This complaint coming up before us for final hearing on 21-10-14 in the presence of Sri C.V. Ramaiah, advocate for complainant and of                             Sri D. Narayana Murthy, advocate for opposite party, upon perusing the material on record, after hearing both sides and having stood over till this day for consideration this Forum made the following:-

O R D E R

Smt T. Suneetha, Member:-    The complainant filed this complaint                      u/s 12 of the Consumer Protection Act seeking directions on the opposite party to pay the policy amount of Rs.1,50,000/- along with interest @24% p.a., from the date of due till realization and Rs.10,000/- towards mental agony and to pay Rs.5,000/- towards legal expenses.

2.   In brief the averments of the complaints are these:

          Complainant’s husband Alamuri Venkata Narayana obtained a policy No.100700051194 from the opposite party agent Srinivasarao Gajula for a sum of Rs.1,50,000/- by paying Rs.10000/-  as premium on 28-03-07. The complainant’s husband died on 22-08-08.  The complainant was nominee for the policy taken by her husband.   The complainant submitted all the papers along with claim to the opposite party.   The complainant received a letter dated 21-01-09 with all false allegations stating that the contract of insurance is void and unenforceable and that is being repudiated from the opposite party.   The complainant also received another letter dated 14-05-11 from the opposite party  that they would pay Rs.8,327/- fund value to the full and final settlement of the policy.   The complainant got issued legal notice on 29-09-11 requiring the opposite party to settle the claim within fifteen days.   The opposite party received the same and kept quite.   The complainant after the death of her husband is shouldering the responsibility of her family with two children Anuradha and Harish.   The complainant has no other income except sundry shop and pulling her life with very meager income.   The repudiation made by the opposite party is baseless.   It is for the opposite party to produce evidence substantiating the reasons for repudiation.   Opposite party repudiating the claim of the complainant without any proper reason is deficiency of service.  Hence the complaint.

3.  The opposite party filed its version and its contents in brief are follows:

          The late Venkata Narayana during his lifetime took Shriplus policy bearing No.LN100700051194 commenced on 28-03-07 for a term of fifteen years for the amount Rs.1,50,000/- and nominated his wife as nominee.  

          The opposite party repudiated the claim on 24-01-09 for non disclosure of pre-existing health problems. The complainant filed this complaint after lapse of 3 ½ years after repudiation and it is liable to be dismissed on the ground of limitation.  

          The complainant did not disclose pre-existing disease that he was suffering from diabetes and hypertension past 7 years before death.   The opposite party investigator derived this information from the medical reports obtained from MV Hospital, Diabetes Private Limited.   At the time of taking policy he answered negative as no to the questions asked in the proposal form.   The opposite party submits that ‘life insurance policies are contracts governed by the principle of OBERRIMA FIDE and the proposal applying for insurance is expected to correctly furnish all material information regarding the health, habits, correct age, family history, personal medical history, income, height, weight etc., of the life proposed for insurance by providing correct answers to the questions in the proposal form.  

            The policy taken by the insured was unit linked plan wherein the investment risk relating to funds available for investment (After appropriation of charges from the premium paid) is fully governed by the policy holder and the funds are invested by the company as per the choice of the policy holder at the time of taking the policy and subsequent switching exercised if any.  Though the claim of insurance benefit was repudiated due to non disclosure of pre-health problems the balance fund value of the policy holder of Rs.8,327.09 has been paid to the nominee.   There is no deficiency of service on the part of the opposite party.  The complaint is delayed by 3½ years after the repudiation and it barred by limitation.   Therefore the complaint may be dismissed with exemplary costs.

4.      The complainant and opposite party filed their respective affidavits. Exs.A-1 to A-7 and Exs.B-1 & B2 were marked on behalf of the complainant and opposite party.

5.    The points that arose for consideration in this complaint are these:

          1.  Whether the complaint is barred by limitation?

2.  Whether the repudiation made by the opposite party justified?

3.  Whether the opposite party committed deficiency of service?

          4. To what relief?

6.   POINT No.1:-    The delay made by the complainant in filing the complaint was condoned u/s 24(A) of the Consumer Protection Act vide IA.No.233 of 2013 on 27-06-14 by this Forum.  The opposite party has not canvassed the order passed by this Forum in IA 233/14 and made it to become final. Hence the complaint is filed within time and answered this point in favour of the complainant.

7.  POINT No.2:-    The opposite party contended that the insured’s disease was pre-existing and in support of their contention they filed surveyor report Ex.B-1 dated 18-01-09.  The opposite party did not file any document to corroborate with the contents of surveyor report.   Therefore we cannot infer that the insured’s decease was pre-existing and had suppressed such fact from the opposite party.   Therefore the repudiation made by the opposite party is not justifiable.   This point is answered against the opposite party.

8.  POINTS 3&4:-    The opposite party repudiated the insurance claim of the complainant for suppression of pre-existing decease and confirmed the complainant’s entitlement to the balances in the fund account of the policy holder amounting to Rs.8327.00 through a letter dated 14-05-2011.

The benefits available to the policy holder under the policy as per the terms and conditions of the policy are  extracted below:

       The above conditions reveal that the policy holder is eligible to receive sum assured together with value of units.

9.     The sum assured was repudiated by the opposite party for  insured  suppressing the pre–existing decease , was not accepted in view of absence of cogent evidence to the surveyor report adduced by the opposite party and answered against the said contention and in favor of the complainant  in point no :1.

10.     The value of the units of the policy holder’s account of Rs.8327/- offered by the opposite party was rejected by the complainant ( as stated in the complaint ).

11.   The opposite party in para 10 of their version and para 8 of their affidavit stated that  “……….balance fund value of the policy holder as on the date of registration of claim the fund value of Rs.8327.09 has been paid to the nominee”.  But they did not mention the payment details like cheque number, date etc.   In such circumstances, it is pertinent to believe the complainant’s narration that she did not receive any fund value payment from the opposite party.

12.   The complainant as per the policy is eligible for policy amount and the value of the units . But the complainant did not claim value of the units in the relief portion of the complaint. In absence of claim for the value of units, the Forum is constrained to direct the opposite party to pay the insurance claim.

13.  In the light of aforesaid discussion, the Forum opines that the complainant as nominee is entitled to the policy amount and unit value amount.   The opposite party repudiated the claim of the complainant with no fault of the complainant which is nothing but deficiency of service.  Therefore the opposite party is liable to compensate the complainant.  

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

1. The opposite party is directed to pay policy amount of Rs.1,50,000/- (Rupees one lakh fifty thousand only) to the complainant together with interest @9% p.a., from the date of repudiation (i.e., from 04-05-11) till realisation.
2. The opposite party is directed to pay Rs.5,000/- (Rupees five thousand only) as compensation towards mental agony to the complainant.
3. The opposite party is directed to pay Rs.2,000/- (Rupees two thousand only) towards legal expenses to the complainant.
4. The amounts ordered above shall be paid within a period of six weeks from the date of receipt of copy of the order.

Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 5^th day of November, 2014.

MEMBER                                  MEMBER                        PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:    NIL

PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.