Karnataka

Mysore

CC/1558/2014

Smt. Madamma - Complainant(s)

Versus

PNB Metlife India Insurance Co. LTd., & another - Opp.Party(s)

Sri. Lokesha .N

30 Jul 2015

ORDER

Sri Devakumar.M.C.

Member

 

1.     The complainant has filed the complaint under section 12 of the C.P.Act 1986, against the opposite parties, seeking a direction to pay the Insurance Policy amount of `1,93,418/- along with interest under the policy and to award damages for deficiency in service.
2.     The deceased husband of the complainant got insured his life for a sum of `1,93,418/-  with opposite parties.  After the death of the insured, the complainant (the nominee) approached the opposite parties’ branch office at Mysore and submitted all the documents to opposite parties on 07.05.2014 and claimed the policy amount.  The complainant alleged that the opposite parties have repudiated the claim.  The reconsideration letter also rejected.  Hence, the complainant alleged deficiency in service and unfair trade practice.  Hence, pray to allow the complaint with damages.
3.     The opposite parties Nos.1 and 2 have filed its common version with documents.  The opposite parties admitted the issuance of the insurance policy to the insured w.e.f 29.01.2014, along with a welcome letter.  It is contended that the policy was issued with utmost good faith relying on the information furnished in the proposal form.  The opposite parties have received the death claim intimation from the complainant on 07.05.2014 and same has been repudiated for nondisclosure of the pre-existed ailments in the proposal form.  At the outset, the opposite parties have contended that the complaint as false, malicious and frivolous.  Hence, denied the allegations of deficiency in service and unfair trade practice as baseless.  Hence, pray for dismissal of the complaint with costs.
4.     Both parties filed their affidavits with documents.  Perused the documents and after hearing both sides, matter posted for orders.
5.     The points that arise for our consideration of this Forum are as follows:-

1. Whether the complainant has proved that deficiency in service by the opposite parties and she is entitled for reliefs as claimed?
2. What order?

 

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

Point No.1 :- Partly in the Affirmative

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

 

:: R E A S O N S ::

 

7.    Point No.1:- The insured is the husband of the complainant, intended to avail loan from Karnataka Bank, got the insurance policy from the opposite parties company for a term of 10 years.  The complainant was nominated as the beneficiary.  After the death of the insured, the complainant submitted all the documents relating to the insurance policy on 07.05.2014 and claimed the policy amount.  The complainant alleged that the opposite parties have repudiated the claim and sent the claim decision letter on 24.06.2014, stating that the insured has concealed the material facts in the proposal form of the policy.
8.    The insurance policy was issued on 29.01.2014.  It is contended that the policy was issued to the insured with utmost good faith, relying on the information furnished in the proposal form.  The opposite parties have received the death claim intimation from the complainant on 19.03.2014.  Being the early claim, the opposite parties have investigated the matter.  Based on the medical reports at Vikram Hospital and Basappa Memorial Hospital, the opposite parties came to know that the insured was a chronic alcoholic addict, suffered with diabetes and hypertension, prior to the issuance of the insurance policy.  The opposite parties contended that knowingly the insured, did not revealed the facts relating to his health.  Thereby, contended that the insured misrepresented the opposite parties by suppressing the facts.  Further, the questionnaire was answered and also declaration was made that the information furnished are true and correct.  Hence, the suppression of the material facts will vitiate the contract and the opposite parties have the right to treat the contract as void as per the terms and conditions of the policy.  Thus, the opposite parties contended that it has rightly repudiated the claims made by the complainant.  Further, the opposite parties referred to the decisions rendered by the Hon’ble National Commission, Hon’ble Supreme Court of India, relating to the concealment of material facts by the proposer, in respect of the insurance claims.  As such, contended that there is no negligence, deficiency in service and unfair trade practice on the part of the opposite parties.  Hence, pray for dismissal of the complaint with costs.  At the outset, the reason assigned by the opposite parties for repudiation of the policy amount, is not a valid ground to deny the reliefs sought by the complainant.
9.    It is observed that the agents of opposite parties are only interested in selling insurance policies rather than explaining the terms and conditions of the policy to the illiterate prudent individuals.  Since, the insured is not well educated, it is presumed that the proposal form might have been filled up by the opposite parties agent only.  Hence, there is no concealment of facts by the insured.  As such repudiation of the policy amounts to be unfair on the part of the opposite parties, after the demise of the insured.  Therefore, it is held that the complainant is entitled for the reliefs as sought.  Accordingly, we answer the point No.1 in partly affirmative.
10.  Point No.2:- In view of the above finding, we pass the following

:: O R D E R ::

1. The complaint is partly allowed.
2. The opposite parties are hereby directed to pay the policy amount `1,93,418/- with interest at 18% p.a. from the date of demise of the insured i.e. 19.03.2014 within 30 days of this order.
3. Further, the opposite party No.1 shall pay a sum of `5,000/- towards mental agony and `2,000/- towards litigation expenses within 30 days from the date of this order.  In default, the opposite parties shall pay the interest at the rate of 10% p.a. on the said sum of `7,000/-.
4. In case of default to comply this order, the O.P. shall undergo imprisonment and also liable for fine under section 27 of the C.P.Act, 1986.
5. 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 30^th day of July 2015)