1. Heard Ms. Suman Bagga, Advocate, for the appellant and Mr. Poornachandiran R., Advocate, for the respondents. 2. The above appeal has been filed against the order of the State Consumer Disputes Redressal Commission, Telangana dated 03.10.2022 passed in CC/104/2018 whereby the complaint has been allowed and the appellant has been directed to pay the insurance benefit of Rs.50 lacs alongwith interest @ 6% per annum from the date of repudiation of the claim and Rs.10000/- as compensation and litigation cost. 3. K. Pushpavati & Ors., the respondents filed CC/104/2018 for directing the HDFC Life Insurance Co. Ltd., (Appellant) to pay Rs.50 lacs as insurance benefit under the plan ‘HDFC Life Click 2 Protect’ policy no.16720344 with interest and pay Rs.2 lacs as compensation for deficiency in service and Rs.2 lacs as compensation for mental agony and litigation costs. The complainants stated that K. Prabhakar, husband of complainant no.1 and father of complainants no.2 to 4, applied for ‘HDFC Life Click 2 Protect’ insurance policy on 13.03.2014 and deposited the initial premium. Thereafter, the opposite party had made necessary medical investigation and tests in respect of health of the deceased life assured and after obtaining the relevant reports, issued policy no. 16720344 on 18.03.2014. Thereafter, the deceased life assured has deposited its premium which was payable annually. Unfortunately, Mr. K. Prabhakar (deceased life insured) expired on 16.08.2017. As per procedure of the opposite party, the complainants submitted the claim form. Thereafter, the opposite party conducted investigation and rejected the claim through letter dated 27.12.2017 on the ground that the deceased life assured has given age details in the proposal form which was found to be false and the deceased life assured was suffering from diabetes which was concealed in the proposal form. The grounds on which the claim was repudiated, are incorrect inasmuch as it is incorrect to say that deceased life assured has given incorrect age details or was suffering from diabetes. 4. The opposite party contested the case and filed its written reply. In the written reply, the opposite party has again raised the same issues and stated that the deceased life assured has applied for insurance policy with Aditya Birla Sun Life Insurance Company Ltd. in which the premium was charged at a higher rate inasmuch as the deceased was suffering from diabetes. Thereafter, the deceased had got that policy cancelled but this fact has not been disclosed in the proposal form dated 13.03.2014. As such, the material fact has been concealed and the insurance policy was voidable for concealment of material facts. 5. The State Commission, after hearing the parties, by the impugned judgment dated 03.10.2022, held that the ground taken for repudiation of the claim in respect of misstatement of age is not correct inasmuch as a 10th class mark memo was filed in which the same date of birth has been mentioned which was mentioned in the proposal form i.e. 06.05.1974. The other ground taken by the opposite party that the deceased was suffering from diabetes, is also not liable to be accepted inasmuch as at the time of issue of policy, the opposite party got the blood test report of the deceased in which no diabetes was found. In any case, the policy cannot be avoided on this ground after two years of issue of the policy as per Section 45 of the Insurance Act, 1938. So far as the withdrawal of policy issued by Aditya Birla Sun Life Insurance Company Ltd. is concerned, it is not proved that the insurer has rejected the policy due to health conditions of the life assured nor it is proved that life assured was suffering from diabetes and hypertension. On these findings, it has been held that repudiation of the claim was illegal. Accordingly, the opposite party has been directed to pay the insurance benefit under the policy. Hence, this appeal has been filed. 6. I have considered the arguments of the counsel for the parties and examined the record. A perusal of the letter dated 27.12.2017 issued by the appellant shows that the claim was repudiated on the ground that the life assured had disclosed incorrect age. Before the State Commission, the 10th class mark memo of the deceased life assured has been filed in which the same date of birth as mentioned in the proposal form i.e. 06.05.1974 was mentioned. The appellant has not produced any other material to dispute the age of the deceased life assured. The finding of fact recorded in this respect does not suffer from any illegality. 7. In the letter dated 27.12.2017, the appellant has taken other ground for repudiating the claim that deceased was suffering from diabetes and was rated accordingly by Aditya Birla Sun Life Insurance Company Ltd. Being higher rate of premium, the deceased life assured had withdrawn the policy. Along with the policy, the appellant had filed copy of the application for withdrawal as given by the deceased. In this application, the deceased has mentioned that he had taken ‘Easy Protect Plan’ and after going through it, he found that in the mediclaim, extra premium was required to be deposited. Therefore, he proposed for cancellation of this policy. The appellant has also filed letter of Aditya Birla Sun Life Insurance Company Ltd. dated 31.03.2014 in which the only fact has been mentioned that as you get initial deposit cancelled, as such, the policy was cancelled. From these documents, it is not proved that the deceased life assured was suffering from diabetes. It is not disputed by the appellant that before issue of the policy, blood test report was obtained by the appellant in which blood sugar was found normal. The reason assigned for repudiation of the claim that due to diabetes, he was rated at a higher rate by Aditya Birla Sun Life Insurance Company Ltd., is also incorrect inasmuch as in the application of the deceased life assured, he sought cancellation only on the ground that the policy does not include the mediclaim for which extra premium was required, reason was entirely different. 8. So far as the argument that the deceased has concealed the fact relating to the previous policy is concerned, the relevant column no.13 in the proposal form which required any application for insurance on word life has been withdrawn by you. The proposal form was filled up on 12.03.2014 and the withdrawal application is also allegedly given on 12.03.2014. As such, it cannot be said that whether withdrawal application was prior to filling up of the proposal form and this does not amount to concealment of any fact. O R D E R In the result, the appeal has no merit. It is accordingly, dismissed. |
