BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.135/2017

DATED ON THIS THE 28^th February 2019

      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 complainant filed the complaint under section 12 of the C.P.Act, 1986, against the opposite party, alleging deficiency in service and seeking a direction to pay the death benefit of Rs.15,65,655/- of her deceased husband, along with interest and also damages of Rs.2,00,000/- with cost and other reliefs.
2.     The complainant’s deceased husband borrowed housing loan from opposite party and in that connection obtained an insurance policy for a sum assured of Rs.15,60,000/- on 23.12.2015.  After the death of life assured on 02.02.2016 due to cardiac arrest (massive heart attack), the complainant made the claims under the policy.  The opposite party rejected the claims on the ground of suppression of material facts.
3.     The aggrieved complainant approached insurance Ombudsman, they also rejected the claims on 02.03.2017, and communicated the same vide letter dated 04.04.2017, and subsequently, the complainant filed the complaint seeking reliefs.
4.      The opposite party filed version and admitted the issue of insurance policy coverage under SBI Life Rinn Raksha Policy, based on the information furnished by the life assured.  The policy coverage starts from 23.12.2015 for an initial sum assured of Rs.16,65,655/-.  The risk coverage under the said group insurance policy diminishes as and when EMIs are paid as per policy terms and conditions, subject to payment of all premium amount.  The proposal form becomes the basis for issuance of the policy and the life assured has suppressed his health information.  The insurance being a contract of “utmost good faith”, the proposer is duty bound to disclose all the particulars without any concealment.
5.     The life assured died in 01 month 10 days only from the date of commencement of the policy.  Being an early claim, the investigation revealed that, the life assured was suffering from kidney diseases prior to the commencement of insurance coverage.  Thus repudiated the claims.
6.      Further, as per letter dated 08.08.2016 from opposite party, the complainant had approached the insurance Ombudsman (Karnataka) against repudiation of her claims by opposite party and sought for reconsideration of her claims, which came to be dismissed on 02.03.2017 and communicated the same on 04.04.2017.  In spite of the same, the complainant had filed the present complaint seeking reliefs.  Since the complainant, claim was similar in nature and against the same party which was already adjudicated upon by an appropriate forum, the complaint filed by the complainant is hit by law of Res-judicata and hence prays for dismissal of the complaint as not maintainable.
7.     Both parties lead evidence by filing respective affidavits supported with several documents and also filed written arguments.  Heard the counsel for complainant only. Perused the material on record and posted the matter for orders.    
8.     The points arose for our consideration are:-

1. Whether the complaint is maintainable?
2. Whether the complainant establishes deficiency in service by opposite party, for not settling the insurance policy benefits of her deceased husband and thereby she is entitled for the reliefs?
3.  What order?

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

Point No.1 :- In the negative.

Point No.2 :- Does not call for discussion.

Point No.3 :- As per final order, for the following

:: R E A S O N S ::

10. Point No.1:- The complainant’s husband (Dr.Chaluvappaji) has borrowed housing loan from opposite party as security towards loan, obtained an insurance policy.  The opposite party issued a “certificate of insurance” with coverage for a sum of Rs.15,60,000/- on 23.12.2015.  The complainant was appointed as nominee to the said policy bearing No.70000011607.  The life assured died on 02.02.2016, due cardiac arrest (massive heart attack).  The death claims made under the policy was repudiated by opposite party, on the grounds of suppression of pre-existing diseases prior to the commencement of insurance coverage.  The opposite party investigation revealed that, the life assured was suffering from kidney related diseases and has availed treatment on 03.03.2004 to 04.03.2004 and 14.10.2011 to 20.10.2011.
11. Aggrieved with the repudiation of the claims by opposite party, and as per the letter dated 08.08.2016, the complainant approached insurance Ombudsman (Karnataka) seeking reconsideration of her claims.  The insurance Ombudsman, dismissed the complainant on 02.03.2017, on the basis of the facts and circumstances of the case and also the submissions made by both parties.  The dismissal of the complaint by insurance Ombudsman was communicated to the complainant vide letter dated 04.04.2017.  Later, the complainant filed the present complaint against the same opposite party and for the same reliefs.  Thereby, the present complaint is hit by law of res-judicata under section 11 of the C.P.C.  As such the objection raised by the opposite party is justified and we opine the complaint is not maintainable as already an appropriate forum has passed an order on the matter on board.  Hence, the point No.1 is answered in the negative.
12. Point No.2:- In view of the above observations, this point does not require any discussion, hence answered in the negative.
13. Point No.3:- With the above observations, the complaint filed by the complainant is liable to be dismissed as not maintainable as the same is already heard and adjudicated upon, by the appropriate forum i.e., insurance Ombudsman (Karnataka) and hence, the following:-

:: O R D E R ::

1. The complaint is hereby 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 28^th February 2019)