JUDGMENT

            The complainant has filed this complaint u/sec. 12 of the Consumer Protection Act – 1986 against the OP alleging deficiency in service in not settling the claim of the policy amount of Rs.5,13,000/-. Hence, prays for relief to settle the policy claim allowance of Rs.5,13,000/- for physical and mental agony and Rs.50,000/- for deficiency in service and Rs.10,000/- for litigation and miscellaneous expenses.

             Brief averments of the Complaint are;

            2.  That the complainant’s husband had made on policy during his life time in the branch of OP-Company. The policy number is 51761348 and the total sum assured is Rs.5,13,000/- and it had a yearly premium of Rs.30,091/-. The policy was issued on 06.08.2014. The nominee in the policy is the complainant.

3.         The complainant further alleged that on 7.10.2014, the complainant husband died due to Heart attack in his own village Achar Narsapur, Gangavathi taluk. The complainant after getting the knowledge of the policy informed about the policy to the OP and then submitted the Policy claim along with the related documents to the OP. The complainant further alleged that on 25.06.2015 the OP had posted a letter to the complainant stating that the policy amount cannot be paid because DLA (Deceased Life Assured) at the time of making policy, the life assured had given wrong information regarding the Age, due to this reason, this policy has been rejected.

4.         The complainant further alleged that the complainant husband was physically and mental fit and was healthy and he did not suffer with any diseases. The complainant alleged that the proposal form was filled by the representative of the OP-Company and the age is mentioned correctly. The OP instead of settling the claim is giving silly reasons and has rejected the claim amount of the policy and due to this reason the OP has committed the deficiency in service and hence filed this complaint. praying for settling the poicy claim of Rs.5,13,000/- along with compensation of Rs.50,000/- for deficiency in service andj Rs.50,000/- for physical and mental agony and Rs.10,000/- for litigation and miscellaneous expenses as prayed above.

5.         This Forum after admitting the complaint, a notice was issued to the opponents and the said notice is served upon him. The OP has failed to appear before the Forum on the date of appearance and hence was placed as exparte and the case was posted for complainant’s evidence.

6.         On the basis of the above pleadings, the following points that arise for our consideration are:

POINTS

1.  Whether the complainant proves that there is deficiency in service in not settling the policy amount after the death of her husband?

2. Whether the complainant is entitled for any relief sought for?

3. What order?

7.          To prove the case of the complainant, the complainant herself examined as PW-1 and she has got marked the documents as per Exhibit A1 to Exhibit A4 and closed their side of evidence.

8.   Heard the arguments of the counsel and perused the records.

9.  Our findings on the above points are as under;

Point No. 1 :  In Affirmative

Point No. 2 :   In partly Affirmative

Point No. 3:   As per final Order for the following.

REASONS

10.  POINT No. 1and 2:  As these issues are interconnected each other, hence they are taken together for common discussion to avoid repetition of facts, evidence documents and arguments.

            11.  On perusal of the pleadings, evidence coupled with the documents of respective parties on record.  It is the case of the complainant alleging deficiency in service in not settling the claim of the policy amount of Rs. 5,13,000/-.  There is no dispute regarding that the complainant’s husband during his life time had obtained policies by name Reliance Super Endowment Plan life insurance policy with a policy No.1761348 which was issued on 06.08.2014 with a premium of Rs.30,093/- annually and the sum assured amount is Rs.5,13,000/-. There is also no dispute that the premium of the policy is not paid. On 07.10.2014 the complainant husband died due to Heart Attack in his village Achar Narasapur, Gangavathi Taluk leaving the complainant as a nominee in the policy. Being a beneficiary in the policy, the complainant approached and claimed for assured amount and submitted the claim form and necessary documents. Till today, the OP has not settled the claim. The complainant alleged deficiency in service.

            12.       To prove the case of the complainant, the PW-1 has reiterated the complainant’s averments in her examination in chief and in support of her case. She has produced the policy document which has been marked as Ex. A1. It is admitted that this policy was issued by OP after going through the proposal form. This policy was issued to the complainant’s husband at the time of making the policies. She has further averred that the policy contain the details of the sum assured and the premium to be paid i.e. Ex. A1. The Ex. A1 clearly reveals that this policy is issued in the name of the complainant husband during his life time and the premium was paid and the policies are commenced from 06.08.2014.

            13.       As per Exhibit A2 is the Death Certificate issued by Chief Register of Birth and Death. As per Exhibit A3 the claim repudiation letter given by OP. On perusal of it, it is crystal clear that the OP has rejected the claim stating that DLA has mentioned his Age wrongly in the proposal form prior to the issuance of the policy and this was known to them from investigation. To prove that the DLA has suppressed the age, the OP has not appeared before this Forum and has not produced any cogent evidence. Therefore, the contention which was taken by the OP in their claim repudiation letter is vague and is not justifiable one. The OP instead of settling the claim amount has issued a cheque on 27.01.2016 in the name of the complainant through H.D.F.C. Bank bearing cheque No.751954 to the tune of Rs.30,828.19 after the service of notice to the OP. The said amount is the premium amount paid by the OP to the complainant and the same is marked as Exhibit A4 and the said cheque is not accepted by the complainant and the same is produced before the Hon’ble Forum. This itself clearly goes to show that the said OP has committed the deficiency in service in not settling the claim amount.

            14.       At the time of issuing the policy, it becomes the duty of the insurance as to verify and see that the particulars are filled correctly. The DLA has mentioned the Date of birth has 5^th August 1963 and the age at the time was 51 years. This is clear in the EX A-1, that his age was mentioned as 51 years. So here the question of suppressing the age of DLA is no way applicable as per the suggestions made by OP in their claim repudiation letter.

            15.       The counsel for the complainant has relied on the citations reported in 11 (2011) CPJ 7 (NC) Life Insurance Corporation of India and Anr. V/s Gopal Singh. Where it has held by the Hon’ble National Consumer Disputes Redressal Commission, New Delhi that:

                        “Consumer Protection Act, 1986 – Sections 2 (1) (g), 14 (1) (d), 21 (b) – Insurance (Life) – Endowment Assurance Policy with Profits – Suppression of material facts – Dispute in age – Claim repudiated – Forum allowed complaint – State Commission dismissed appeal – hence, revision – Contention, assured had given his age incorrectly while filling proposal form on basis of voter’s list – Not accepted – Age given in voter’s list cannot be taken as sure test to determine exact age of a person – It is a common knowledge that frequently small mistakes regarding residence, age, parent age do occur while preparing voter’s list – No conclusive evidence on record to show that assured had mentioned his age incorrectly with mala fide intention with any ulterior motive – Assured has correctly mentioned age in proposal form.

           Result: Revision Petition dismissed.”

            The counsel for the complainant has also relied upon the citation reported in II (2014) CPJ 20A (CN) (AP) Reliance Life Insurance Ltd.,   and Another V/s B.Koti Ratnam that:

                          “Consumer Protection Act, 1986 Section 2 (1) (g), 14 (1) (d), 15 – Insurance (Life) – Deather Claim – Alleged suppression of correct age – Claim repudiated – Alleged deficiency in service – District Forum allowed complaint – Hence appeal – Entries made in ration card or voter list by themselves cannot be considered as criteria to ascertain correct age of insured more particularly when there has been discrepancy in age of insured as seen from voter’s list and ration card – Insurance Company that failed to substantiate its contention that insured was aged 68 years at time of submitting proposal form – Repudiation not justified.

            Result: Appeal dismissed.”

            It has been held that entries made in ration card or voter list by themselves cannot be considered as criteria to ascertain correct age of the insured. This lordship have held that there is no conclusive evidence on record to show that assured that mentioned his age incorrectly with a mala fide intention with any ulterior motive.

            The facts and circumstances of the case in hand and circumstances of the said citations is same and applicable in this case.

            16.       Therefore, in the light of principle laid down by this lordship in the aforesaid citation more specifically with respect to suppressed the age it is crystal clear that the DLA has mentioned as 51 years in the proposal form. Therefore, it can be presumed that the complainant’s husband (DLA) has not mentioned the age incorrectly.

            17.       The OP has not appeared before this Forum to answer any ofj the allegations made by the complainant and have not shown any reasons for repudiation of the claim of the complaint. Therefore, it can be presumed that there is deficiency in service in not settling the claim.

            18.       From the arguments submitted by the learned counsel, we are of the opinion that DLA has not given or suppressed information relating to his age to the OP. Hence, the OP is not supposed to repudiate the claim of the complainant, because the ones lies on the OP-Company to establish that DLA has suppressed material facts regarding his age. In the absence of such evidence, we found a deficiency in service on the part of OP in not settling the claim. As such, the OP is liable to pay the sum assured amount to the complainant.

            19.       The OP-Company is also liable to pay compensation of Rs.3,000/- for deficiency in service along with litigation expenses of Rs.1,500/- to the complainant. Hence in the light of above observations, we constrained to hold point No.1 and 2 in affirmative.

20.  POINT No. 3 :- In view of above discussion and findings we proceed to pass the following;

O R D E R

1. The complaint is partly allowed.

2. OP is directed to pay Sum Assured of the policy of Rs.5,13,000/- (Rupees five lakh thirteen thousand) along with Rs.3,000/- (Rupees three thousand) towards compensation for deficiency in service and Rs.1,500/- (Rupees one thousand five hundred) towards litigation expenses to the complainant within one month from the date of receipt of this Order, failing which 12% p.a. interest will be charged from the date of filing of the complaint, till realization.

3. Send the free copies of this order to both parties.

Dictated to the Stenographer, transcribed, typed by her, typescript, corrected by me and then pronounced in the Open Fora on 15^th day of March, 2016.

// ANNEXURE //

List of Documents Exhibited for the Complainant.

Witnesses examined for the Complainant / Respondent.