| Final Order / Judgement | Dated:06.12.2022 ORDER BY Mr. K. B. SANGANNANAVAR: Pri. Dist. & Session Judge (R)- JUDICIAL MEMBER - This is an appeal filed by OP in CC/75/2015 on the file of District Consumer Disputes Redressal Forum, Tumkur aggrieved by the order dated 10.12.2015.
- The Commission examined grounds of appeal, impugned order, appeal papers, additional documents placed on record and heard.
- It is not in dispute that Smt.R.S.Bharathi W/o Chandrashekar had obtained endowment policy bearing no.617202171 on 07.10.2012 under Table No.91 for a term of 16 years. The sum assured was Rs.1,00,000/- and it was a non medical policy considering her age, the premium of every quarter to be paid by her and the present complainant is her nominee. When the policy was in force, she died on 15.06.2014 i.e. 08 months 08 days after obtaining endowment policy and when her nominee submitted a claim form along with required documents, insurer repudiated her claim on the ground that insured concealed her bodily defect or deformities and did not disclose her ailment. A Consumer complaint raised and the Forum below held an enquiry, allowed the complaint in part, directed OP to pay Rs.1,00,000/- along with interest @ 09% p.a. from the date of repudiation till realization. Further awarded some amount of compensation and it is this order being assailed in this appeal contending, insured died on 15.06.2014 within 08 months 08 days from the date of commencement of policy, since it was a early claim, insurer investigated the claim as per Section 45 of Insurance Act and found life assured was fitted with artificial limb due to Gangrene as per declaration form dated 25.07.2011 issued by Karnataka Marwari Youth Federation as per Ex.R2. Learned counsel submits that from the proposal form marked as Ex.R1, it is made clear life assured had diabetes and had physical deformities, did not disclose about diabetes and physical deformities and answered column no.11 in the negative and submits there is suppression of material facts about her health. However, the Forum below has failed to appreciate these vital aspects, since terms and conditions of the policy are governed by Section 45 of the Insurance Act on the principles of utmost good faith and the insured had concealed her ill health in particular answer ‘F’ in the negative, as she had already gangrene fitted with artificial limb, was not considered by the Forum below. The OP insured has also placed some medical records to show that she had ill health, was not considered. In such circumstances, considering date of obtaining policy and in consideration of her suffering from severe diabetes, as a result of which her leg was amputated and an artificial limb fixed on 25.07.2011 itself and such amputation was due to diabetes gangrene and her obtaining of insurance policy on non medical, mentioning in correct information in the LA has to be held concealment, considering the date of her death. In such circumstances, Forum below has to be held committed gross error in directing OP to settle the claim. Hence we proceed to allow the appeal. Consequently set aside the order dated 10.12.2015 passed in CC/75/2015 by District Consumer Disputes Redressal Forum, Tumkur and as a result dismissed the complaint with no order as to cost.
- The Amount in deposit is directed to be refund in favour of appellant with proper identification by his advocate.
- Send a copy of this Order to the District Commission and parties to the appeal.
Lady Member Judicial Member *GGH* | |
