BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.1523/2016

DATED ON THIS THE 5^th October 2018

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

                     2) Sri. Devakumar.M.C.                  

                                                B.E., LLB., PGDCLP   - MEMBER

Sri. Devakumar,M.C.

Member

1.     The complainants filed the complaint under section 12 of the C.P.Act 1986, against the opposite parties, alleging deficiency in service and seeking a direction to pay balance amount of Rs.68,015/- with interest till date and compensation of Rs.1,50,000/- for the mental agony with such other reliefs.
2.     The complainants submits that, the life assured, has obtained an insurance policy for a sum assured Rs.1,00,000/- from opposite parties, duly submitting all the relevant documents relating to diagnosis in respect of his health condition.  The life assured failed to pay the premium amount between March 2012 to March 2013, which resulted the lapse of the policy.  Subsequently, the lapsed policy was revived by opposite party, considering the health report submitted by the life assured.  Three months later, the life assured died on 03.01.2014.
3.     The complainants, LR’s of life assured claimed Rs.1,37,600/- under the policy.  The ops deducting Rs.68,015/-, paid the balance amount of Rs.30,429/- and refused to pay the remaining on the grounds of suppression of facts.  Hence, the aggrieved filed the complaint, seeking reliefs.
4.     The opposite parties filed the version and admits the insurance policy obtained by the deceased.  On revival of the policy, fresh contract of insurance begins as per policy terms and conditions.  Since the claim was filed early on revival of the policy, the opposite parties found there was concealment of information relating to life assured’s health status prior to revival of the policy.  As such, the policy was treated as null and void.
5.     Later, the complainants approached the insurance ombudsman, seeking reliefs, which on deliberate verification, dismissed the complaint.  Hence, the deficiency in service is denied and prayed for dismissal of the complaint.
6.     Both parties led evidence by filing respective affidavits and relied on several documents.  Written arguments filed by the complainant.  Heard the counsel for the opposite parties.  Perused the material on record and posted for orders.
7.     The points arose for our consideration are:-

1. Whether the complainants establishes the deficiency in service by the opposite parties for deduction of Rs.68,015/- in respect of insurance policy obtained by the deceased life assured and thereby they are entitled for the reliefs sought?
2. What order?

8.    Our findings on the aforesaid points are as follows:

Point No.1 :- In the negative.

Point No.2 :- As per final order, for the following

:: R E A S O N S ::

9.    Point No.1:- The legal representatives of deceased life assured, filed the complaint seeking reliefs for the deduction of Rs.68,051/- from the policy benefits.
10. The deceased M.H.Krishnegowda obtained an insurance policy from opposite parties on 28.09.2005 and the policy period was for 17 years.  The life assured was hale and healthy and promptly paid the premium amount.  On failure to pay the premium amount between March 2012 to March 2013, the policy got lapsed.  The policy has been revived, on submission of medical reports from the approved medical officer of opposite parties and on payment of penalty with premium amount on 27.09.2013.  Later, the life assured M.H.Krishnegowda died on 03.01.2014 at JSS Hospital, Mysuru.
11. On verification of the early claim with documents, the opposite parties deducting a total sum of Rs.99,171/- towards the loan amount, interest, premium amount and other deductions and paid a sum of Rs.30,429/- only.  The clarification sought relating to deduction, was refused.  Further, the claim of sum assured was denied for suppression of facts.
12. Aggrieved with the same, a complaint was lodged with insurance ombudsman on 13.03.2015, which on considering the material on suppression of facts, during revival period of the policy repudiated the claim and passed an award.  On the grounds of insurance being a contract of utmost good faith, the insured is bound to give the correct information about his health related questions.  Further, upheld the decision of opposite parties to pay the paid up value and dismissed the complaint.
13. The decision relied on by the complainants does not support their contentions.  However, the opposite parties relied on several decisions rendered by the Hon’ble National Commission, which upheld the decision of opposite parties in repudiation of claims, on the ground of suppression of material facts relating to the health conditions, ailments, treatment availed.  In view of the same, we opine the decision of opposite party is correct and the complainants are not entitled for any reliefs sought for and the complaint is liable to be dismissed. Accordingly, the point No.1 is answered in the negative.
14. Point No.2:- In view of the above observations, the complainants are not entitled for any reliefs and hence the complaint is liable to be dismissed and hence, we proceed to pass the following

:: O R D E R ::

1. The complaint is dismissed.
2. Give the copies of this order to the parties, as per Rules.

(Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 5^th October 2018)