ADV. RAVI SUSHA, MEMBER.

          This is a complaint for getting  to realize the policy amount of  Rs.5,00,000/- as insurance amount , compensation and other reliefs.

The averments in the complaint can be briefly summarized as follows:

          The complainant is the wife of Late A. Solomon, Mullasseriyil House, Kannanalloor.P.O., Kollam, that the said Solomon died on 6..2..2008 due to Heart attach at his residence, that he was working as Mechanical Fitter in Abudabi, that the opp.parties are dealing in insurance business, that the 1^st opp.party is the branch manager of Kollam Branch and the 2^nd opp.party is the Head Office at Pune, that on 15^th December 2007 the agent of the opp.parties approached to late Solomon and described about the various policies that are issued by the opp.parties and the benefits that is offered by the opp.parties, that the complainant’s husband agreed to purchase an Insurance Policy, that accordingly the complainant’s husband took a policy vide Policy No.A.0626521 by paying Rs.25,000/- by way of cheque bearing No.290083 of SBT., Kottiyam and filing up a proposal form truly and completely which was accepted by the 1^st opp.party after thoroughly verifying the same and convinced about the veracity of the contents and entries made in the proposal form, that even though he had visited the office many times the 1^st opp.party informed the late Solomon that the policy certificate is not ready and the same will be sent by registered post, that believing their  words he was expected to receive the  policy certificate by registered post, that on 6..2..2008 the said Solomon died due to Heart Attack, that the complaint had intimated the fact of death to the 1^st opp.party and claimed the policy amount and other benefits,  that the 1^st opp.party had obtained all relevant records from the complainant by making her believes that the policy will be processed and the claim amount covered by the policy will be given to the complaint without delay, that even though the complainant was waiting for a long time the complainant could not receive the policy amount till date.  Hence filed this complaint for getting the policy amount and  reliefs.

Opp.parties counsel filed objection before the Forum raising contentions that  the opp.parties had not issued any policy to the said Solomon, and also they contented that the said Solomon had suppressed the material fact such as he was a diabetic, that in this context he choose to mention that the said Solomon did not appear before a medical  officer  even after repeated request, that however he appeared before the Medical Officer on 4..2..2008 and  disclosed that he was a diabetic, that so his proposal was not accepted by the opp.party and he is not entitled for any amount as compensation..  Hence the opp.parties prays to dismiss the complaint.

Points that would arise for consideration are:

1.     Whether there is any suppression of material facts?

2.     Whether there is any deficiency in service on the side of opp.parties

3.     Reliefs and cost.

For the  complainant  PW.1 and 2 were examined and Exts. P1 and P2

marked

For the opp.parties DW.1 and 2 were examined and Exts. D1 to D7 are marked.

POINTS:

In this case, the opp.parties had not filed any version.   During cross examining, DW.1 deposed that they have not filed any version.   An objection signed by the  Advocate alone cannot be accepted as pleadings against the complainant.  Without filing proper version, mere adducing  evidence does not have any legal value.  Here PW.1 and PW.2 were examined in chief and cross examined by the opp.parties counsel and adduced oral and documentary evidence from opp.parties side.

Here there is no dispute that the opp.party has received a sum of Rs.25000/- from the complainant’s husband Sri.A.Soloman [deceased] for purchasing an insurance policy from the opp.party, on 10..1..2008 by way of cheque bearing No.290083 of SBT, Kottiyam and issued Ext.P1.   The complainant’s husband had died due to heart attack on 6..2..2008 ie. he had died  about one months of the date of proposal.

Counsel for the opp.party has not been able to show that there is any nexus between Diabetes and the heart disease because  according to both sides cause of death was due to heart failure.   The main contention of  opp.parties counsel is that the deceased had suppressed material fact regarding his health as he had been suffering from diabetes in Ext. D1 proposal form, claim preferred by the complainant had not been paid.  The opp.party reluctant to pay the claim amount on the basis of Ext. D4  Medical report prepared by DW.2.   Since he filled Ext.D1 that he had not been suffering from any disease, it is unbelievable that such a statement was made by the deceased soloman before the panel doctor of the opp.party ie DW.2.  that he is suffering from diabetics.  It might have been made by the opp.party or DW.2 himself for helping the opp.parties.  It is not clear from Ext. D4 that how much time he had been suffering from diabetes.  Moreover there is no evidence that he got treatment for diabetes prior to Ext. D1.  Thus it cannot be said with certainly that he had intentionally made fraudulent suppression of material facts and further that material fact had no nexus with the cause of death.

          Another contention of opp.party  is that the complainant’s husband’s payment is Rs.25,000/- had not been accepted as a premium amount and he never became a policy holder.   But in Ext. P1 issued by the opp.party clearly stated that the name of policy holder is  A Soloman.  Here also the opp.parties contention cannot be accepted.  Learned counsel of the complainant argued that as per the provisions of Insurance Act,  if the proposal is not accepted then the proposal has to be  rejected and the same is to be intimated to the proposer within 15 days from the date of receipt of the proposal form.  Otherwise it will be presumed that the proposal is accepted.  In this case opp.party DW.1 admitted that they have not rejected the proposal form till the complainant submitted the claim .  Consumer case of LIC of India and another V/s. Jyothi Shilka in Appeal No.17 of 2007 passed by Rajasthan State  Consumer Disputes Redressal Commission, Jaipur, it is stated that as per regulations provided under Insurance Regulatory and Development Authority, all proposals shall be processed within a reasonable period not exceeding  15 days from receipt of proposal by the insurer.   Here proposal received by the opp.party on 10.1.2008.   That proposal should have been processed within 15 days as provided under guidelines. Learned counsel for the opp.parties argued that they have sent Ext. D3 series to the deceased, but he did not appear before the medical officer in time.  Here the opp.parties failed to prove Ext. D3 series, by producing any postal receipts  or Acknowledgement cards.  Hence Ext. D3 series cannot be accepted.  In this case contract concluded on receipt of Rs.25,000/- dated 10..1..2008 .  Here repudiation of claim cannot be justified.   There is clear deficiency in service on the part of opp.parties.   The point found accordingly.  The Legal heirs of Mr.A. Soloman are entitled to get the policy amount .   According to the complainant her husband had taken the policy having sum assured amount of Rs.5,00,000/- .  Opp.party denied the said contention.  According to them the sum assured is Rs.1,25,000/- only.   As per Ext. D1 proposal form , it is clearly mentioned that the sum assured is Rs.1,25,000/-.  Hence the complainant is entitled to receive only that amount as sum assured.

In the result the complaint is allowed in part.  Opp.parties are directed to pay Rs.1,25,000/- with interest at the rate of 9% per annum and cost of Rs.5,000/- .  The order is to be complied with within one month from the date of  receipt of the order.

          Dated this the 13^th day of March, 2012

List of witnesses for the complainant

PW.1. – Jaseentha  Soloman

PW.2. – Smitha Soloman

List of documents for the complainant

P1. – Receipts

P2. – Death Certificate

List of witnesses for the opp.parties

DW.1. – Ratheesh

DW.2. – Anil Robi

List of documents for the opp.parties

D1. – Proposal form for Life Insurance

D2. –Authorization letter

D3. – Letter sent by Bajaj Allianz to the complainant dt.11..1..2008

D4. – Medical report.

D5. – Invade register

D6. – Underwriting sheet

D7. – Policy conditions