Sri. Devakumar,M.C.

Member

1.     The complainant filed the complaint under section 12 of the C.P.Act 1986, against the opposite party, alleging deficiency in service and seeking a direction to pay the insurance policy sum assured of Rs.3,73,000/- with profits and to pay compensation of Rs.50,000/- towards loss suffered and inconvenience and damages of Rs.10,000/- for the delay with litigation expenses and such other reliefs.
2.     The complainant’s deceased husband obtained life insurance policy from opposite party, for a sum of Rs.3,73,000/-, on payment of a premium of Rs.24,897.03 on 22.03.2016.  On verification of medical certificate, the policy documents were issued by opposite party.  The complainant was appointed as the nominee to the policy.  The life assured died on 22.07.2016.  The policy benefits were claimed by submitting the relevant documents on 07.10.2016 from opposite party.  The opposite party vide letter dated 31.10.2016 repudiated the claim on the ground of suppression of material facts.  Hence, the aggrieved, filed the complaint seeking reliefs.
3.     The opposite party in their version and denies the allegations.  The insurance policy was issued with utmost good faith under the “principle of uberrima fide”.  The life insured shall disclose all known material facts in the proposal form at the time of obtaining the policy.  Any suppression of material facts, disentitle the claims.  The life assured was a chronic alcoholic and was suffering from diseases.  The same was not disclosed in proposal form.  The life assured died within a short span of four months from the date of issuance of the insurance policy.  On verification found that, the life assured was under treatment for alcohol intoxication and related diseases and was under treatment for the same.  In view of suppression of material facts, the claims made under the insurance policy was repudiated.  As such, the allegation of deficiency in service is denied and prays for dismissal of the complaint with costs.
4.     In lieu of evidence, both parties filed their affidavit with several documents, in support of their contentions.  Written arguments filed by both and heard the counsel for complainant only.  Perused the material on record and posted for orders.
5.     The points arose for our consideration are:-

1. Whether the complainant establishes the deficiency in service by the opposite party, for not settling the claims made under the insurance policy of the life assured and thereby the complainant is entitled for the reliefs sought?
2.  What order?

6.    Our findings on the aforesaid points are as follows:

Point No.1 :- In the negative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

7.    Point No.1:- The insurance policy was obtained by the deceased husband of the complainant from opposite party, on payment of premium amount of Rs.24,897/- on 22.03.2016.  The medical documents, relating to his health condition were submitted along with the proposal form, disclosing relevant information and a declaration.  The insurance policy for a sum assured of Rs.3,73,000/- has been issued.  The complainant was appointed as nominee to the insurance policy.  On sudden demise of the life assured on 22.07.2016, the complainant made the claims under the policy, submitting necessary documents.  The opposite party vide letter dated 07.10.2016, intimated the complainant, repudiating the claims.  Hence, the aggrieved filed complaint and sought for the reliefs.
8.    The opposite party contended that, they have issued the insurance policy believing the information furnished in the proposal form by the complainant and with utmost good faith. On receipt of an early death claim benefits under the policy, the opposite party held an investigation, which revealed that, the life insured was a chronic alcoholic and was under treatment for abdominal diseases, prior to obtaining the policy, which was not disclosed in the proposal form.  The insurance of contract is based on the “Principle of uberrima fide” and any suppression of known material facts, does not entitle the life assured to any benefits under the policy.  As such, the opposite party repudiated the claims and hence the deficiency in service is denied and prays for dismissal of the complaint.
9.    On perusal of the material on record, the issue of insurance policy is established on receipt of premium amount and the complainant was appointed as nominee.
10. Every insurance policy is issued believing the information furnished in the proposal form and the declaration by the proposer.  The life assured replied negatively, relating to the diseases, treatment obtained by him prior to the issuance of the policy.  Believing the same under the principle of “uberrima fide”, the opposite party had issued the insurance policy.
11. An investigation relating to the death of the life assured, the opposite party found that, the insured was a chronic alcoholic and was obtained treatment for abdominal diseases, which was not disclosed in the proposal form.  Hence, the repudiation of the claim is justified.
12. The opposite party relied on catena of judgements rendered by the Hon’ble Supreme Court and Hon’ble National Commission, relating to suppression of material facts and in support of their contention to repudiation of the claim.
13. In view of the same, the complainant failed to justify the deficiency in service and thereby is not entitled for any benefits under the insurance policy and the complaint is liable to be dismissed.  Accordingly, the point No.1 is answered in the negative.

14. Point No.2:-  In view of the observations made in point No.1, we proceed to pass the following :-

:: O R D E R ::

1. The complaint is hereby dismissed.
2. Give the copies of this order to the parties, as per Rules.

(Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 29^th June 2018)