BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.1706-2014

DATED ON THIS THE 31^st March 2016

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

    2) Smt. M.V.Bharathi                    

                                   B.Sc., LLB., -  MEMBER

                     3) Sri. Devakumar.M.C.                  

                                                          B.E., LLB.,    - MEMBER

Sri Devakumar.M.C.

Member

1.     The complainant filed the complaint under section 12 of the C.P.Act, against the opposite parties, seeking a direction to pay the sum assured under the policy and to pay interest at 24% p.a. on the sum assured from the date of death of the life assured and to pay `50,000/- towards compensation for mental agony and such other reliefs.
2.     The complainant’s wife (Smt. Venkatamma – life assured) purchased a insurance policy on 07.09.2012.  The annual premium has been fixed at `49,998/-.  The life assured paid premium on 03.09.2012 and 07.07.2013.  The sum assured under the policy was `3,53,000/-.  The life assured died on 15.09.2013, due to heart attack.  The complainant being a nominee submitted documents to claim the insurance amount.  The opposite parties repudiated the claim vide its letter dated 29.03.2014 on the ground of suppression of material facts.  On approaching the opposite parties Internal Claims Review Committee, it has decided to consider the claim as ex-grati for a sum of `1,25,000/- on humanitarian grounds.  Aggrieved by the offer, the complainant filed this complaint seeking reliefs.
3.     The opposite party Nos.1 and 2 submits the complaint is not maintainable as the life assured had obtained the insurance policy by suppressing of material facts with regard to pre-existing ailments.  The opposite party Nos.1 and 2 admitted the policy and payment of premium amount for two years.  The policy period from 07.09.2012 to 07.09.2020. Being an early claim, the opposite party on investigation found that, the life assured was under treatment for heart ailments even prior to the policy proposal.  The documents clearly establishes that the life assured was under treatment.  Hence, the claim of the complainant, is rightly repudiated.  As such, there is no negligence and deficiency in service and prays for dismissal of the complaint.
4.     To prove the facts, the complainant filed his evidence and relied upon several documents.  The opposite party Nos.1 and 2 also filed affidavit and produced documents to deny the allegations.  Both complainant and opposite parties filed written arguments.  On perusing the material on record, the matter has been posted for orders.
5.     The points arose for our consideration are:-

1. Whether the complainant establishes the negligence and deficiency in service on the part of opposite parties in non-settlement of the insurance claim amount under the policy and thereby entitled for the reliefs sought?
2. What order?

6.    Our findings on the aforesaid points are as follows:

Point No.1 :- In the negative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

7.    Point No.1:- Admittedly, the life assured had deposited the premium amount in respect of the policy issued by the opposite parties, for a period of two years.  The annual premium was `49,997/- and the sum assured was `3,53,000/-.  The policy period between 07.09.2012 to 07.09.2020.  The life assured died on 15.09.2013 due to heart attack.
8.    Being an early claim under the policy, the opposite parties investigated the health history of the life assured and the medical records revealed that, the life assured was ailing from heart disease and was under regular treatment, even prior to obtaining the insurance policy.   The life assured had suppressed the material facts, with regard to her ailments and treatment prior to the policy, in the proposal form.  The doctor who treated the life assured also confirmed that the life assured was ailing from heart diseases and was under treatment since many years.  As such, the opposite parties have rightly repudiated the claim on the ground of suppression of material facts by the life assured.
9.    Further, the claim of the complainant has been considered on humanitarian grounds by the opposite parties Internal Review Claim Committee, considering the policy and payment of premium amount, decided to settle the claim by paying a sum of `1,25,000/-.  The committees offer has been rejected by the complainant.  This attitude of the complainant establish that, the present complaint has been filed with an intention to make unlawful gain only.  As such, there is no negligence and deficiency in service on the part of opposite parties has been established by the complainant. 
10. The judgement relied on by the complainant does not support the claims of the complainant.  However, the judgements relied upon by the opposite parties, supported the repudiation.
11. The opposite party relied on the order reported in III (2015) CPJ 341 (NC) by the Hon’ble National Commission, support the defence contention taken by the opposite parties.
12. Accordingly, point No.1 is answered in the negative.
13. Point No.2:- In view of the above observations, we proceed to pass the following

:: O R D E R ::

1. The complaint is hereby dismissed.
2. Give the copies of this order to the parties, as per Rules.

(Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 31^st March 2016)

                          (H.M.SHIVAKUMARA SWAMY) 

                                      PRESIDENT     

(M.V.BHARATHI)                           (DEVAKUMAR.M.C.)

      MEMBER                                         MEMBER