Order-13.

Date-21/06/2017.

       Shri Kamal De, President.

This is an application u/s.12 of the C.P. Act, 1986.

Complainant’s case, in short, is that her husband Ajaharul Haque since diseased availed loan from M/s. Reliance Capital Limited (OP-2) to purchase a commercial vehicle being No. Tata Motor Carego Rack 2013 to the tune of Rs.15,82,454/- . The deceased husband of the Complainant also executed an agreement  dated 30.03.2013  against  the said loan and the loan to be repaid in 59  monthly installments amounting to Rs.37,500/-. It is also stated that the life of Ajaharul Haque since deceased was also insured by Bharati Axa Life Insurance Company  Ltd., OP-1 under the policy being no 20000014 which was issued to Ajaharul Haque and it was insured with the husband i.e. borrower Ajaharul Haque will be entitled to the benefits as per the policy. The certificate of the Insurance  Policy was also issued on 29.03.2013 with coverage amount of rs. 15,60,000/-. The term was for 60 months which would expire on 30.03.2018. It was also ensured by OP-1 that the husband of the Complainant would be entitled to death benefits payable by the Company as per the contract of Insurance. It was also ensured  that if the Complainant dies at the end of 10 months from the date of issuing the policy, he will be entitled to get Rs.13,93,065/-. It is stated that Ajaharul Haque died of heart attack on 21.01.2016 at New Life Nursing Home. It is stated that the Complainant is entitled to get the benefit i.e. Rs.13,93,065/- from OP-1.  It is also alleged that the Complainant claimed money from the OP-1, but OP-1 repudiated the claim stating that the husband of the Complainant was known patient of tongue cancer since October,2011 and was hospitalized for treatment of the same before enrolment under the Policy and that the ‘self filled questionnaire’ by him has been found to be false. It is stated that Ajaharul Haque died of heart attack and he was not also medically examined at the time of enrolment of the Policy  by the Company.  It is stated that  the Complainant is beneficiary of the Policy and has prayed for a direction upon OP-1 to pay to the Complainant an amount of Rs.13,93,065/-. Hence this case.

            OP-1 has contested the case in filing w.v. contending inter alia that the case is not maintainable either in fact or in law and the allegations in the petition of Complainant are also denied. It is stated that the instant complaint  is false and malicious. It is stated that the husband of the Complainant took loan from Reliance Capital Limited (OP-2) to purchase a Commercial Vehicle. The deceased life insured was offered the Policy  Bharati Axa Life Insurance Company Limited and the Complainant after completely understanding the terms and conditions of the said Policy decided to take the same. The Death Life Insured (DLI) filled up the proposal form for a sum assured of Rs.15,60,000/- under the said Policy and a gross single  premium of Rs.22,453.57 was paid. OP issued Group Policy No. 1000014 on March 29,2013 to the DLI. Unfortunately, on 31.01.2014, life assured expired  and a claim form was submitted by the nominee i.e. the Complainant. On receipt of death claim by OP-1, it was  noted that the DLI, aged-34 years had expired within 10 months from the inception of the Policy. Opposite Party conducted inspection of the said claim and during inspection it was established that the DLI was a patient of CA Tongue since October,2012 and was hospitalized prior to the taking of the Policy, moreover, the DLI underwent a surgery and the one of the causes of the death has been mentioned as CA Tongue. It is stated that the DLI willfully suppressed the material fact at the time of filing the Policy and therefore, the said claim was repudiated. It is alleged that the said Policy was obtained by suppression and misrepresentation of fact. This OP has prayed for dismissal of the case.

            OP-2 has also contested the case in filing w.v. contending inter alia that the Complainant has not made any allegation or cause of action against OP-2. It is stated that OP-2 is a NBPC who had financed a Commercial Vehicle to the deceased husband of the Complainant. The instant issue relates to repudiation of Insurance by the OP-1 and OP-2 is not an necessary party to the case. It is stated that the Complainant has pursued multiple remedies against the multiple OPs in a single consumer case. It is stated that the Complainant is misconceived and is liable to be dismissed.

Point for Decision

1)         Whether the OPs are deficient in rendering services to the Complainant?

2)         Whether the OP1 has repudiated the claim of the Complainant arbitrarily?

3)         Whether the Complainant is entitled to get relief as prayed for?

Decision with Reasons

            We have travelled over the documents on record i.e. Certificate of Insurance  and its terms and conditions, photocopy of Death Certificate, photocopy of Claim repudiation letter, photocopy of Medical Certificate of New Life Nursing Home, photocopy of Hospital treatment certificate, photocopy of last attending Doctor’s certificate as filed from the side of the Complainant.

            We have also gone through the documents filed from the side of OP, namely photocopy of Death Claim Form, photocopy of last attending Doctor’s certificate, photocopy of Discharge of Disan Hospital, photocopy of Medical Certificate of New Life Nursing Home, photocopy of Accounts Statement, photocopy of Self filled questionnaire, photocopy of Certificate of Insurance, photocopy of investigation report, photocopy of Discharge Certificate and other documents on record.

            We find that the Deceased Life Insured (DLI) had history of post operated case of CA Tongue since October, 2012 at Apollo Hospital, Chennai.  On 20.01.2014, he was admitted at New Life Nursing Home, where he expired on 31.01.2014 due to CA Cardiac Respiratory Failure in case LRTI Sepsis, CA Tongue. It also appears that the DLI did not disclose about the disease CA Tongue at the time of availing the Policy. It also appears from the treatment papers of the Hospital that the DLI underwent a surgery as well.

            We find that the Policy was obtained by him by suppression and misrepresentation of the facts in the ailment form. He also answered ‘No’ as against the replies, ‘whether he suffered from any disease like Cancer, Cardiac disease, Heart disease, Heart Attack and Angina etc. etc’. It is  submitted by the OP-1 that had it been the OP aware of his health status at the time of singing of the application for Insurance,  the said Policy would not have been issued to the DLI at the first steps. We find that OPs have repudiated the claim of the Complainant on the ground of suppression of material facts by the DLI at the time of filling of the proposal form.  We do not find any negligence or deficient in service whatsoever on the part of the OP, as such.

            Regarding OP2, we find that DLI entered into a loan-cum-hypothecation agreement on 30.03.2013. The relation between the deceased and OP-2 happens to be the relation of Debtor and Creditor. Moreover, the Complainant has not made out any allegation against OP2.  OP2 had financed a Commercial Vehicle to the deceased husband of the Complainant. The instant case relates to repudiation of Insurance by OP-1.

            We find that Complainant has conjoined multiple remedies against OPs in this case. We do not find any deficiency in service or unfair trade practice on the part of the OPs.

            In result the case merits no success.

Hence,

Ordered

That the instant case be and the same is dismissed on contest against the OPs.

            We make no order as to cost.