This complaint coming up before us for hearing on 08-05-12               in the presence of Sri G. Punna Reddy, advocate for the complainant and of Sri P. Kishore, advocate for opposite parties, upon perusing the material on record and having stood over till this day for consideration this Forum made the following:-

O R D E R

Per Sri A. Hazarath Rao,  President:-

        The complainant filed this complaint under section 12 of the Consumer Protection Act seeking the insured amount of Rs.2,25,000/- together with interest; Rs.5,000/- towards mental agony and physical strain and Rs.5,000/- towards expenses and costs of the complaint.

2.   In brief the averments of the complaint are hereunder:

        One Rachakonda Ramaiah S/o Somaiah R/o Madala took the insurance policy bearing No.LN100900137836 for Rs.2,25,000/-.   The validity of the said policy from 28-09-09 to 28-09-24.   The said Ramaiah paid Rs.30,000/- as premium.  During the existence of the said policy the said Ramaiah died on 05-03-10.  Being nominee under the said policy the complainant informed the same to the 1^st opposite party.   The 1^st opposite party on 12-07-10 informed the complainant that the said Ramaiah suppressed his ailments of diabetes, urine infection and kidney failure basing on the statement said to have been given by Dr. K. Venkateswara Rao.   The said Ramaiah never suffered with diabetes at any point of time.   The authorities of the opposite parties obtained certificate fromf Dr. K. Venkateswara Rao by making false representation.  The repudiation of the claim by the opposite parties is unjust.   The complaint therefore be allowed.

3.   The 1^st opposite party filed memo adopting the version of the 2^nd opposite party and their contention in brief is hereunder:        

The insured died within five months after taking the policy.   The insured obtained the policy suppressing his pre-existing diseases to extract money for unjust enrichment.   The complainant failed to submit either case history or post mortem report or claim form in prescribed form.  As the insured Ramaiah suppressed his pre-existing ailments while taking policy, the policy is void-ab-initio. The complainant kept silent till 19-05-11 and got issued legal notice.   The complaint even in her notice dated 19-05-11 was silent with regard to the certificate issued by the doctor to the opposite parties herein.   The procurement of the letter influencing the doctor through local prominent persons revealed the attitude and conduct of the complainant.    The opposite parties did not commit any deficiency of service.   The complaint therefore be dismissed.

4.   Exs.A-1 to A-8 and Exs.B-1 to B-13 on behalf of complainant and opposite parties were marked respectively.

5.    Now the points that arise for consideration in this complaint are:       

1. Whether the repudiation of claim by the opposite parties is justifiable?
2. Whether the opposite parties committed deficiency of service?
3. Whether the complainant is entitled to compensation?
4. To what relierf?

6.    Admitted facts in this complaint are :

1. The opposite parties issued the policy bearing No.LN100900137836 (Ex.A-2).
2. The complainant is the nominee under the above policy     (Ex.A-2).
3. The insured Ramaiah died on 05-03-10 (Ex.A-3).
4. The opposite parties repudiated the claim on 12-07-10                   (Ex.A-4=Ex.B10).
5. Exchange of notice took place between the complainant and the opposite parties (Ex.A-5 and Ex.A-6=Ex.B-11 and B-12).
6. The insured paid Rs.30,000/- (Ex.B-6).

7.    POINTS 1 AND 2:-    The contract of insurance is UBERRIMA FIDE as rightly contended by the opposite parties.   The opposite parties on 12-07-10 repudiated the claim of the complainant under Ex.A-4=B10 and it reads as follows:

       “On going through the investigation report and Lab reports and letter dated 18-06-10 given by Dr. Venkateswara Rao, it is understood that deceased life assured was severe diabetic and suffering with kidney infection and kindly failure was ………04/05/09.   This was not disclosed by the life assured in the proposals dated 25-09-09.   Life insurance policies are contracts governed by the principles of “UBERIMA FIDE” and proposer applying for insurance is expected to correctly furnish all material information regarding the health, habits, family history, personal medical history, …. Etc of the life proposed for insurance by giving correct answers to the questions in the proposal form.

In this case, had we been informed correctly about the health problems of the life proposed for insurance, it would have influenced our decision in issuing the policy.   As such, the contract is void, unenforceable and not legally binding on our company and we are repudiating your claim for payment of death benefit under the policy.

Please note that no claim is payable under this policy and we treated this matter as closed.”

8.       Burden is on the opposite parties to prove that any insured suppressed pre existing disease by adducing cogent evidence.     Non disclosure of temporary ailments does not amount to suppression of material facts as held in LIC of India vs. Tarachand 2011 (4) CPR 122.   Under those circumstances, the burden heavily lies on the opposite parties.

9.     In order to discharge their burden the opposite parties relied on the certificate dated 18-06-10 issued by RW2 i.e., Exs.B-1 and B-2.    In Ex.B-1 the patient’s name was mentioned as……………                     “R. Ramaiah”.   In Ex.B-2 patient’s name was mentioned as “Ramayya”.   Either in Ex.B-1 and Ex.B-2 father’s name, age of the said Ramaiah was mentioned to ascertain whom it belongs to.   Ex.B-1 =(Ex.A-7) dated 18-06-10 letter is extracted below for better appreciation:

         “This is to certify that R. Ramaiah has got treatment on 04-05-2009 at my out patients room.   There were no records regarding disease.”  

10.   RW2 gave certificate after one year without seeing records.   The contents of Ex.B-1 itself created a doubt to whom it belong to.  In the absence of father’s name and residence address it cannot be said that Ex.B-1 and B-2 pertained to the insured. To counter this the complainant filed Ex.A-1 dated 07-06-11 obtained to buttress Ex.B1 RW2 admitted that Ex.A-1 and Exs.B-1 and B-2 were issued by him.   No reliance can be placed on Ex.A-1 as it was filed at a belated stage.   The conduct of RW2 in issuing Exs.B1, B2 and A1 without having records is deplorable. The contention of the opposite parties that the complainant did not submit claim forms in the prescribed forms is devoid of merit in view of Ex.B-10 letter.   Therefore                                    we opine that the opposite parties miserably failed in                                                 establishing that the complainant suppressed his pre-existing ailment which affects the policy.   Hence we feel that the repudiation of the claim basing on Exs.B-1 and B-2 by the opposite parties is unjust. 

11.   In Ex.B-5 it was mentioned that the insured is entitled to the sum assured together with the net asset value of the units of the policy holders account against the column upon death before the end of the policy term.   Therefore the complainant being nominee is entitled to receive the sum insured.   We therefore answer these points against the opposite parties.

12.   POINT No.3:-    The complainant claimed Rs.5,000/- towards damages which is reasonable.    Therefore, we award Rs.5,000/- as damages.    Hence, we answer these points against the opposite parties.

13.   POINT No.4:-   In view of above findings, in the result the complaint is allowed partly as indicated below:

1. The opposite parties are directed to pay Rs2,25,000/- @9% p.a., from the date of complaint till the date of realization.
2. The opposite parties are directed to pay Rs.5,000/- as damages.
3. The opposite parties are directed to pay Rs.2,000/- toward costs of the complaint.
4.  The amounts ordered above shall be paid within a period of six weeks from the date of complaint till the date of realization. 

 Typed to my dictation by Junior Stenographer, corrected by us and pronounced in the open Forum dated this the 11^th day of               May, 2012.

MEMBER                                       MEMBER                                      PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite paries: 

                                                                                      PRESIDENT