BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE.
DATED THIS THE 11th DAY OF NOVEMBER 2021
PRESENT
MR. RAVISHANKAR : JUDICIAL MEMBER
MRS. SUNITA CHANNABASAPPA BAGEWADI : MEMBER
APPEAL NO. 2155/2012
1. | The Manager, M/s Bajaj Allianz Life Insurance Company Ltd., Regd. and Head Office, G.E. Plaza, Airport Road, Yerawada, Pune – 411 006, Maharashtra State. | ……Appellant/s |
2. | The Manager, Bajaj Allianz Life Insurance Company Ltd., Claims Review Committee, 5th Floor, G.E. Plaza, Airport Road, Yerawada, Pune – 411 006, Maharashtra State. (By Sri J.R. Jagadish) | |
V/s
Smt. Kasturi.V.Badigere, No.36, 320/2, Chowdeshwari Nagara, Laggere Main Road, Peenya Post, Bangalore 560 058. (By Sri P.R. Dhananjaya) | ..…Respondent/s |
ORDER
MR. RAVISHANKAR, JUDICIAL MEMBER
1. The appellants/Opposite Parties have preferred this appeal being aggrieved by the Order dt.28.09.2012 passed in CC.No.1568/2011 on the file of 2nd Additional District Consumer Disputes Redressal Commission, Bangalore.
2. The brief facts of the case are as hereunder;
It is the case of the complainant that her husband Mr.Veeranna.V.Badigere had obtained two policies bearing No.0138733371 for a sum of Rs.1,12,000/- and No.0184758002 for a sum of Rs.60,000/- from the Opposite Party and made the complainant as nominee of the policies. After taking the policy, the policy holder died on 26.12.2010 due to hypertension and the same was informed by the complainant who is the nominee of the policy. After the information, the Opposite Parties have investigated the matter and repudiated the claim for the reason that the policy holder had suppressed the previous health conditions at the time of taking the proposal and also submits that the policy holder was hospitalized from 30.05.2007 to 08.06.2007 for bilateral plantar fasciitis with callosities and advised surgery, but, the said ailment was not disclosed at the time of taking the policy. Hence, the Opposite Parties repudiated the claim for suppression of material facts against which the complainant alleged deficiency in service and filed a complaint against the Opposite Parties before the District Commission. After trial, the District Commission allowed the complaint and directed them to pay a sum of Rs.1,72,000/- death benefit under two policies to the complainant along with costs.
3. Aggrieved by the said Order, the appellants/ Opposite Parties are in appeal. Heard the arguments of appellant.
4. On going through the memorandum of appeal, certified copy of the Order and documents produced before the District Commission, there is no dispute that the husband of the complainant one Mr. Veeranna.V.Badigere had obtained two insurance policies from the Opposite Parties one for Rs.1,12,000/- and another for Rs.60,000/-. It is also admitted that during the policy in force, the policy holder died and the complainant being a nominee had claimed for assured amount by virtue of the said policies. We noticed that the appellants have urged that the policy holder had a disease earlier to taking the policies and had not disclosed the said disease at the time of taking the policies. The cause of death is also for hypertension, hence, submits that there is no deficiency in service.
5. After thorough observation of the documents, we noticed that the complainant had underwent treatment for bilateral plantar fasciitis with callosities and the same was not disclosed at the time of taking the policy. We are of the opinion that the said complication is not a disease at all. It is only a pain which caused to heels due to long time standing. He has taken the treatment for that and it is not called as disease. The policy discloses that the policy holder at the time of taking the proposal has to disclose the ailments or diseases which is suffered, but the said complication was not a disease at all and does not supposed to be disclosed. Even further we noticed that the policy holder died in is residence and the said death is a natural death and not due to any disease. The District Commission has rightly appreciated the complaint and documents and also given opinion that the certificate produced by the Opposite Party to show the cause of death has no evidentiary value. The grounds urged by the appellant for repudiation of the claim are not in accordance with law and against the terms and conditions of the policy. Hence, there is a clear deficiency in service on the part of the appellants in repudiating the genuine claim of the complainant. Hence, the Order passed by the District Commission is just and proper. Hence, the following;
ORDER
The appeal is dismissed.
The amount in deposit shall be transmitted to the District Commission for disbursement of the same to the complainant.
Forward free copies to both parties.
Sd/- Sd/-
MEMBER JUDICIAL MEMBER
KCS*
