Karnataka

StateCommission

A/822/2013

The Manager, M/s. Bajaj Allianz Life Insurance Co. Ltd., - Complainant(s)

Versus

B. Kavitha W/o. Pampapathi Baligar - Opp.Party(s)

Vidya Selvamony

06 Aug 2022

ORDER

BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE

 

DATED THIS THE 06^TH DAY OF AUGUST 2022

 

PRESENT

 

SRI. RAVI SHANKAR                         : JUDICIAL MEMBER

SMT. SUNITA C. BAGEWADI              : MEMBER

 

Appeal No. 822/2013

 

1.  The Manager,      M/s. Bajaj Allianz Life Insurance Co. Ltd.            No. 1078, 2nd Floor, United Chambers,          Sathy Road, Ganapathi,      Coimbatore 641006 2.  The Branch Manager,      Bajaj Allianz Life Insurance Co. Ltd.,      Parvathi Nagar, Bellary 583103      Rep. by M. Aravinda, Zonal Legal Manager (By Smt. Vidya Selvamony) V/s	….Appellants
B. Kavitha W/o. Late Pampapathi Baligar R/o. 323, Ward No. 25, Near Kenchigarpet, Vadada Rayanagudi, Hospet Tq., Bellary Dist. (By Sri. Prabhu K.M.)	..…Respondent

O R D E R

 

BY SMT. SUNITA C. BAGEWADI, MEMBER

The OP preferred this appeal against the order dated 30.04.20013 passed in C.C.No.5/2013 on the file District Consumer Disputes Redressal Forum, Bellary.

2. The brief facts of the case are that the complainant’s husband during his life time had taken two life insurance policies on 10.03.2011 from the respondent/insurance company.  The term of each was 20 years, premium payment is for 15 years, he had paid premium of Rs.12,500/- for each policy and the sum assured was Rs.2,91,000/- each.  The complainant is the nominee under the said two policies.  The complainant’s husband died due to heart attack on 11.12.2011.  The complainant after the death of her husband filed the claim form before the respondent/insurance company seeking amount assured under the policies issued.  However, the respondent/insurance company repudiated the claim of the complainant on the ground of non-disclosure of pre-proposal treatment for tuberculosis of the deceased/life assured.  In fact the complainant’s husband did not suffer from TB, as alleged by the respondents.  Thus repudiation is illegal and amounts to deficiency in service.  Hence, the complaint.
3. The OP filed written version stating that all the allegations made in the complaint except which are those specifically admitted are denied and contended that the deceased/ life assured has not disclosed the fact that he was suffering from ailment prior to making the proposal which he was under obligation to mention in the proposal form at the time of applying for insurance policies.  If he had disclosed the same the company would not have insured life assured under the policies or would have certainly called for more documents and the medical tests.  OP further contended the OPs have made various investigations and various medical certificates confirmed that deceased life assured was under treatment for Tuberculosis since 28.02.2011 and these facts were known to the life assured prior to making the proposal for insurance.  Hence, they rightly repudiated the claim and pray to dismiss the complaint.
4. After trial District Commission partly allowed the complaint.
5. Aggrieved by the order the appellant has preferred this appeal.
6. Perused the appeal memo, order passed by the District Commission and materials on record.  We noticed that it is an admitted fact that the husband of respondent/complainant during his life time had taken two life insurance policies on 10.03.2011 from appellant/insurance company for the term 20 years, premium payment is for 15 years, he had paid Rs.12,500/- for each policy and sum assured was Rs.2,91,000/- each.  It is also an admitted fact that husband of respondent/complainant died on 11.12.2011 and after death of complainant’s husband she had filed claim form before the insurance company.  However, appellant insurance company repudiated the claim of complainant on the ground that non-disclosure of pre-proposal treatment of Tuberculosis of the life assured.
7. Perused the proposal form.  We noticed that while submitting proposal form it was required to answer several questions with respect to the state of life assured’s health and in column No.22 ‘Declaration of Good Health”, the husband of complainant answered all the questions as ‘No’, such as Question No. C – Any diseases or disorders of the respiratory system such as but not limited to Blood in Sputum, Tuberculosis, Asthma, Infected Respiratory Disease or any Respiratory System Disease including frequent nose bleeding, fever and Dyspnoea? and the life assured answered this question as ‘No’.  Since he had taken the treatment for Tuberculosis at District Hospital, Bellary from 28.02.2011 to 28.08.2011 before taking the policy from appellant company, it is evident that letter issued by District Hospital Bellary which communicated that the life assured was under treatment for TB since 28.02.2011 also the treatment card issued by the District Hospital Bellary discloses that treatment started to the life assured on 28.02.2011 and patient cured on 28.08.2011.  We agree Tuberculosis could be cured by antibiotics after taking medicines for several weeks, but, leading infectitious killer and leads to sudden cardiac death.  It is reality that the people who have had TB in the past are more chances to have it again.  Hence, in our opinion the deceased/life assured ought to have disclosed the said treatment at the time of submitting the proposal form, if he had disclosed the fact appellant company would not have accepted the proposal and issued the policies to the life assured.  Hence, there is clear failure on the part of the life assured and complainant also not disclosed the fact.  It is breach of duty and good faith.  Hence, the failure of insured to disclose the past history of TB was a valid ground for repudiation to the appellant company.  The District Commission held that if the deceased/ life assured had taken treatment at Government Hospital there must be record maintained in the hospital and insurance company to prove its case would have obtained the said from the hospital and could have produced it before this Commission to prove its contention, but, it was not done by the insurance company.
8. Perused the documents.  There are two documents and appellant company after investigation obtained these two documents.  Hence, it is necessary to produce the government hospital records.  Moreover Life assured had obtained two policies on 10.03.2011 and died on 11.12.2011 within 9 months from taking the policy and paid only one premium towards each policy which seems to be life assured had under taken treatment for Tuberculosis before taking policies and intentionally he suppressed the fact.  Hence, considering the facts and discussion made here we are of the opinion that repudiation of the claim of complainant by the appellant company is valid and order of the district forum is not just and proper.  Accordingly, the appeal is allowed and the order passed by the District Forum is set aside.  Consequently, the Complaint is dismissed with no order as to costs.
9. The amount in deposit is directed to be refunded to the appellant/ insurance company.

 

MEMBER                                   JUDICIAL MEMBER

 

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