This is a complaint filed under Section 12 of Consumer Protection Act for an order directing the opposite party to pay the claim amount of `2,00,000 with interest at the rate of 12% per annum and to pay `50,000 as compensation for mental and physical pain together with the cost of `5,000.

          The case of the complainant in brief is as follows :  Insurance claim preferred by the complainant was repudiated by the Insurance Company and thereby the complainant lodged this complaint.  The husband of the complainant who had insured for an amount of ` 2,00,000, died on 29.09.03 for reasons of failure of blood and breath circulation.  Death was informed and submitted the claim with all documents.  But the opposite party was not ready to fulfill the conditions in policy and to allow the claim amount.  As per the said insurance policy no medical report is required.  Moreover at the time of taking policy there was no health problem suffered by the complainant.  His health was good at that time of taking insurance policy.  Since claim was repudiated the complainant sent lawyer notice demanding to pay the amount.  They sent reply stating various reasons.  One of the reasons to reject the claim was that the averments in the proposal were untrue.  As a matter of fact complainant’s husband has no connection with the averments in the proposal form.  The full entries in the proposal form were filled up by the agent of the opposite party.  So the contentions in reply notice are not lawful. There is no reason to say that the assured was died within a few months of taking policy causing much loss to opposite party.  As per the stipulations in the LIC policy the opposite party is bound to pay the said amount.  The denial of the amount is a deficiency in service on the part of opposite party and hence they are liable for payment of claim amount as well as compensation and cost.  Hence this complaint. 

          Pursuant to the notice opposite parties No.1 and 2 entered appearance and filed version jointly.  The brief facts of the contentions are as follows:  The policy bearing No.793762445 was issued to Late Sri. Abdulla M.K. assuring a sum of ` 2,00,000.  The proposer died due to attack on 29.11.2003 just after 3 months and 1 day of the date of policy 28.08.2003.  Proposer died at Al Mana General Hospital, Al-Khobar, Saudi Arabia and was buried there itself.  The proposer has given untrue answers suppressing and concealing information that were relevant for the assessment of the risk by the opposite parties No.1.  In fact the opposite party was suffering from cardiac rheumatism and he had undergone artificial valve transplantation two years prior to his proposing for insurance and the same concealed while answering the questions.  The medical report dated 31.12.2004 issued by Kingdom of Saudi Arabia, Ministry of Health States the history of the preceding illness as suffering from cardiac rheumatism as transplanted artificial valve 2 years back and he was under the treatment against thrombosis for long time, applying penicillin.  Also it is found the sign of operation undergone earlier in front part of the chest by setting artificial valve. The cause of death mentioned is sever stroke at blood circulation and respiratory system due to cardiac rheumatism.  It is clear from this report that the proposer was suffering from pre-insurance illness which he concealed in the proposal form and thereby fraudulently caused the insurer to issue a policy on his life. That is why the death claim benefit under the policy was repudiated by the 1^st opposite party.  The opposite party acted in accordance with law, rules and regulations.  There is no deficiency on the part of the opposite party.  Hence to dismiss the complaint.

          On the above pleadings the following issues have been taken for consideration.

1.      Whether there is any deficiency in service on the part of 2^nd opposite party?

2.      Whether the complainant is entitled for the relief as prayed in the complaint?

3.      Relief and cost?

          This is a complaint once decided by the Forum but it was challenged before the Hon’ble State Commission and the same finally remanded back to the Forum for fresh consideration and disposal of the same on merit with a direction to consider the additional documents produced by the opposite parties as per I.A.1246/10.  Accordingly opposite party filed  documents which is marked as Ext.B7 to B10.  At present the evidence consist of the oral testimony of PW1, DW1, Ext.A1, A2 and Ext.B1 to B10.

Issues No.1 to 3 :

          Admittedly husband of the complainant insured for a sum of `2,00,000.  Opposite party repudiated the claim preferred by the complaint, after the death of the assured.  The case of the complainant is that the claim form was filled up by the agent of opposite party and the insured only put his signature without knowing what was written in the Form.  Complainant pleaded that he was bodily fit and permanent employee, who had complied every conditions in the policy.

          Opposite party raised the contention that the assured Abdulla suppressed the material fact regarding his health which is sufficient enough to repudiate the claim.  He was suffering from cardiac rheumatism and he had artificial valve transplantation two years prior to taking of policy.

          Admittedly the life assured died on 29.11.2003, which is after 3 months and one day of the commencement of the policy.  Ext.B1 is the copy of the policy issued in the name of the policy holder Abdulla which would show that the said policy commenced on 28.08.2003 and complainant Shahida is shown as the nominee of the assured.  Ext.B4 is the death certificate that shows the assured died on 29.11.2003.  Ext.B4 also recorded the cause of death as severe failure of blood and breath circulation, which is not challenged.

          Ext.B3 is the repudiation letter dated 14.03.2005.  Claim was repudiated on the ground that the life assured had made incorrect statements and withheld correct information with regard to the health of assured at the time of effecting the assurance.  Opposite party reiterated the same stand in replying the legal notice Ext.A1 of complainant.  Ext.A2 is the reply notice of opposite party which justified their action in repudiating the claim.

          It can be seen that the perusal of the proposal submitted by the assured along with declaration stating that he has given only true and correct information.  Such decalaration has been signed by him in the presence of the LIC agent Deepthi Rajan.  The LIC agent has also affixed her signature as a witness to the said declaration.  It can also be seen that the LIC agent has also declared that she fully explained the questions and answers to the proposer and the same have been truthfully recorded.  That shows the case of the complainant that the life assured has only put his signature in the proposal form and the proposal form was filed by the LIC agent and that the life assured was not aware of the contents of the proposal can not be accepted.  PW1 also admitted that the proposal was filled up by the LIC agent in the presence of the life assured.  A close analysis of the facts would also reveals that the details incorporated in the proposal was not possible for the LIC agent to fill up the proposal form without the assistance and co-operation of the life assured, since the details were only known to the life assured.  It can be seen that the details regarding place of employment, details of the salary, annual income etc were within the knowledge of the life assured.  Hence it is clear that the form has been filled by the LIC agent with the details furnished by him.  The evidence of PW1 also indicates that the details were furnished by the life assured.  Hon’ble State Commission pleased to observe that the answers given in the proposal would bind the proposer, viz., the life assured M.K. Abdulla.

          However, it is pointed out by the Hon’ble Commission that the material point for consideration is as to whether the life assured had given false answers and incorrect information regarding his health condition while submitting the proposal for the policy.  It can be seen that the life assured gave the proposal stating his health condition as good and he had also given the answers to the effect that he had not undergone any treatment for any illness and he had no occasion to undergo any treatment pertaining to his heart, liver or other important organs of the body.  The opposite party relied upon Ext.B5 combined medical report (death) dated 06.12.2003.  Ext.B5 is only a photocopy of English translation of medical report issued in Arabic.  It is to be noted that the original translation was not produced before the Forum. It is pertinent to note that the opposite parties did not produce the original continued medical report dated 06.12.203, which is in Arabic.  In the absence of original it is not possible to rely upon a mere translation of the same.  It has to be taken into account that the original translation is  also not available.  Further more the complainant has disputed the genuineness and correctness of Ext.B5 documents.  It is therefore, as is correctly observed by the State Commission, incumbent upon the opposite party/LIC to prove Ext.B5 document.  It is not possible to peruse the original document which is in Arabic since the same is not available.  The Hon’ble State Commission also observed that the materials on record would show that the opposite party/ LIC have not succeeded in establishing the case regarding suppression of material fact by the life assured.  On analysing the facts it is also pointed out that the opposite party has got a case that they were not given sufficient opportunity to adduce evidence in support of their contentions regarding suppression of material facts by the life assured.  They have also case  that the original of Ext.B5 document which is in Arabic was produced by the complainant and that the opposite party/ LIC returned the original on getting the English translation of the document.  But complainant disputed the said case of opposite party/LIC.  It can also be seen that the opposite party had no such case in their written version.  It is considering the above aspects the Hon’ble State Commission pleased to remit the matter for affording an opportunity to the opposite parties to substantiate their case regarding suppression of material facts by the life assured while submitting the proposal for the life policy pointing to be noted that the opposite parties can very well call for the original combined medical report (death) issued by the Ministry of Health, Kingdom of Saudi Arabia.  It is also brought to notice that the original of that document can also be obtained through Indian Embassy at Riyadh.  The opposite party can also obtain a true English translation of the same and the translation can be proved by examining the person who translated the document.  Thus the matter was remitted back considering the above said aspects.

          Opposite party/LIC filed Ext.B1 to B10 documents to prove their contentions.  Primarily DW1 adduced evidence and Ext.B1 to B6 produced.  Ext.B7 to B.10 produced after remittance of the matter.  The above matter subjected to remittance for the purpose of affording an opportunity to substantiate their case regarding suppression of material facts by the life assured while submitting the proposal for the life policy. The analysis of entire evidence available on record before the matter remitted by the Hon’ble State Commission would show that the Insurance Company have not succeeded in establishing their case regarding the suppression of material facts by the life assured while submitting the proposal of the policy.  Availing the opportunity again to substantiate their case opposite party /LIC produced additional documents Ext.B7 to B.10.  How far these documents are helpful to come into a conclusion is the relevant question before us, at this juncture, to fulfill the very purpose of remittance.

          Ext.B7 dated 09.02.11 is the copy of letter send by the opposite party/LIC to the Embassy of India requesting to arrange for the original of Ext.B5 ‘Combined Medical Report (Death)’ in Arabic.  Ext.B7 reveals that opposite party had attempted to get the original of Ext.B5.  Ext.B8 dated 17.03.2011 is only a reminder of Ext.A7. Ext.B9 dated 20.05.2011 is a fresh letter of the same request of arranging for the original/duplicate copy of the combined Medical Report in Arabic.  Ext.B10 dated 14.10.2011 is the reminder of previous letters.  Opposite party/ LIC produced nothing more than the above letters Ext.B7, B8, B9 and B10.  These letters reveals the earnest attempt on the part of LIC to get the original or duplicate copy of the Combined Medical Report in Arabic.  But that alone cannot prove Ext.B5.  In short there is little further improvement from the earlier position before the remittance as far as the evidence is concerned.  The failure of the opposite party to prove the contention of the opposite party regarding the suppression of material facts continued to remain still, without discharging the burden to rpove the same which naturally attribute liability upon the opposite party / LIC to disburse the claim amount, since it is amount to deficiency in service.

          In the light of the above discussion we are of opinion that the complainant is entitled to get the claim amount of ` 2,00,000 with a cost of `1000.  Thus the issues No.1 to 3 are found in favour of complainant and order passed accordingly.

          In the result the complaint is allowed directing the opposite party to pay a sum of ` 2,00,000 (Rupees Two Lakhs only) as claim amount with a cost of ` 1,000 (Rupees One Thousand only) within one month failing which the complainant will be entitled to 12% interest on `2,00,000 from the date of filing of the case till the realization of the amount.  The complainant is entitled to execute the order on the expiry of 30 days, as per the provisions of Consumer Protection Act.

                     Sd/-                         Sd/-                         Sd/-

       President                  Member                   Member

APPENDIX

Exhibits for the Complainant

A1.  Copy of the lawyer notice dated 28.04.2005.

A2.  Reply notice.

Exhibits for the opposite party

B1.  Copy of the policy dated 27.08.2003.

B2.  Copy of the Ashadeep policy dated 28.08.03.

B3.  Copy of the letter repudiating claim dated 14.03.2005.

B4.(a) Translation of death certificate signed by Embassy.

B4.(b)  Notification of death.

B5.  Document in Arabic instituted translation.

B6.  Medical examiner’s confidential report.

B7.  Letter dated 09.02.11.

B8.  Letter dated 17.03.2011.

B9.  Letter dated 20.05.11.

B10.Letter dated 14.06.2011.

Witness examined for the complainant

PW1. Complainant

Witness examined for the opposite party

DW1. V.P. Gopalan

                                                                          /forwarded by order/

                                                                     SENIOR SUPERINTENDENT