Presented by Sri B.K. Pati, Member:-<br /> <br /> The present complaint pertains to deficiency of service as provided under the Consumer Protection Act-1986. Its brief history is as follows:- <br /> <br /> Ratna Prava @ Ratna Kumari Behera, the wife of the Complainant was assured by the Opposite Parties, company for Rs.50,000/-(Rupees fifty thousand)only vide policy No. 592882066 on Dt.22/03/2004 wherein the Complainant was the nominee. The policy is to mature on Dt.22/03/2027. The first yearly premium of Rs.3,787/-(Rupees three thousand seven hundred eighty seven)only, was paid on the very date of opening of the policy i.e. Dt. 22/03/2004. The Policy holder died on Dt. 27/04/2004 at Christian Hospital, Diptipur due to Cardio-Pulmonary Arrest. The Complainant, being the nominee, applied for payment of the sum assured before the Opposite Party No.1(one). The Opposite Party No.1(one) vide letter Dt. 31/03/2006 refused to pay the sum assured on the ground that, the policy holder was suffering from Amenorrhea before she proposed for the policy and she gave a false statement regading the date of her last menstruation to obtain the policy and hence the claim was repudiated and the amount already paid towards the policy forfeited. The Petitioner drew the attention of Opposite Party No.2(two) and No.3(three) as regards the same, but in vain. The Complainant contends that the policy holder had not given false statement regarding her last menstruation and her death was due to Cardio-Pulmonary Arrest and as such, the Opposite Parties, by with holding payment of the sum assured, have committed deficiency of service.<br /> <br /> The Complainant claims from the Opposite Parties Rs.50,000/-(Rupees fifty thousand)only, the sum assured, Rs.30,000/-(Rupees thirty thousand)only towards damages, Rs.5,000/-(Rupees five thousand)only towards expenses, and Rs.8,000/-(Rupees eight thousand)only towards litigation expenses.<br /> <br /> The Opposite Parties in their version question the jurisdiction and maintainability of the present Forum to try the complaint claiming that the correctness of repudiation can only be determined by Civil Court and not the Consumer Forum. They contend that the policy bond being a contract between the insured and insurer, non-observance of the condition by one party absolves the other party from his legal liability. The Opposite Party No.1(one) after going through the details of the contents and footnotes of the proposal form accepted the proposal for insurance and issued policy No. 592882066 . It is evident from claim form B1 submitted by the Complainant/claimant the life assured was suffering from (a) Severe abdominal pain with history of (b) Amenorrhea for one and half month as on the date of admission to the hospital on Dt. 27/04/2004. So the life assured was aware of her illness and she suppressed the same to obtain the policy. Hence policy was repudiated by the Opposite Parties. <br /> The Opposite Parties pray for dismissal of the complaint with cost. <br /> <br /> Perused the complaint, the version of the Opposite Parties and copies of documents filed by the Parties and find as follows:-<br /> <br /> The Opposite Parties claim that the consumer law agencies do not have the power and jurisdiction to determine the correctness or otherwise, of repudiation made by the insurance company. Insurance constitutes and forms a part of services as provided under the Consumer Protection Act-1986 and so, this Forum is well within its jurisdiction to determine the validity of repudiation of such a case. <br /> <br /> The Opposite Parties contend that the life assured was suffering from Amenorrhea prior to taking the policy and she suppressed the same while taking the policy. The Opposite Parties quote Question No. 11(a),(e) & (i). Question No.11(a) is vague and no human being can be an exception to it. Question No.11(e) deals with really serious ailments like Diabetes, Tuberculosis, High blood pressure, Low blood pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy suppression of which might have rendered the claim fit for repudiation. The life assured was not found to be suffering from any of such ailments. Amenorrhea, from which the life assured was allegedly suffering from, at the time of taking the policy, is a common and routine health problem of women in general and hence, rightly, not included in the list of serious ailments enumerated by the Opposite Parties company. And when the insured admittedly died due to Cardio-Pulmonary Arrest, the claim of the policy cannot be repudiated on the mere ground that she gave a false statement as regards the date of her last menstruation.<br /> <br /> The above fact and circumstances lead to the irresistible conclusion that the Opposite Parties by repudiating the claim, have committed deficiency of service towards the Complainant. <br /> In the result, the Opposite Parties are directed, jointly and severally, to pay to the Complainant Rs.50,000/-(Rupees fifty thousand)only, the sum assured and Rs.5,000/-(Rupees five thousand)only towards cost/compensation, along with interest @ 9%(nine percent) per annum chargeable from Dt. 31/03/2006, the date of repudiation of the claim, within thirty days hence, failing which both the amount shall carry 12%(twelve percent) interest per annum till payment.<br /> Complaint disposed of accordingly.<br />