This complaint coming up before us for final hearing on                          02-06-15 in the presence of Sri M.D.Prasad, advocate for complainant and                       Government Pleader, for opposite parties, upon perusing the material on record and 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 to the opposite parties to settle the claim together with interest @ 18%pa and to award compensation and costs. 

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

The complainants husband late Bellamkonda Paparao while he was alive obtained Rural Postal Life Insurance Under Endowment Assurance (Santosh) Policy bearing No.R-AP-VJ-EA-403918 for a sum of Rs.1,00,000/- with the 2^nd opposite party on 19-02-2006 and he was paying premiums regularly.  The policy holder died on 03-04-11 due to cardiac arrest in Attaluru Village.  The complainant being the nominee of the policy holder Bellamkonda Paparao made a claim with the opposite parties for the settlement of the policy by enclosing all the necessary original documents. Subsequently, the opposite parties inspite of repeated requests and persuasions did not choose to settle the claim.  The complainant issued registered legal notice dated 21-10-14 to the 1^st opposite party seeking settlement of claim.  The 1^st opposite party replied on 07-11-14 stating that the claim of the complainant was rejected vide letter dated 11-06-13 with a reason “furnishing inaccurate information regarding the insured health condition while taking the policy”.  The opposite parties at the time of taking the policy the health of the insured was examined by the competent medical officer and there after issued the policy.  Having received the premium amounts from the insured the opposite parties are under legal statutory obligation to settle the genuine claim of the complainant. Hence the complaint.            

3.    2^nd opposite party filed memo adopting the version of the 1^st opposite party and the contents in brief are hereunder:

          It is admitted that Bellamkonda Paparao had taken Rural Postal Life Insurance Under Endowment Assurance (Santosh) Policy bearing No.R-AP-VJ-EA-403918 for a sum of Rs.1,00,000/- by paying Rs.655/- as premium from February, 2006 to March, 2011 to the 2^nd opposite party and died on 03-04-11 due to cardiac arrest and the complainant Marry Vijaya who is the nominee of the policy preferred the claim.  The claim was processed and departmental enquiries are conducted by the opposite parties.

4.      The insured while furnishing information regarding his health condition in the proposal form at Sl.No.22 & 25 that he did not suffer from any disease three years before the policy.  As per the medical certificate dated 15-04-10 issued by Dr. P.V.R. Sarma, Lalitha Super Specialty Hospital Pvt.Ltd., Guntur certified under the head past illness that Sri Bellamkonda Paparao is a known case of “IHD-Ant Wall MI DM” for 18 years.  The complainant during enquiry admitted before the enquiry officer i.e., Inspector, Posts, Sattenapalli Sub-Division that her husband had taken treatment at Lalitha Super Specialty Hospital Pvt., Ltd.,, Guntur.  But she stated in her complaint that in grief and by mistake she stated that her husband in the said hospital, instead of saying her son’s name B.Vijay which shows mollified intension of the complainant to suppress medical history of the insured. 

5.      Rule 39 of the POLI Rules, 2011 says that inaccurate information furnished by a person or suppression of factual information by a person admitted to the benefits of the POLI fund will at the discretion of the Principal Chief PMG/CPMG/PMG, rendered violable the contract concluded with that person and lead to forfeiture of all payments made by him.  After careful enquiry the competent authority rejected the claim as per the above rule.  Therefore the Hon”ble Forum may be pleased to dismiss the complaint.          

6.  Both parties filed their respective affidavits.  The documents filed by the complainants were marked as Exs.A1 to A5 and the documents marked by opposite parties were marked as Exs.B1 to B4.

7.   Now the points that arose for consideration in this complaint are these:

1. Whether the opposite parties committed deficiency of service?
2. To what relief the complainant is entitled for?

8.   POINT No.1&2:-   The complainant alleged that the repudiation of the death claim of the complainant’s husband by the opposite parties is not justified.  The opposite parties contended that the insured is having pre-existing decease IHD-Ant Wall MI, DM (Diabetes Mellitus) for 18 years.

9.      The summery sheet Ex.B-2 issued by Lalitha Super Specialty Hospital Pvt Ltd., Heart & Brain Centre revealed the following :

          Past Illness:- “known IHD-Ant Wall MI

          DM              :    18 years only. 

10.    The insured did not disclose about his illness in the personal history column having questions from 22 to 25 in proposal form Ex.B-3 as rightly contended by the opposite parties.   

11.    The insured obtained policy on 19-02-2006.  The medical record of the insured, issued by Lalitha Super Specialty Hospital Pvt Ltd.,Ex.B-2 dated             19-04-10 that the insured suffered from diabetes Mellitus since 18 years .The insured is having DM in the year 1992 itself ie.;much prior to taking the policy. 

(1)    In Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., VI (2009) SLT 338 wherein the Supreme Court held that the term ‘material fact’ is not defined in the Act and, therefore, it has been understood and explained by the courts in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk.  Any fact which goes to the root of the contract of insurance and has a bearing on the risk involved would be ‘material’.

(2)    In LIC of India Vs. Dalbir Kaur I 2011) CPJ 83 (NC) between, the National Commission held that “any untrue averment be contained therein the said contracts shall be absolutely null and void and all moneys which shall have been paid in respect therefore shall stand forfeited to the corporation.”  If the declaration made is found to be false to the knowledge of the declarent.  The insurance company is entitled to repudiate the claim.     

(3)     In Kokilaben Narendrabhai Patel Vs. LIC of India IV (2010) CPJ 86 (NC) between, the opposite party repudiated the claim stating that the insured did not disclose that he was suffering from enteric fever 11 months prior of taking policy.  This amounts to suppression of material facts.  The insured died due to heart attack.  The National Commission held that “there was clear suppression of material facts with regard to his health and the insured was fully justified in repudiating the contract of insurance.”

12.    It is evident from the medical record that the insured was having diabetes mellitus prior to taking the policy. The insured obtained policy suppressing his health condition.          

13.    In light of the aforesaid discussion, the Forum comes to a considered opinion that, there is no deficiency on the part of opposite parties and there is no need to compensate the complainant. 

14.    In the result the complaint is dismissed without costs.    

Typed to my dictation by junior stenographer, corrected by me and pronounced in the open Forum this the 3^rd day of June, 2015.

 MEMBER                                                                          PRESIDENT(F.A.C)

APPENDIX OF EVIDENCE

          DOCUMENTS MARKED

For Complainant:

For opposite parties:   

PRESIDENT(F.A.C)

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.