JUSTICE V.K. JAIN, PRESIDING MEMBER (ORAL) Late Sh. Odu Lingegowda submitted a proposal to the petitioner, Birla Sun Life Insurance Co. Ltd. on 21.07.2008 to obtain an insurance cover to the extent of Rs. 8 lakhs and also deposit premium amounting to Rs. 12,187/-. The proposal came to be accepted and a policy was issued to late
Sh. Odulingegowda on 19.08.2008. The insured died of heart attack on 30.08.2008. On his death, being his nominee, the complainant submitted a claim with the petitioner, Insurance Company. The claim, however, was repudiated vide communication dated 03.08.2009, which the petitioner had sent in response to a legal notice of the complainant dated 12.05.2009. Being aggrieved, the complainant preferred a complaint before the concerned District Forum, seeking payment of policy amount of Rs. 8 lakhs, alongwith guaranteed maturity benefit of Rs. 70,000/- with interest. 2. The complaint was resisted by the petitioner, inter-alia, on the ground that the insured was suffering from diabetes for the last 10 years before taking the policy and the aforesaid fact was concealed by him while submitting the application form. The amount of the policy, however, was not disputed in the reply. 3. The District Forum, vide its order dated 15.01.2010, directed the petitioner to pay the insured amount of Rs. 8 lakhs to the complainant alongwith cost amounting to Rs. 2,000/-. The petitioner was also directed to pay interest to the complainant at the rate of 7% per annum. Being aggrieved from the order of the District Forum, the petitioner preferred an appeal before the Karnataka State Consumer Disputes Redressal Commission, Bangalore. The said appeal having been dismissed vide impugned order dated 28.03.2011, the petitioner is before us, by way of this revision petition. 4. The order passed by the State Commission has been assailed by the learned counsel for the petitioner on two grounds. The first ground taken by her is that the sum assured was Rs. 4,43,018/- and not Rs. 8 lakhs, whereas the second ground taken by her is that the deceased had concealed a material fact about her being a patient of diabetes, for about 10 years before submitting the proposal. 5. Though, in the reply filed before the District Forum, the petitioner did not dispute the sum assured by it, when a contention in this regard was raised before this Commission on 24.03.2014, a direction was given to the complainant to file copy of the policy showing that the said policy was for Rs. 8 lakhs. However, no copy of the policy has been filed by the complainant. A copy of the proposal form has been filed, which shows that the deceased was seeking insurance cover to the extent of Rs. 8 lakhs. The petitioner, however, has placed on record the copy of the insurance policy, which was issued to the deceased and the said policy clearly shows that the sum assured was Rs. 4,43,018/-. Though, the policy also had an AD&D rider, the said rider is not applicable in the present case, since the deceased did not die because of accident. In these circumstances, when the complainant has failed to produce any policy document, showing the sum assured to be Rs. 8 lakhs, it would be highly unfair to penalise the complainant only on account of wrong admission made in the reply. This is more so when the policy document filed by the petitioner clearly shows that the sum assured was not Rs. 8 lakhs. We, therefore, conclude that the sum assured in this case was only Rs. 4,43,018/- and not Rs. 8 lakhs. 6. As regards the alleged illness of the deceased, admittedly no evidence was produced by the petitioner before the District Forum to prove that he was suffering from diabetes before or at the time he submitted the proposal form for taking insurance cover from the petitioner company. The learned counsel for the petitioner submits that in the claim form it was stated that the deceased was suffering from diabetes and this was noted by the District Forum in its order dated 15.01.2010. We, however, find that the District Forum, on perusal of the material placed before it and also noticing that the complainant was an illiterate, who did not know English felt that there could be some tampering with the claim form produced by the petitioner company, to the extent it related to the assured suffering from diabetes for the last 10 years. It was also noted by the District Forum that it was only after receipt of legal notice that the Insurance Company came out with an allegation that he was suffering from diabetes for the last 7 years. The finding returned by the District Forum has been accepted by the State Commission. Exercising the revisional jurisdiction conferred upon us, we will not be justified in interfering with concurrent finding of facts recorded by the fora below unless it is shown to be perverse. Considering the fact that no evidence at all was produced by the petitioner to prove that the deceased was suffering from diabetes for about 10 years before taking the policy the finding recorded by the fora below cannot be said to be perverse so as to sustain interference by us in exercise of our revisional jurisdiction. 7. For the reasons stated hereinabove, we modify the order passed by the fora below by directing that as against the sum of Rs. 8 lakhs awarded by the said for a, the petitioner shall pay an amount of Rs. 4,43,018/- to the complainant alongwith interest at the rate of 7% per annum. According to the learned counsel for the petitioner, the entire amount already stands paid alongwith interest at the rate of 7% per annum. If that is so, the complaint shall stand satisfied in terms of this order. |
