This C.C. is coming before us for hearing in the presence of Sri K. Upender Reddy, Advocate for complainant and of Sri M. Srinivasa Reddy, Advocate for opposite parties No.1 to 3; upon perusing the material papers on record; upon hearing and having stood over for consideration, this Forum passed the following:-

O R D E R

(Per Smt.V.Vijaya Rekha, Member)

This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. 

2.       The brief facts as stated in the complaint are that the husband of complainant had obtained a Life Insurance policy from the local branch of opposite parties vide policy bearing No.101200142437 for a sum of Rs.1,91,000/- from the period 28-12-2012 till 28-12-2016.  The term of policy is 15 years and the mode of payment of premium is yearly.  The opposite parties have issued policy after satisfying the medical examination report.  During the policy was in force, the policy holder felt ill health on 13-07-2013 and joined as in-patient in Rohini Medicare Hospital, Warangal on 17-07-2013, the doctors conducted surgery on 22-07-2013.  He was discharged from the hospital on 03-08-2013.  Thereafter, taken treatment as per the advices of doctors.  Suddenly, he was died due to stomach pain while shifting to the hospital on 26-09-2013 at midnight.  After that, being the nominee, the complainant intimated the same to the opposite parties and claimed by submitting required documents.  Instead of settling, the opposite parties repudiated her claim.  The complainant further alleges that the opposite parties repudiated her claim on baseless and flimsy grounds and also submitted that even after making written representation dated 13-01-2014 to the internal claims review committee, they failed to settle her claim.  Therefore, constrained to file the complaint by alleging the deficiency of service on the part of opposite parties in settlement of her claim and by praying to pay Rs.1,91,000/- with vested bonus under policy together with interest @ 12% per annum and to pay all the other death benefits under policy and also prayed to pay Rs.50,000/- towards damages and costs.  

3.       In support of her case, the complainant filed exhibits A1 to A11.

4.       After service of notice, the opposite parties appeared through their counsel but failed to file written version even after grating sufficient chances, so, the matter was posted for orders as there was no response from the opposite parties.

5.       In view of above circumstances, now the point that arose for consideration is,

          Whether the complainant is entitled to the relief

                    as prayed for?

Point:-                  

          It is the case of the complainant, during the life time of her husband, he had obtained a life insurance policy from the opposite parties for an assured amount of Rs.1,91,000/-.  The policy was came into existence on 28-12-2012 for a term of 15 years, he had paid Rs.19,934/- towards first premium amount for the period from 28-12-2012 to 28-12-2013.  After a period of 6 months, he had joined in Rohini hospital due to ill health, during the course of treatment he was operated.  After taking treatment from 17-07-2013 to 03-08-2013 he was discharged from the hospital with satisfactory health condition.  Unfortunately, the life assured was died on 26-09-2013 inspite of taking treatment as out-patient  as per the advices of doctors of Rohini Hospital.  Thereafter, being the nominee, the complainant claimed the opposite parties for assured amounts.  After all efforts were in vain and also as there was no response in settling the claim, filed the present complainant by alleging the deficiency of service on the part of opposite parties.  In order to substantiate her claim, placed exhibits A-1 to A-11.  On the other hand the opposite parties neither filed written statement nor placed any material on record to disprove the allegations as mentioned in the complaint.  In the absence of any sufficient proof / cogent evidence filed on behalf of opposite parties we cannot consider the matter against the complainant.  And, we cannot be presumed that the causes for repudiation is genuine.  Without filing any previous medical record pertaining to the deceased / life assured prior to the Proposal Form, the allegations raised by the opposite parties in repudiation letter were not succeeded.  Mere allegations are not sustainable without filing of any supporting / relevant proof, in this regard we have relied upon the Judgment of Hon’ble National Commission in Kamla Devi Vs. Life Insurance Corporation of India & Ors. II (2016) CPJ 649 (NC), wherein, the Hon’ble National Commission clearly stated that “in the absence of any cogent evidence it cannot be presumed that the deceased has taken treatment pertaining to chronic renal failure before filing proposal Form and has suppressed material disease”.

In the light of above decision and in view of above circumstances the point is answered accordingly in favour of complainant by holding that the opposite parties are liable to pay the assured amount along with all the other death benefits if any under policy, issued by them.        

6.       In the result, the complaint is allowed in part directing the opposite parties to pay the assured amount of Rs.1,91,000/- under policy bearing        No. NP101200142437 together with interest at 9% per annum from the date of repudiation i.e. dt.16-01-2013, further directed to pay the other death benefits if any under said policy to the complainant.  The opposite parties are also liable to pay Rs.1,000/- towards costs.  The amount shall be paid within one month from the date of receipt of this order.

           Typed to my dictation, corrected by me and pronounced by us, in this Forum on this the  23^rd day of August, 2016.                                                         

                         FAC President              Member

District Consumer Forum, Khammam

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant:-                                                     For Opposite party:-   

       -None-                                                                           -None-

DOCUMENTS MARKED:-

For Complainant:-                                                     For Opposite party:-   

FAC President               Member

District Consumer Forum, Khammam.