Karnataka

StateCommission

A/1681/2014

The Branch Manager, EXIDE Life Insurance - Complainant(s)

Versus

H.K. Sunanda alias Nanda H.K - Opp.Party(s)

V. Raman

12 Oct 2023

ORDER

Date of Filing: 08.12.2014

Date of Disposal:12.10.2023

 

BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)

 

DATED:12.10.2023

 

PRESENT

 

HON’BLE Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

Mr K BSANGANNANAVAR: JUDICIAL MEMBER

 

Mrs DIVYASHREE M:LADY MEMBER

 

 

 

APPEAL No.1681/2014

 

 

The Branch Manager

M/s Exide Life Insurance Company Ltd.,

(Formerly known as ING Vysya Life Insurance

Company Ltd.,)

1^st Floor, SBI Building

Opp. to District Library

Sanjay Talkies Road

Mandya      

 

Through Registered Office

EXIDE Life Insurance Company Ltd.,

(Formerly ING Vysya Life Insurance

Company Ltd.,)

3^rd Floor, J P Techno Park

No.3/1, Millers Road

Bengaluru – 560001                                                         Appellant             

(By Mr V Raman, Advocate)

 

-Versus-

Smt H K Sunanda

alias Nanda HK

W/o Sri Gurusiddegowda

No.125-A, Hullukere Village

Bevanahalli Post

Maddur Taluk

Mandya District – 571403                                                Respondent

(By Mr H S Sanjya, Advocate)

 :ORDER:

 

Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

1.       This Appeal is filed under Section 15 of Consumer Protection Act 1986 by the OP, aggrieved by the Order dated 11.11.2014 passed in Consumer Complaint No.111/2014 on the file of District Consumer Disputes Redressal Forum, Mandya (hereinafter referred to as District Forum).

2.       Heard the arguments of the Learned Counsels on record. Perused the Impugned Order, Grounds of Appeal and secured Lower Court Records.

3.       The District Forum after enquiring into the matter, deemed it fit to allow the Complaint in part and directed the OP to pay a sum of Rs.2,06,510/-, Rs.5,000/- towards mental agony and Rs.2,000/- as a Litigation Cost to the Complainant within two months from the Date of Complaint till realisation etc.,

4.       Aggrieved by this Order, OP is in Appeal inter-alia contending amongst other grounds that, despite the Appellant having proved beyond doubt that the claim of the Respondent herein is not tenable or maintainable and its contention in the Written Version by adducing documentary evidence as required under the provisions of law, the District Forum ignoring the same, has chosen to pass the Impugned Order fastening the liability on the Appellant.   The very fact that Life Assured has suppressed, concealed the material fact of his past critical illness while submitting the proposal form itself is sufficient to attract the forfeiture provisions and thus his Nominee is not entitled to the benefits under the Policy.   Therefore, the Appellant Company rightly repudiated the claim of the Respondent, duly explaining the reasons for repudiation.  Thus, the Appellant seeks to set aside the Impugned Order by allowing the Appeal.

5.       It is also not in dispute that the Husband of the Complainant during his life time has obtained Reassuring Life Endowment Plan with Reversionary Bonus Policy from OP on 10.10.2012 with the Sum Assured of Rs.2,06,510/- vide Policy No.02543537; paid premium of Rs.14,518/-; Complainant being the Nominee to the said Policy and during subsistence of the Policy, the insured died on 16.12.2012.  The Complainant being the Nominee to the said Policy, submitted the duly filled in Claim Form along with relevant documents to the OP.  OP repudiated the Claim on the ground that non-disclosure of materials facts relating to the previous medical history by the life assured. Therefore, the Complainant lodged the present Complaint seeking direction to the OP, to pay the Sum Assured of Rs.2,06,510/- with interest at the rate of 12% p.a and litigation costs.

6.       The stand taken by the OP before the District Forum is that believing the answers, statements and declaration made in the Proposal Form by the Life Assured as true and correct, OP’s Underwriter has reviewed the relevant factors such as the age, income, occupation, habits and pre-existing health condition as declared of the prospective Life Assured and upon receipt of the Insurance premium, the OP had issued the Policy bearing No.02543537 on 11.10.2012.   Further, took a stand that during the course of investigation and assessment of the Claim, it was revealed to the OP that the Life Assured had taken medical consultation in Kidwai Memorial Institution of Oncology, Bangalore which is renowned Cancer Hospital in the State of Karnataka on 05.11.2011 for ailment in Head & Neck and OP had collected the Case Summary Sheet from Kidwai Memorial Institution, Bangalore, wherein, it disclosed that the Life Assured had taken treatment, which fact was suppressed while availing the Policy and played a fraud with OP.

7.       The observation of the District Forum in Paras 13, 14, 15 and 16 of its impugned Order that OP has produced the copy of Kidwai Medical Case Summary Sheet to show the Name & Address of the Life Assured who had taken treatment for his disease.  Further, as per the request of OP, original case Summary Sheet pertains to the Life Assured has been secured and on perusal of the same, the District Forum came to a conclusion that the Life Assured not suffered any disease prior to obtaining of the Policy.   The Case Summary sheet has only mentioned the Name & Address of the Patient, not mentioned any line of treatment, medicine and prescription.  Even the Doctor’s name & signature of the treating Doctor and signature of the patient/Guardian also not been mentioned.  Hence, it cannot be presumed that the Life Assured had suffered from any serious illness and documents produced by the OP cannot be accepted and OP failed to produce the acceptable evidence to prove that they repudiated the Claim on the Life Assured was suffering from any sort of disease, which had any direct relation to the cause of the Insured’s death..

8.       On perusal of the copy of the Proposal Form produced by OP, it is seen that the same is dated 10.10.2012, at Page No.4 under the heading, ‘Health Details of the life to be assured’, the questionnaire submitted to the insured, in particular for the questions at Sl Nos 69, 70 & 71, the Life Assured has mentioned his reply as ‘NIL’.  Further, on perusal of the Case Summary Sheet, which is marked as Annexure-A-8 issued by Medical Record Officer of Kidwai Memorial Institute of Oncology, Bangalore with regard to particulars of the Insured, wherein Hospital No.201114937, Patient Name: Mr Gurusidde Gowda, Age : 48 years, Sex : Male, Registration Date : 08.11.2011, Time: 12.13 pm relationship of the Insured Person only have been mentioned, but nothing is mentioned with regard to details of Date of Discharge and line of treatment taken for which disease.  Further, the Terms & Conditions of the Policy at Clause 5.1.1- ‘Forfeiture of amounts in certain cases, if any material information is found to be withheld or misrepresented, the policy shall become null and void from date of commencement and company shall cease to be liable for any benefits under the policy’ cannot be accepted in the present case on hand, since there is no credible evidence to show that the Life Assured was suffering from any serious illness which can be said to be directly related to the cause of death of the Life Assured.  Thus, OP had miserably failed to substantiate his case for repudiating the claim, by producing cogent evidence to show that Life Assured had suppressed the material facts with regard to pre-existing disease while obtaining the Insurance Policy. In the circumstances, this Commission is of the considered opinion that the Impugned Order is just and proper and there are no strong reasons to interfere with the same.   Accordingly, Appeal is Dismissed, with no order as to costs.

9.       The Statutory Deposit in this Appeal is directed to be transferred to the District Commission for further needful.

10.     Return the LCR forthwith to the District Commission

 

11.     Send a copy of this Order to the District Commission, as well as to the parties concerned, immediately.

 

 

Lady Member                  Judicial Member                     President

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