policies which have been purchased in the year 2018, the complainant is not entitled for the claim since because she was suffering from Cancer on those days and she knows very well that, she was a patient of Cancer and she cannot take the policies.  Hence, we answer Point No.1 is in partly Affirmative and Point No.2 in partly Affirmative.

12.     Point No.3:-        For the reasons and discussion made above we proceed to pass the following:-

6698606.  

1.       The complaint filed by the complainant is partly allowed.

2.       OPs are directed to pay the sum assured along bonus with interest @ 12% p.a to the Policies which has been purchased in the year 2016.   Further OPs are directed to pay an amount of Rs.10,000/- towards mental agony and harassment, deficiency of service and Rs.2,000/- towards litigation charges.

3.       Complainant is not entitled for the policies which have been purchased in the year 2018.

4.       Further OPs are directed to comply this order within one month, failing which OPs are liable to pay interest @ 18% on the sum assured from the date of repudiation till realization.    

5.       Send a copy of this order to both parties free of cost.  

(Dictated to the Stenographer, transcribed by him, corrected and then pronounced by me in the Open Court 31^st day of December-2020)

 

 

 (Shri B.S.Keri)                                        (Smt.C.H.Samiunnisa Abrar)

       MEMBER                                                      PRESIDENT