THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 11th DAY OF AUGUST 2021
PRESENT
SRI RAVI SHANKAR – JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI - MEMBER
APPEAL NO. 628/2013
1. Branch Manager,
Birla Sun Life Insurance Life Insurance Co., ltd.,
Limited II Floor, Upstaris Koutouns
Parvathinagar Main Road, Bellary.
2. Birla Sun Life Insurance Co., Ltd.,
One India Bulls Centre Tower1,
16th Floor, Jupiter Mill Compound,
841, Senapati Bapat Street,
Elpinstone Road, Mumbai-400 013.
….Appellant/s.
(By Shri/Smt. H.K.Revana Siddappa, Adv.,)
-Versus-
J. Ramesh S/o Late Gadilingappa
A/a 32 years, R/o Karur Village,
Bellary Tqluk and District.
……….. Respondent/s
(By Sri/Smt B.Pramod, Adv.,)
:ORDERS:
BY SRI.RAVI SHANKAR - JUDICIAL MEMBER
The appellants were the Opposite Parties in complaint No.140/2012 preferred this appeal against the order dated:12/02/2013 passed by the Bellary District Commission which directed the Opposite Parties to pay an amount of Rs.15,00,000/- + 2,00,000/- with interest @ 6% p.a. from the date of the complaint till realization and also directed to pay Rs.1,000/- towards costs.
2. The brief facts of the case are as under:-
The complainant’s Father one Gadilingappa had obtained two life insurance policies bearing Nos.004939710 and 004942757 for an assured amount of Rs.2,00,000/- and Rs.15,00,000/- respectively and the premium amount was Rs.18,130/-. After receipt of the proposal from the deceased Gadilingappa, the Opposite Parties have accepted and issued the policies in favour of the said deceased Gadilingappa. After obtaining the policies, the Opposite Parties received a claim form for compensation under the policies as the policy holder died on 19/11/2011 due to hypertension. After receipt of the claim, they have investigated the matter as the claim was within a year after issuance of the policy and they came to know that the deceased policy holder had not disclosed the health condition during the proposal. The deceased insured was suffered from Left Ventricular Failure (LVF) with Dilated Cardiomyopathy and he was taken treatment at Vijayanagar Institute of Medical Science, Bellary as an inpatient from 21.10.2011 to 26.10.2011. The same was not disclosed at the time of taking the policy. Hence, they have repudiated the claim under the ground for suppression of material facts and submits to set-aside the order passed by the District Commission.
3. We have heard the arguments from both sides.
4. On going through the certified copy of the order, memorandum of appeal and documents produced by the appellant, we noticed that the Father of the complainant had obtained two life insurance policies from the Opposite Party/company for a sum of Rs.2,00,000/- and Rs.15,00,000/- under the policy bearing Nos.004939710 and 004942757 dated:21/06/2011 and 13/07/2011 and accordingly paid the first premium and after receipt of the premium amount, the Opposite Party has issued the policies. But, unfortunately, on 19/11/2011, the insured died. By virtue of the policies, the complainant being the nominee had claimed for sum assured under the two policies. But the Opposite Party/company repudiated the claim as the insured has suppressed the health condition at the time of taking the policies.
5. The District Commission after evidence from both sides, has noticed that the complainant had obtained the policies in the month of June 2011, whereas he went to hospital for check-up as he noticed shortfall of breathing and some pain in the heart on 21.10.2011 and on the advice of the Doctors, he was hospitalized as an inpatient and treated till 26.10.2011. But after discharge, the insured was died on 19/11/2011 and gave opinion that the said ailment was suffered by the insured only after taking the policies. Hence, the question of suppression of material facts with respect to the ill health does not arise and awarded for payment of the assured amount to the complainant under the two policies. Of-course, we agree with the order passed by the District Commission. We noticed that the appellants have not produced any materials/evidence before the District Commission or before this Commission to show that the insured was suffered from the above said diseases prior to taking the policies and prior to making the proposal for taking the policies. In the absence of such materials/evidence, the subsequent ill-health cannot be considered as suppression of material facts at the time of taking proposal. Further, the insured himself does not know about his ill health and hence appellant cannot expect that he was suffering from Left Ventricular Failure (LVF) with Dilated Cardiomyopathy. The Opposite Parties would have arranged for thorough check-up at the time of accepting the proposal, but they have not done so. Hence, the ground taken for repudiation of the claim of the complainant is not acceptable and not in accordance with law. As such the appeal is liable to be dismissed. Accordingly, we proceed to pass the following:-
:ORDER:
The appeal is dismissed. No costs.
The impugned order dated:12/02/2013 passed by Bellary District Consumer Commission in C.C.No.140/2012 is hereby confirmed.
The amount in deposit shall be transmitted to the concerned District Commission to pay the same to the Respondents/complainant.
Return the LCR forthwith to the concerned District Commission.
Send a copy of this order to both parties as well as Concerned District Commission.
Sd/- Sd/-
Member. Judicial Member.
Tss
