THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 14th DAY OF JUNE 2021
PRESENT
SRI RAVI SHANKAR – JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI - MEMBER
APPEAL NO. 1328/2012
Bajaj Allianz Life Insurance Company Ltd.,
Near Durgamma Temple, Jawahar Road,
Koppal Taluk & District,
Represented by Zonal Legal Manager,
Mr. M.Aravinda.
…….Appellant/s.
(By Shri/Smt. Geetha Raj, Adv.,)
-Versus-
Mrs. Pushpadevi
W/o Late Mahaveer Prasad Sharma,
A/a 47 years, Raghavendra Metal Store,
Near Trinity School,
Koppal Taluk and District.
……….. Respondent/s
(By Shri/Smt N.P.Singri, Adv.,)
:ORDERS:
BY SRI.RAVI SHANKAR - JUDICIAL MEMBER
The appellant/Opposite Party preferred this appeal against the order dated:27/04/2012 passed by the Koppal District Consumer Commission in C.C.No.8/2012.
2. The brief facts of the complaint are as under;-
The husband of the complainant had obtained one health insurance policy from the Opposite Party on 11.01.2010 which commencing the risk w.e.f 22.01.2010. As per the policy sum assured is Rs.5,00,000/-. The premium is one time premium for the year amounting to Rs.1,00,000/-. At the time of taking the policy, the husband of the complainant aged about 49 years and he was running metal store at Koppal. Such being the case on 09/11/2010 the insured died at home in Koppal Town due to massive Cardiac Arrest as per the medical attendance certificate and the husband of the complainant died within 10 months from the date of taking the policy. After receipt of the claim from the complainant, they have investigated the claim and noticed that the insured had suppressed the previous disease at the time of taking the proposal, he has suppressed the health conditions as given and provided an answer as “NO” when they asked whether he had been to hospital for any treatment of ailments, before taking the policy, the husband of the complainant suffered from Blood Pressure and diabetes diseases. Hence, under the Clause of suppression of pre existing disease, they repudiated the claim, for which the complainant being the nominee had preferred a complaint before the District Commission, but the District Commission allowed the complaint without considering the terms and conditions of the policy. Hence, prays to set-aside the order passed by the District Commission by allowing the appeal.
3. Heard arguments.
4. On going through the memorandum of appeal, certified copy of the order passed by the District Commission and documents produced before the District Commission, we noticed that during the policy is in force, the husband of the complainant died at home due to massive Cardiac Arrest. We consider the said death of the insured is a natural death. The Opposite Party has not produced any materials before this Commission or before the District Commission to show that the husband of the complainant died due to any other ailment. The only contention taken by the Opposite Party to substantiate their repudiation is that the complainant had Blood Pressure and Diabetes before taking the policy. But we are of the opinion and it is well established fact that the Blood Pressure is not a disease. It is only the disorder in the human body. The District Commission after considering the documents produced has given an opinion that the husband of the complainant had not taken any treatment and the records reflects the sugar/diabetes is normal. When such being the case it cannot be considered as he is having a severe diabetes disease. The repudiation made by the Opposite Party is definitely deficiency in service. Hence, the District Commission has rightly ordered to pay the compensation as per the policy. But the District Commission made an error in awarding repayment of the premium amount which has no reason. Hence, the complainant is not entitled to Rs.1,00,000/- paid towards the premium of the policy. Accordingly, we proceed to pass the following:-
:ORDER:
The appeal is disposed-of by modifying the impugned order/award as under:-
The Opposite Party is directed to pay Rs.5,00,000/- to the complainant within 30 days from the date of this order, failing which, the said amount carries interest @ 10% from the date of filing of the complaint till realization.
The Opposite Party is further directed to pay Rs.15,000/- towards litigation cost of this appeal and Rs.5,000/- towards litigation cost of the complaint.
The amount in deposit shall be transmitted to the concerned District Commission to disburse the same to the respondent/complainant.
Send a copy of this order to both parties as well as Concerned District Commission.
Sd/- Sd/-
Member. Judicial Member.
Tss
