This C.C. is coming on before us for hearing in the presence of      Sri. K.V.S. Pundarikakshudu, Advocate for complainant; and of Sri. K. Uttam Kumar, Advocate for opposite party No.2; and of Sri. S.V.R. Gupta,  Advocate for Opposite party No.3; opposite party No.1 served called absent; upon perusing the material papers on record; upon hearing and having stood over for consideration, this Forum passed the following:-

O  R  D  E  R

(Per Sri R. Kiran Kumar, FAC President)

          This complaint is filed u/s.12-A of Consumer Protection Act, 1986.  

2.        The averments made in the complaint are that the husband of the complainant  by name Pasunuti Ram Reddy had availed loan facility from the opposite party No.3, at the time of availing the loan the opposite party No.3 put a condition on the husband of the complainant, to take insurance policy, because there is a tie up between the opposite party No.1 and 3 and as he has no other go he accepted the said condition and obtained policy from the opposite party No.2 who is the agent of opposite party No.1 insurance company.  The husband of the complainant had paid the policy amount of Rs.30,000/- on 31-03-2009 and put the complainant as nominee in the policy and the opposite party No.1 has sent the policy bond on the name of the complainant’s husband.  The complainant further submitted that her husband died on 03-09-2009 due to ill health at Gundepudi Village, Maripeda Mandal, Warangal District, after death of her husband she approached the opposite party No.1 and submitted claim along with all relevant papers.  The complainant further submitted that at the time opposite party No.2 also present, he played a game with the complainant’s innocence, the opposite party No.2 himself draft a matter and handed over the same to the complainant and told to her that  “you take a doctors certificate stating that your husband suffering with heart problem since October 2008 to 02-09-2009, then only the death benefits will be released”.  The complainant further submitted that she innocently believed the words of the opposite party No.2 and took the certificate from the doctor and submitted the same before the opposite party No.2, but she does not know the actual consequences of the said certificate and she believed that it is meant for only to release the death benefits of her husband policy.  The complainant also submitted that the opposite party No.2 intentionally took the certificate from the complainant with a malafide intention to avoid the death benefits, the same is not fair on the part of opposite party No.2 and to avoid the death benefits by cheating the nominee by encashing her innocence.  In fact the complainant’s husband was not a cardiac patient and he was not suffering with cardiac disease till his death and it is the idea of the opposite party No.2 and he played a high-tech drama by taking undue advantage of the innocence of the complainant.  The complainant further submitted that the opposite party No.1 sent a letter to the complainant on 05-05-2010 stating that the opposite parties are unable to admit the liability for the above policy claim due to non-disclosure of material facts and have treated the said policy as void abinitio and issued a cheque for an amount of Rs.17,872/- drawn from opposite party No.3 under full and final payment.  The complainant further submitted that she approached the opposite parties number of times for the death benefits of the policy, but there is no use, vexed with their attitude finally she got issued notice to the opposite parties but they did not choose to pay the policy death benefit.  Since the opposite parties did not comply the policy a condition, the complainant has no other go filed this present complaint.

3.        On behalf of the complainant, the following documents were filed and marked as Exhibits A1 to A6.

Ex.A1:-Photocopy of MetLife booklet along with welcome letter, schedule, first premium receipt, statement of account and terms and conditions.

Ex.A2:-Photocopy of death certificate dt. 07-09-2009.

Ex.A3:-Photocopy of letter issued by the Medical Officer.

Ex.A4:-Repudiation letter, dt. 05-05-2010.

Ex.A5:-Letter drafted by the opposite party No.2.

Ex.A6:-Office copy of legal notice along with postal receipts and acknowledgements (Nos.2), returned unserved cover.

4.        On receipt of the notice, the opposite party No. 2 appeared through their council and filed counter.  In their counter the opposite party No 2 admitted the issuance of policy to the husband of the complainant, and submitted that the husband of the complainant after completely understanding the terms and conditions of their product Met Easy had voluntarily filled up the proposal form bearing No.302077464 signed on 21-03-2009 and applied for the said product and offered to pay Rs.30,000/- annually towards the premium to be paid for 20 years.  On receipt of the duly filled form along with the initial premium of Rs.30,000/-, the opposite party No.1 & 2 had issued the policy bearing No.1200900879245 to the policy holder and also delivered the policy documents along with the schedule, the standard terms and conditions and a welcome letter to the husband of the complainant.  The opposite party No.2 further submitted that the proposal form of the policy contains the Section 4 pertaining to the medical details of the policy holder wherein, a set of questionnaire and following questions were answered negative by the policy holder, as per questionnaire “have you ever consulted a doctor, been investigated and are been treated for: 1. High Blood Pressure, Chest pain, Angio, heart attack or any other ailments pertaining to heart circulatory system? Answered No”.   The opposite party further submitted that within the year from the issuance of the said policy, the complainant submitted the death claim intimation along with the death certificate whereby they were given to understand that the deceased policy holder died on 03-03-2009, being an early claim, on receipt of the said death claim from the complainant, an investigation was conducted by them and during the course of investigation it was revealed that the deceased policy holder was suffering from heart problem and taking treatment from October 2008 which was prior to taking insurance policy.  However, the material fact was not disclosed by the policy holder in his application for the policy, based on the observations and documents collected during the course of investigation, it clearly reflects that these material details effecting the decision of the insurer for the acceptance or rejection of the contract of insurance for willfully suppressed by the deceased policy holder and the same was not disclosed by him in the proposal form at the time of availing the policy, inspite of specific question in the proposal form.  The opposite party further submitted that  suppressed disease being a material fact and if disclosed by the deceased policy holder would not have lead to issuance of the said policy and the repudiation of the claim made by the complainant on the grounds for repudiation was communicated to the complainant vide letter dt. 05-05-2011.  The opposite party further submitted that the contract of insurance is of utmost good faith and in as much as there has been non disclosure of material facts in obtaining the policy it is initiated and they are unable to process the complainant’s request for the payment for the claim amount.   And to support their contention the opposite party submitted the citations, the Hon’ble Apex court in United India Insurance Co. Ltd., Vs. M.K.J. Corporation (1996) 6 SCC 428, Modern insulators Ltd. Vs. Oriental Insurance Co. Ltd., (2000) 2 SCC 734 and LIC of India Vs. Sampat Devi III (2006) CPJ 32.  The opposite party further submitted that in light of the facts and circumstances mentioned above, prayed to dismiss the complaint.

5.      On behalf of the opposite party No.2 the following documents are filed and marked as Exhibits B-1 to B-3.

Ex.B1:-Photocopy of Repudiation Letter dt. 05-05-2010 along with cheque for Rs.17,872/-.

Ex.B2:-Photocopy of Death/Critical Illness/Disability claim intimation, dt.13-02-2010.

Ex.B3:-Photocopy of Application form, Welcome letter, Schedule, First Premium Receipt, Statement of Account and terms and conditions.

6.      Complainant and opposite party No.2 filed written arguments.

7.      Heard oral arguments from both sides.

8.      Upon perusing the material available on record, now the point that arose for consideration is,

Whether this complaint comes under the perview of Consumer Protection Act, 1986?

Point:-

In this case the husband complainant by name Pasunuti Ram Reddy had availed loan facility from the opposite party No.3, at the time of availing loan, the opposite party No.3 put a condition on the husband of the complainant to take insurance policy, on that husband of the complainant had obtained policy from the opposite party No.1 by paying an amount of Rs.30,000/- on 31-03-2009 and put the complainant as nominee.  According to the complainant her husband died on 03-09-2009 due to ill health, after death of her husband she approached the opposite party No.1 and submitted claim form along with all relevant papers.  According to the complainant at the time of submission of claim form the opposite party No.2 is present and he had drafted a matter and handed over the same to the complainant and told to her that “You take a doctors certificate stating that your husband suffering with heart problem since October 2008 to            02-09-2009, then only the death benefits will be released”.  She innocently believed the words of the opposite party No.2 and took the certificate from the doctor and handed over the same to the opposite party No.2 and she believed that it is meant for only to release the death benefits of her husband policy.  According to the complainant her husband was not a cardiac patient and he was not suffering with cardiac disease till his death and it is the idea of the opposite party No.2.  The opposite party No.1 addressed a letter to the complainant on 05-05-2010 stating that the opposite parties are unable to admit the liability for the above policy claim due to non-disclosure of material facts and have treated the said policy as void abinitio and issued a cheque for an amount of Rs.17,872/- drawn from opposite party No.3 under full and final payment.  As the opposite parties failed to pay the death benefits under the policy the complainant approached the Forum for redressal.

From the documents and material available on record, we observed that the husband of the complainant obtained policy from the opposite party No.1 on 31-03-2009 and he died on 03-09-2009 due to ill health.  After death of her husband complainant submitted claim form along with necessary documents to the opposite party No.1.  It is the case of the complainant that at the time of submission of claim form to the opposite party No.1, the opposite party No.2  i.e. agent of opposite party No.1 is very much present and he advised the complainant that “You take a doctors certificate stating that your husband suffering with heart problem since October 2008 to 02-09-2009 and then only the death benefits will be released to her”, and also drafted a letter which is marked as exhibit A-5. On the advice of opposite party No.2 the complainant approached the Medical Officer, P.F.W.C. Maripeda, Warangal District and obtained exhibit A-3 certificate and handed over the same to the opposite party No.2.  After that the complainant received a repudiation letter dt.05-05-2010 from the opposite party No.1 stating that “Late Mr. Ramreddy pasunuti was on treatment for heart problem from October 2008, which was prior to taking the insurance policy, however, this material fact was not disclosed by late Mr. Ramreddy pasunuti in his application for the above said policy, dt. 21-03-2009”.  According to the complainant her husband was not a cardiac patient and he was not suffering with cardiac disease till his death and it is an evil idea of opposite party No.2 taking undue advantage of her innocence.                                       

In view of the above facts we are of the opinion that there are several question of facts and law is involved in the present complaint, which required adducing evidence and production of voluminous documents, and hence, a civil court of competent jurisdiction only could handle the matter hence the complainant directed to get redressal on her grievance before appropriate Forum / Civil court.

In the result, the complainant is at liberty to file a fresh complaint before the appropriate Forum for redressal of her grievance.  The time consumed during the pendency of this complaint in this Forum can be saved from the period of limitation.  Accordingly, this complaint is disposed off.

          Typed to dictation, corrected and pronounced by us, in the open forum on this the 6^th day of March, 2017.    

        FAC PRESIDENT                      MEMBER

   DISTRICT CONSUEMR FORUM,

        KHAMMAM.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant:-                                                 For Opposite party:-   

       -None-                                                                       -None-

DOCUMENTS MARKED:-

For Complainant:-                                                           For Opposite party:-   

FAC President              Member

District Consumer Forum, Khammam.