Per Sri A. Hazarath Rao, President:-

       The complainant filed this complaint under section 12 of the Consumer Protection Act seeking Rs.2,00,000/- being the insured amount under policy No.675280664; Rs.5,000/- towards mental agony and physical strain and Rs.5,000/- towards expenses and costs.

2. In nutshell the averments of the complaint are hereunder:

One Alluri Appa Rao s/o Appaiah i.e., the husband of the

complainant on 09-10-07 took Jeevan Mitra policy from the opposite parties bearing No.675280664 for Rs.2,00,000/-.  The annual premium is Rs.17,551/- and the policy matures by 09-10-2028. The insured died on 28-03-08 suddenly due to heart complaint.  The insured never took any treatment for any ailment in any hospital.  The complainant after the death of the insured being nominee informed the death of her husband to the 1^st opposite party and submitted claim forms with all relevant documents.   The 1^st opposite party on 03-03-09 required the complainant to send attested copies of documents relating to the treatment of the insured in M/s Aswini hospital, Guntur.   The act of the opposite parties in not settling the claim within a reasonable time constituted deficiency of service.   On account of that the complainant suffered mental agony. The complaint therefore be allowed.

3.   The contention of the opposite parties in brief is thus:

        The complainant is barred by time.   The assured Alluri Appa Rao took policy of assurance under policy No.675280664 for Rs.2,00,000/- under plan No.133. In the proposal form the assured gave an undertaking that he was in good health and fit person without any ailments.   Prior to obtaining the policy the assured Appa Rao took treatment for kidney problem in M/s Aswini hospital, Guntur as                   out-patient on 29-09-07.   The assured under went dialysis at regular intervals during 24-11-07 and 23-03-08.    The assured suppressed the above facts and obtained the insurance policy by playing fraud with a malafide intention.   The cause of death of the assured is ailment of kidneys.   A medical examiner at the time of obtaining the policy relies on the answers given by the proposer for the questions in the proposal.   The opposite parties have rightly repudiated the claim of the complainant. The complaint therefore be dismissed.

4.   Exs.A-1 to A-5 and Exs.B-1 to B4 on behalf of complainant and opposite parties were marked respectively.

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

        1.   Whether the complaint is barred by time?

        2.   Whether the opposite parties committed deficiency of                                 service?

        3.   Whether the complainant is entitled to compensation?

        4.   To what relief?

6.    POINT No.1:-   The assured Alluri Appa Rao died on 28-03-08 as seen from Ex.A-4.   On 03-03-09 the opposite parties required the complainant to furnish the treatment taken by the assured in M/s Aswini hospital to process the claim as seen from Ex.A-5.  By 03-03-09 the opposite parties did not process the claim.   The complaint was filed on 19-02-11.   Therefore the complaint is in time in our considered opinion.   Hence, this point is answered in favour of the complainant.

7.    POINTS 2 & 3:-    By Ex.A-5 letter dated 03-03-09 the opposite parties required the complainant to furnish particulars of treatment taken by the assured in M/s Aswini hospitals, Guntur.  Under Ex.A-5 the opposite parties did not repudiate the claim. Therefore the contention of the complainant about the opposite parties not settling the claim is unjustified.   The complainant in para ‘c’ of her complaint mentioned that she informed the 1^st opposite party that her husband never took treatment in M/s Aswini hospitals.  There was no proof to show that the complainant replied to Ex.A-5 in writing.  In Ex.B-4 it was not mentioned about the complainant complying the queries under Ex.A-5.   Therefore the contention of the complainant about she orally informing the opposite parties cannot be accepted.

8.    The opposite parties on 26-03-11 i.e., after filing this complaint repudiated the claim by sending it through registered post (Ex.B-4).   The opposite parties repudiating the claim that too after filing CC, without clarification from the complainant in our considered opinion is not proper.   The opposite parties did not file either the postal receipt or acknowledgement of the complainant to show that it was posted/received.   We therefore infer that the complainant did not respond to the query of the opposite parties raised under Ex.A-5 and the opposite parties did not respond in time.   Therefore the complainant is not entitled to the claims sought.  We therefore answer these points against the complainant.

        In view of afore mentioned discussion disposing the complaint with the following directions instead of dismissing the complaint will meet ends of justice.

9.  POINT No.4:-   In view of above findings, in the result the complaint is disposed off without costs as indicated below:

1. The complainant is directed to answer the queries raised by the opposite parties under Ex.A-5 in writing under acknowledgment within two weeks from the date of receipt of the order.
2. On receipt of such information from the complainant as required under Ex.A-5 the opposite parties are directed to process the claim within four weeks.
3. Each party is directed to bear their own costs.

Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 13th day of October, 2011.

MEMBER                                  MEMBER                        PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:

                                                                                               PRESIDENT