IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA, Dated this the 5th day of April, 2011. Present : Sri. Jacob Stephen (President). Smt. C. Lathika Bhai (Member) Sri. N. Premkumar (Member) C.C.No.25/06 (Remanded) Between: Mariamma Abraham, W/o. Late Abraham. P. Thomas, Palamoottil House, Karikulam.P.O., Ranni. (By Adv. K.M. Alexander) ..... Complainant. And: 1. The Manager (Claims), LIC of India, Divisional Office, Jeevan Prakash, P.B.No.609, Nagampadom, Kottayam – 686 001. 2. The Branch Manager, LIC of India, Branch Office, Kalayil Buildings, P.B.No.6, Pazhavangadi, Ranny – 689 673 (Old Address) The Branch Manager, LIC Of India, Branch Office, Othara Complex, Ranny – 689 672 (New Address). (By Adv. K.T. Thomas) ..... Opposite parties. O R D E R Smt. C. Lathika Bhai (Member): The complainant has filed this complaint against the opposite parties for getting a relief from the Forum. 2. The facts of the complaint is as follows:- Complainant is the wife of the deceased Abraham. P. Thomas, who had taken an insurance policy bearing No.391217592 from the opposite parties. The sum assured is ` 5 lakh and the yearly premium amount is ` 15,356 and the 1st instalment was paid on 9.1.02. The said policyholder died on 11.2.02 due to cardiac arrest and the complainant intimated the matter on 11.4.02 to the opposite parties. All the relevant records demanded by the opposite parties were submitted to the opposite parties but they refused to settle the claim or repudiated the claim. On 9.11.05 the complainant had sent legal notices to the 1st and 2nd opposite parties demanding to settle the claim. The same was received by them and the 1st opposite party has issued a reply stating that the certificate by the employer of the deceased i.e. form E, giving details of leave availed, nature of leave, nature of illness etc. is necessary for settling the claim. But the deceased’s employer had already produced the above said certificate dated 30.8.04 and the same was mentioned in the legal notice. But opposite parties did not settle the claim or repudiated the claim till this date. Non-settlement of the complainant’s claim is a deficiency in service, which caused mental agony and financial loss to the complainant and the opposite parties are liable to compensate the same. Therefore the complainant filed this complaint for directing opposite parties for settling the insurance claim for the death of her deceased husband, who is having a valid policy at the time of his death, with interest, compensation and cost. The complainant prays for granting the relief. 3. The authorized representative of the opposite parties filed a common version inter alia with the following contentions: The complaint is not maintainable either in law or on facts. The insured died within 5 days from the issuance of the policy and the death of the policyholder was intimated after a lapse of two months of the death. The certificate from the employer produced is incomplete and the entries in column 3 are not legible. As per the certificate the insured attended duties last on 29.12.2000. In the proposal form the name of the last employer is given as “St. Marian ALT Heim Germany and without a certificate from the employer (Form E) giving full details of the treatment availed by the deceased, opposite parties cannot settle the claim. The answers given in proposal form are suppressing the true and relevant facts. The incomplete certificate in Form-E shows that the insured was suffering from heart decease for a long time and was under going treatment at the time of submitting the proposal form. The opposite parties have not settled the claim due to the non-production of the original of form E with all the particulars and due to suppression of material facts. There is no negligence or deficiency in service from the part of opposite parties and the complainant is not entitled to get any relief. The opposite parties prayed for dismissing the complaint. 4. On the basis of the above pleadings, the following points were raised for consideration: (1) Whether the complaint is maintainable before this Forum? (2) Whether the complainant is entitled to get a relief as prayed for in the complaint? (3) Reliefs and Costs? 5. The evidence of this case consists of the oral evidence of the complainant as PW1 and Ext.A1 to A8(a) marked from the complainant’s side. For the opposite parties the authorised representative of the opposite party examined as DW1 and DW2 and Ext.B1 to B4 marked. After remanded DW2 is examined and Ext.B5 and B6 marked. After closure of the evidence, both sides heard. 6. This complaint was already disposed by this Forum as per the order dated 8.6.2010 by allowing the complainant to realise the insured amount along with compensation and cost. Aggrieved by this order, the opposite parties preferred an appeal before the Hon’ble CDRC calling for the interference of the commission as to the sustainability of this order. After hearing both sides, the Hon’ble commission remanded back the matter to this Forum with a direction for fresh consideration and disposal of the same on merits by giving one more opportunity to the opposite parties to substantiate their case. 7. The complainant’s case is that the complainant’s deceased husband had taken an insurance policy from opposite parties for Rs. 5 lakhs on 9.1.2002. The policy holder died on 11.2.02 due to cardiac arrest. The complainant submitted all the relevant available documents before the opposite parties necessary for processing the claim. But the opposite parties have not settled the claim. By non-settling the complainant’s claim there is a deficiency in service from the part of opposite parties hence the complainant filed this complaint for getting the reliefs as sought for in the complaint. 8. In order to prove the complainant’s case, the complainant has examined as PW1 and Ext.A1 to A8(a) were marked. Ext.A1 is the proposal deposit receipt. Ext.A2 is the death certificate of the complainant’s husband. Ext.A3 is the letter dated 13.8.04 issued by the LIC Manager (Claims). Ext.A4 is the copy of the certificate of Employer, claim form E dated 30.8.04. Ext.A5 is the copy of legal notice dated 9.11.05. Ext.A6 is the reply dated 30.11.05 of Ext.A5. Ext.A7 and A7(a) are the acknowledgment cards of Ext.A5. Ext.A8 and A8(a) are the proposal receipts of Ext.A5. 9. Opposite parties counsel has cross-examined PW1. 10. The opposite parties contended that the complainant failed to submit the certificate in Form E. Ext.A4, certificate of the employer produced by the complainant is not admissible in evidence and there is suppression of material facts. 11. In order to prove the contentions of opposite parties, two legal managers of opposite parties examined as DW1 and DW2. Ext.B1 to B4 were marked. Ext.B1 is the certificate of indemnity and burial or cremation issued by the priest of Catholic Church, Ranni for the burial of the complainant’s husband. Ext.B2 is the proposal form and declaration signed by the insured. Ext.B3 is the claim form E and Ext.B4 is the copy of reply letter from opposite party to the legal notice sent by the complainant. Ext.B5 is the letter dated 3.1.2011 from Consulate General of India Frankfurt. Ext.B6 is the letter dated 27.12.2010 issued to Consulate General of India Frankfurt from Dcutches Rotes KREUZ. 12. The complainant’s counsel cross-examined DW1 and DW2. 13. We have perused all the documents produced from both sides. There is no dispute on the point that the deceased had taken an insurance policy from the opposite parties. The 1st premium of the policy was paid by the deceased on 19.1.02 and the policy was issued. On 11.2.02 the life assured died due to cardiac arrest. As the nominee of the insured the complainant had ledged a claim before the opposite parties with relevant available documents for getting the insured amount. The opposite parties neither repudiated the claim nor settled. According to the opposite parties, the insured was suffering from serious heart ailment during the time when the policy was issued. He had obtained the policy by suppressing his ailment. Moreover, the complainant failed to submit the certificate in Form E necessary for processing the claim. The incomplete certificate in Form E Ext.A4 showed that the insured was suffering from heart disease and was undergoing treatment at the time of submitting the proposal form. The period of employment from 2000 to 2002 is not covered by Ext.A4. Besides that in the proposal form the name of the employer is shown as St. Marian Alt Heim Germany and the name of the employer shown in Ext.A4 is Deutsches, Rotes, Kreuz Schwestethsl haft, Bonn Venus berg Weg. There is discrepancies with the name and address of the employer of the life assured in Ext.B1 proposal form and Ext.A4 certificate. 14. The materials on records does not show that before the date on which the policy had come into force the decreased had availed treatment for heart ailment. The policy was issued after conducting a medical examination by the panel doctors of the opposite party. The opposite parties have not produced any evidence to substantiate their contention that the deceased was suppressed his ailment at the time of taking the policy and he was under the treatment. Further the discrepancies of name of employer in Ext.B1 and Ext.A4, at the time of cross-examination, PW1 stated that her husband was worked at St. Marian Alten Zentru 51103-Koln up to 2002. Opposite parties counsel put a question by showing Ext.B4 as “CXn second page.þ address of the employerþDw Ct¸mÄ ]dª Øehpw X½n hyXymkapv. Ext.A4þ ImWp¶ addressþ Bbncpt¶m `À¯mhv Ahkm\w tPmen sNbvXncp¶Xv? Cu ]dª addressþ AhcpsS Iognembncp¶p tPmen sNbvXncp¶Xv. At the time of re-examination PW1 stated as German Red Cross Head Quarters Bonnþ BWv. German Red Crossþsâ Iogn {]hÀ¯n¡p¶ Øm]\amtWm St. Marian Alten Zentru at Koln? AsX (A). The State Commission had given an opportunity to clear the doubt created in the mind of opposite party to approach the Indian Embassy at Germany to get the details regarding the employer of the life assured including the leave particulars. 15. As per the direction of the State Commission , the opposite parties have obtained a letter from Deutsches Rotes Kreuz through Consulate General of India Frenkfurt i.e. Ext.B6. In Ext.B6 it was stated as follows:- “Mr. Abraham. P. Thomas was never employed by the German Red Cross, National Head Quarter in Bonn during the period 2000-2002. We are not able to re-trace where or when Mr. Thomas was employed by the German Red Cross in General, because we are not responsible for the employment of the whole German Red Cross in Germany. For being employed by the National Headquarter as a male nurse Mr. Thomas had to work in a project abroad. We have no information about an assignment abroad of Mr. Thomas”. From the deposition of PW1 and the facts stated in Ext.B6 shows that Ext.B6 was not issued by the real employer of the deceased. As per Ext.A4, the principal employer of the deceased is Deutsches, Rotes, Kreuz Schwestethsl haft, Bonn Venus berg but Ext.B6 is issued from German Red Cross National Headquarters, Berlin. It is the duty of the opposite party to establish their contention that the life assured had suppressed any material fact regarding his health condition or other details of employment while submitting the proposal for the policy. The opposite parties failed to substantiate their contentions by adducing cogent evidence. Without establishing such suppression of material facts, the opposite parties are liable to pay the insured amount to the complainant. 16. It is pertinent to note that the complainant, the widow of the life assured is not in a position to get any more details from Germany than submitted along with claim form. The insured died due to cardiac arrest during the coverage period. The opposite parties have not produced any evidence to prove that the insured was suffering from heart disease prior to taking the policy. It is not fair from the part of opposite parties that the non-settlement of complainant’s claim by raising some untenable grounds. By non-settling or non-repudiating the complainant’s claim, the opposite parties have put considerable inconveniences and mental agony to the widow of the insured. We are therefore of the opinion that the complainant is entitled to get insurance claim amount with interest along with compensation and cost. 17. In the result, the complaint is allowed thereby the complainant is allowed to realise an amount of ` 5,00,000 (Rupees Five Lakhs only) as the insured amount taken by the complainant’s deceased husband with interest at the rate of 8% per annum from the date of filing of this complaint till this date. The complainant is also allowed to realise an amount of ` 10,000 (Rupees Ten Thousand only) as compensation and a cost of ` 3,000 (Rupees Three Thousand only) from the opposite parties. The opposite parties are directed to pay the amount within two months from the date of receipt of this order, failing which the rate of interest will follow at 10% for the whole amount till the payment. Declared in the Open Forum on this the 5th day of April, 2011. (Sd/-) C. Lathika Bhai, (Member) Sri. Jacob Stephen (President) : (Sd/-) Sri. N. Premkumar (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant (after remand) : Nil Exhibits marked on the side of the complainant (after remand) : Nil Witness examined on the side of the opposite parties (after remand): DW2 : K.V. Venugopal. Exhibits marked on the side of the opposite parties (after remand) B5 : Letter dated 3.1.2011 sent by the Consulate General of India Frankfurt to the Regional Manager, (L& HP), LIC of India, Southern Zonal Office, Chennai. B5 : Letter dated 27.12.2010 issued to Consulate General of India Frankfurt from Dcutches Rotes KREUZ. (By Order) Senior Superintendent. Copy to:- (1) Mariamma Abraham, Palamoottil House, Karikulam.P.O., Ranni. (2) The Manager (Claims), LIC of India, Divisional Office, Jeevan Prakash, P.B.No.609, Nagampadom, Kottayam – 686 001. (3) The Branch Manager, LIC Of India, Branch Office, Othara Complex, Ranny – 689 672. (4) The Stock File. | 
