KERALA STATE CONSUMER DISPUTES REDRESSAL
COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL 265/2011
JUDGMENT DATED 11.10.2011
PRESENT:-
SHRI.S.CHANDRA MOHAN NAIR : MEMBER
APPELLANT
M/s. Bajaj Allianze Life Insurance Company Ltd.
3rd Floor, Ravi Arcade, Padma Jn, Kochi – 35
Rep. by T.K. Subraminian, State Operations Manager, M/s. Bajaj Allianze Life Insurance Co. Ltd.,
Kailas Plaza, 3rd Floor, Pattom, Tvpm - 4
( Rep. by Adv. Siju Rajan)
RESPONDENT
K. S. Smitha,
W/o Late Pradeepan, Kottarappatt house,
Chittethukara P.O, Kakkanad - 30
(Rep. by Adv. Sri. George Cheriyan)
JUDGMENT
S. CHANDRAMOHAN NAIR : MEMBER
The order dated 30.9.2010 of CDRF, Ernakulam in C.C. 178/08 has been challenged by the opposite party who is aggrieved by the directions of the Forum below to pay to the complainant a sum of Rs. 4,50,000/- within one month from the date of receipt of the order, failing which the opposite party is liable to pay 12% interest per annum also to the complainant from the date of default till payment.
The complainant who is the wife of the deceased Pradeepan has approached the Forum stating that her husband had a Life Insurance Policy with the opposite party for a sum of Rs. 4,50,000/- and that the policy was taken on 10.2.2005 and subsequently renewed in 2006 and further that her husband had died on 13.4.2006 due to some ailments and when she approached the opposite party for the amount covered under the policy, the opposite party repudiated the claim alleging that the deceased had suppressed the material facts regarding his health conditions. Alleging deficiency in service, the complainant has prayed for directions to the opposite party to pay the insured amount with 12% interest and cost.
The opposite party in their version contended that the insured had suppressed the material fact of treatment for Diabetic Mellitus and that at the time of taking the policy the complainant had Diabetic Mellitus for the last 5 years and also that the deceased was fully aware of his ailment which was pre existing from the year 2000 onwards. Contending for the position that the repudiation was legal and valid and also that the complaint was filed after a lapse of 26 months, the opposite party prayed for the dismissal of the complaint.
The evidence consisted of the oral testimony of the complainant as Pw1 and Exts. A1 to A15 had her side. On the side of the opposite party the Assistant Manager was examined as Dw1 and Exts. B1 to B4 were marked. It is based on the said evidence that the Forum below had passed the impugned order.
Heard both sides.
The learned counsel for the appellant/opposite party vehemently argued before us that the Forum below had lost sight in considering the fact that the complainant herself had admitted that the insured was suffering from Diabetic Mellitus and was under treatment. It is also his case that the complaint was not maintainable as it was filed out of time. The learned counsel advanced the further contention that the Medical Treatment Certificate and the treatment records revealed the fact that the deceased was not in good health at the time of taking the policy and the suppression of material facts entitled the opposite party to repudiate the claim. He has also submitted before us that the Forum below did not consider Ext. B3, in which the doctor has stated that the complainant was under treatment for a period of 5 years and hence the Forum below ought to have dismissed the complaint.
On the other hand, the findings and conclusions were supported by the learned counsel who appeared for the respondent/complainant. It is his very case that the Forum below had passed the order after appreciating all the materials before it. It is also submitted before us that the claim by the Life Insurance Corporation was disbursed to the complainant and it was only the appellant who repudiated the claim on untenable grounds. It is further argued that Ext. B3 was not proved by the opposite party and it was only a concocted document produced by the opposite party to justify their illegal repudiation. Thus he canvassed for the position that the appeal is liable to be dismissed with compensatory cost.
On hearing both sides, and also on perusing the records we find that the complainant had taken the policy in 2005 for a sum of Rs. 4,50,000/- from the opposite party. It is also found that the policy was renewed in 2006. It is the further admitted fact that the complainant’s husband who was the insured had died on 13.4.2006 consequent to the ailment of Hepatitis B and multi organ failure etc. The appellant argued that the deceased had the pre existing decease of Diabetics Mellitus. To support this contention, the opposite party/appellant is relying on Ext. B3, Medical Attendance Certificate which was obtained by the opposite party. The Forum below was of the opinion that Ext. B3 could not be relied upon as it was not properly proved by examining the Doctor who seems to have issued Ext. B3. The Forum below had also found that the complaint was not barred by limitation as the complaint was filed within 2 years after the repudiation of the claim by the opposite party on 1.9.2006. On an appreciation of the entire facts and circumstances, it is found that the Forum below had considered all the aspects in detail while disposing of the complaint. Hence it is found that findings and conclusions of the Forum below need not require any interference. All the same it is noted that the Forum below had ordered 12% interest on the insured sum of Rs. 4,50,000/- which is on the higher side. It is felt that 6% interest is just and reasonable to be paid by the opposite party/appellant from the date of default till payment.
In the result, the appeal is allowed with the only modification shown above. Thereby the appellant/opposite party is liable to pay to the complainant the sum of Rs. 4,50,000/- with 6% interest from the date of default of the order of the Forum below till payment.
In the nature and circumstances of the present appeal, the parties are directed to suffer their respective costs.
S. CHANDRAMOHAN NAIR : MEMBER
ST
