BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. M.N.MANOHARA, B.A., LLB., Member, 3. A.P.MAHADEVAMMA, B.Sc., LLB., Member, ORDER Complaint No.MDF/C.C.No.133/2009 Order dated this the 11th day of February 2010 COMPLAINANT/S Smt.Swapna W/o Dayananda D. Opposite to Chamundeswari Temple Road, Chamundeswari Nagar, Mandya. (Sri.H.K.Nangegowda., Advocate) -Vs- OPPOSITE PARTY/S Reliance Life Insurance, No.28, East Wing, 4th Floor, Centenary Building, M.G.Road, Bangalore 560 001. (ABSENT) Date of complaint 11.11.2009 Date of service of notice to Opposite party 14.12.2009 Date of order 11.02.2010 Total Period 1 Month 27 Days Result The complaint is allowed, directing the Opposite party to pay the insurance amount of Rs.2,50,000/- to the Complainant with interest at 8% p.a. from 27.06.2009 with cost of Rs.500/-. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act, 1986 against the Opposite party claiming the insurance amount of Rs.2,50,000/-. 2. The case of the Complainant is that her husband D.Dayananda, had obtained a policy No.12087931 from the Opposite party for Rs.2,50,000/-. The said D.Dayananda, fell down in his house on 29.10.2008 complaining of chest pain and he was taken to Primary Health Centre, Maduvinakodi, K.R.Pet Taluk, Mandya District, who died due to acute myocardial infarction. After the death of D.Dayananda, the Complainant being a nominee, preferred the claim. But, the Opposite party has not settled the claim, but issued endorsement dated 27.06.2009 repudiating the claim on untenable grounds that the deceased D.Dayananda had brain tumor at the time of insuring his life. The Opposite party has repudiated on false ground and has committed deficiency in service. Therefore, the present complaint is filed. 3. Notice served on the Opposite party, but remained absent and version not filed. Thereafter, the Complainant has filed affidavit and documents. 4. We have heard the counsel for the Complainant. 5. Now the points that arise for our considerations are:- 1. Whether the repudiation of the claim by the Opposite party is proper? 2. Whether the Opposite party has committed deficiency in service? 3. Whether the Complainant is entitled to the insurance amount? 6. Our findings and reasons are as here under:- 7. POINTS NO.1 & 2:- The Complainant has produced Ex.C.5 the copy of the insurance bond issued by the Opposite party in favour of D.Dayananda for Rs.2,50,000/- on 15.06.2008. The Complainant has produced the death certificate Ex.C.6 to show that D.Dayananda, died on 29.10.2008. As required by the Opposite party, the Complainant has furnished Claim Form-B Medical Attendant Certificate Ex.C.1 issued by the Medical Officer, Primary Health Centre, Madavinakodi, K.R.Pet Taluk, Mandya District. According to this document, the assured D.Dayananda was brought with acute myocardial infarction on 29.10.2008 to the Hospital complaining chest pain and at the time of discharge he was dead and it is a sudden event. Ex.C.3 is the insurance premium receipt. The Opposite party has sent letter Ex.C.2 repudiating the claim on the ground that the deceased assured furnished false and inaccurate answers to the question number 28 & 29 with regard to the diseases, treatment and has not disclosed the brain tumor and suppressed the material fact. The Opposite party has also furnished Ex.C.4 death claim investigation report without any signature of Investigation Officer stating that D.Dayananda died on 29.10.2008 at Mysore, Prashanth Medical Services, but cause of death is not mentioned. 8. Therefore, from the available materials on record, it is established that D.Dayananda, had obtained insurance policy from the Opposite party Rs.2,50,000/- in January 2008 as per Ex.C.5 from the Opposite party Insurance Company and he died on 29.10.2008 due to sudden heart attack (Acute Myocardial Infarction) in sudden event and died in the hospital. The contention of the Opposite party is that the assured was suffering from brain tumor and he had taken treatment and has suppressed the said material fact at the time of obtaining the policy. But, it is not at all proved by the Opposite party by producing any evidence. The burden is on the Opposite party to prove that the deceased assured was suffering from brain tumor and had undergone test or surgery and in spite of it, he has suppressed the same giving false answers at the time of obtaining the policy. Of course, the contract of insurance is based on utmost good faith and the insurance company relies on the statement given by the insured with regard to the health condition at the time of obtaining the policy. Though, the Opposite party has repudiated the claim on the ground of suppressing the material fact about brain tumor in the present case, but the Opposite party has not contested the complaint and has not placed any material to prove the said defence of suppression of material fact by the deceased assured, though the burden is on the insurance company. Therefore, the Opposite party has failed to prove the suppression of material fact by the assured. Then Ex.C.1, the medical certificate issued by the Medical Officer, Primary Health Centre, Madavinakodi, K.R.Pete Taluk, Mandya, has to be accepted that deceased assured died on account of Acute Myocardial Infarction in a sudden event and this document is not challenged by the Opposite party by producing the contrary evidence. Under these circumstances, the repudiation of the claim by the Opposite party is improper and unjust. Therefore, the Opposite party has committed deficiency in service in repudiating the claim and Complainant is entitled to the insurance amount. 9. In the result, we proceed to pass the following order; ORDER The complaint is allowed, directing the Opposite party to pay the insurance amount of Rs.2,50,000/- to the Complainant with interest at 8% p.a. from 27.06.2009 with cost of Rs.500/-. (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 11th day of February 2010). (PRESIDENT) (MEMBER) (MEMBER)
