Date of filing: 18.11.2021

                                                               Date of Disposal:19.10.2022

 BEFORE THE III ADDITIONAL BANGALORE URBAN

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

                               BENGALURU – 560 027.

DATED THIS THE 19^th DAY OF OCTOBER, 2022

CONSUMER COMPLAINT NO.434/2021

PRESENT:

SRI.RAJU K.S,

SMT.REKHA SAYANNAVAR,:MEMBER

S.Pradeep Kumar,

S/o K.Shivasiddaiah,

Aged about 30 years,

Residing at No.14, 1^st Main,

Bangaloe-560 085.……COMPLAINANT

(Rep by Sri.K.S.Mohith Kumar, Adv).

V/s

Head of Claims Department,

Aditya Birla Capital,

Aditya Birla Sun Life Insurance Company Limited,

One India Bulls Centre,

Tower-1, 16^th Floor,

Jupiter Mill Compound, 841,

Senapati Bapat Marg,

Eiphinstone Road,

Mumbai:400 013. ……      OPPOSITE PARTY-1

Head of claims Department,

Aditya Birla Capital,

Aditya Birla Sun Life Insurance Company Limited,

G-Corp Tech Park, 5^th and 6^th Floor,

Kasar Vadavali,

Near Hypercity Mall,

Ghodbunder Road,

Thane West-400 601.……      OPPOSITE PARTY-2

//JUDGEMENT//

BY SRI.SHIVARAMA K, PRESIDENT

The complainant has filed this complaint under Section-35 of Consumer Protection Act, 2019 seeking for a direction to the opposite parties to pay a sum of Rs.12,00,000/- with interest at the rate of 18% p.a. from the date of complaint and a sum of Rs.3,00,000/- as compensation for misleading and forcing the deceased to take a life insurance policy at the time of loan and a sum of Rs.1,00,000/- as compensation and a sum of Rs.50,000/- towards litigation charges and such other reliefs

as this commission deems fit in the circumstances of the case.    

2. In spite of receipt of notice, the opposite parties remained absent. 

3. It is the case of the complainant that he is the nominee/beneficiary of deceased Puttarajamma, who had taken life insurance policy from the opposite parties.  Further on 07.10.2020 Puttarajamma has passed away due to a natural cause, in Meenakshi Hospitals, Bangalore due to Bilateral Broncho Pneumonia as indicated in the discharge summary and death report dt.07.10.2020.  Further, during the life time the deceased had obtained loan by mortgaging the property site No.30 from the opposite parties.  Further, it was assured that in the event of the death of the insured the assured amount of Rs.12,00,000/- would be adjusted  towards the loan of Rs.12,00,000/- and the deceased was issued the life insurance policy for the assured amount of Rs.12,00,000/- on 16.07.2019.  Further, the deceased had paid single pay premium of INR Rs.41,892/-.  Further, since the illness has commenced only 4 days prior to death, the opposite parties without any reason had repudiated the claim on the ground that the insured did not disclose the deceased and only disclosed that she had BP and diabetic.  Hence, there is deficiency of service on the part of the opposite parties in not honouring the claim of the complainant. 

4. To prove the case, the complainant (PW1) has filed affidavit in the form of his evidence in chief and got marked EX.P1 to P10 documents.  

 5. Counsel for the complainant had filed written arguments.       

6. The points that would arise for consideration are as under:

i) Whether there is deficiency of service on the part of the opposite parties ?

    ii) Whether the complainant is entitled for the  

         compensation as sought ?

     iii) What order ?

  7.   Our findings on the aforesaid points are as follows:

Point No.1 :  In affirmative

Point No.2 :  Partly in affirmative   

Point No.3 :  As per the final order for the following;

REASONS

8. POINT NO.1:- The complainant (PW1) has reiterated the fact stated in the complaint, in the affidavit filed in the form of his evidence in chief.  EX.P1 is the Xerox copy of the Aadhar card relates to the deceased insured of the complainant, who is the son of the deceased.  EX.P2 is the statement of account.  The opposite parties had repudiated the claim of the complainant as per EX.P10.  EX.P10 is the reply given by the opposite parties to the notice issued by the complainant through his advocate vide EX.P9 dt.11.08.2021 calling upon the opposite parties to pay the policy amount of Rs.12,00,000/-  In EX.P10 repudiation letter, it is stated that if the insured would have disclosed at the proposal stage, about past medical history, the deceased member would have subjected to detailed underwriting procedure and the company would have not issued policy at all and the copy of the said repudiation letter dt.26.08.2021 has been sent to the complainant to his registered address.  It is the duty of the insurer to get the insured medically examined before issuing the policy.  Hence, any fault cannot be attributed on the deceased for non-examination of the deceased medically.

9. In support of the oral evidence, the complainant has produced EX.P4 death summary.  In which it is stated that on 07.10.2020 the deceased had admitted to the hospital with the complaint of severe breathlessness, cough with expectoration since one week, no fever spikes and rapid antigen test-negative.  Further, the deceased had desaturation while brought to the hospital.  Further the deceased had died on 07.10.2020 at 8.15 p.m.  It is stated in the letter of reply dt.26.08.2021, as per EX.P10 that on investigation it was revealed that the deceased was diagnosed with left ventricle hypertrophy and diabetes mellitus prior to the date of declaration of good health by the deceased.  The opposite parties did not produce any document in support of the said defence taken in the reply given to the notice.  The complainant had submitted the claim as per Ex.P7 on 09.11.2020 and had issued notice dt.11.08.2021 vide EX.P9 and it was served on the opposite parties and the complainant had produced postal acknowledgment for having received the notice by the opposite parties.  In spite of that, the opposite parties did not honour the claim of the complainant.  Hence, the act of the opposite parties amounts to deficiency of service within the meaning of Section-2(11) of Consumer Protection Act, 2019.  Hence, we answer this point in affirmative. 

10.POINT NO.2:- The complainant claimed a sum of Rs.12,00,000/- with interest at the rate of 18% p.a.   The assured amount in the policy was Rs.12,00,000/- and the loan amount was Rs.12,00,000/- as per EX.P3.  Further one time premium/single pay premium was of INR Rs.41,892/-.  In EX.P3 credit account statement of the insured member issued by the opposite parties, it is stated that on the date of contingent event occurred the outstanding loan balance was Rs.7,20,000/- and the Master Policy holder recovered the loan of Rs.4,80,000/- and the balance claim amount was of Rs.4,08,360/- and the said balance shall be payable to the insured on the happening of the other contingent event or to the nominee/beneficiary of the deceased member in case of death claims.  Hence, we feel the complainant is entitled for the balance claim amount of Rs.4,08,360/-.  Since, the opposite parties had repudiated the said claim the complainant is entitled for interest for the same from the date of repudiation i.e., 20.02.2021 till realization.  Further, the complainant is entitled for a sum of Rs.20,000/- towards mental agony and a sum of Rs.10,000/- towards litigation cost, since the opposite parties without any reason had repudiated the claim of the complainant and made the complainant to approach the court seeking for the reliefs.  ence, H

 Accordingly, we answer this point partly in affirmative.

11.POINT NO.3:- In view of the discussion made above, we proceed to pass the following;

The complaint is allowed in part.

The opposite parties are directed to pay a sum of Rs.4,08,360/- to the complainant with interest at the rate of 9% p.a. from the date of repudiation i.e., 20.02.2021 till realization.

Further, the opposite parties are directed to pay a sum of Rs,20,000/- towards mental agony and a sum of Rs.10,000/- towards litigation cost. 

The complainant and opposite parties shall comply the order within 30 days. In case, the opposite parties fail to comply the order within the said period, the above said amount of Rs.30,000/- carries interest at the rate of 9% p.a. from the date of order till realization.

Supply free copy of this order to both the parties and return extra copies of the pleading and evidence to the parties.

Applications pending, if any, stand disposed of in terms of the aforesaid judgment.

  (Dictated to the Stenographer, typed by her, the transcript corrected, revised and then pronounced in the open Commission on 19^th day of October, 2022)                                            

• REKHA SAYANNAVAR)    (RAJU K.S)         (SHIVARAMA. K)    
•  

Witness examined for the complainants side:

Sri.S.Pradeep Kumar, the complainant has filed his affidavit.

Documents marked for the complainant side:

1. 1.Xerox copy of Adhar Cards (two pages).
2. Xerox copy of the statement of loan account.
3. Xerox copy of the credit account statement.
4. Xerox copy of the death summary.
5. Xerox copy of the death report.
6. Xerox copy of the medical attendance certificate.             
7. Xerox copy of the Group death claim form.
8. Xerox copy of the letters of repudiation.
9. Xerox copy of the legal notice postal receipt and acknowledgement.
10. Xerox copy of the reply notice issued by opposite parties.

Witness examined for the opposite party side: 

Documents marked for the Opposite Party side:

• REKHA SAYANNAVAR)    (RAJU K.S)         (SHIVARAMA. K)    
•