KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD, THIRUVANANTHAPURAM

FIRST APPEAL 96/2011

JUDGMENT DATED: 9..12..2011

PRESENT

JUSTICE SRI.K.R.UDAYABHANU                     : PRESIDENT

SRI.S.CHANDRAMOHAN NAIR                          : MEMBER

1. HDFC Standard Insurance Co.Ltd.,              : APPELLANTS

    Ramon House, H T Prarekh Marg,

    Blackway Reclamation Church Gate,

    Mumbai – 400 200.

2. HDFC Standard Insurance Co.Ltd.,

    IVth Floor, Deepa Towers,

    Deepa Junction, M.C.Road,

    Thiruvalla, Pin-689101.

(Adv.Saji Isac.K.J)

                  Vs.

Baby George,                                                          : RESPONDENTS

Pulimoottil Divya Darshan,

Thiruvalla – 689101,

Pathanamthitta.

(By Adv.R.Jagadish Kumar)

JUDGMENT

JUSTICE SRI.K.R.UDAYABHANU         : PRESIDENT

          The appellants are the opposite parties/Insurance Company in CC96/09 in the file of CDRF, Pathanamthitta.  The appellants are under orders to pay the deposited amount of Rs.1,50,000/- with its accrued growth  amount and Rs.1,50,000/- insured sum with respect to the life of the assured with interest at 9% per annum from the date of complaint and also compensation of Rs.10000/- and cost of Rs.1000/-.

          2. The complainant is the mother of the deceased Thomas George who had availed a life insurance policy along with HDFC unit linked medical endowment plan with effect form 26.5.06.  He paid 3 premiums of 50000/- each. The assured died on 24.7.08 ie after 2 years.  The opposite parties have repudiated the claim.

          3. It is the contention of the opposite parties that the assured had suppressed material facts in the proposal form as the medical certificate issued from Thiruvalla Medical Mission hospital  the deceased was suffering from sever portal gastropathy and liver cirrohosis, spleenomegaly/ascites and portal hypertension  and he was under treatment from 1.2.05 to 5.2.05.  As the assured had not disclosed the existing diseases  the claim could not be considered.

          4. The evidence adduced consisted of the proof affidavits filed by the respective sides; Exts.A1 to A4.

          5. In the absence of any objective evidence the Forum allowed the claim.

          6. Alongwith with the appeal memorandum the opposite parties have produced the copy of the discharge particulars from Thiruvalla Medical Mission Hospital wherein IP treatment from 1.2.05 to 5.2.05 is mentioned.  Severe portal gastropathy ,chronic parenchymal liver(the next word is not readable), spleenomegaly/ascites and portal hypertension.  It is submitted that the documents could not be produced before the Forum below due to inadvertent mistake.  The counsel has sought for an opportunity to adduce evidence before the Forum.  Of course the matter  has been filed on 17.7.09 and the case was disposed of 20.9.10. The opposite parties had sufficient opportunity to adduce evidence.  All the same in view of the treatment record produced and in view of the fact that the above contention had been raised in the version itself  we find it would be reasonable to afford an opportunity to the opposite parties to adduce evidence. All the same we find that being a unit linked endowment plan the opposite parties are liable to refund the deposited amount of Rs.1,50,000/- with its accrued growth amount which is independent of the life cover Rs.1,50,000/-.  In the circumstances we find that it would only be just to direct the opposite parties to make the payment with respect to the deposited amount and its accrued growth amount.  Hence the opposite parties/appellants are directed to pay the above sum of Rs.1,50,000/- with its accrued growth amount with interest at 9% per annum from the date of complaint.  The opposite parties also will pay a sum of Rs.10,000/- towards cost to the complainant.  The amounts are to be paid within 3 months from the date of receipt of this order failing which the complainant will be entitled for interest at 12% per annum from 9.12.11 the date of this order.  The Forum will permit the opposite parties to adduce evidence with respect to the alleged suppression of material facts regarding the health of the assured and dispose of the above segment of the claim on merits.  The case stands posted before the Forum on 10.1.2012.

          Office will forward the LCR along with the copy of this order.

          JUSTICE K.R.UDAYABHANU                             : PRESIDENT

            S.CHANDRAMOHAN NAIR                                  : MEMBER

Ps