BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION AT BANGALORE (URBAN)

DATED 11^TH DAY OF AUGUST 2022

ORDER

SRI.K.S.BILAGI, PRESIDENT

          The complainant being a nominee and son of his father Chennappa filed the complaint against the OPs u/s 35 of the Consumer Protection Act 2019 for the following reliefs;

1. Direct the OPS to pay the amount of Rs.15,00,000/- covered under the policy bearing No.613524689 dated 12.04.2019 under the plan and policy term No.823 along with accidental benefits covered under the said policy along with interest @ 18% p.a., to the complainant
2. Direct the OPs to pay a sum of Rs.1,00,000/- as compensation.
3. Direct the OP to pay cost of the proceedings
4. Grant such other relief/s.

2.       The case of the complainants in brief is as under;

The Chennappa father of the complainant during his life time took a life insurance policy bearing No.613524689 dated 12.04.2019 for a sum assured amount of Rs.15,00,000/- from OP3 and paid premium of Rs.20,381/-.

3.       On 14.06.2019, the father of the complainant met with an accident near Nelamangala - Sondekoppa road and complainant set the criminal law into motion by filing a complaint with the police, who registered a case in Crime No.254/2019 for the offences punishable u/s 279 and 337 of Indian Penal code.  The father of the complainant succumbed to injury on 22.06.2019.

4.       It is further case of the complainant that the death of father of the complainant was intimated to OP3 and claim petition was submitted, but OP2 issued a repudiation letter dated 21.12.2020 stating that the policy was taken by concealing the facts with false information.  The repudiation of claim of the complainant is illegal.  This act of the OP amounts to deficiency of service.  Hence this complaint.

5.       After receipt of notice, OPs appeared through their counsel and filed version.  They admit that father of the complainant insured his life for 25 years agreed to pay premium for 16 years for sum assured amount of Rs.15,00,000/- on 15.04.2019.  The father of the complainant had submitted ITRS of 2014-15, 2015-16, 2016-17 and 2018-19.  The OPs denied the claim of the complainant.  The complainant has not produced injury certificate and postmortem report to prove that his father sustained injury in the road traffic accident and succumbed to such injuries.

6.       It is further case of the OPs that prior to taking this policy, the father of the complainant had taken two more policies for Rs.58,00,000/- from K.R.Puram branch of the OP.  The fact of earlier policies was suppressed and concealed by deceased Chennappa.  Chennappa got withdrawn his earlier proposals on the health ground.  Therefore, the present policy of Chennappa suffers from the fact of concealment.  Therefore, there is no deficiency of service on the part of the OP.  They request to dismiss the complaint.

7.       The complainant files his affidavit evidence and relies on 11 documents.  The affidavit evidence of Manager Legal has been filed and relied on 16 documents. Heard the arguments and perused the records including written arguments.

8.       The points that would arise for our consideration are as under:-

1. Whether the complainant proves deficiency of service on the part of the OP?
2. Whether the complainant is entitled to reliefs mentioned in the complaint?
3. What  order?

9. Our answer to the above points are as under:

       Point No.1:- Negative

      Point No.2:- Negative

       Point No.3:- As per the final order.

                                      REASONS

10.    Point No.1 AND 2:   Both the parties have reiterated the facts pleaded in the complaint, version in their affidavit evidence.  Both the parties have also relied on their affidavit evidence and documentary evidence.  It is necessary to refer the documentary evidence produced by both the parties and admitted facts.

11.     The complainant’s father took Ex.P1 policy on 14.03.2019 for sum assured amount of Rs.15,00,000/- subject to payment of premium of Rs.20,381/-.  The due date for payment was on 12.01.2035, Ex.P2 is an endorsement issued by OP.  Ex.P3 is the endorsement issued by OP on 21.12.2020 repudiating the claim of the complainant stating that while answering the question Chennappa as a proposar concealed the fact of earlier withdrawal of the proposals submitted to K.R.Puram Branch and he also suppressed the fact of his health condition.  By issuing Ex.P4 legal notice dated 07.01.2021 the complainant called upon the OPs to pay sum assured amount of Rs.15,00,000/- with interest in respect of this policy and Rs.31,00,000/- in respect of another policy bearing No.613524690.  Ex.P5 is the postal receipt.  Ex.P6 is the postal acknowledgement of OP3.  Ex.P7 is the covering letter dated 15.01.2021 with repudiation letter dated 21.12.2020 wherein OP repudiated the claim of the complainant.

12.     The complainant has set the criminal law into motion by filing a complaint that his father met with an accident.  This fact is proved from Ex.P8, copy of the FIR.  Ultimately the policy filed Ex.P9 final report that the accused driver of the vehicle was not traced.  It is admitted and proved from Ex.P10 that Chennappa father of the complainant died on 22.06.2019.  Ex.P11 is the copy of the election ID of the complainant.  The evidence of the complainant and documentary evidence produced by the complainant are not in dispute.  It is proved that Chennappa father of the complainant had assured his life by sum assured amount of Rs.15,00,000/- with the OPs and father of the complainant died on 22.06.2019.

13.     The OP repudiated the claim of the complainant stating that the father of the complainant had suppressed his profession, he had no sufficient income and Chennappa also concealed the earlier proposals submitted to K.R.Pruam branch and withdrawal of the same.  Therefore, OPs contend that the policy obtained by concealing facts against the principle of good faith and the complainant is not entitled to sum assured amount from the OP under the policy mentioned in this complaint.  The OPs also contend that there is no deficiency of service.  These facts are reiterated by Manager Legal of OP in his affidavit evidence and OPs have relied on Ex.R1 to R18.

14.     After filing version, the complainant has not filed any rejoinder denying the fact of submitting two proposals by his father in the year 2018 to K.R.Puram Branch and sending request letter not pursuing the proposal on health ground. This fact is proved from the documentary evidence produced by the OP.

15.     Ex.R1 is a policy involved in this case. It indicates that father of the complainant took the policy for the sum assured amount of Rs.15,00,000/- on 14.03.2019 from Vijayanagar branch.  Ex.R2 and R3 are the copies of two proposal forms submitted by Chennappa in K.R.Puram branch of OP for a sum assured amount of Rs.58,00,000/- and Rs.10,00,000/-.  In both the proposals Chennappa disclosed his profession as real estate business showing his annual income as Rs.10,00,000/- from his business. The complainant has not produced any document to show that his father was doing either real estate business or the contract work.  Ex.P4 indicates that on 24.07.2018 Chennappa had submitted application to K.R.Puram Branch, stating that he is not required the policy because of his health is not good.  These Ex.R2 to R4 indicate that Chennappa father of the complainant had submitted proposals with K.R.Puram Branch, for two policies and got withdrawn the same.  However by submitted Ex.P5 proposal for insurance on 14.03.2019 the father of the complainant has obtained the policy involved in this case for sum assured amount of Rs.15,00,000/- showing that he was contractor. Ex.R2 and R3 were only proposals of Chennappa dated 23.07.2018 for proposed sum assured of Rs.58,00,000/- and Rs.10,00,000/-.  On the same day Chennappa gave Ex.R4 that he was not required policy because of his health was not good and he asked for refund of the amount.  Ex.R2 and R3 remained only proposals and Chennppa didn’t take the policies from K.R.Puram branch.

16.     While submitting Ex.R5 proposal for the present policy Chennappa claimed as a contractor and is only income was Rs.4,39,289/-.  Whereas present complainant had return Ex.R16 dated 10.12.2019 stating that his father Chennappa was doing painting work of the house and big buildings.  The present complainant nowhere whispered in Ex.R16 that his father was either as a contractor or painting contractor.  Therefore diseased Chennappa concealed the fact of his profession as painter while submitting Ex.R5 proposal for present policy.  The fact of concealment of his occupation by Chennappa is sufficient to say that repudiation of the claim of the complainant is legally correct.

17.     According to the complainant and Ex.R10 FIR the unknown two wheeler dashed to Chennappa who sustained injuries over chest, head, face and lost the tooth.  Ex.R10 further indicates that the treatment was provided complainant’s father at Nelamangala Government Hospital and he got admitted his father in Victoria Hospital.  The complainant neither produced the wound certificate nor produced the medical records of Nelamangala government hospital and Victoria hospital.  But later on the complainant cooked up a theory under Ex.R4 that doctor suggested to shift to Victoria hospital and he has not admitted his father in Victoria hospital.  The complainant set a criminal law into motion on 15.06.2019 and after a lapse of three moths, he cooked up a theory that his father was not admitted in Victoria hospital.  This theory is cooked up only to get money from the OP.  At this stage it is also once again relevant to refer Ex.R16.  According to the complainant’s letter dated 10.12.2019 after providing treatment to his father at Nelamangala Government hospital they suggested to take injured to Victoria hospital and his father refused to go to Victoria hospital.  It is further stated that after lapse of six days while taking Chennappa to Global Hospital, Chennappa died on the way.  This explanation also creates a doubt about the genuineness of the claim of the complainant.  At earlier point of time the complainant has admitted that his father was admitted in Victoria hospital.  Probably when he was not able to get favourable records from the Victoria hospital, he cooked up a theory that his father refused to go to Victoria hospital.

18.     It is proved that Chennappa did not peruse his two earlier proposals submitted to K.R.Puram LIC branch on health ground.  But while submitting the proposal for getting present policy for Rs.15,00,000/- he claimed as his health was good.  The complainant has not produced any health records of his father of the withdrawal of two proposals in the year 2018 till getting the present policy.

19.     Ex.R17 dated 12.05.2020 only medical certificate of cause of death of Chennappa indicates that sudden cardiac respiratory arrest secondary to ?? may be cardial infection(cause not known) brought dead.  It is admitted fact that Chennappa died on 26.02.2019  if this medical certificate is taken into consideration death was due to sudden cardiac.  The complainant has not produced any wound certificate of Chennappa either issued by Nelamangala Government Hospital or by any hospital to prove that Chennappa sustained injuries in the road traffic accident.  The complainant has not purposefully produced the medical records of treatment given to his father at Victoria hospital as there is a reference in the complaint to the police that Chennappa was admitted in Victoria hospital.  These factors also tilt against the complainant. The father of the complainant concealed certain material facts and complainant also suppressed the material documents. 

20.     It is also relevant to refer Ex.R5 and R18 the claim of the complainant was repudiated on 21.12.2020 referring clause 4a, 8a, 11d and g of the proposal.  As indicated in the previous paragraph Chennappa shown his occupation as a contractor.  But complainant has nullified this contention in his letter addressed to OP that his father was a painting the house and big buildings.  Clause 8a of the proposal reads that “has a proposal, (or an application for revival of a policy) on your life made to any office of the corporation or to any other insurer ever been; withdrawn, deferred, or dropped or declined was answered as NO. It is proved from Ex.R4 letter of the Chennappa dated 24.07.2018 that he was not required the term policy.  This fact was suppressed at the time of submitting proposal for present policy. This act of Chennappa amounts to concealment.

21.     When policy is obtained by concealing the material facts, the repudiation of the claim cannot be considered as illegal or deficiency of service.  The complainant failed to prove the deficiency of service and illegality in repudiation of his claim. Therefore, complainant is not entitled to any of the reliefs. Accordingly we answer point NO.1 and 2 in the Negative.

22.         POINT NO.3: In view of the discussion referred above, complaint requires to be dismissed. In the result, we proceed to pass the following;

O R D E R

1. The complaint is Dismissed without cost.
2. Furnish the copy of this order to both the parties.

(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open Commission on this 11^TH day of August, 2022)

Documents produced by the Complainant-P.W.1 are as follows:

Documents produced by the representative of opposite party – R.W.1 :

HAV*