O R D E R

(By Sri D.Shankar Rao, Member)

1.       The facts in brief, giving rise to the complaint are that the complainant is the nominee of her son Mr.Puppala Ashok who had taken life insurance policy No.16858010 from opposite parties company under term plan for basic benefit of Rs.14,00,000/- by paying premium Rs.5,944/-.  The term of basic benefit is 17 years with yearly mode premium payment.  The policy is commenced on 12^th April 2010 and inforce the same till 12^th April 2027.  During the validity period of said policy, the insured died suddenly on 03-11-2011 due to chest pain.  On the death of her son, the complainant made a claim with all relevant documents to opposite parties on 04-12-2012 through their branch office of opposite party No.3 at Nizamabad.  Even lapse of 9 months, the opposite parties have neither accepted claim nor repudiated the same for the reasons best known to them.  Having vexed with the attitude of opposite parties, the complainant got issued a legal notice dated 15-07-2013 and its reminder dated 26-08-2013 to the opposite parties.  It is the bounded duty and obligation of opposite parties to settle the claim within 45 to 60 days from the date of claim.  The transaction took place in between opposite parties and son of complainant is a statutory contract in accordance with the terms and conditions of the policy.  The opposite party No.3 who is the branch office of opposite parties is not able to ascertain whether the claim is under process or rejected.  As the opposite parties failed to discharge their contractual obligations in disposing claim since 9 months, the complainant has knocked the doors of the Judiciary for redressal.  Therefore the opposite parties are liable to pay the policy amount of Rs.14,00,000/- with 24% per annum, Rs.1,00,000/- compensation towards ignorant acts, Rs.50,000/- compensation towards mental agony, Rs.5,000/- towards legal notice, altogether comes to Rs.17,79,000/- plus future interest.

2.       The opposite party No.3 filed its counter and the same is adopted by opposite parties 1 & 2.  Briefly stated that the life assured Mr.Puppala Ashok had obtained policy No.16858010 on 12-04-2010 under Reliance term plan for a term of 17 years with sum assured Rs.14,00,000/- by misrepresentation, fraudulent and suppressed facts.  Prior to taking the policy, the life assured was taking treatment for Pulmonary Tuberculosis since April 2008 at T.B. unit Armoor.  Such fact was deliberately concealed by giving wrong answers in the proposed Form dated 7^th April 2010 which are contrary to the terms & conditions of the policy with an intention to deceive and induce the opposite parties to issue policy.  The life assured, answered in negative to the specific questions in respect of his health medication including tuberculosis.  The copy of policy and proposed Form are herewith filed. 

          Since the death of life assured occurred within 1 year 6 months 27 days, from the date of issue the policy, the opposite parties have conducted a statutory investigation after receiving the claim.  It was found that the life assured had undergone treatment for Pulmonary Tuberculosis from April 2008 to June, 2008 at T.B. unit Armoor under the revised National Tuberculosis control programme.  On further investigations, it was also found that he was irregular in T.B. treatment and reflected the same in T.B. card.  A true copy of T.B. card herewith produced. 

          In the present case the pre-existing disease, which the life assured suffering, was material in determining to grant the claim under the policy as per its terms & conditions.  It is apparent form the policy document and proposed Form that the life assured had full knowledge with the terms and conditions of the policy.  The concealment of pre-existing disease is contrary to his declaration made in the  proposed Form.  As per terms & conditions the policy shall became void and shall ceased all claims.  Therefore the opposite parties have repudiated the claim and cancelled the policy.  A true copy of repudiation letter dated 26-02-2013 is herewith produced.

          The opposite parties are not liable to make any amount under the policy which was obtained by fraud.  Hence the complainant has not made out any case for deficiency of service against opposite parties.  The complaint is frivolous, vexatious and liable to be dismissed with compensatory costs to the opposite parties. 

3.       During enquiry the complainant filed her evidence affidavit as PW1 and got marked exhibits A1 to A6 documents and closed her evidence.  The opposite parties 1 to 3 have not adduced their evidence nor marked the documents as exhibits on their be-half and reported that they have no evidence.  Hence the evidence of opposite parties 1 to 3 is closed. 

4.       Heard Arguments.

5.       The points for consideration are:-

          1)  Whether there is any deficiency Service on the part of opposite  parties                           1 to 3 in repudiation of claim under the policy ?

          2)  To what relief?

6.  POINT No.1 & 2 :

                    It is not disputed that the son of complainant Puppala  Ashok was issued Life Insurance Policy No. 16858010 under Reliance Term Plan with sum assured                Rs. 14,00,000/-.  The complainant being mother of the policy holder, she is the nominee of the policy also not in dispute.  The life assured Puppala Ashok was died on 03-11-2011 during subsisting period of the policy also not in dispute. 

                   The disputed fact is that the life assured Puppala Ashok had obtained the policy by suppressing his pre-existing disease Pulmonary Tuberculosis prior to taking policy.

                   In order to prove the case of complainant, she filed her evidence affidavit as PW1 and relied upon exbhits  A1 to A6 documents.

                   The opposite parties 1 to 3 have not adduced any evidence but filed Xerox Copy of T.B. Unit  Card and copy of repudiation letter dt. 26-2-2013 issued by Opposite party No. 1 along with the counter of Opposite party No. 3 which is adopted by Opposite parties 1&2.

                    The written arguments have filed by both counsels for the parties. Both the counsels have cited the Hon’ble Apex Court Judgments. The counsel for the complainant also submitted his oral arguments.

                    We have heard the arguments and perused the exbhits in A1 to A6 documents as well as unmarked documents of T.B. Unit Card and repudiation letter.  We have also gone through the cited Judgments of Hon’ble Apex Court.

                    Ex.A1 is the Life Insurance Policy No. 16858010 under Reliance Term plan for sum assured Rs. 14,00,000/- issued on 12-04-2010 infavour of Puppala Ashok. It is showing the basic benefit will be payable as sum assured Rs. 14,00,000/- on the death of life assured at any time prior to 12^th April 2027.  It is also mentioned that the name of complainant Mrs. P. Ganganarsu as nominee of the policy as mother of Life assured.  Ex. A2 is the Medical Certificate in form No. 8 issued in the name of Puppala Ashok.  It is mentioned that the death of Puppala Ashok on 03-11-2011 due to for as a consequence of chest- pain.  Ex. A3 is the legal notice dated 15-07-2013 issued by complainant. Ex.A4 is the track result of Indian Post in 3 copies for Ex.A3 legal notice.  Ex. A5 is the reminder legal notice dated 26-08-2013 issued by complainant.   Ex.A6 is the track result of Indian Post in 3 copies for Ex.A5 legal notice.

          The unmarked Xerox copy of T.B. Unit Card document is issued infavour of Puppala Ashok.  It is mentioned that the name of disease is Pulmonary new type patient  pretreatment from 28-04-2008 till 14-11-2008.  It is also mentioned the words as “Signature of MO with date” but not signed. 

           The copy of repudiation letter dated 26-02-2013  addressed to complainant   issued by opposite party No. 1 and marked copy to Opposite party No. 3. It is stated that, on a review, and documents collected during investigation of claim the life assured  Puppala Ashok was hospitalized and treated for Pulmonary Tuberculosis since April 2008.

          The opposite parties 1 to 3 have pleaded that the life assured Puppala Ashok had suppressed his Medical treatment history of Pulmonary Tuberculosis since April 2008 and gave negative answers in the proposed form.   Hence the policy is void            ab-intio.  Therefore the claim under the policy is repudiated.  As such the onus to prove the same is shifted against opposite parties.  

          Though the opposite parties 1 to 3 have mentioned that they have produced the policy document as well as life assured proposed form, but those are not placed into case record.  Except unmarked documents of Xerox copy of T.B. Unit Card and copy of claim repudiation letter dated 26-02-2013, there is no other document filed into the case record on behalf of opposite parties 1 to 3.  The said unmarked documents have been denied by complainant.  The counsel for complainant vehemently argued that there is no evidence or at least the evidence affidavit of a person  who issued such T. B. Unit Card into the Case record.  The opposite parties 1 to 3 also have not filed any evidence affidavit on their behalf of, supporting their pleas.

          Further no proof is filed that the claim repudiation letter dated 26-02-2013 was served against complainant.  The cited Judgment of Hon’ble Apex Court in P. Venkat Naidu V/s LIC of India & another reported in CPJ 2011 IV SC-6 is applicable in view of the opposite parties 1 to 3 have not produce any tangible evidence to prove that the life assured Puppala Ashok withheld information about his treatment of Pulmonary Tuberculosis since April 2008 prior to taking policy.

          We have read the Hon’ble Apex Court Judgment cited by complainant,                        P. Venkat Naidu  V/s LIC of India & another reported in CPJ 2011 IV SC-6 wherein the Hon’ble Apex Court held that since the respondents had come out with the case that the deceased did not disclose correct facts relating to his illness, it was for them to produce cogent evidence to prove the allegation.  In the instant case the contention  of the opposite parties 1 to 3 are also that the life assured Puppala Ashok had suppressed his medical treatment of Pulmonary Tuberculosis prior to taking the policy and gave answers in negative to the questionnaire in proposed form in respect of Medication history of Tuberculosis. 

          We have gone through the entire case record.  We have also scanned the unmarked documents of T.B. Unit Card in Xerox copy and copy of repudiation letter dated 26-02-2013 placed into the case record on behalf of opposite parties 1 to 3.  There is no signature & seal who issued the Xerox copy of T.B. Unit Card.  It is also not having proof that the claim repudiation letter dated 26-02-2013 was served against the complainant.  The opposite parties 1 to 3 have not filed any independent evidence or any statutory investigation report over the claim or at least any pies of evidence in respect of unmarked Xerox copy of T.B. Unit Card as proof & relevance.  In the absence of such evidence and in the light of Hon’ble Apex Court Judgment in between P. Venkat Naidu V/s LIC of India & another reported in CPJ 2011 IV SC-6, the decision taken by opposite parties 1 to 3 in repudiating the claim of complainant under the policy on 26-02-2013 is not correct and proper.  Therefore the opposite parties 1 to 3 are liable to pay inter-alia claim under the policy.  

                   The complainant has not filed any record how she is entitled the relief for compensation.

                   In view of aforesaid discussions and findings we are of the considered view that the Opposite parties 1 to 3 are liable to pay sum assured Rs. 14,00,000/- with interest under Ex. A1 policy and costs of the proceedings.  

7.       IN THE RESULT, the complaint is allowed in part as under :-

1.  The opposite parties 1 to 3 are directed to pay sum assured Rs. 14,00,000/- with 9% interest under Ex.A1 policy from the date of repudiation i.e 26-02-2013 till realisation to the complainant.
2.  The opposite parties 1 to 3 are further directed to pay Rs.1000/- to the complainant towards costs of the complaint.

          Typed to dictation, corrected and pronounced by the Member in Open Forum on this the 18^th day of November 2014.