THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 14th DAY OF JUNE, 2023
APPEAL NO.898/2023
PRESENT
SRI RAVI SHANKAR, JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI, MEMBER
Manager,
DHFL Pramerica Life Insurance
Now known as Pramerica Life
Insurance Limited Co., Ltd., ...Appellant/s
4th Floor, Building No.(9),
Tower-B, Cyber City.
DLF Phase-III, Gurgaon-122 022
Haryana
(By Sri.B.V.Mohan Adekar, Advocate)
-Versus-
1. Puneetha.S.S,
W/o late Kumaraswamy.T.C,
38 Years, Hallimysore village & Post,
Holenarasipura Taluq, … Respondent/s
Hassan District
2. Manager,
Aadhar Housing Finance Ltd,
Regd. Office, 2nd Floor, 31 JVT Tower,
8th “A”, A Main Road,
S.R.Nagar, Bangalore-560 027
ORDER ON ADMISSION
BY SRI RAVI SHANKAR, JUDICIAL MEMBER
The Opposite Party in complaint No.05/2022 has preferred this appeal against the order passed by the District Consumer Commission, Hassan which directed this appellant to pay an assured amount with interest @ 9% per annum from the date of death of husband of the complainant along with Rs.10,000/- litigation expenses, Rs.10,000/- for mental agony and Rs.10,000/- towards compensation towards deficiency in service.
2. The brief facts of the complaint is that, the husband of the complainant had purchased insurance policy from Opposite Party on 30-4-2018 called “ADHAR SHILA +” bearing No.GC0003800LNT00 from this appellant in order to cover the home loan amount of Rs.15,79,658/- and also to cover any future contingencies in the event of death and he paid an amount of Rs.60,896.76 towards premium of the policy. At the time of issuance of the policy, this appellant assured to cover the risk of payment of the loan in case of death of the life assured. Such being the case, when the policy is in force the husband of the complainant Kumaraswamy.T.C died on 21-12-2020. There afterwards being the nominee and legal heir of the deceased the complainant lodged a claim with the Opposite Party by providing required documents, the said claim was repudiated through their letter dated 31-3-2021, on the ground that the deceased life assured was suffering Diabetes and Hypertension prior to issuance of the policy and the same was not disclosed by the deceased life assured at the time proposal. Hence, they have shown their inability to settle the claim. Aggrieved by the said repudiation, the complainant approached the District Commission alleging deficiency in service and sought for payment of the assured amount as per the policy.
3. The District Commission after trial allowed the complaint and directed this appellant to pay the above said amount. In fact, this appellant is not liable to pay any amount as directed by the District Commission. It is bounden duty of the deceased life assured to declare his health condition and to provide the detail information with respect to the any ailment suffered. It is noticed that, the life assured during proposal was suffering from Diabetes and High Blood Pressure, the said information was not given in the proposal. The policy has to be obtained in a good faith but the deceased life assured suppressed the said fact and obtained the policy. Hence, the complainant is not entitled any compensation under the ground of suppression of material facts and also no information with respect to the health condition. There is no any deficiency in service on the part of this appellant in repudiating the claim, but the District Commission failed to appreciate the said facts and allowed the complaint. The order passed by the District Commission is illegal and not in accordance with law, hence prays for set aside the order passed by the District Commission and dismiss the complaint.
4. Heard on admission.
5. On perusal of the certified copy of the order, memorandum of appeal and other documents produced before the District Commission, there is no dispute that the complainant in order to cover the risk of loan availed had obtained the policy called “ADHAR SHILA +” bearing No.GC00003800LNT00 for an assured amount of Rs.15,79,658/- and also paid premium of Rs.60,896.76. Such being the case, he died on 21-12-2020 leaving behind the complainant as legal heir. Being a legal heir the complainant claimed for compensation by virtue of the policy. The said claim was repudiated for the reason that the life assured during submitting the proposal had not disclosed the information with respect to his health condition it was later on reveals that he was suffering Diabetes and Hypertension, for that ground this appellant had repudiated the claim. The repudiation was challenged by the complainant before the District Commission. The District Commission after trial and considering the documents produced by both parties allowed the complaint and directed the appellant to pay the above said amount.
6. The order passed by the District Commission is in accordance with law. We are of the opinion that mere suffering from Diabetes and Hypertension is not considered as disease. In this regard the Apex Court has given verdict so many cases. Therefore, it is well established that the said Diabetes and Hypertension are only a disorder which can be regularized by changing the life style, therefore not discloser of the said disorders not amounts to any suppression of material fact or not giving any information with respect to the health conditions. It is deemed that at the time of obtaining the policy, the life assured had not suffering any Diabetes or Hypertension. Further, we are of the opinion that, if at all the life the assured was suffering from Hypertension and Diabetes subject to medication then the such information has to be provided at the time of proposal. Here we noticed this appellant failed to provide any materials to prove that, the life assured is under medication towards the above said disorder. In the absence of such, it is a deficiency in service on the part of the appellant in repudiating the genuine claim made by the complainant. The said facts are noticed in the order passed by the District Commission and it is rightly appreciated. The order passed by the District Commission is in accordance with law. This appellant is liable to pay the assured amount to the complainant by virtue of the policy. Hence, no interference is required. Accordingly the appeal is liable to be dismissed. Hence, we proceed to pass the following:-
O R D E R
The appeal is dismissed. No order as to cost.
The impugned order 6.4.2023 passed by the District Consumer Disputes Redressal Commission, Hassan in CC.No.05/2022 is confirmed.
The amount in deposit shall be transmitted to the concerned District Commission to pay the same to the complainant.
Send a copy of this order to both parties as well as Concerned District Commission.
Member Judicial Member
