BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, VIJAYAPUR

DATE OF FILING 14^th  DAY OF SEPTEMBER 2016

CONSUMER COMPLAINT NO:73/2016

DATED THIS THE 15^th  DAY OF MARCH, 2018

01) Sri S.H. Hosalli                            -             President.  

                  B.Com.LLB. (Spl),

02) Smt.G.S. Kalyani                         -        Lady Member.

                 B.Com.LLB. (Spl),

- V/S -

                                                                           2        Tata AIA Life Insurance Co. Ltd.,

                                           R/by The Manager/Authorized

                                          Signatory, 14^th floor, Tower A,

                                          Peninsula Business Park,

                                          Senapati Bapat Marg, Lower Parel,

                                          Mumbai-400013.                                                        

                                           3       Customer Care Cell

                                          Tata AIA Life Insurance Co. Ltd.,

                                          6^th floor, Peninsula Towers,

                                          Peninsula Corporate Park,

                                         Ganpatrao Kadam Marg, Lower

                                         Parel (W) Mumbai-400013.

                                (Op-1 to 3 by Sri. M.I.Manoor, Adv)

O R D E R

Speaking through Smt. G.S. Kalyani, Lady Member.

This is a Complaint filed by the complainant under Section 12 of the Consumer Protection Act, 1986 (herein after referred to as the Act) against the Opposite Parties (in short the “Ops”) directing the Ops to make payment towards Death benefits of the Tata AIA Life Raksha Rs.10,00,000/- along with interest 18% P.A. from the date of the death of the insured till realization, Rs.2,00,000/- towards mental agony and harassment and Rs.20,000/- towards cost of litigation.

2)       The brief facts of the case are that:-

          The Complainant contended that the complainant is the father of deceased Vijaya Nana Kambale  the said Vijay was applied for Tata AIA  Life Raksha Policy on 11/12/2013, after due investigations and medical checkups the Op issued a policy bearing No. C063421833 for a sum of Rs.10,00,000/- towards death benefits.

3)       It is submitted that on 08/02/2014, at about 10.45 p.m. the said insured Vijya Nana Kambale was died due to Cardiac Shock (Hear Attack).  After the death of his son Complainant know that he is the nominee under the said policy and after collecting required documents, sent the death certificate along with claim application on 18/08/2014 to Op.  On 27/11/2014 complainant received reply notice from Op-2 stating that the claim is repudiated with a reason that;

“ As per the information produced by us during course of claim evaluation, it has been established that the Life Insured been insured for huge sums of money by other insurance companies prior to his application for insurance under the policy.  Had such information been disclosed, we would not have issued the policy”.

4)       The reason for repudiating the claim assigned by the Op is not proper and valid.  The act of repudiating the claim on unlawful reasons it amounts to unfair trade practice and he is trying to escape from liability. The act of Ops amounts to deficiency in service.  Hence complainant filed this complaint

5)       After receipt of notice Ops appeared through counsel and resisted the case by filing written version, in this version they submits as under:-

          Ops submits that complaint is false is not maintainable either in law on the material facts and it is ambiguous one and complaint is liable to be dismissed with exemplary cost.

6)       Op-1 submits that the deceased had opted for TATA AIA Life Raksha 25 policy and premium for the policy was issued on 02/01/2014 term of policy is 25 years with a sum assured of Rs.10,00,000/- bearing No.10078672, in the said application the insured had replied in the negative to the question on previous policy details under step-8 as under:-

          “ Have you ever had an application for life, accident, medical, or health related insurance refused, post poned or offered with restricted benefits or with an increased premium, or made any claim under any such policy insurance?” for which Mr. Vijaya S/o Nana Kamble the LA had indicated that ‘No’

7)       Op submits that the life assured has been insured for huge sums of money by Aviva life insurance company prior to his application for insurance under the policy and had such information been disclosed the decision of Op Company would have been different and this policy would not have been issued, the policy is valid from the inception it has been taken by fraudulent means and misrepresentation.  Therefore Op-1 prays for dismissal of complaint.

8)       Other Op No.2 & 3 adopt the objection of Op-1 as their objection.

          Complainant Advocate filed complainant affidavit in lieu of evidence and produced 7 documents same are marked as Ex.C-1 to  C-7.  On Ops side Ops Advocate filed Op-1’s affidavit in lieu of evidence and in support of their case Ops produced 21 documents, same are marked as Ex.Op-1 to Op-21 respectively.

9)       Both counsel filed written argument.  Heard the oral argument perused the records the following points does arise for our consideration in deciding the case is as under:-

1. Whether the complainant is entitled for the reliefs as he sought for?

    2) What order?

   10)    Answer to the above points.

2. Partly in affirmative.

3. As per final order.

   REASONS

   11)    Point No.1:- It is admitted fact that complainant’s Son by name Vijaya S/o Nana Kambale taken policy of TATA AIA Life Raksha 25 policy on 02/01/2014 the policy term was 25 years with sum assured of Rs.10,00,000/- from Op company, Op company issued the policy in the name of deceased Vijaya and present complainant is nominee under the said policy and the said policy is bearing No.10078672.

    

   12)     It is further admitted by both the parties that on 08/02/2014,  the said policy holder died due to heart Attack.  Thereafter complainant applied claim in Ops Company for death benefits on 18/08/2014 along with documents.  It is also admitted fact that on 27/11/2014.  Op repudiated the claim of complainant that life insured had insured for huge sums of money in other insurance companies prior to his application for insurance under the policy, if such information disclosed by the insured Op submits that they would not have issued the policy.

    

   13)     The only question remains to decide in this case that, whether the Op proves that complainant not entitled to the claim as per the terms and conditions of policy.  The burden lies upon the Ops to prove his case; Ops not produced any document to show that if the insured had insured his life in other insurance companies he is not entitled to get reliefs; hence Ops version is not acceptable in the eye of law.  Moreover Ops submits the true fact that already deceased taken policy before obtaining this policy in question this fact is known to Op company at the time of settling the claim and hence Ops submits that they repudiated the claim.  This being the fact, whether Op proves that if insured submitted false inform in proposal form and it is found to be not true, then his policy would lapse.  But Op Company not done so, till today, the policy is valid, Op Company if the policy is not valid why they take premium. He kept silent till to the date of death of insured only when the claim was made by the complainant at that time.  Op submits that they verify and if found that complainant made false answer to the question in proposal form at step-8 and claim was repudiated.  This Ops act amounts not only deficiency in service but also cheating the customer, like this complainant.

    

   14)     At the time of issuing policy it is duty of Ops to explain each and every columns in the proposal form then after accepting by the insured then only Op ought to have issued policy. Here in this case ops received the premium from insured and after his demise his claim was repudiated this repudiation is against the law, if the Op company disclose such information at the time of taking the policy insured would not take the policy.  The act of Ops in repudiated the claim of death benefits is clearly goes to show that deficiency in service as well as mala trade business.

    

   15)     The policy in question is admitted by the Op Company and received the premium and this bounden duty to act according to the policy, here in this case Op’s negligence in service towards their customer like this complainant. Complainant claimed Rs.10,00,000/- towards insured amount, Rs.2,00,000/- towards  mental agony for that complainant not produced any document to show that complainant sustained mental agony to the tune of Rs.2,00,000/-.  It is quite natural that the act of repudiation of claim it makes suffer the complainant mentally. Hence, we order to pay Rs.5,000/- towards mental agony and complainant asked Rs.20,000/- towards litigation charges which is exorbitant, hence, we ordered Rs.2,000/- towards litigation cost. Hence, complainant is entitled to the benefits under the policy.  Hence, we answer to the point No.1 as partly in affirmative.

    

   16)    Point No.2:- In view of the above discussion at point No.1  we proceed to pass the following order.

    

   O R D E R

4. The complaint is allowed in part.

    

5. The Op-1 to 3 are jointly and severally ordered to pay Rs.10,00,000/- (Rs. Ten Lakh Only) with 9% interest from the date of filing of complaint i.e.14/09/2016 towards Death benefit of the Tata AIA Life Raksha policy.

1. The Ops are jointly and severally also ordered to pay Rs.5,000/- (Rs. Five Thousand Only) towards mental agony and Rs.2,000/- (Rs.Two Thousand Only) towards litigation cost.

    

2. The Op-1 to 3 are comply this order within two months from the date of this order, failing which the above said amount of Rs.10,00,000/- (Rs. Ten Lakh Only)) shall carry on interest at the rate of 12% p.a. from the date of filing of this complaint i.e. 14/09/2016.

3. Free copy of this order shall be sent to the parties

 (This order is dictated to the Stenographer, directly on computer transcript edited, corrected and then pronounced in the open forum on this 15^TH day of MARCH 2018).