Date of filing: 09.6.2017 Date of Order : 11.7.2018
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, B.L., LADY MEMBER
WEDNESDAY THE 11th DAY OF JULY, 2018
CONSUMER COMPLAINT No. 51 / 2017
Varada Rama Krishna, S/o V. Veeranna,
Hindu, aged about 44 years,
Private employee,
Residing at Dumpalagattu Village,
Khajipet Mandal,
Kadapa District. ….Complainant.
Vs.
1. The Manager, India First Life Insurance Co. Ltd.,
3rd Floor, Kerthi N Pride towers, Near Cine Max,
Opposite R.B.S. Royal Bank of Scotland,
L.V. Prasad Road, Banjara Hills, Hyderabad.
2. The Governing Body of Insurance Counsel,
Jeevan Seva Annexe, 3rd floor, S.V. road,
Santa Cruz (W), Mumbai – 400 054.
3. The Manager, Andhra Bank, Mydukur Branch,
Mydukur Mandal, Kadapa district.
4. The Manager, Andhra Bank,
Mandavakurthi Branch, Srikakulam District. ….. Opposite parties.
This complaint coming for final hearing on 03-7-2018 in the presence of Sri T. Mohana Krishna, Advocate for complainant and Sri B. Muralidha, Advocate for O.P.1 and Sri A. Raja Reddy, Advocate for O.P.3 and O.P.2 appeared as in person and O.P 4 remained exparte on 11-8-2017 and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Sri V.C. Gunnaiah, President),
1. The complainant filed this complaint under section 12 of Consumer Protection Act, 1986 (for short herein after called as C.P. Act) directing the opposite parties 1 & 2 to pay insured amount of Rs. 7,70,000/-, to pay Rs. 2,25,000/- towards compensation or deficiency in service and to pay Rs. 5,000/- towards costs of the complaint.
2. The brief averments of the complaint are as follows:- The complainant is the son of late Varada Chandramma. The said Varada Chandramma, mother of the complainant during her life time she got insured her life and obtained two policies bearing No. 10141837 for Rs. 4,20,000/- on 30.10.2010 and another policy bearing No. 10152347 for Rs. 3,50,000/- on 27.12.2010 under smart save plans and the term of the policy is 20 years and 15 years respectively and premium payable is Rs. 10,000/- and Rs. 20,000/- respectively. The above said policies from opposite parties 1 & 2 were obtained through opposite parties 3 & 4 as there was tieup in between opposite parties 1 & 2 with the opposite parties 3 & 4. While taking the said insurance policies the opposite parties 1 & 2 have taken PAN card of late Varada Chandramma into consideration for the proof of her age as there was no aadar card to her at that time. Subsequently, the deceased Varada Chandraamma and her son obtained aadhar cards. But in the aadhar card their year of birth was wrongly mentioned. The year of birth of mother of complainant is correctly mentioned in PAN card, voter identity card and ration card. The mother of the complainant i.e. insured died on 07.8.2016 and the policies were inforce as premiums for both policies were paid by her. Taking advantage of wrong year of birth in aadhar card of the mother of the complainant and elder son, the opposite parties 1 & 2 rejected the claim of the complainant by overlooking of their identity proofs of PAN card, voter card and ration card. Hence, the complaint for the above reliefs.
3. Oppoiste party No. 4 remained exparte on 11.8.2017.
4. Opposite parties 1 to 3 filed separate written versions.
5. O.P.1 filed written version denying the allegations of the complainant with regard to the date of birth particulars mentioned in the complaint of the insured and deficiency in service on their part. It is further averred complaint is false, frivolous in correct and filed with malafide intention by abusing the process of law. It is further pleaded the deceased life assured (herein after referred as DLA) internally and with malafide intention had understated her age below 60 years, though she was 70 years at the time of availing the insurance coverage. The maximum age of entry under the policies obtained by the complainant mother i.e. deceased life assured is 60 years. Hence, the claim made by the complainant was rejected by this party for reasons of fraudulently misrepresentation and non-disclosure of material facts by DLA at the time of applying for the subject policies. So the complainant who is nominee has no locus standi to claim any alleged sum assured. More over that the DLA passed away in 892 and 296 days from the reinstatement date of the said policies. This O.P. got an investigation done through Southern Insurance Management Services under clause – 8 (3) of Insurance Regulatory and Development Authority regulations 2002 and during the investigation it was revealed that the DLA i.e. insured was having aadhar card bearing No. 913179812327 and her date of birth is mentioned 01.01.1938 which is approximately 72 years at the time of obtaining policy in the year 2010. Her elder son Varada Pattabhi Nayudu is having aadhar card No. 383706392169 and his date of birth is 1966. So it was found that the DLA i.e. life assured Varada Chandamma was 9 years at the time of her first child was born which is humanly impossible as voter I.D. card of DLA shows that year of her birth is mentioned as 1957. Thus the DLA had under stated her age which was material for the O.P underwrite to risk before issuance of insurance policies. The DLA was sufficiently old lady while entering into subject policies but she had under stated her age despite knowing maximum age of her entry to avail the subject policies was 60 years which was also clearly explained in the Sales Literature. The complainant filed a complaint before insurance ombudsman of Andhra Pradesh against this party on 27.12.2016 and this party contested the same and after consideration of the facts and circumstances of the case ombudsman dismissed the complaint on 24.3.2017, observing that the DLA had not disclosed her correct age and her actual date of birth in the proposal of insurance. The repudiation of the oppoiste party is valid. The other contentions raised in the complaint are wrong and denied. The contract of insurance is being utmost good faith it was not followed by the life assured. Hence, the complaint is not maintainable and it is a vexatious, frivolous and the same is liable to be dismissed.
6. Opposite party No. 2 filed written version by way of letter addressed to this Forum denying the allegations stating that executive council of insurers i.e. O.P.2 cannot be made a party to the complaint and if the customer had any grievance following RPG Rules 1998 / Insurance Ombudsman Rule, 2017 he / she approach to the respective office of Ombudsman for redressal.
7. O.P.3 filed written version denying the allegations in the complaint that nowhere averred in the complaint that there was any deficiency in service on the part of the bank since there was insurance tie up with the opposite parties 1 & 2 for coverage of insurance whatever records deceased life assured submitted they are transmitted to the opposite parties 1 & 2 for becoming member of the scheme for coverage of policies. As per policy conditions there was discrepancy with regard to the age of the complainant’s mother. Therefore, the settlement was not made. There was no negligent conduct on the part of this O.P. Hence, he is not liable to pay any amount to the complainant and complaint against this O.P. is liable to be dismissed.
7. No oral evidence reported by the parties. On behalf of the complainant Exs. A1 to A5 documents are marked and on behalf of O.P.1 Exs. B1 to B11 documents are marked. No documents are marked on behalf of O.Ps 2 & 3.
8. Heard arguments on both sides and perused the documentary evidence placed on record by O.P.1.
9. On the above pleadings the following points are settled for determination.
- Whether is there any deficiency of service on the part of opposite parties 1 & 2 in repudiating the claim of the complainant?
- Whether the complainant is entitled for the reliefs claimed against Opposite parties 1 & 2 as prayed for?
- To what relief ?
10. Point Nos. i and ii: These two points are connected to each other, hence, they are discussed together for the sake of convenience and better understanding.
Learned counsel for the complainant contended that at the time of proposal age mentioned in PAN card complainant’s mother was accepted and issued policies. So at the time of taking policies she was only 53 years of age but the opposite parties after the death of the insured on 07.8.2016 repudiated the claim of complainant who is nominee of the deceased under the policies Exs. A1 & A2. Therefore, repudiation of claim by opposite parties 1 & 2 comes under deficiency in service. As such the complainant is entitled for the whole claim against the opposite parties 1 & 2 and the complaint may be allowed accordingly.
11. Per contra learned counsel for O.P.1 vehemently contended a contract of insurance is based on utmost good faith and the proposer should disclose all the material facts including correct age at the time of taking policies under Ex. A1 & A2 which are to be availed by the people who do not cross 60 years. But in this case Varada Chandramma the mother of the complainant suppressed her age though she was more than 70 years at the time of taking policies under Ex. A1 & A2 by mentioning that she was only 53 years. Had the DLA given her correct age as 70 years at the time of taking polices, O.P.1 would not have accepted the proposal and issued policies under Exs. A1 & A2 and the investigation also revealed the same and Ombudsman under Ex. B9 also observed and dismissed the claim of complainant. Ex. B5 aadhar card of DLA disclosed that she was born in 1938 so by the date of obtaining policies Ex. B1 & B2 she was 72 years. Hence, the same is proved by filing documentary evidence Exs. B1 to B5 and as per Ex. B12 the DLA’s elder son was born in 1966. As per Ex. A2 the PAN card and voter identity card of DLA her date of birth was 04.6.1957 and if such is the case she gave birth to her elder son only at the age of 9 years which is highly impossible. Therefore, the DLA suppressed the material facts and obtained the policies fraudulently by suppressing her age. Hence, the complainant who is nominee of the policies under Ex. A1 and A2 is not entitled for the claims and the claim was rightly repudiated by the O.P.1 and the complaint is liable to be dismissed.
12. After going through the contentions of both parties and considering the submissions made by them and minutely persuisng the material on record we hold that there is no deficiency in service on the part of O.P.1 in repudiating the claim of complainant and receipt of policies under Ex. A1 & A2 regarding her mother Varada Chandramma and complaint is liable to be dismissed.
. The complainant’s mother Varada Chandamma i.e. DLA obtained policies from O.P.1 under Ex. A1 & A2 on 30.10.2010 & 27.12.2010 respectively. There is no dispute in this regard between the parties in respect of obtaining the policies payment of premium during life time of deceased. The deceased died as per Ex. A3 on 07.8.2016. The complainant herein who is the younger son of DLA was the nominee. This fact is also not in dispute.
13. As per terms and conditions of the policies Exs. A1 & A2 the maximum age limit for issuing or availing the insurance coverage is for the persons upto the age of 60 years i.e. the maximum age for the smart save plan policies is available only for the persons up to 60 years of age. The persons more than 60 years of age cannot avail insurance coverage for the above policies covered under Ex. A1 & A2.
14. Now it has to be seen whether by the date of 30.10.2010 and 27.12.2010 on which dates Exs. A1 & A2 policies were obtained by the DLA from O.P.1 was she aged 60 years or more than 60 years of age. According to the complainant her mother was aged 53 years at the time of obtaining policies under Ex. A1 & A2 and the same was accepted by O.P.1 and issued policies. But according to O.P.1 the life assured should disclose all the facts at utmost good faith to cover the insurance under the above polices, however, the insured suppressed her real age and mentioned as 53 years in the proposal form though she was more than 70 years by the date of Ex. A1 & A2. During the investigation when the claim was made by the complainant the same fact is revealed and proved by the O.P.1 by filing Exs. B4, B5, B7, B10 and B12.
15. A perusal of Ex. A2 the policy particulars, PAN card of Varada Chandramma, (DLA) and her election identity card shows that her date of birth was 04.6.1957. Basing on this PAN card and voter identity card the complainant claimed that her deceased mother was aged 53 years at the time of taking policies in the year 2010. But Exs. B5 is aadhar card of Varada Pattabhi Naidu, elder son of Varada Chandramma, DLA herein. Ex. B4 aadhar card bearing No. 913179812327 belonged to Varada Chandramma the life assured under Exs. A1 & A2. As per Ex. B4 date of birth life assured is 01.01.1938, as per Ex. B5 her elder son date of birth is in the year 1966. As per Ex. A2 her date of birth is 04.6.1957 if such is the case by the date of giving birth to her elder son she was only 9 years old, which is highly impossible as argued by the learned counsel for O.P.1. So the correct date of birth of Varada Chandramma must be on 01.01.1938 as per Ex. B4 aadhar card which is reasonable to give birth to her elder son in 1966. So Varada Chandramma the life assured under Exs. A1 & A2 intentionally suppressed her age and not disclosed her correct age but mentioned wrongly as 53 years in 2010 through she was more than 70 years at the time of obtaining policies under Exs. A1 & A2. The investigation report under Ex. B7 also proves the same.
16. The contract of insurance is based on utmost good faith. The persons who intended to obtain insurance policies should disclose all the facts and shall not suppress any material fact regarding the particulars of the person who intends to obtain the policies. If any facts suppressed by the insured and such suppression of facts are proved by the insurance company, the claim of insured can be repudiated by the insurance company. The mother of the complainant Varada Chandramma (DLA) suppressed the fact of her real age and obtained policies under Exs. A1 & A2 by mentioning her age as 53 years, though she was more than 70 years in 2010. The said fact of her date of birth was proved by O.P.1 by filing Exs. B4 to B6 andB9 and further proved that the DLA was more than 70 years at the time of taking policies under Ex. A1 & A2. The ombudsman order under Ex. B9 also reveals the same. So the repudiation of claim of complainant for the policies under Exs. A1 & A2 is on right grounds and there was no deficiency in service on the part of O.P.1 and the complaint is not maintainable and the complainant is not entitled for any relief and complaint is liable to be dismissed. Accordingly, points 1 & 2 are answered against the complainant.
17. Point No. iii:- In the result, the complaint is dismissed, but in the circumstances no costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 11th day of July, 2018.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined
For complainant : NIL For opposite party : Nil
Exhibits marked on behalf of the Complainant :-
Ex: A1 P/c of policy bearing no.10141837.
Ex: A2 P/c of policy bearing no.10152347.
Ex: A3 P/c of death certificate V.Chandramma,
Ex: A4 P/c of the complaint given by the complainant to Office of the Insurance Ombudsman, Hyderabad.
Ex: A5 Copy of the rejection of claim dt.2-11-2016.
Exhibits marked on behalf of the O.P.No.1 :–
Ex:B1 The Copy of proposal forms for both the policies .Annexure-1.
Ex:B2 P/c of policy documents are Annexured-2,
Ex:B3 P/c of claim intimation form along with death certificate,
Annexure-3.
Ex:B4 P/c of Aadhar card bearing no.9131-7981-2327, Annexure-4,
Ex:B5 P/c of Aadhar card of son of DLA bearing NO.3837-0639-2169 AS Annexure-5,
Ex:B6 P/c of Abhay Hastam Scheme Records as Annexure-6,
Ex:B7 P/c of investigation report along with affidavit of investigator is Annexure-7,
Ex:B8 P/c of Sales Literature is Annexure-8,
Ex:B9 P/c of complaint dt.27-12-2016, reply of opposite party dt.19-01-2017 and award passed by the insurance Ombudsman dt.24-03-2017 is Annexure-9,
Ex:B10 P/c of Decision letter dt. 02-11-2016 is Annexure-10,
Ex:B11 P/c of the letter of the complainant is Annexure-11,
Ex. B12 P/c of PAN card of V. Ramakrishna.
MEMBER PRESIDENT
Copy to
1) Sri T. Mohana Krishna, Advocate for complainant.
2) Sri B. Muralidhar, Advocate for O.P.1.
3) Sri A. Raja Reddy, Advocate for O.P.3.
4) The Governing Body of Insurance Counsel, Jeevan Seva
Annexe, 3rd floor, S.V. road,Santa Cruz (W), Mumbai–54.
5) The Manager, Andhra Bank, Mandavakurthi Branch,
Srikakulam District
B.V.P
