This complaint coming up before us for hearing on                      03-11-11 in the presence of Sri S. Kalesha, Advocate for complainant and of Sri P. Kishore, advocate for opposite party, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following:

O R D E R

Per Sri M.V.L.Radha Krishna Murthy, Member:

        The complaint filed under section 12 of Consumer Protection Act praying to direct opposite party to pay a sum of Rs.50,000/-  being the assured amount for the death her father with interest @24% p.a., from the date of death till realization; to pay Rs.500/-  towards every month following the date of death of life assured till 21-10-2024 and also to pay Rs.12,500/- on 21-11-2021; 21-11-2022, 21-11-2023 and 21-11-2024 and to direct opposite party to pay Rs.25,000/-  towards mental agony caused to the complainant and Rs.10,000/- towards legal expenses.

2.   The averments of the complaint are as follows:

        Complainant’s father obtained policy with opposite party at Guntur under ‘Shri Vidya Plan’.   The date of commencement of the policy is 21-11-06 and the date of maturity is 21-11-2024.   The premium for the above said policy is Rs.3,549/- p.a., and the sum assured is Rs.50,000/-.   As per the terms of the policy schedule Rs.50,000/- plus vested bonus will be paid at any time if death occurs during the period of policy, in addition to Rs.500/- payable every month following the date of death of the policy holder till 21-10-2024 to the nominee besides Rs.12,500/- payable on 21-11-2021,                  21-11-2022, 21-11-2023 and 21-11-2024.   The complainant’s father nominated the complainant to receive the above mentioned benefits if any risk took place in his lifetime.   Complainant’s father had been paying the installments to opposite party regularly without fail.   Unfortunately the life assured Dhiravat Sagar died on 21-12-08 due to massive heart attack.   Immediately the said fact was informed to the opposite party and as per the advise of the opposite party complainant’s mother submitted claim form to opposite party with all relevant original documents as required by opposite party to settle their claim,   but opposite party failed to settle the claim.   Complainant’s mother approached the office of opposite party several times and requested them to settle their claim but in vain.  The opposite party is dodging the matter on one pretext or the other without settling the claim.   Hence complainant got issued legal notice to opposite party on 11-08-09 and requested for settlement of claim.   Opposite party acknowledged the said notice on 17-08-09 and got issued a reply with false and baseless allegations such as the life assured was having habits of alcohol and smoking etc., and the said fact was not revealed at the time of applying for policy and did not settle the claim.   Thus there is deficiency of service on the part of the opposite party.   Due to the attitude of opposite party complainant suffered a lot mentally and financially.   Hence the complaint.

3.    Opposite party filed its version which is in brief is as follows:

        All the averments in the complaint are false, frivolous and vexatious.    There is no deficiency on the part of the opposite party.   The complainant’s father was suffering with pre-existing disease and hide the same and paid installments towards the policy and died within twenty four months after taking the policy.  No valid reasons with documentary proof have been furnished by the complainant along with the claim forms.    This opposite party gave reply to the notice given by the complainant.  The life insurance policies are contracts governed by the principle of UBSERRIMA FIDE.   The proposer is expected to furnish correct material information regarding his health, habits, family history, personal medical history, income by giving correct answers to the questions in the proposal form.   In the present case the deceased/insured concealed the relevant facts and his medical history and as such the claim of the complainant is not maintainable and was repudiated on valid grounds.  No proof of treatment rendered by the insured has been furnished.   Hence the complaint may be dismissed with costs.

4.     Complainant and opposite party filed their respective affidavits in support of their contentions reiterating the same.  

5.     On behalf of complainant Exs.A-1 to A-8 are marked.   On behalf of opposite party Exs.B-1 to B-7 are marked. 

6.   Now the points for consideration are:

1.   Whether there is any deficiency of service on the part of     opposite party?

        2.   To what relief the complainant is entitled to?

7.   Point No.1:-   It is not in dispute that the complainant’s father obtained policy under Ex.B-1 from opposite party and it is also not in dispute that the complainant is the nominee of the life assured.   The life assured died on 21-12-08.  As seen from the schedule of the policy Ex.A-2 the policy was commenced on 21-11-06 and the date of maturity of the policy is 21-11-2024.  The claim of the complainant was repudiated by opposite party on the ground that the life assured was having habits of alcohol and smoking at the time of applying for insurance and the same were not revealed to opposite party, as such the contract is void unenforceable and not legally binding on opposite party and the same was informed to the complainant under Ex.B-2 dated 30-04-09.   As per the version of the opposite party the deceased had concealed the relevant facts and his medical history and as such the claim of the complainant is not maintainable.   In support of their contentions opposite party filed Exs.B-3 to B-7.   Ex.B-3 is the copy of report of bio-chemistry; Ex.B-4 and Ex.B-5 are the copies of prescriptions of doctor dated 18-12-08 and 09-12-08;   Ex.B-6 is the copy of Echo cardiography report dated 19-12-08 and Ex.B-7 is the copy of letter of complainant.   As seen from Ex.B-3 the figure representing the year in the date was corrected as ‘6’.  Exs.B-4 to B-6 are all relate to the year 2008.    It appears that in Ex.B-3 the date representing the year the figure ‘8’ was corrected into ‘6’ in order to suit the case of the opposite party to show that the life assured was in the habit of alcohol at the time of submitting proposal for obtaining policy and deceased suppressed the medical history and submitted the proposal.   The original of Ex.B-3 was not filed before this Forum for the reasons best known to the opposite party.   Since Ex.B-4 to Ex.B-6 are of the year 2008 it can be inferred that Ex.B-3 also relates to the year 2008, and the opposite party deliberately tampered the figure ‘8’ representing the year in Ex.B-3 and corrected it as ‘6’.  The copy of letter of complainant Ex.B-7 dated 16-01-09 reveals that the life assured suffered with high BP and sugar and died on 21-12-08.   Exs.B-4 to B-7 does not reveal that the deceased life assured was in the habit of taking alcohol or smoking at the time of submission for the proposal for obtaining the policy.   Therefore in view of the foregoing discussion, it can safely be concluded that opposite party failed to establish that the life assured suppressed the material facts as alleged by them for obtaining the policy.   Therefore, it can be concluded that the repudiation of the claim of the complainant is not justified and that therefore we find deficiency of service on the part of the opposite party. Accordingly this point is answered.

8.  POINT No.2:-   As seen from the policy schedule Ex.A-2 the death benefits are :-

Rs.50,000/- plus vested bonus if death occurs at any time during        the policy term.

Rs.500/- payable every month following the date of death till  21-10-24.

Rs.12,500/- payable on 21-11-2021, 21-11-2022, 21-11-2023, 21-11-2024.

        Therefore, the opposite party is liable to pay the above said death benefits as per Ex.A-2 policy schedule.  Complainant further claimed a sum of Rs.25,000/- towards compensation for the mental agony suffered by her and Rs.10,000/- towards legal expenses.   The above said amounts claimed towards compensation and legal expenses are too high and they are imaginary.   Therefore we are of the opinion that awarding an amount of Rs.10,000/- towards compensation and Rs.2,000/- towards legal expenses apart from the scheduled amount as mentioned in Ex.A-2 together with interest @9% p.a., from the date of repudiation would meet ends of justice. Accordingly this point is answered in favour of the complainant. 

9.     In the result the complaint is allowed in part as indicated below:

1. The opposite party is hereby directed to pay Rs.50,000/- plus vested bonus (as per Ex.A-2 policy schedule) together with interest @9% p.a., from the date of repudiation i.e., 30-04-09 till the date of realization.
2. The opposite party is further directed to pay Rs.500/- every month to the complainant from the date of death of the life assured i.e., 21-12-08 till 21-10-2024 (as per Ex.A-2 policy schedule).
3. The opposite party is further directed to pay Rs.12,500/- on 21-11-2021, 21-11-2022, 21-11-2023 and 21-11-2024 to the complainant (as per Ex.A-2 policy schedule).
4. The opposite party is further directed to pay Rs.10,000/- (Rupees ten thousand only) to the complainant towards compensation for the mental agony.
5. The opposite party is further directed to pay Rs.2,000/- (Rupees two thousand only) towards legal expenses to the complainant.

         The amounts ordered above except item No.3 shall be complied within a period of six weeks from the date of receipt of the copy of the order failing which the amounts ordered in item No.4 also carry interest @9% p.a, till realization.   

         Soon after receipt of amount ordered in clause No.1 the office is directed to deposit the said amount in any Nationalized bank in the name of minor petitioner till the minor attains majority.   The guardian of the minor is permitted to withdraw interest accrued thereon quarterly.

Typed to my dictation by the Junior Steno, corrected by me and pronounced in the open Forum, this the 8^th day of November, 2011.   

       MEMBER                            MEMBER                            PRESIDENT

     APPENDIX OF EVIDENCE

                                  DOCUMENTS MARKED

For Complainant:      

For opposite parties : 

                                                                                                                                                                                      PRESIDENT