O R D E R

Smt.T.Suneetha, Member:-  The complainant filed this complaint                      u/s 12 of the Consumer Protection Act seeking directions to the opposite parties to pay policy amount of Rs.10,00,000/- along with interest @ 18% p.a. from 02-04-2014 till realization, towards deficiency of service Rs.15,000/- and towards mental stress and damages Rs.10,000/- and costs of the complaint.

2.  In brief the averments of the complaint are these:

          The complainant obtained Vision Life Income Plan for life of his son Battula Venkata Naga Jwala Raja Sekhar vide policy No.005945411 on            31-01-2013 for Rs.10,00,000/- with monthly premium of Rs.2,579.09ps.  On 31-01-2014 the assured was admitted as an inpatient in St.Joseph’s Hospital, Guntur and died on 05-02-2014 due to cardio respiratory to bilateral pulmonary tubeuloins.  On 02-04-14 the complainant submitted claim intimation along with death certificate, written statement , cancelled cheque and other ID proofs to the opposite party for settlement of the claim.  The opposite party repudiated the claim of the complainant on 30-06-2014 reasoning that the life assured was suffering from psychiatric illness prior to his application for insurance.  The act of the opposite party in repudiating the claim is arbitrary and negligent.  The complainant never suppressed any information about his son and he was not suffering any periodic illness prior to date of policy.  At the time of issuance of the policy the 1^st opposite party branch was functioning at Narasaraopet and subsequently it was closed and thereafter all the correspondence was done by the complainant through the 2^nd opposite party.  The 2^nd opposite party who is the representative of the 1^st opposite party is arrayed in this complaint.  The complainant paid a sum of Rs.33,529/- towards premium of the policy.  The repudiation of the claim by the opposite party is not justified.  The opposite parties committed deficiency of service and liable to compensate the complainant.  Hence the complaint. 

3.    The opposite parties filed version and the contents in brief are hereunder:

          The 2^nd opposite party is the branch of the 1^st opposite party.  The averments mentioned in the complaint are baseless and devoid of merit.  It is well settled legal proposition that one who seek justice must come to the court with clean hands.  In the opposite parties investigation it was found that the complainant concealed material fact pertaining to his son/assured’s past medical history i.e. psychiatric illness for past seven years. 

The admission sheet medical progress notes states as follows:

Known case of psychiatric problem since seven years problem started while doing M.Tech, where he was blamed to the harassing girl students and was forced to marry a girl.  Later on he came to his home in Narasaraopet, wherein he confined himself to a room disassociated with his surrounds for seven years.  Able to take of himself for last three months. 

4.      In the proposal form the life assured wrongly answered to the questions regarding his health. 

11.     Insurability declaration for the life to be insured;

(B.)             In the past five years have you ever undergone any surgical operation at the hospital or clinic or under gone any investigations other than normal or negative results (including X-rays, E.C.G., Blood test, Biopsies etc.,)?

ANSWER:   NO

(E).   Have you ever been diagnosed with or treated/consulted for diabetes or sugar in urine, high or low blood pressure, chest pain, heart attack or any other heart disease, stroke, paralysis, kidney, urinary or bladder disorders, reproductive organ or prostrate disorders, mental disorders, neurological disease, musculoskeletal disorders, cancer or tumour or any type, gastro intestinal, liver diseases, tuberculosis, asthma or any other lung diseases, blood disorders, anemia, endocrine or thyroid disorders?

ANSWER:   NO

14.   Medical history:

ii).  Have you ever sought advise or suffered from any of the following :

f).  Dizziness/fainting spell, epilepsy, paralysis, stroke, nervous or mental/emotional disorder?

ANSWER:   NO

5.      The premium of Rs.5,159.46ps paid by the life assured before his death has been paid to the complainant being full and final settlement of the captioned policy.  The opposite parties have right to cancel the policy, if the statement given by the life assured in the proposal form is untrue and inaccurate.  There is no deficiency of service on the part of the opposite parties.  Therefore the opposite parties pray that the complaint be dismissed with compensatory costs in favour of the opposite parties. 

Both parties filed their respective affidavits.  Ex.A-1 to A-6 on behalf of the complainant and Ex.B-1 to B-7 were marked on behalf of opposite parties and Ex.C-1 marked by this Forum.     

6.  Now the points that arose for consideration in this complaint are:

1.       Whether the opposite parties committed deficiency of service by repudiating the claim of the complaint?

2.       To what relief the complaint is entitled?

7.   POINT No.1 & 2:-   The complainant alleged that the repudiation of his son’s death claim by the opposite parties is not justified.  The opposite parties contended that the complainant/ life assured concealed the facts about his medical history while answering the questions No.11 (B) (E) & 14 (ii) (F) in the proposal form and have elicited the progress notes regarding health condition in the admission sheet which is as follows :

Known case of psychiatric problem since seven years problem started while doing M.Tech, where he was blamed to the harassing girl students and was forced to marry a girl.  Later on he came to his home in Narasaraopet, wherein he confined himself to a room disassociated with his surroundings for seven years.  Able to take care of himself for last three months. 

8. Policy  promoted by Insurance Advisor of the opposite parties :- In Ex.B-1 proposal form the advisors report given by P.Rama Satyanarayana is as follows:

3.How do you know the LIFE to be insured/proposer         :  Business

4.How long have you known the life to be insured/proposer:  Y10 M5

     Investigation Report:- Conclusions given by the investigator     M.S,Prasad in the report EX B5 is as follows: 

It is observed that the insurance adviser promoted subject business is one and the same who promotes/mis sell policies selectively to chronic disease suffers, psychiatric patients etc.  The business of the present advisor shall be once again checked to prevent such mis-selling.

9.      The policy of the deceased is promoted by the agent of the opposite parties as per Ex.B-1 proposal form.  The investigation report also establishes the fact that the agent of the opposite parties proposed and promoted the proposal.   In this circumstance it is the look out of the opposite parties to check whether his declaration is correct or not before issuing the policy.              

10.    Cause of death :-The insured herein died due to Bilateral Extensive Pulmonary Tuberculosis (as per EX B5 investigation report ).There is no direct nexus between the cause of death and his past medical history. 

11.    In view of the opposite parties agent accepting and promoting the policy of the insured/deceased and in absence of direct nexus between the cause of death and his past medical history the opposite parties are liable to pay the insurance amount to the complainant in toto and answer these points in favour of the complainant.  

12.    In the result the complainant is partly allowed as indicated below : 

1.The opposite parties are directed to pay Rs.10,00,000/- (Rupees ten lakhs) to the complainant. 

2.The opposite parties are further directed to pay Rs.3,000/- (Rupees three thousand) towards compensation and Rs.2,000/- (Rupees two thousand) towards costs of the complaint to the complainant. 

The above order shall be complied within a period of six weeks from the date of receipt of copy of this order, failing which the Item No.1 will carry interest @ 9% p.a. till realization.        

          Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 15^TH day of July, 2015.

          MEMBER                                                         PRESIDENT (FAC)

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For Opposite Parties

Marked By This Forum:-

                                                                                                                                               PRESIDENT(FAC)

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.