Date of Complaint : 10/10/2014

                                  Date of Disposal: 02/07/2015

IN THE KODAGU DISTRICT CONSUMER DISPUTES REDRESSAL FORUM MADIKERI

 JUDGEMENT BY SRI. V.A. PATIL, PRESIDENT

1. This complaint is presented under section 12 of the C.P. Act, alleging the deficiency in service on the part of the opponents and also for directing them to pay Rs.1,80,000/- plus interest and such other reliefs deemed fit under the circumstances of the case.

    

2. The brief facts leading to this complaint are that, the deceased, wife of the complainant took group insurance policy on 18/07/2012 for a sum of Rs.1,80,000/- with the opponents subsequently she died on 09/03/2013.The complainant, who is the husband and nominee of the deceased, submitted the claim documents to the opponents and the claim was repudiated, on the ground that the deceased had not disclosed that she was suffering from cancer, prior to the date of opting the policy.Subsequently the complainant referred the matter to the insurance Ombudsman.After considering the facts and documents submitted by both the parties, the said insurance Ombudsman also repudiated the claim on the same grounds.The complainant dissatisfied with the order passed by the insurance Ombudsman approached this Forum stating that the act of the respondents shows the deficiency of service and negligency.

    

3. Notice of the complaint duly served on the opponents.Sri. M.S. Jayachandra, Advocate representing the opponents filed, the detailed objections contending that the opponent no.2 and 3 are residing at Hyderabad and Mumbai respectively and there is no jurisdiction. The complaint is hit by principles of Res-judicata.The order of the Ombudsman is binding on both the parties.The contract of insurance is based on utmost good faith and the deceased had concealed the facts that, prior to the date of insurance she was suffering from cancer.Hence the contract of insurance is vide-abinitio and there is neither deficiency of service nor negligency on the part of the opponents with these contentions, the opponents prayed for to dismiss the complaint, with cost.

    

4. The complainant in support of his case, filed the affidavit reiterating the allegations made in the complaint and produced the documents.The opponents have also submitted the affidavit and necessary documents to defend their case.

    

5. Heard the arguments and perused the documents submitted by both the parties.Now the points that arise for our consideration are as under;

    

6. Whether there is deficiency of service on the part of the opponents as alleged in the complaint?

    

7. Whether the complainant is entitled for the relief sought?

    

8. What order?

    

9. Answer to the above points are as under ;

10. Point No.1 :- Negative

11. Point No.2 :- Negative

12. Point No.3 :- As per final order

     

13. Point No.1 and 2 :- In this case it is an admitted fact that the deceased, wife of the complainant  took a group insurance policy with the opponents on 18/07/2012 for Rs.1,80,000/-.  The complainant and the opponents also admitted the death of the wife of the complainant on 09/03/2013.

     

14. Now the complainant alleging the deficiency in service on the part of the opponents praying for award of Rs.1,80,000/- and compensation and the cost of the complaint.According to the complainant, the opponents did not pay the insurance coverage amount after the death of his wife and violated the contractual agreement entered in to between the deceased policy holder and the opponents.But on the other hand the opponents have filed the detailed objections and in support of their case, the opponents have submitted the necessary documents.But here in this case though the deceased wife of the complainant entered in to the contract with the opponents by holding the group insurance policy.She has violated one of the ingredients of the contract of insurance i.e., the contract of insurance is based on “UTMOST GOOD FAITH”.Hence, violation of this condition itself suffice to dismiss the complainant, as no liability with the opponents.

     

15. On perusal of the complaint averments and the objections of the opponents and the documents submitted by both the parties and their affidavit and the admission given by the complainant at para no.6 of the complaint his wife was suffering from some problem with her tongue prior to the date of obtaining the group insurance policy.She did not disclose the same in her membership form dated 16/02/2012.Thus it was evident that she obtained insurance coverage with fraudulent intention.

     

16. The complainant also approached the insurance Ombudsman, after repudiation of the claim by the opponents.It is clear that the Ombudsman also repudiated the claim of the complainant, since the contractual obligations, which were entered between the parties in writing, the court cannot go beyond the terms of the insurance contract and assist the consumer against the contract agreement. The complainant and the deceased knowing full well that the deceased was suffering from carcinoma of Tongue and got operated for the same on July 2011, i.e., much prior to the date of taking the insurance policy.The complainant approached this Forum inspite of the decision given by the insurance Ombudsman (“Annexure Z”), which is also a quasi-Judicial Authority.This fact itself shows the intention of the complaint and it is clear that the complainant did not approached this Forum with clean hands.

     

17. Hence, we have answered the point no.1 & 2 in negative.

     

18. Point No.3 :- In the light of the above discussion and our findings on point no.1 and 2 as negative, we proceed to pass the following;

    O R D E R

19. The complaint is dismissed, and both the parties have bear their own cost.

20. Issue certified copies of this order at free of cost to the parties.

(Dictated to the Stenographer and got it transcribed and corrected and pronounced in the open Forum on this 18^th day of JUNE 2015)