ADV. RAVI SUSHA, MEMBER This complaint is filed for directing the opp.parties to pay the policy amount of Rs.1,00,000/- with compensation and cost. It is stated in the complaint as follows: The complainant’s deceased husband Sri.A. Mohammed Mustafa availed a policy for Rs.1,00,000/- bearing policy No.781720600 from the 2nd opp.party in the year 1997. The mode of premium was once in three months. The policy was issued after due verification and enquiry from the side of the opp.parties and due medical examination by the approved doctor’s certificate of the opp.parties. The complainant’s husband fwas punctual in paying the premium from the very beginning and later he became a defaulter for four instalments. The entire premium amount till 24.6.99 was paid and the policy was renewed. After the renewal of the policy, the said A.Mohammed Mustafa the husband of the complainant effected premium till his demise date on 2.8.2000. The death of the complainant’s husband was a natural one. Since the complainant is the nominee cum legal heir of the policy amount of the deceased A Mohammed Mustafa the husband of the complainant, the complainant accordingly applied to the 1st and 2nd opp.parties for releasing the policy amount. But unfortunately the claim of the complainant was rejected by the opp.parties stating that the deceased was suffering from Tuberculosis and Diabetes since 11.4.1999, and he had suppressed these facts in the renewal statement dated 24.6.99. No such statement have been filled by the complainant’s husband. Only in certain documents filled by the 3rd opp.party in English alone were signed by the deceased husband without even knowing the contents therein as per the direction of the 2nd and 3rd opp.parties. The opp.parties have no right or power to reject the claim of the complainant after accepting all the relevant and original documents in connection with the policy from the complainant. There is deficiency in service on the part of the opp.parties. Hence prays for relief. The opp.parties have filed the version contending as follows: The complaint is not maintainable. The deceased Mohammed Mustafa had submitted a proposal for a money back Life Insurance Policy on 30.3.1997 and in consideration of the proposal a policy of insurance bearing No.781720600 for a sum assured of Rs.1,00,000/- with date of risk commencing from 28.3.97 and for a term of 15 years was issued on the life of Mohammed Mustafa. The premium was arrived at Rs.2411/- payable once in every quarter from 28.3.1997 till the date of maturity or till the earlier death of the life assured. The nominee under the policy is Rasiya Beevi the wife of the life assured. As per condition No.2 of the policy document if the said premium is not paid atleast within the grace period allowed after the due date, the policy will lapse. The life assured did not pay the consideration for the contract of insurance for its continuance viz, premium from 28.9.99 and did not care to pay further premium, thus causing the policy to lapse. The life assured opted for the revival of the policy. For that purpose he had submitted a personal statement regarding his health. His state of health as declared by him in the personal statement dated 24.6.99 is good. The 2nd opp.party received a letter dt. 23.8.2000 from Rasiya Beevi, the nominee that her husband who was the life assured under the policy died on 2.8.2000 and requested to settle the payment under the policy. She submitted the claim form and death certificate. Since the death of the life assured happened on 2.8.2000 ie, immediately after the revival of the policy an investigation was conducted in the matter of the claim. It was revealed in the investigation that the life assured Mohammed Mustafa was suffering from infection of lungs consolidation R midland lower zone and was also suffering from Recurrence of pulmonary Tuberculosis and diabetes mellitus since 1.4.99. He underwent treatment as an inpatient at Medical College Hospital, Thiruvananthapuram and inpatient number was 1908 as on 1.4.99. The life assured was a psychiatric patient and he also underwent treatment for the same at Medical College Hospital, Thiruvananthapuram before reviving the policy. He had not disclosed such ailments or such treatments while submitting the personal statement regarding for reviving the policy on 24.6.99. Since the death occurred within two years of the revival of the policy the matter of the claim preferred by the complainant was properly investigated and the decision to repudiate her claim had been arrived at after due application of mind in good faith in the larger interest of the insuring public. The reason for repudiation of the claim is made known to the complainant vide letter dt. 12.4.2001. There is no deficiency in service on the part of the opp.parties. Hence the opp.parties prays to dismiss the complaint. Points that would arise for consideration are: 1. Whether there is deficiency in service on the part of opp.parties 2. Reliefs and costs. For the complainant PW.1 is examined. Exts.P1 to P are marked. For the opp.parties DW.1 is examined. Ext. D1 to D5 are marked. Points 1 and 2: The Forum found that no positive evidence has been adduced by the opp.party to prove that the life assured was suffering from the diseases as alleged in the version. Forum allowed the complaint and directed the opp.parties to pay the complainant Rs.1,00,000/- with 9% interest from the date of filing of the complaint and also directed to pay Rs.1000/- as compensation and cost. Aggrieved by this order the opp.parties filed appeal before Kerala Stae Consumer Disputes Redressal Commission [Appeal No.215/2004]. After hearing the appeal, the State Commission remanded the matter to the Forum on the finding that the matter has not been adjudicated in the absence of objective evidence with respect to the contentions of the opp.party that the assured was suffering from the infection of lungs and recurrence of pulmonary Tuberculosis and diabetes since 1.4.99. The matter is remanded to the Forum by the State Commission with a direction to dispose the matter on merits within 3 months from the date of taking the matter into the file. Subsequent to that from the side of opp.parties DW.2 was examined and marked Ext.X1 case sheet of HDC sanatorium for chest diseases, Pulayanarkotta with regard to IP No.1008/99. During examination DW.2 deposed before the Forum that he has not treated the patient mentioned in Ext. X1 and further one of the treated Doctor. is now working in the hospital field. The specific contention of the opp.parties is that the Life assured having not disclosed of his suffering from pulmonary Tuberculosis and diabetic before revival of the policy. The only documentary evidence produced with regard to the said contention is Ext. X1 . There is nothing in Ext. X1 to show that prior to the revival of policy on 24.6.99, the Life assured was suffering and taking treatment for Tuberculosis and diabetic. The history recorded in Ext. X1 where the life assured was admitted in 1.4.99 cannot be treated as evidence, as the doctors, recording that history, were not examined as witnesses or their affidavit filed. So, it was not proved that the life assured was suffering and taking treatment for pulmonary Tuberculosis and diabetes even before the revival of the policy. Opp.parties failed to examined the concerned doctors. mentioned in Ext. X1. After marking Ext. X1 opp.parties submitted before the forum that they have no further evidence. From the available evidence we find that there is deficiency in service on the part of the opp.party who repudiated the claim of the complainant illegally. The complainant is entitled to get the policy amount. In the result the complaint is allowed directing the opp.parties to pay the complainant Rs.1,00,000/- with 9% interest from the date of filing of this complaint. The opp.parties are also directed to pay Rs.1000/- as compensation and cost. The order is to be complied with within one month from the date of receipt of the order. Dated this the 29th day of June, 2009. : I N D E X List of witnesses for the complainant PW.1. Rasiya Beevi List of documents for the complainant: P1. – Renewal premium receipt dt. 30.10.99 P2. – Renewal premium receipt dt. 28.3.2000 P3. – Renewal Premium receipt dt. 24.6.99 P4. – Appeal petition filed before the Zonal Manager, LIC of India Chennai, dt. 23.4.01 P5. – Letter to the complainant by the 1st opp.party dt. 12.4.01. P6. – Personal statement regarding health P7. – Advocate notice P8. – Acknowledgement cards P9. – Acknowledgement cards List of witnesses for the opp.parties DW.1 Abdul Rahaman List of documents for the opp.parties D1. – Policy D2. – Medical Examiner’s confidential report D3. – Claim form D4. – Proposal for insurance on own life D5. – Extract of original school certificate or record to be certified by Development Officer. X1. – O.P. tickets and prescription of Pulayanarcotta | 
