Karnataka

StateCommission

A/1577/2016

LIC of India - Complainant(s)

Versus

Manjula - Opp.Party(s)

Saravana P

10 Jan 2024

ORDER

                                                                     Date of Filing : 08.07.2016

                                                                Date of Disposal : 10.01.2024

 

BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)

 

DATED :10.01.2024

 

PRESENT

 

HON’BLE Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

Mr K B SANGANNANAVAR : JUDICIAL MEMBER

 

Mrs DIVYASHREE M : LADY MEMBER

 

 

APPEAL No.1577/2016

1. M/s LIC of India

    Main Branch Office

    Gulbarga

 

2. M/s LIC of India

    Divisional Manager

    Raichur

 

    Duly represented by

    Sri K Bheemasena Rao

    Manager (Legal and HPF)

    LIC of India, DO.1

    J C  Road

    Bengaluru - 560 002                                                      Appellants

    (By Mr Saravana P Advocate)

 

• Versus -

Smt  Manjula

W/o Late Mallikarjuna Shahapur

Aged 35 years

Occ : Household

C/o Shivashanappa Ankal

Near Goa Hotel

Brahampur

Gulbarga District

(By Mr M M Sangond, Advocate)                                        Respondent  

                                                

   : ORDER :

 

Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

01.     This Appeal is filed under Section 15 of Consumer Protection Act 1986 by the OP, aggrieved by the Order dated 19.05.2016 passed in Consumer Complaint No.112/2014 on the file of District Consumer Disputes Redressal Forum, Kalburgi (hereinafter referred to as the District Forum).

02.     Heard the arguments of the learned Counsels on record.

03.     The District Forum after enquiring into the matter, deemed it fit to allow the Complaint in part and held that OPs are jointly and severally held liable to pay the Sum Assured of Rs.50,000/- under Policy bearing No.666036125 and Rs.2,000/- towards mental agony & litigation expenses to the Complainant within 9 weeks, on failure to pay the said amount, it shall carry interest @ 8% p.a from the Date of Complaint i.e., 20.11.2014, till realisation.

04.     Aggrieved by this order, OPs are in Appeal, inter-alia contending amongst other grounds that, the District Forum grossly mis-understood and drawn a conclusion on the  disputed facts under Policy dated 16.10.2012, where the Life Assured had furnished false answers to health related questions under Question No.11 in Proposal Form for Insurance which lead for acceptance of proposal and completion of the policy   These facts found to be false after investigation into bonafides of the Claim, as the Policy resulted into an early claim, based on the principle of Utmost Good Faith.  It is the duty of the Life Assured to disclose all ailments and treatments taken by him while answering  proposal for assurance.   If the claim is made within 3 years from the date of commencement of the Policy, then the OP, as per its Rules, Regulations & Provisions, cause investigation and if it finds that the policy was obtained mis-representing and with-holding material information, then it will repudiate the Claim by forfeiting the amount as per Section 45 of the Insurance Act 1938.  On the other hand, he was suffering from Pulmonary Tuberculosis prior to date of taking the policy and ID Card TB No.579/2011 issued by Medical Officer, Town Health Center, Ashok Nagar clearly indicates that the deceased Life Assured had availed treatment for T.B before taking this policy.   Thus Appellant seeks to set aside the Impugned Order by allowing the Appeal.

05.     Admittedly, the Late Husband of the Complainant Mr Mallikarjun Shahapur, during his life time, had obtained LIC policy bearing No.666036125 dated 15.10.2012, with Sum Assured being  Rs.50,000/- by paying yearly premium of Rs.3,296/- and declared that Complainant is the Nominee to the said Policy.   On 29.04.2013, the deceased Life Assured died suddenly in a public Garden at Gulbarga and a case was also registered before Brahampur Police Station under UDR No.05/2013 u/s 174 of Cr PC.   Complainant being the Nominee to the said Policy, submitted the Claim along with original Policy Bond, Death Certificate and requisite documents to the OPs, which had not settled it, citing one or the other reasons.     

06.     Perusal of the records also reveals that the OPs contested the case before the District Forum by taking a stand that the Death Claim has been preferred within one year of issuance of the Policy, as such the Complainant is not entitled to any Death Claim, since the deceased Life Assured was suffering from Pulmonary Tuberculosis and was under treatment.

07.     Perusal of the records reveals the observation of the District Forum in Para 9 of its Order, that OPs have not produced Affidavit Evidence of the Doctor, who has given treatment and issued ID Card  and it has not lead any evidence regarding the deceased Insured having received any treatment for Tuberculosis and it has also not filed the Affidavit of any Doctor.   OP failed to establish that prior to taking the Insurance Policy, the deceased insured was suffering from Tuberculosis and mere production of ID Card, does not suffice to hold that the insured was suffering from said disease as mentioned in ID Card.  The burden of proof of establishing the existence of pre-existing disease and that the Insured was having knowledge regarding the disease is on the Insurer.  The document produced by the insurer viz., Patient ID Card, Policy Bond and Proposal Form is not sufficient to prove the pre-existing disease of the Insured.  

08.     The OP after conducting enquiring, coming  to the conclusion that the deceased Life Assured fraudulently obtained the Policy by suppressing the material fact about his health condition
and thus proceeding to  repudiate the Claim, is  expected to prove the reason for repudiation by adducing cogent and acceptable evidence which he has miserably failed.  Further, the Policy obtained by the deceased Life Assured is New Janaraksha Plan Policy which is nothing but non-medical policy.   In the circumstances, the Order passed by the District Forum directing the OPs to answer the Claim of the Complainant is proper.   Hence, the following

O R D E R

The Appeal No.1577/2016 is Dismissed. 

Parties to bear their own cost in this Appeal.

Amount in deposit is directed to be transmitted to the District Commission for the needful.

           Send copy of this Order to the District Commission as well as to the parties, immediately.

 

Lady Member                   Judicial Member                       President

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