THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 13th DAY OF JUNE, 2024
APPEAL NO.128/2018
PRESENT
SRI RAVI SHANKAR, JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI, MEMBER
1. The Branch Manager,
Jeevan Jyothi,
LIC of India,
Kuvempu Nagar,
Hassan-573 201
...Appellant/s
2. The Divisional Manager,
Jeevan Prakasha,
Divisional office,
Mysore-Bangalore Road,
Banimantappa,
Mysuru-570 015
(Both represented by the
Authorized Representative)
Manager, (Legal & HPF)
LIC of India, Divi.office-1,
JC Road, Bengaluru-560 002
(By Sri.Rohith Gowda, Advocate)
-Versus-
H.A.Rajashekara
S/o late Annappa.K.N,
Aged 50 years, No.424, EW-25, ...Respondent/s
Sri Manjunath Krupa,
Yellamma Temple Road,
Doddagarudi Cross,
Hassan-573 201
(By M/s.Legal Elite Jurist, Advocates)
O R D E R
BY SRI RAVI SHANKAR, JUDICIAL MEMBER
The Appellants/Opposite Party Nos.1 and 2 in complaint No.23/2017 preferred this Appeal against the order passed by the District Consumer Commission, Hassan which directed this appellant to pay an amount of 75% of the assured amount under non-standard basis and submits that the complainant had obtained non-medical life insurance policy bearing No.726236546 which commences from 28.7.2014 for a sum of Rs.4,50,000/-. After issuance of the policy, they received information that the life assured was died on 26.1.2015 for the death of the complainant the claim form was filed along with the original policy. After investigation upon the claim this appellant had repudiated the claim for the reason of pre-existing diseases. Aggrieved by the same, the complainant approached the District Commission and filed a complaint and sought for payment of the assured amount. The District Commission after trial allowed the complaint and directed this appellant to pay the above said amount. The order passed by the District Commission is not in accordance with law. The claim was rejected only basing on the pre-existing diseases and the same was not disclosed by the life assured at the time of taking policy, it was noticed that the life assured undergone sonogram at District Hospital, Hassan on 9.9.2014 as per the sonogram report of Pelvic scan it reveals that the deceased life assured had a mass measuring 20 – 17 mm which was firm in consistency which affected her movement. Further the age of such mass accumulation was 22 weeks prior to 9.9.2014 so she was restricted to bed from about 1.1.2014. Such being the case, she obtained the policy on 28.7.2014. Considering the said they have repudiated the claim, but the District Commission not considered the said facts and allowed the complaint. The order passed by the District Commission is not in accordance with law, hence prays to set aside the order passed by the District Commission and dismissed the complaint, in the interest of justice and equity.
3. Heard from both sides.
4. On perusal of the certified copy of the order and memorandum of appeal, it is admitted that the life assured had obtained the life insurance policy on 28-7-2014 and subsequently the life assured died on 26.1.2015. Being the nominee and LRs of the life assured, the complainant claimed for assured amount by virtue of the policy. After investigation, this appellant repudiated the claim for the reason of pre-existing diseases and submits that she was suffering from carcinoma ovary at the time of availing the policy and shown their inability to settle the claim. Consequently the complaint was filed and the District Commission after trial allowed the complaint. We are of the opinion that prior to taking the policy by the life assured she had underwent only a scan which discloses there was a mass in the Pelvic ovary it was noticed that there was mass measuring 20-17 mm. Basing on the said sonogram report only this appellant had repudiated the claim. Mere basing on the sonogram report this appellant had come to the conclusion that she had a cancer and the same was not disclosed by the said life assured. The grounds urged for repudiation of the claim is not justifiable. This appellant has not produced any materials to show that she has taken treatment for cancer prior to taking the policy. Further notice that she was admitted to hospital on 13-9-2014 subsequent to taking the policy itself at Kidwai Memorial Hospital, Bengaluru where it was noticed that she had carcinoma ovary when the cancer was noticed subsequent to the policy this appellant cannot be take a ground that the life assured had suppressed the said facts prior to taking the policy. Subsequently she died on 26.1.2015. The life assured came to know about her ailment only after admitted to Kidwai Memorial Hospital. As such the grounds taken for repudiation of the genuine claim is not in accordance with law. The District Commission after considering the documents produced by both parties and evidence and allowed the complaint. The order passed by the District Commission is in accordance with law. No interference is required and the same time no valid grounds urged before this Commission. As such the appeal is dismissed and accordingly we proceed to pass the following:-
O R D E R
The appeal is dismissed. No order as to cost.
The impugned order dated 15.12.2017 passed by the District Consumer Disputes Redressal Commission, Hassan in CC.No.23/2017 is confirmed.
The amount in deposit shall be transmitted to the concerned District Consumer Commission to pay the same to the complainant.
Send a copy of this order to both parties as well as Concerned District Commission.
Member Judicial Member
