<br /> COMPLAINT FILED: 29.08.2008<br /> <br /> BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN)<br /> <br /> <br /> 12th NOVEMBER 2008<br /> <br /> <br /> PRESENT :- SRI. A.M. BENNUR PRESIDENT <br /> SMT. M. YASHODHAMMA MEMBER <br /> SRI.A.MUNIYAPPA MEMBER <br /> <br /> COMPLAINT NO.1906/2008<br /> <br /> <br /> COMPLAINANTS 1. Smt.R.Yashoda,W/o Late Kempaiah Ramalingaiah,Aged about 45 years,R/at:No.431/C, “Shivakrupa”2 A Cross, 9th Main Road,Ideal Homes Township,Raja Rajeshwarinagar,Bangalore – 560 098.2. Smt.R.Divya,D/o Late Kempaiah Ramalingaiah,W/o Lohit,Aged about 25 years,R/at: No.5, 4th Cross,Supraja Nagara,Chunchangatta Main Road,Konanakunte,Bangalore – 560 062.3. Kum.R.Prathiba,D/o Late Kempaiah Ramalingaiah,Aged about 20 years,R/at: No.431/C “Shivakrupa”2 A Cross, 9th Main Road,Ideal Homes Township,Raja Rajeshwarinagar,Bangalore – 560 098.4. Kum.R.Vanitha D/o Late Kempaiah Ramalingaiah,Aged about 18 years,R/at: No.431/C “Shivakrupa”2 A Cross, 9th Main Road,Ideal Homes Township,Raja Rajeshwarinagar,Bangalore – 560 098.Advocate – Sri.Varadaraj R Havaldar.V/s.<br /> OPPOSITE PARTIES 1. ICICI Prudential Life Insurance Company Limited.,No.1, Industrial Layout,SJR Primus, 2nd Floor,Koramangala,Bangalore – 560 095.2. ICICI Prudential Life Insurance Company Limited.,Central Claims Department,4th Floor, Stanrose House,Appa Saheb Maratha Marg,Prabhadevi,Mumbai – 400 025.Maharashtra.Advocate – Kumar & Bhat <br /> O R D E R<br /> <br /> <br /> This is a complaint filed U/s. 12 of the Consumer Protection Act of 1986 by the complainants seeking direction to the Opposite Party (herein after called as O.P) to pay insurance claim of Rs.1,50,000/- and a compensation of Rs.50,000/- on an allegations of deficiency in service. <br /> <br /> The brief averments, as could be seen from the contents of the complaint, are as under:<br /> <br /> The husband of complainant No.1 father of complainant No.2 to 4 Kempaiah Ramalingaiah obtained an L.I policy from OP for a sum of Rs.1,50,000/- on 16.04.2007. He was prompt in making payment of the premium without any default. The said life assured died on 20.08.2007 leaving behind the complainants as his legal heirs that to complainant No.1 being a nominee under the said policy. After the death of her husband, complainant No.1 made a claim to OP to settle the policy amount, sum assured by producing all the relevant documents for their consideration. Unfortunately OP repudiated the said claim on 24.03.2008 contending that there is a suppression of material facts with regard to the disease and treatment taken by the life assured while submitting the proposal. The life assured died due to Myocardial Inforction (AWMI) and secondary cause is Diabetic. Deceased was hale and healthy, he was not aware of the said ailment nor he was subjected to medical examination before acceptance of the said proposal. The said repudiation is unjust and improper without due application of the mind. OP admitting their liability came forward to pay only ex-gratia amount of Rs.15,248/- as against the sum assured. Complainants are not ready to accept the same. The hostile attitude of the OP has caused them both mental agony and financial loss. Thus they felt deficiency in service on the part of the OP. Under the circumstances they are advised to file this complaint and sought for the reliefs accordingly.<br /> <br /> 2. On appearance, OP filed the version denying all the allegations made by the complainant in toto. According to OP the life assured concealed and suppressed certain material facts with regard to his ailment and the treatment taken while submitting the proposal. The said policy was under non medical category, hence he was not subjected to medical examination. But within a span of 4 months from the date of issuance of the policy he died, cause for death is diabetes and CA Myocardial Infraction (AWMI). Life assured deliberately gave wrong answers to question No.27. On through investigation OP came to know that life assured was a known diabetic and he was on regular treatment. Under such circumstances OP is justified in repudiating the said claim. The other allegations made by the complainants are all false and frivolous. Complaint is devoid of merits. Among these grounds, OP prayed for the dismissal of the complaint.<br /> <br /> 3. In order to substantiate the complaint averments, the complainant filed the affidavit evidence and produced some documents. OP has also filed the affidavit evidence and produced the documents. Then the arguments were heard.<br /> <br /> 4. In view of the above said facts, the points now that arise for our consideration in this complaint are as under:<br /> <br /> Point No. 1 :- Whether the complainants have Proved <br /> the deficiency in service on the part of <br /> the OP?<br /> <br /> Point No. 2 :- If so, whether the complainants are <br /> entitled for the relief’s now claimed?<br /> <br /> Point No. 3 :- To what Order?<br /> <br /> <br /> 5. We have gone through the pleadings of the parties, both oral and documentary evidence and the arguments advanced. In view of the reasons given by us in the following paragraphs our findings on:<br /> <br /> Point No.1:- In Affirmative<br /> Point No.2:- Affirmative in part<br /> Point No.3:- As per final Order.<br /> <br /> <br /> R E A S O N S<br /> <br /> 6. At the outset it is not at dispute that the husband of complainant No.1 father of complainant No.2 to 4 Kempaiah Ramalingaiah obtained the life insurance policy from OP on 16.04.2007, sum assured is Rs.1,50,000/-, he has paid the premium as contemplated. It is also not at dispute that the said life assured died on 20.08.2007 that is hardly within a period of 4 months from the date of issuance of policy. The cause of death is due to AWMI and secondary cause is diabetes. After the death of life assured complainant No.1 being a nominee and other complainants being heirs approached the OP to settle the claim and pay the assured sum, but OP failed to heed to their request and demand. On the other hand OP repudiated the claim on 24.03.2008 that is nearly after the lapse of 7months. Thus complainants felt deficiency in service.<br /> <br /> 7. As against this it is contended by the OP that there is a suppression and concealment of material facts with regard to the health condition of the life assured. Though life assured is aware of the fact of diabetes, he failed to mention the same. It is a non medical category policy. Under such circumstances OP is not obliged to subject the said life assured for the medical examination. The medical reports obtained by the OP during the course of investigation clearly shows that he is a known diabetic and on regular treatment. With all that the answers given by the life assured to question no.27 in the proposal form are other wise. The documents themselves show that life assured was suffering from diabetes. Hence they are justified in repudiating the claim.<br /> <br /> 8. We have gone through the proposal, who filled it up answered said question No.27 is not known. For question No.27 simply some dots were put across at the block as ‘No’. The said proposal also speaks to presence of one advisor may be the agent of OP. Whether the information furnished under the said proposal is actually made by the life assured is not known. To substantiate their defence OP has not examined their so called agent or advisor who must have filled up the said proposal form. Hence for this simple reason the defence of the OP does not hold much force with regard to their claim. In client confidential report it is mentioned the general assessment with regard to the health condition of life assured is good. Certain witnesses have signed the said declaration. This part of the proposal form goes against the defence set out by the OP.<br /> <br /> 9. In addition to that the said life assured died due to heart attack (AWMI) and the secondary cause of death is diabetes. When that is so, it can’t be said that life assured died because of the diabetes only even if it is there. So on this score also OP defence does not hold much force. We are satisfied that the complainants are able to prove the deficiency in service on the part of the OP. The repudiation appears to be unjust and improper. Complainants for no fault of theirs were made to suffer both mental agony and financial loss. Under such circumstances they are entitled for certain relief. Accordingly we answer point Nos.1 & 2 and proceed to pass the following: <br /> <br /> O R D E R<br /> <br /> The complaint is allowed in part. OP is directed to settle the insurance claim for Rs.1,50,000/- the sum assured and pay the same to the complainants within four weeks from the date of communication of this order along with a litigation cost of Rs.500/-.<br /> <br /> (Dictated to the Stenographer and typed in the computer and transcribed by him, verified and corrected, and then pronounced in the Open Court by us on this the 12th day of November 2008.) <br /> <br /> <br /> <br /> <br /> MEMBER MEMBER PRESIDENT<br /> <br /> <br /> Vln* <br /> <br /> <br />