This C.C. is coming before us for hearing in the presence of Sri Vallala Srinivas, Akula Srinivas, Advocates for complainant; and of Sri Kancharla Vijay Kumar, Advocate for opposite parties No.1 to 3; upon perusing the material papers on record; upon hearing arguments and having stood over for consideration, this Forum passed the following:-

ORDER

(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 wife of complainant had obtained Reliance life insurance policy vide policy No.50102510 on 05-05-2012 for assured amount of Rs.3,80,000/- from the opposite parties by paying Rs.9,929.62 ps towards premium amount.  Further the complainant also submitted that including all expenses she had paid Rs.10,000/-  in all.  During the policy was in force, the wife of complainant was died on 16-07-2012. Immediately, the death was informed to the opposite parties.  Thereafter, being the nominee, the complainant approached the opposite party No.1 and submitted claim Form along with necessary documents.  Despite settlement, the authorities of opposite parties have been postponing the matter by simply saying that the matter is still pending before its head office.  Vexed with the same, the complainant issued legal notice on 24-06-2016. The notice of opposite party No.1 was returned as its office was closed.  The opposite party No.2 had given reply dt.12-08-2016 with false allegations that the wife of complainant was suffered from tuberculosis since September 2011 till February 2012, which was also not disclosed in the Proposal Form.  The complainant alleges that the opposite parties raised false allegations only to avoid payment of assured amounts under policy.  Therefore, filed the present complaint by alleging the deficiency of service in settlement of claim till the date of complaint and by praying to pay Rs.5,00,000/- under death benefits of deceased / policy holder together with interest @12% per annum from the date of complaint till realization and costs.

3.      In support of his case the complainant filed affidavit and Exhibits A1 to A5.

4.      After having receipt of notice, the opposite parties No.1 and 2 appeared through their counsels and filed counter by denying the averments of complaint.  In their counter, they submitted that the present complaint is barred by limitation, therefore, it is liable to be dismissed.  Further they also submitted that the policy was issued on 05-05-2012 and the policy holder was died on 16-07-2012, whereas, the claim was repudiated vide letter dt.29-05-2014, accordingly, the cause of action was arose either at the time of policy was issued or lastly, when the claim was repudiated.  So, the time of two years for filing of complaint under Consumer Protection Act was expired on 28-05-2016 but the present complaint was filed in the year 2017, for which, they have quoted the citation of Hon’ble Apex Court in Kandimalla Raghavaiah & Co. Vs. National Insurance Co. Ltd., and Anr. (2009) CPJ 75 (SC).  The opposite parties No.1 and 2 also stated the contract of insurance is based on utmost good faith.  The death of life assured was occurred within 2 months 11 days from the date of policy.  Therefore, the opposite parties were conducted investigation according to Section 45 of Insurance Act, which reveals that the life assured suppressed the material fact that she was suffering from TB since 2011, that was prior to issuance of policy, in support of their case, the opposite parties referred the citations of Hon’ble Apex Court and the National Commission in Life Insurance Corporation of India & Ors. Vs. Smt. Asha Goel & Anr. (2001) ACJ 806, United India Insurance Company Ltd., Vs. M.K.J. Corporation 1996 (6) SCC 4281, P.C. Chacko and Anr. Vs. Chairman, Life Insurance Corporation of India and Ors. AIR 2008 SC 424, Satwant Kaur Sandhu Vs. New India Assurance Company Ltd.,(2009) 8 SCC 316, TATA AIG Life Insurance Co. ltd. Vs. Orissa State Co-operative Bank & Anr. (2012) CPJ 310 (NC) and Dineshbhai Chandrana Vs. LIC & Anr. First Appeal No.242/2006, decided on 27-07-2006.  Further they also contended that the facts of the present case are highly complicated and as such cannot be decided in summary procedure.  The life assured had admittedly suppressed or concealed the material information with malafied and dishonest intention. While submitting Proposal Form, the life assured had given a declaration that the insurer may cancel and forfeited all the premiums in case of untrue or in-correct statements made in the Proposal Form.  They received the claim intimation on 20-02-2014 by informing that the life assured was died on 16-07-2012 due to Jaundice, being the early claim, they conducted investigation, during the course of investigation, it was revealed that the life assured was suffered from Tuberculosis since 2011, by suppressing the same, obtained policy.  During the investigation, the investigator also obtained reply from the Medical Officer, P.H.C., Lanka Sagar, Khammam District under RTI Act.  According to which, the life assured was diagnosed under T.B. category – I, date of treatment was started from 14-09-2011 till 03-02-2012.  The claim was repudiated on the ground of non-disclosure of Medical condition in the Proposal Form, the same was conveyed to the complainant by letter dated    29-05-2014.  The claim was submitted on 26-02-2014 intimating that the life assured was died on 16-07-2012 i.e. the claim Form was submitted after 2 years of death.  The opposite parties also stated that they repudiated the claim basing on the thorough investigation and conveyed the same through the letter dated 29-05-2014.  Therefore, there is no deficiency of service on their part and prayed to dismiss the complaint with costs.     

5.      In support of their averments, the opposite parties No.1 and 2 filed written arguments with the same averments as mentioned in their counter.

6.      In view of the above submissions, 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 and basing on the material available on record, there is no dispute regarding the issuance of life insurance policy under Reliance endowment plan (regular) vide policy No.50102510 in the name of wife of complainant on 05-05-2012 and also not in dispute that the policy holder was died on 16-07-2012 and the submission of claim form on 26-02-2014.  The only dispute is with regard to the suppression of material facts relating to past medical history of life assured at the time of submission of Proposal Form and filing of complaint after the period of limitation.  It is the case of the complainant, prior to issuance of policy, the opposite parties conducted Medical Examinations.  After death of life assured the complainant made many rounds to the office of opposite parties by submitting claim Form along with required documents.  Despite settlement, the opposite parties postponed the matter one pretext to other, finally, they issued reply notice on 12-08-2016 in response to the legal notice, dt.24-06-2016 by stating that the life assured was obtained policy by misrepresenting the material facts relating to her health.  Upon which, filed the present complaint as there was no hope of settlement.  On the other hand the opposite parties contended that the policy was taken by withholding material information in respect of past medical history relating to TB and conveyed their decision of repudiation to the complainant through the letter dt.29-05-2014, upon which, they have taken a plea that the time for filing of present complaint is barred by limitation under Consumer Protection Act.  In fact, they did not file any material except filing of counter.  Even they failed to file the proof of acknowledgement to prove that the information regarding repudiation was carried to the complainant and also failed to file the copy of repudiation letter for perusal of this Forum.  In the absence of any proof it is deemed that the repudiation was not informed to the complainant in any way.  Therefore, the cause of action is continuous and treated as the filing of present complaint is in time, in this regard we have relied upon the judgment of Hon’ble State Commission of Gujarat in United India Insurance Co. Ltd., Vs. Malkit Singh Dharra Singh Gill, in appeal No.1725 of 2013, II (2016) CPJ 106 (Guj.) 

So far as the other contention with regard to the concealment of material facts at the time of proposal is concerned, there is no proof on record that the deceased / life assured had obtained the policy by withholding material information with respect of Tuberculosis. Without placing any cogent / reliable medical evidence, oral submissions are not sustainable.  Therefore, we cannot come to the conclusion that the policy holder was deliberately suppressed the material information regarding her past medical history. The onus probandi, in cases of suppression of material facts rests heavily party, alleging the misrepresentation / suppression namely the insurer, burden of proving that the insured had made false representation and suppressed material facts is undoubtedly under insurer.  In this regard we have relied upon the judgment of Hon’ble National Commission in ICICI Prudential Life Insurance Co. Ltd., Vs. Veena Sharma and Anr. IV (2014) CPJ 480 NC, wherein, the Hon’ble National Commission clearly stated that the onus to prove the contention of suppression was on the insurance company that the policy holder was suffering pre-existing disease and had knowingly failed to disclose the same.

In the light of above judgments and in view of above discussion, the contentions raised by the opposite parties regarding the limitation and repudiation are not sustainable.  Therefore, the point is answered accordingly in favour of complainant.      

7.      In the result, the complaint is allowed in part, directing the opposite parties No.1 and 2 to pay Rs.3,80,000/- plus vested bonus and term benefits accrued if any to the complainant under policy bearing No. 50102510 together with interest @9% per annum from the date of complaint i.e. 24-01-2017.  Further directed to pay Rs.2,000/- towards costs within one month from the date of receipt of this order.  The complaint against opposite party No.3 is dismissed.

           Typed to dictation, corrected and pronounced by us in the open forum, on this the 4^th day of August, 2017.

Member                   Member               President

                                                          District Consumer Forum,

Khammam.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant                                                    For Opposite party  

       None                                                                          None

DOCUMENTS MARKED:-

For Complainant                                                    For Opposite party

Member                   Member               President

                                                          District Consumer Forum,

Khammam.