THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 10th DAY OF AUGUST, 2023
APPEAL NO.1153/2015
PRESENT
SRI RAVI SHANKAR, JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI, MEMBER
1. LIC of India
P B No.19953, 4th Floor,
West Wing, Jeevan Bima Marg,
Nariman Point, Mumbai-400 021
...Appellant/s
2. LIC of India, Divisional Office,
Jeevan Prakash, P B No.37,
Bannimantap, Mysuru
Both are represented by the
Authorized Representative
Sri.K.Bheemasena Rao,
Manager (Legal & HPF), LIC of India,
Division office No.1, JC Road,
At Bangalore – 560 002
(By Sri.Rohith Gowda, Advocate)
-Versus-
Smt.Neelamma,
W/o Late Prabhuswamy,
Major in age,
R/o Benkanahalli village,
T.Narasipuru Taluk,
Mysuru- District
O R D E R
BY SRI RAVI SHANKAR, JUDICIAL MEMBER
The Opposite Party in complaint No.676/2014 preferred this appeal against the order passed by the District Consumer Commission, Mysuru which directed this appellant to pay an amount of Rs.50,000/- with 9% interest per annum towards the claim made by the complainant and submits that the complainant being the wife of life assured one Prabhuswamy had claimed for compensation by virtue of the policy obtained by her husband. After receipt of the claim, this appellant verified and investigated that the life assured at the time of obtaining policy has suppressed the material facts with respect to his health condition and it was noticed that the husband of the complainant had taken treatment from 24-6-2008 to 5-9-2008 at JSS Hospital, Mysuru as an inpatient for decease called Gangrine Disla Phalanx of Middle Left Finger. The left finger was amputated such facts were not disclosed at the time of taking the policy. Subsequently, the complainant’s husband was died on 11-4-2013; the said claim was rejected for the reason of suppression of material facts, hence decline to settle the claim.
2. Aggrieved by the said, the complainant approached the District Commission and the District Commission after trial allowed the complaint without considering the suppression of the material facts by the life assured. The order passed by the District Commission lacks legality, hence prays for set aside the order passed by the District Commission.
3. Heard from both sides.
4. On perusal of the certified copy of the order, memorandum of appeal and other documents produced before the District Commission, it is not in dispute that the husband of the complainant one Prabhuswamy had obtained a policy bearing No.724988815 for an assured amount of Rs.50,000/-on 8-6-2011. Accordingly he had paid three premiums and last paid on 23-11-2012, there afterward during the policy in force the husband of the complainant died due to heart attack. The complainant being the legal representative of the deceased life assured had claimed for assured amount as per the policy. The said claim was repudiated by this appellant for reasons of suppression of material facts and submits that the life assured prior to taking the policy had hospitalized at JSS hospital, Mysuru from 24-6-2008 to 5-9-2008 as an inpatient and he was treated for Gangrine Disla Phalanx of Middle Left Finger, subsequently the left finger was amputated. The said facts were not disclosed and obtained the police, hence they shown their inability to settle the claim. Having no option, the complainant approached the District Commission by filing a complaint No.676/2014, after trial the District Commission allowed the complaint and directed this appellant to pay the above said amount and also awarded compensation of Rs.5,000/- for deficiency in service and Rs.2,000/- towards litigation expenses.
5. The order passed by the District Commission according to us is in accordance with Law. The complainant’s husband was died due to heart attack; the said death is normal death, at the time of death he was not hospitalized to any hospital.
6. The Opposite Party after receiving the claim have investigated the matter and obtained the some information from the JSS Hospital that the life assured Prabhuswamy was hospitalized on 24-6-2008 with history of Gangarene Distel Phalanx of left middle finger. We noticed the hospital records wherein the Gangarene was attacked the lift middle figure and subsequently it was removed. The Gangarene which was attacked to the left figure, it is only due to bacterial infection. Further on perusal of the hospital records it is noticed that the life assured was not suffering from any diabetes or any other ailments. Merely amputation of lift figure due to Gangarene does not mean that life assured was died due to Gangarene. It is only a small part of the body i.e. middle left figure was removed due to effected tissue in order to avoid spreading, the said Gangarene is not a disease. Therefore the repudiation on the ground of suppression of material facts is not justifiable. Mere nor discloser of the said fact not amounts to suppression of any material facts because the husband of the complainant was died due to heart attack which is natural death. Hence, it is clear case of deficiency in service on the part of this appellant in repudiating the claim made by the respondent.
7. The District Consumer after hearing from both sides and observation of the documents has rightly appreciated and directed this appellant to pay the assured amount to the complainant. We do not find any irregularity in the order passed by the District Commission. As such the appeal is dismissed as no merits and we proceed to pass the following:-
O R D E R
The appeal is dismissed. No order as to cost.
The impugned order 20.11.2015 passed by the District Consumer Disputes Redressal Commission, Mysuru in CC.No.676/2014 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
Jrk/-
