:: O R D E R ::
(BY Smt.K.VINAYA KUMARI, MEMBER)
1. THIS IS A COMPLAINT FILED U/SEC.12 OF Consumer Protection ACT, 1986.
2. The brief facts of the complaint are:
3. The complainant is the wife of insured Sri Shaik Chand who died on 14-5-2010 due to chest pain. During his life time Sri Shaik Chand obtained life insurance policy vide policy bearing No.0127217803 on 19-5-2009 from opposite party for a term of 20 years. The premium is Rs.99,000/- per annum and the sum assured towards minimum death benefit is Rs.4,95,000/-. The insured deceased paid premium regularly, for two instalments and thereafter he died.
After the death of the insured the complainant as nominee submitted all the required documents to the opposite party and claimed the insured amount. To the dismay of the complainant the opposite party repudiated the claim of the complainant vide their letter dated 13-8-2010 stating that the insured did not disclose his treatment for blood pressure and diabetes mellitus since 2008.
It is alleged in the complaint that the opposite party issued policy to the insured after thorough examination by their panel Doctors, and the repudiation of the claim of the complainant by opposite party is unfair and it amounts to deficiency in service and hence she approached the Forum with a prayer to direct the opposite party to pay the assured amount of Rs.4,95,000/- with interest @24% per annum from 19-5-2009 till realization and to pay compensation of Rs.50,000/- for negligence and deficiency in service Rs.5,000/- as cost of proceedings and also any other relief or reliefs which the Forum deem fit and proper in the ends of justice and equity.
On 3-4-2012 Forum opined that the notice was deemed to be served.
4. There is no representation on behalf of opposite party and hence on 3-4-2012 Forum opined that the notice was deemed to be served and opposite party was set ex-parte on 3-4-2012.
5. During the enquiry the complainant filed her affidavit and got marked Ex.A1 to A7 documents and PW1 was examined by the Forum.
6. Heard the arguments of complainant counsel.
7. The following points arise for consideration:
- Whether there is any deficiency in service on the part of opposite party in repudiating the claim of the complainant ?
- Whether the complainant is entitled for any relief prayed for?
- To what relief
8. POINT No.1: It is evident from Ex.A1 to A5 that the complainant husband obtained Unit Gain policy vide policy vide policy No. 0127217803 from opposite party on 19-5-2009 and paid policy premiums on 18-5-2009 and 10-5-2010. The annual premium amount is Rs.99,000/- and the minimum sum assured under death benefit as per policy is Rs.4,95,000/-. The complainant is the nominee.
The opposite party vide their letter dated 13-8-2010 (Ex.A7) repudiated the claim of the complainant stating that their various investigation and medical certificates confirm that the insured took treatment for high blood pressure and diabetic mellitus since February 2008 i.e. before obtaining policy and had willingly suppressed in the proposal Form.
The complainant contended that the insured never showed any symptoms of high blood pressure and diabetic mellitus at any time and further contended that the opposite party issued policy to her husband after thorough examination by their panel doctors and rejection of her claim on false and fabricated documents is unfair and it amounts deficiency in service.
The opposite party though in their repudiation letter dated 13-8-2010 Ex.A7) stated that their investigation revealed that the insured was suffering from high blood pressure and diabetis mellitus and took treatment prior to taking policy did not produce any document to prove the same and the opposite party chose to remain ex-parte.
In (1991) 1 SCC 9357 in case of Life Insurance Corporation of India V/s G.M. Channabasamma the Hon’ble Supreme Court observed as under, if the claim is repudiated by the insurance company on the ground that the insured had suppressed the material facts, the burden shall lie heavily on the insurance company.
After carefully going through the record and the arguments advanced by the counsel for complainant and judgement of Hon’ble Supreme court referred to above we are of the considered opinion that the repudiation of the claim of complainant by opposite party under the policy is arbitary and it amounts to deficiency in service.
Accordingly this point goes in favour of the complainant and against opposite party.
9. POINT No.2: In view of our findings on the foregoing point No.1 and the reasons mentioned there in we are of the considered opinion that the complainant is entitled for amount. When PW1 was examined by the Forum she prayed that she is entitled for Rs.5,00,000/- the sum assured and Rs.2,00,000/- the premium amount paid and Rs.50,000/- as compensation from opposite party.
As per Bajaj Allianz New unit gain schedule (Ex.A5) minimum death benefit is Rs.4,95,000/-. As per premium allocation rate percentage 45% of premium is allocated to unit purchase of funds in the first year and in 2-5 years. 95% of the premium collected is allocated to unit purchase.
In the complaint the prayer of the complainant is only for Rs.4,95,000/- policy assured amount and Rs.50,000/- towards compensation with regard to deficiency of service and negligence on the part of opposite party and Rs.5,000/- towards cost of the proceedings but in the chief affidavit dated 23-4-2012 she added Rs.1,98,000/- (Rupees One lakh ninety eight thousand only). In fact there is no pleading with regard to payment of Rs.1,98,000/- apart from Rs.4,95,000/-. When the Forum examined PW1 she went to the extent of praying the Forum for Rs.5,00,000/- and Rs.2,00,000/- the main principle is plead and prove. When there is no prayer for Rs.1,98,000/- in the complaint there is no question of proof. Therefore this Forum is grating only Rs.4,95,000/- with accrued interest at @ 9% per annum from the date of repudiation i.e. from 13-8-2010. However this Forum is directing the opposite party to pay a sum of Rs.15,000/- towards compensation for deficiency of service and negligence and this Forum is also directing opposite party to pay Rs.2,000/- towards costs of the proceedings. Point No.2 is decided only to the above extent.
10. POINT No.3 : In the result, the complaint is allowed partly directing the opposite party to deposit Rs.4,95,000/- (Rupees Four lakhs ninety five thousand only) with interest @ 9% per annum from the date of repudiation i.e. from 13-8-2010 and the opposite party is further directed to pay Rs.15,000/- (Rupees Fifteen thousand only) towards compensation for deficiency of service and negligence on the part of the opposite party. Opposite party is further directed to pay Rs.2,000/- (Rupees Two thousand only) towards costs of the present proceedings.
Opposite party is directed to comply with the above said directions mentioned in the order within one month from the date of receipt of copy of this order.
Typed to our dictation corrected and pronounced in the open Forum on this 3rd day of May 2012.
