SMT. RAVI SUSHA  : PRESIDENT

         Complainant  has filed this complaint  U/S 12 of Consumer Protection Act 1986  for getting an order directing opposite parties to pay an amount of Rs.612186/- with  other guaranteed benefits, with accrued interest @12%  thereon for the period from 23/9/2017 till realization and to pay Rs.2,00,000/- towards compensation for mental agony and pain together with cost of the proceedings.

  Case of  complainant is that her husband Sunil Kumar C,  who had served in Indian Army  and died on 23/9/2017 due to pancreatic disease and the deceased had taken a  life insurance policy  No.35002367 under the plan  Max Life group  credit life secure  plan from 1^st OP on 31/3/2017 ,the said  policy was  commenced from 3/4/2017 .  As per the terms of  the policy, in case of death of  the policy holder during the  continuance of the policy period, his dependent and legal heirs are entitled to get an amount of Rs.612186/- being the  sum assured with other guaranteed benefits.  The complainant submits that subsequently her husband suffered some sort of illness and was admitted in the  Military hospital and finally on 23/9/2017 he succumbed to the illness.  The  nominee,  Mr. Narayanan, the father of insured submitted the claim  form before the OPs for getting the death benefits, but the  OPs  rejecting the  claim  on the alleged ground that  the policy holder had not revealed certain facts regarding his physical ailments at the time of joining for the said policy. The complainant submits that the disease with which  her husband suffered was an after occurrence and not a pre-existed one.  So the reason stated from the  OPs  for rejecting the claim is not at all justifiable.  The complainant submits that  she is the beneficiary of the said policy. She further  states  that Mr.Sunilkumar had also availed a loan from 2^nd OP and an amount of Rs.420000/- was paid to him by 2^nd OP towards loan amount on 3/4/2017 vide cheque No.99999999 and pre-EMI amount of Rs.19,502/- was paid by Sunilkumar to 1^st  OP.  Due to untimely death of  Sunil Kumar, the complainant could not clear of the above said loan availed by her husband and  then even after the rejection of the deserving insurance claim including property insurance and life insurance to the complainant by 1^st OP, without considering the precarious condition of the complainant, OPs with their other authorized officers  by colluding with each  other  had exerted  much pressure on the complainant and ill-advised, enticed and compelled her with threat of dare consequences immediately after her delivery to clear off the entire loan liability  of her husband. It is further stated that  father of deceased  send a lawyer notice to the OPs, but the OPs ventured to send a false reply.  There is deficiency of service and unfair trade practice on the side of OPs.  Hence this complaint.

   After receiving notices both parties appeared through their counsels and filed separate versions.   1^st OP Max Life Insurance company has stated the fact that the complainant is the window of the insured  , late Sunil Kumar .C is not known and the  dependents and legal  heirs  of the  insured  are not entitled to an amount of Rs.6,12,186/- along with other guaranteed benefits in the  event  of death of the insured as per the terms of the policy .  1^st OP stated  that the   insured Sri.Sunil Kumar had taken a Max Life group  credit life policy from 1^st OP and had willfully suppressed material facts at the time of submitting the proposal form.  The insured was a known case of alcohol dependence syndrome, mental and behavior disorders due to alcohol dependence, acute pancreatitis and abdominal pain prior to the commencement of the policy, the details  of which were not  disclosed to the 1^st OP at the time of obtaining the policy.  The insured was diagnosed for pancreatic disease which  was a complication  of his preexisting ailments.  The insured had specifically stated in the proposal form  that he had not consulted  any doctor for treatment or is under any treatment for any ailment other than  common  cough or cold or undergone any surgical operation  at a hospital  or clinic or undergone any  investigations with other than  normal or  negative results or was currently aware that he may need  to seek medical advice in the near future.  The insured had further  declared that he had never been diagnosed  with or  received treatment for any  disability or medical condition.  The insured had declared and warranted in the proposal form that he had made complete, true and accurate disclosure of all facts and that he had not withheld or suppressed any information or facts.  According to the terms and conditions of the policy availed by the insured, insurance is a contract of utmost good faith and the 1^st OP relies and trust upon the master policy holder’s and the members(s) representations.  If any condition or endorsement made here to  is  contravened or if it  appears that an untrue or incorrect averment is contained  in the proposal form, enrolment form, documents or other statements furnished  to the 1^st OP by the  master policy holder  or any member or that any material information has been withheld, then subject to Sec.45 of the Insurance Act, the death benefit under the policy is so far as the same relate to a member shall be void  and the  relative insurance  shall cease and be determined. 1^st OP further submitted that the policy availed by the insured further had a free look period, whereby he could  return the policy within  a period of 15 days from the date of receipt of policy if any of terms and conditions mentioned in the policy were not  agreeable to the insured.  The non exercise of the free look provision and subsequent payment of premium can only be deemed to be an acceptance of the terms and  conditions of the policy.  OP has stated that the insured had obtained the policy by suppressing  material facts and hence the policy was obtained by non disclosure and dishonest means.  The policy was issued to the insured based on the information  provided by him.  Had the 1^st OP known about the  past medical details of the insured, the policy would  not have been issued to him on the terms and conditions on  which the policy was issued.  The 1^st OP had rejected the claim, cancelled the policy of the insured  and refunded the premium of Rs.10,596.93 as  he had acted in a dishonest manner in relation to the policy.  The insured had suppressed material facts pertaining to his pre-existing ailments as a result of which the policy itself  had become void.   It is submitted that there has not  been any deficiency in service and unfair trade practice, the 1^st OP is not liable to compensate the complainant.  Hence prayed for the dismissal of   the complaint.

   2^nd  OP submitted that the complainant has no locus standi to file the above complaint.  The 2^nd OP is an unnecessary party to the litigation and the complaint is bad for misjoinder of parties.  It is submitted that the home loan account availed by Sunil Kumar C & Mr.Narayanan being  No.PHR013602360186 with the 2^nd OP has been closed and the entire documents of title with respect to the property over which equitable mortgage was created have been returned to the mortgage or title holder Mr.Narayanan. The terms and conditions of the insurance policy as well as the reasons for grant or denial of an insurance claim are matters solely and exclusively within the power  and discretion of the 1^st OP as specifically provided in clause 4.3  policy conditions The late  Sunilkumar had signed the Group credit life Secure application cum Health Declaration form wherein he has declared that he has not withheld any relevant information, in the event of which the insurance company reserves  the right  to cancel the insurance cover..  It is admitted that  late  Mr.Sunilkumar C had availed a housing loan No.PHR013602360186 from 2^nd OP.  The said loan account was secured by an  equitable mortgage of immovable property owned by Mr.Narayanan.  In the event of the death of a principal borrower, his legal  heirs are bound to discharge the liability.  2^nd OP had not resorted to any compulsion or threats to settle the loan account. 2^nd OP had sent a reply explaining  the true fact situation and the legal position, inspite of which the complainant has chosen to file this complaint against  them.  The complainant has not suffered any damages and no act amounting to breach of trust, fraud or deficiency  of service and prayed for dismissal of the complaint.

    While pending of this case, Legal heirs of deceased insured was impleaded as additional complainants 2 to 4 as per IA No.255/2022 dtd.29/11/2022.  The father of the insured Mr.Narayanan.C was expired and produced his death certificate.

   At the evidence time complainant has filed her proof affidavit and documents.  She has been examined as PW1 and documents marked as Exts.A1 to A9.  She has been examined as  PW1 and documents marked as Exts.A1 to A9.  She has been cross examined  for the OPs.  On the side of OPs, 1^st OP has submitted documents, marked as Exts.B1 to B4.  Further from the  side of 1^st OP steps has been taken for production of case records of the deceased  insured from Aster MIMS Hospital from where he availed treatment.  The case sheet produced from Aster Mims Hospital is marked as Ext.X1.

    After that the learned counsels of OPs 1&2 filed their written argument notes.

   In the instant case the undisputed facts are that the complainant’s husband late Sri.Sunil Kumar had taken a Max Life group  credit life secure  plan from 1^st OP on 31/3/2017 and for taking the policy for Rs.612186/- a proposal form was submitted with single premium of Rs.12186.46/-.  The life assured died on 23/9/2017 due to severe acute pancreatitis.  The life insured claimed himself in the proposal form to be healthy, He while answering the question whether he had suffered from any disease, for which treatment was taken, he answered in negative.

   OPs case is that the insured late Sunilkumar.C had obtained the Maxlife Group Credit Life policy  from the 1^st OP and had willfully suppressed material facts at the time of submitting the proposal form.  Further, the insured was a known case of alcohol dependence  syndrome, mental and behavior disorders due to alcohol dependence, acute pancreatitis and abdominal pain prior to the commencement of the policy, the details of which were not  disclosed to the 1^st OP at the time of obtaining the policy.  For proving the contention, 1^st OP has submitted  Exts.B1 to B3 and Ext.X1 case  record from the  treated hospital Aster MIMS Calicut.  The  documents on record go to show that before submitting declaration of good health, the insured had diagnosed acute  pancreatitis, mental and behavioral disorders due to  use of alcohol dependence in Ext.B3.  Employer certificate dtd.1/9/2016.  Further in Ext.X1 case record in discharge summary, it is stated that history of abdominal pain  8 months back from 8/9/2017 ie before taking policy.  He was admitted in the hospital on 1/9/2016(Ext.B3) for the complaint  diagnosed as acute pancreatitis .  All these facts  go to  show that before taking the policy, the deceased was suffering from serious disease for which he had undergone treatment but he deliberately suppressed this fact  while filing up the statement of good health.  The learned counsel of 1^st OP submitted number of decisions of Hon’ble  Apex court regarding the suppression of material fact.  It is evident that Insurance company was already refund the premium amount, the insured had paid Rs.10596.93(excluding service tax).  In our view on the basis of decisions of Apex courts  and from available material evidence and medical records there is no deficiency in service or  unfair trade practice on the part of 1^st OP insurance company and hence the  repudiation of complainant’s claim is justifiable.

    In the result complaint fails and hence the same is dismissed.   No order as to cost.

Exts: 

A1-Policy certificate

A2-leter dtd.31/1/2018

A3-letter send by Naryanan dtd.24/4/2018

A4-Death certificate of insured

A5-lawyer notice

A6-postal receipt

A7-Acknowledgment card

A8-reply notice

A9-Death certificate of Narayanan

B1-certificate of insurance

B2-copy of death claim form

B3- copy of Employer certificate

X1- case record

Sd/                                                         Sd/                                                     Sd/

PRESIDENT                                             MEMBER                                               MEMBER

Ravi Susha                                       Molykutty Mathew                                    Sajeesh K.P

eva           

                                                                       /Forwarded by Order/

                                                                   ASSISTANT REGISTRAR