IMPORTANT POINT
Non-mentioning of minor injuries does not amount to suppression of material facts.

Inderjit Kaushik, Presiding Member—Shri Jagmohan Bajaj, appellant/complainant (in short “the appellant”) has filed this appeal against the order dated 11.8.2006 passed by the learned District Consumer Disputes Redressal Forum, Jalandhar (in short “the District Forum”).

2. Facts in brief are that the appellant filed a complaint under Section 12 of the Consumer Protection Act, 1986 (in short, “the Act”) against the respondents, pleading that Mohit Bajaj (since deceased) son of the appellant took a policy of insurance on his life for Rs.1,00,000 through the authorized agent of the respondent, bearing No. 131357362 under Table No.133 for a term of 25 years. The premium was to be paid yearly and the insurance policy commenced on 28.2.2001. The main feature of the said policy i.e. Jeevan Mitra Policy was that it covered three risks. On survival of the policy holder till the end of the term, the policy holder was to get the sum assured plus bonus. In case of death before maturity, the nominee gets triple the amount of sum assured plus bonus. In case of accidental death, the nominee would get four times the sum assured plus bonus.

3. The proposal for Insurance of his own life dated 20th March, 2001 was accepted and the life assured underwent thorough medical check-up by the authorized medical examiner Dr. D.V. Arora of the choice of the respondents. The life assured was in good health with no sign of any physical impairment or disease and it was so certified by the medical examiner in Form No.300 and it was further certified that there was no evidence of injury due to accident or otherwise.

4. The respondents also obtained reports on requisite forms from ‘securing agent’ development officer and ‘moral hazard report’ etc. at the time of taking the proposal and all the reports recommended for insurance. The risk was accepted at ordinary rate of premium after due scrutiny and after verifying the reports and satisfying about the health and habits, physical conditions and insurability as standard life.

5. The insurer had other policy No. 130228982 for Rs.1,00,000 and another policy No. 131130228 for Rs.1,00,000 and the death claim has been paid to the appellant. The life assured was not harbouring and labouring under any disease and had no injury due to the accident or otherwise, nor took any treatment prior to seeking the insurance.

6. The appellant is the nominee appointed u/s 39 of the Insurance Act, 1938 and is a consumer and is competent to file the complaint and to seek redress of his grievance for deficiency in service and unfair trade practice. Unfortunately, the life assured expired on 23.5.2002 due to natural death and the cause for death was septicemia (blood poisoning) and the appellant being nominee filed the claim for triple of the sum assured plus bonus and completed all the formalities and submitted the claim form complete in all respects, but the same was repudiated vide letters dated 5.5.2003/28.5.2003 by respondent No.3 illegally and arbitrarily.

7. Respondent No.2 for extraneous considerations compelled the appellants to pay 10% of the claim amount, to clear the claim of the appellant but when the appellant declined, then respondent No.2 threatened that he will get the claim rejected by hook or crook. The repudiation letter was issued after the expiry of two years from the date of insurance i.e. 28.2.2001, hence exceeding the period mentioned in Section 45 of the Insurance Act, 1938.

8. The life assured never made any incorrect or mis-statement and disclosed all the material facts at the time of taking the insurance. All the questions were correctly answered. The respondents have not stated as to how they came to the conclusion that the life assured had received head injuries and got fractured nasal bone and was treated for it and, ultimately, died of it. There was no nexus between the alleged head injuries and fractured nasal bone and death of life assured due to septicemia and the same are un-related. The claim was