By Smt. Bindu. R,  President:

          This  complaint is filed  by Santhosh.K  under section 35 of the Consumer Protection Act 2019 against  the Divisional Manager and another as Opposite Parties alleging  deficiency of service and unfair trade practice from the side of the Opposite Parties.

          2. The Complainant alleges that the Complainant is the brother and the only legal heir of late Sreeja Balakrishnan who died  on 21.02.2021 who had taken a Life Insurance Policy No.319764215 from the 2^nd  Opposite Party on 17.02.2021 through its agent  Jayan.  The basic sum assured was Rs.4,00,000/-  adding  the Complainant as nominee.  On  21.02.2021  the Complainant’s Sister Sreeja developed  chest pain and she was taken to the Government  Hospital  Mananthavady and she died  on the same day while undergoing treatment.  Thereafter on 02.06.2021,  the Complainant being the nominee  submitted claim form to  2^nd  Opposite Party which was  repudiated by them on the ground that the  insurer had suppressed details regarding  her previous  illness.  Complainant states that  she had not suppressed  anything and had given answers to all the question truthfully and never tried to hide anything from the agent.  It was the agent who filled  up the proposal form and he did not ask her anything regarding her previous illness.  The Complainant states that it is true that the deceased had taken medicine but the same was stopped  6 months prior to the date of taking the policy.  The Complainant states that the illness  which insurer had,  has nothing to do with her death who died due to heart attack and not  due to any disease  connected with the illness for which she had taken medicine.  Complainant states that the repudiation of  claim is without any valid  reason which amounts to deficiency of service and unfair trade practice from the side of the Opposite Parties and hence  the complaint.

          3. Upon notice  Opposite Parties entered into appearance and filed their joint version contenting  that the complaint is not maintainable and is false and frivolous and there is no deficiency of service  from the side of  Opposite Parties.  The policy  in the name of  Sreeja Balakrishnan for sum  assured Rs.4,00,000/- dated 17.02.2021 as  per policy No.319764215 is admitted  by the Opposite Parties.  The policy term is  for 25 years  and premium  paying term is 16 years.  On receiving  the  death claim intimation submitted by the Complainant who is the brother of the insurer,  the claim was examined and it was found that  Smt. Sreeja Balakrishnan had taken treatment for a long time because of mental  disorder and the treatment was stopped five months back.  The certificate of the doctor who treated, Dr. Niranjan Prasad. K, (M D Psychiatry)  shows that the Deceased Life Assured  was  on medication for  bipolar  disorder for a long time.  The said policy has run for  4 days only.  The deceased  life assured has not revealed the said disease in the proposal form dated 17.02.2021 in  the relevant  columns  regarding question related to health  matters.  More over the Doctor from District Hospital Mananthavady where death occurred  also confirmed the history of psychiatric illness of the deceased and on treatment stopped medication   5 month back.  Thus the deceased  Sreeja Balakrishnan the life assured,  suppressed the details regarding her previous illness which amounts to suppression of  material facts before entering in to a contract with the  Opposite Parties and hence  the claim was repudiated and refunded the premium of Rs.22,002/-  paid by the deceased Sreeja Balakrishnan.  The Opposite Parties prayed for dismissal of the Complainant with compensatory costs by denying  the other allegations including the statement in the complaint that the deceased  signed the  proposal form and some  blank papers as per the request of the agent.

          4. Evidence in this  case consists of the  oral evidence of PW1 and OPW1 and Exts.B1 to B8 and X1 series  from the side of Opposite Parties.

          5. The following are the main  points to be analysed in this complaint to derive into an inference of the fact.

1.  Whether the Complainant had sustained to any deficiency of service or   unfair trade practice from the  side of the Opposite Party?
2. If so  quantum of compensation and costs for which the Complainant is eligible to get.

6. Heard  both sides and perused  the records in detail.

7. In this case apart from the interested testimony of the Complainant as PW1 

no other evidences are produced from the side of the Complainant.  Other available evidences are the deposition  of OPW1 and Exts.B1 to B 8 and Ext.X1 series.  Ext.B1 is the copy of proposal form dated 17.02.2021.  Ext.B2 series is the certificate issued by Dr. Niranjan Prasad. K,  M.D (Psychiatry)  supported by medical prescription stating that Mrs Sreeja Balakrishnan (Late) was  under  treatment for Bipolar disorder which comes in episodes.  Ext.B3 is  the repudiation letter refunding  one yearly premium of Rs.22,002/-  towards full and final settlement.  Ext.B4 is the copy of letter from the Complainant to the Manager  claim department of Opposite Party. Ext.B5 is the copy of proposal form submitted by Sreeja Balakrishnan.  Ext.B6 is the copy of Medical  Attendant’s Certificate of the insurer.   Ext.B7 is the copy of  certificate of identity and burial or cremation. Ext.B8 is the copy of Certificate of hospital treatment.  Ext.X1 series is the original policy bond  issued by Opposite Party in the name of Sreeja Balakrishnan (which is the original of Ext.B1).

          8. The Complainant,  the brother and the only legal heir of the insurer Sreeja Balakrishnan was examined as PW1 who deposed in the box during cross examination that “CSbv¡v t]Sn-t]mse ImWn-¡p-t¼mÄ Dr sd ImWpw sImÃ-¯n 1- þ 2 {]mh-iyw ImWn-¡p-am-bn-cp-¶p.  violent  Bhnà AkpJw acp¶v Ign-¡p-t¼m-gmWv amdp-¶-Xv.  am\-knI Ak-z-ØX D­m-bn-cp-¶p”.  PW1  further deposed that  “Policy proposal  form  sImSp-¯Xv   2021 Feb 17 BWv.  Proposal  sImSp-¡p-¼mÄ tN¨n¡v AkpJw DÅ-Xmbn ]d-ªn-«nà tcmKw Dt­m F¶v tNmZn-¨n-Ô.  It is also deposed by the Complainant that “ktlm-Zcn {ioP  AwK³hmSn Helper Bbn-cp-¶p.  tcJ-IÄ t\m¡n-bm tPmen¡v h¶n-«pt­m Fs¶ms¡ a\-Ên-emIpw 2017 apX 2020 hsc AwK³hm-Sn-bn long leave  Bbn-cp-¶p ]d-ªm sXämWv  X1 series  ImWn¨ tcJ-I-fn document 8  lmPÀ ]«n-I-bn {ioP Ah-[n-sb-Sp-¯-Xmbn ImWp-¶p. 16þ17 hÀj-ambn AwK-\-hmSn Helper BWv Ønc-ambn acp¶v Ign-¡p-¶nà             hÃ-t¸mgpw tUmIvSsd IWn-¡m-dp-­v.  \nc-RvP³ {]kmZv tUmIvS-dpsS treatment        Bbn-cp-¶p”.

       9. In this case  the Complainant deposed that the insured had mental disease  like anxiety disorder and during that time she had been taken to the doctor and on taking medicine,  she  used to become alright.  During re examination PW1 deposed that she was  not taking medicine for  6 month prior to the date of taking policy.  At the same time the specific case of  1^st and 2^nd  Opposite Parties is that the insured was a chronic psycho patient and she was on long leave from 2017 to 2020 in her job as  Anganavadi  helper.  It is mentioned in Ext.B8 certificate of hospital treatment that the insured was under “Psychiatric illness on treatment stopped medicines 5 months Back”  and the diagnosis is sudden cardiac death.  It is also stated in Ext.B6 that the primary cause of death is “Sudden Cardiac death”  and the secondary case it is stated as “NIL”.  In Ext.B5, proposal  form the occupation is stated as Anganavadi Helper.  In Ext.B5 in the column personal and family details of health/habits and for the specific question about diseases that mental disorder (Depression/Anxiety etc) the answer stated is ‘No’.  In Ext.B4,  the letter sent to the Manager, Claim Department, LIC of India,  Divisional Office,  Kozhikode-1,  by the Complainant it is stated that “]tc-X-bmb ktlm-Zcn Sreeja Balakrishnan FSp¯p ]d-b-¯¡ tcmK-sam¶pw CÃmsX Btcm-K-y-h-Xn-bmbn AwK³hm-Sn-bn acW Znh-k-¯nsâ Xte¶v hsc tPmen sNbvXv hcn-I-bm-bn-cp-¶p.  Ahn-hm-ln-X-bmb AhÄ¡v AanX DXvIWvT t_Pmdv XpS-§n-bh Nne Ah-k-c-§-fn am{Xw I­p-h-¶n-cp¶p hnwkv hb-\mSv tlmkv]n-ä-dnse am\-knI tcmK NnInÕ tUmIvS-dpsS \nÀt±i {]Imcw Ign¨p-h¶ acp-¶p-IÄ A©m-dp-amkw ap³]v ]qÀ®-ambpw \nÀ¯n”.  Ext. B2 series also shows that she was taking medicine for bipolar disorder.

          10. Even though  1^st and 2^nd Opposite Parties had a specific case that Sreeja Balakrishnan  the insured  was on leave from 2017 to 2020, no documents are seen marked to prove the said contention.  But there is evidence to the effect that the medical condition of bipolar disorder is concealed  by the insurer and the policy is obtained.  In the proposal  form there is  specific question in S.III(e)(11) regarding  mental disorder (Depression/Anxiety etc) and the answer is negative.  Moreover at the end of the proposal form the insurer declared that “the foregoing  statement and answers have been given by me after fully understanding the questions and same are true and complete in every particular and that  I have not withheld any information and I do hereby agree and declare that these statements and this declaration shall be  the basis of the contract of assurance between  me and the Life Insurance Corporation of India and that if any untrue averment be contained therein  the said contract shall be dealt with as per provision of Section 45 of the Insurance Act 1938 as amended  from time to time”.  In this case there is suppression of a pre existing disease  which amounts to suppression of material facts.  More over the policy was taken on 17.02.2021 and the death occurred on 21.02.2021, and hence while  repudiating  the claim,   the Opposite Parties refunded the one yearly premium of Rs.22,002/- paid by Sreeja Balakrishnan (DLA), as per Ext.B3 

          11. In these circumstances this Commission found that the complaint is devoid of merits and there is  no  deficiency of service from the side of Opposite  Parties and point No.1 is found against the Complainant. Since  point No.1 is  found against point No.2 is not considered by the Commission.

          Hence  Consumer Case dismissed without costs.

Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 21^st  day of March 2024.

          Date of filing:12.01.2022.

                                                                                                                           PRESIDENT    :  Sd/-                                 

                                       MEMBER        :    Sd/-

                                                                                                                             MEMBER        :    Sd/-

APPENDIX.

Witness for the Complainant:

PW1.          Santhosh. K.                            Complainant.                            

Witness for the Opposite Parties:

OPW1.        Beena. K.                      LIC Asst. Divisional Manager (Legal)

Exhibits  for the Complainant:

Nil.          

Exhibits for the Opposite Parties:

B1.        Copy of Policy Schedule.

B2 series.  Letter.

B3.        Copy of Letter.                                         dt:10.09.2021.

B4.        Copy of Letter.

B5.        Copy of  Proposal for Insurance on Own Life.

B6.        Copy of Medical Attendant’s Certificate.

B7.        Copy of Certificate of Identity and Burial or Cremation.

B8.        Copy of Certificate of Hospital Treatment.  dt:30.04.2021.

X1 Series.   Policy Bond.

                                                                                                PRESIDENT:  Sd/-

                                                                                                   MEMBER    :   Sd/-

                                                                                                   MEMBER    :   Sd/-