This C.C. is coming on before us for hearing; in the presence of Sri. Machha Nagesh Babu, Advocate for complainant; and of Sri. M. Srinivasa Reddy, Advocate for Opposite party No.2; notice of opposite party No.1 served called absent; 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 mentioned in the complaint are that the husband of the complainant had obtained Shri Vidya Policy Plan from the opposite parties through an agent, for which, he paid Rs.20,033/- on 08-12-2011 towards premium amount.  The opposite parties issued policy bearing No.NP101200009642 after obtaining necessary reports and required statements from the complainant.  As per policy, the mode of payment of premium is yearly and the term of policy is 10 years and matured by 28-01-2022.  The sum assured amount under policy is @ Rs.1,46,000/-.  The complainant also submitted that the opposite parties are liable to pay the sum assured amount with vested bonus in the event of death of the policy holder and also liable to pay a sum of 1% of the sum assured from the month proceeding the date of death till end of the policy term.  On 11-07-2012 the life assured complained chest pain, immediately he was shifted to Mamata General Hospital and had taken treatment as in-patient in MICU.  While taking treatment, died on 12-07-2012 due to Heart Attack.  Being the nominee, the complainant Claimed the opposite parties on 19-10-2012 but the opposite parties repudiated the claim through a letter dt. 21-11-2012 basing on the reason that the deceased / life assured had suppressed the information regarding the habit of alcohol in the Proposal Form, it was revealed through the investigation report.  The complainant further submitted that there is no nexus in between the allegation of opposite parties regarding the habit of alcohol and the cause of death of the policy holder and as such alleged the deficiency of service on the part of opposite parties in repudiation of claim, which is arbitrary and illegal and having no other go, approached the Forum by praying to direct the opposite parties to pay sum assured amount of Rs.1,46,000/- with vested interest and bonus and to pay the other death benefits under policy bearing No.NP101200009642 with interest @24% per annum till realization and to pay Rs.50,000/- towards damages and costs. 

3.       In support of her case, the complaint filed affidavit and also filed Exhibits A1 to A3.

4.       After receipt of notice, the opposite parties appeared and filed written version by denying the averments of complaint.  According to which, they admitted the issuance of Shri Vidya Policy vide its No.NP101200009642 for Rs.1,46,000/-, started from 26-01-2012 for a term of 10 years.  And further submitted that they issued the policy basing on the information supplied by the complainant regarding his health condition and habits, age, occupation and family history etc,.  After receipt of death intimation, they supplied the Claim papers to the complainant and requested to submit the same along with required documents for processing of claim.  As per investigation report, it was revealed that the deceased was chronic alcoholic since long time and died due to portal HTN with alcohol withdrawal symptoms with gastro intestinal bleeding with type-II DM / HTN induced CAD but the policy holder obtained the policy by suppressing his ill heath therefore, repudiated the claim as the life insurance contracts are based on principle of “Uberrina FIDE”.  The opposite parties also averred that the complainant deliberately suppressed the material facts regarding his health and habits at the time of taking the policy and as such the contract becomes void and is un enforceable according to the terms & conditions of policy, therefore, there is no liability on the part of them and prayed to dismiss complaint with exemplary costs.

          To prove their averments the opposite parties filed investigation report and repudiation letter, those were marked as exhibits B1 & B2 on behalf of opposite parties.

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

Whether the complainant is entitled to the relief as prayed for?

Point:-        

According to the aforesaid averments, there is no dispute regarding the issuance of policy bearing No. NP101200009642 in the name of husband of complainant and also not in dispute with regard to the existence of policy at the time of death of policyholder, the only dispute is with regard to the suppression of material facts regarding the health and habits of the life assured at the time of entering into the policy.  It is the case of the complainant that the deceased/policy holder was died on 12-07-2012 due to heart attack.  But the opposite parties repudiated her claim basing on unreasonable grounds and as such by alleging the deficiency of service in settling the claim filed the present complaint. On the other hand, the opposite parties resisted the said averments and denied their liability in payment of insurance amount as the deceased/ policy holder had suppressed the material information regarding his health and habit of alcohol therefore, there is no deficiency of service on their part.   To prove their contention, the opposite parties filed a report issued by a private investigation agency and the photocopy of death report, furnished to the Municipality regarding the death information, contains 2 pages without having signature and seal of proper authority.  Moreover, as it is not visible to read.  Therefore, those documents relied by the opposite parties are neither authentic nor cogent.  I seems that the opposite parties are failed to file any medical record or any other relevant documentary proof in support of their averments except filing of exhibit B1.  In view of above contentions and basing on the material on record, we have observed that in support of averments of the opposite parties, they could not file any sufficient proof.  In the absence of any such evidence, only averments are not sustainable and basing on only allegations we cannot come to the conclusion without cogent proof.  In this regard, we relied on the judgment of Hon’ble National Commission in United India Insurance Co. Ltd. Vs Veena Bhardwaj & Anr. IV 2012 CPJ 782 (NC) wherein, the Hon’ble National Commission clearly stated that “to prove suppression, the insurance company must prove it by producing cogent and plausible evidence.  In the absence of that evidence, no importance can be pinned with this argument”. 

In the light of above decision and in view of the aforesaid circumstances, we opined that the opposite parties failed to file any documentary proof in support of their averments and as such the plea taken by the opposite parties with regard to the suppression of material facts cannot sustainable.  Therefore, the point is safely concluded in favour of the complainant.

6.       In the result, the complaint is allowed in part, directing the opposite parties to pay Rs.1,46,000/- with vested bonus and also liable to pay all the other benefits to the complainant under the policy bearing No. NP101200009642 together with interest @9% per annum from the date of repudiation i.e. 21-11-2012 till realization. Further directed to pay Rs.1000/- towards costs. 

           Typed to dictation, corrected and pronounced by us in the open forum, on this the  29^th day of June, 2015.

                                                  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.