The complaint is filed by the complainant for giving direction to 1^st opposite party to pay Rs.6,70,000/- covered under master policy; Rs.1,00,000/- towards compensation and for costs.

2.       The sum and substance of the case of the complainant as per the material averments made in her complaint is that her husband while taking loan of Rs.6,70,000/- from the 2^nd opposite party had also taken master policy for the said amount from 1^st opposite party as it is mandatory while at the time of obtaining loan for construction of house that subsequently her husband died on 2.8.2013 due to cardio and respiratory arrest in Vijayawada Institute of Nero Sciences (P) Limited, Vijayawada that when she made claim before 1^st opposite party, the same was repudiated and that she filed the complaint for the above reliefs after issuance of legal notice.  Whereas it is the main contention of the 1^st opposite party as per the material averments made in its written version that the claim of the claimant was repudiated due to suppression of facts by the life assured regarding his ill health while submitting proposal form for the policy in question and that the claimant is not entitled to have any reliefs.  While filing its written version, the 2^nd opposite party mainly contested that it has nothing to do with the claim of the claimant as it acted as facilitator only for the life assured to have the policy in question.    

3.       The complainant filed her proof affidavit and marked Exs.A1 to A8 in support of her case before the Forum.  The 1^st opposite party filed the proof affidavit of its Attorney and marked Exs.B1 to B7 to substantiate its case before the Forum.  The 2^nd opposite party filed the proof affidavit of its Manager and marked no documents.  Out of the above documents, Exs.A6 and B6 are one and the same.   

4.       The points for consideration are:        

(i)       Whether there is any deficiency in service on the part of the opposite parties ?

(ii)      Whether the complainant is entitled to have the reliefs as sought for ? and 

(iii)     To what relief ?

5.       Point No.1:

          The complainant filed the present complaint for the recovery of the policy amount, policy of which was taken by her husband, with such contention that her claim was repudiated illegally.  The complainant has also marked the photostat copies of the loan application, letter of sanction, statement of account, death summary, death extract, letter written by 1^st opposite party repudiating her claim, office copy of the legal notice and postal acknowledgement as Exs.A1 to A8 respectively before the Forum.  Whereas it is the main contention of the 1^st opposite party that as the life assured suppressed facts regarding his ill health while at the time of submitting proposal form for the policy in question, claim of the claimant was repudiated.  The 1^st opposite party has also marked the photostat copies of proposal form, policy details, claim intimation, medical record issued by Purna Heart Institute and other medical records, investigation report, letter repudiating the claim of the complainant and the reply got issued by it for the legal notice of the complainant as Exs.B1 to B7 respectively before the Forum.  As the Forum has already discussed above, out of the above documents, Exs.A6 and B6 are one and the same.

6.       The only controversy in this case is whether there is any suppression of material facts regarding his ill health by the life assured while submitting proposal form for the policy in question or not.  If it is proved that there is no such suppression of material facts, then the complainant will be entitled to have the reliefs as prayed for.  The attention of the Forum in this connection has straight away been diverted to Ex.B4.  Ex.B4 is the medical record issued by Purna Heart Institute, Vijayawada relating to life assured, dated 2.6.2007 and 9.6.2007.  It is specifically mentioned at Page 4 of Ex.B4 that the life assured suffered pain on right side of the chest.  A perusal of Ex.B1 shows that when a question was posed to the life assured at Column No.2 (2) about his ailments relating to chest pain prior to the submission of the original of the same, he answered negatively.  As far as the original of Ex.B1 proposal form is concerned, the same was submitted on 13.9.2011.  Whereas as per Ex.B4, the life assured suffered pain on right side chest on 2.6.2007.  No doubt, it is mentioned at Page 4 of Ex.B4 that one month prior to the above date of consultation, the life assured met with road accident.  It is by virtue of the same, the complainant wanted to impress upon the Forum that the life assured suffered such chest pain on account of such road accident.  But whatever may be the reason, the fact remains is that the life assured suffered chest pain prior to his submission of proposal form and he suppressed such fact while submitting the original of Ex.B1 proposal form.  As far as the taking of insurance is concerned, it is a contract of ‘utmost good faith’ and there should not be any suppression of facts regarding the health of the concerned life assured.  Even if illness suffered by the life assured was not the direct cause for his death, then also the same would amount to suppression of fact regarding his ill health.  So the fact remains is that the life assured suppressed such material fact contrary to the spirit of the contract.  When once the position is viewed in the above angle, it must be held that the claim of the claimant was rightly repudiated by the 1^st opposite party.  The 1^st opposite party has also marked photstat copy of medical record issued by Heart Care Center as part of Ex.B4 before the Forum.  But the above record is dated 18.12.2012.  Whereas original of Ex.B1 is dated 13.9.2011.  When such is the position, the above document marked as part of Ex.B4 will not help the case of the 1^st opposite party in any way.  Though the case of the 1^st opposite party with regard to the above aspect is not accepted, in view of the discussion made above, it must be held that there is no deficiency of service on its part.  While coming to 2^nd opposite party, even according to complainant, no relief is claimed against it.  Accordingly the point is answered.

7.       Point No.2:                

          In view of the answering of Point no.1 in the above manner, the claimant is not entitled to have any reliefs against the opposite parties.  Accordingly the point is answered.

8.       Point No.3:

          In view of the answering of Points 1 and 2, the complaint is liable to be dismissed.

          In the result, the complaint is dismissed, but in the circumstances, without costs.

          Typed by N. Ramesh Babu, Junior Stenographer, to my dictation, corrected by me and pronounced by us in the open Forum, this the 9^th day of February, 2015.                          

                                                                                    Sd/-

                                                                                 President

                                                                    Sd/-                                Sd/-      

                Member                           Member

District Consumer Forum-I,

                     Krishna, Machilipatnam.

Appendix of evidence

Witnesses examined

For the complainant:                                     For the opposite parties:

P.W.1: Muppidi Venkata Koteswaramma.      D.W.1:                

(by chief affidavit).                                        K.R.Viswanarayan, Attorney,

Head – Governance & C.S. of IndiaFirst Life Insurance Co. Ltd., 301, B Wing, The Qube, Infinity IT Park, Dindoshi Film City Road, Malad East, Mumbai – 400 097.

(by proof affidavit).

(1^st opposite party).

D.W.2:

Edara Rambabu, Branch Manager,

Andhra bank, Pamarru.

(by chief affidavit).

(2^nd opposite party).                            

Documents marked

On behalf of the complainant:

On behalf of the opposite parties:

                                                                                                  Sd/-                                                                                                                                                                                                               President