BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE.
DATED THIS THE 15th DAY OF NOVEMBER 2021
PRESENT
MR. RAVISHANKAR : JUDICIAL MEMBER
MRS. SUNITA CHANNABASAPPA BAGEWADI : MEMBER
APPEAL NO. 1936/2017
1. | The Senior Divisional Manager, Life Insurance Corporation of India, Divisional Office, “Jeevan Prakash”, P.B.No.37, Bannimantapa, Mysore 570 015. | ……Appellant/s |
2. | The Zonal Manager, Life Insurance Corporation of India, S.C.Z.O., “Jeevan Bhagya”, Saifabad, Hyderabad 560 063. Represented by the Authorized Representative Smt. U.V. Joshi, Manager ( Legal & HPF), LIC of India, Divisional Office No.1, J.C. Road, Bangalore 560 002. (By Sri H.H. Nagaraj) | |
V/s
Smt. Chithra @ J.S. Chaithra, W/o Late Mr.N.T. Venkatesha Kumar, R/o A. Nagathihalli Village, Alisandra Post, Bindiganavile Hobli, Nagamangala Taluk 571 802. (By Sri H.S. Lokapal Rao) | ..…Respondent/s |
ORDER
MR. RAVISHANKAR, JUDICIAL MEMBER
1. The appellants/Opposite Parties have preferred this appeal being aggrieved by the Order dt.25.07.2017 passed in CC.No.660/2015 on the file of District Consumer Disputes Redressal Commission, Mandya.
2. The brief facts of the case are as hereunder;
It is the case of the complainant that her husband Mr.N.T.Venkatesha Kumar had obtained Jeevan Anand – Risk policy bearing No.725659219 from Opposite Parties for an assured sum of Rs.5,00,000/- on 28.07.2012 and paid premium of Rs.11,137/- which is half yearly premium commences from 28.07.2012 and the maturity date is 28.01.2037. Such being the case, on 05.12.2013, the husband of the complainant died and being a nominee/beneficiary the complainant claimed for compensation, but, the Opposite Party repudiated the claim as the insured suppressed the pre-existing disease and he died due to hypertension and kidney related disease, hence, the Opposite Parties declined to pay the assured amount. Aggrieved by the said repudiation, the complainant filed a complaint before the District Commission alleging deficiency in service and prayed for payment of the assured amount. After trial, the District Commission allowed the complaint directing the Opposite Parties to pay the assured amount of Rs.5,00,00/- with interest at 9% p.a. along with compensation and costs.
3. Aggrieved by the said Order, the appellants/ Opposite Parties are in appeal. Heard the arguments of both parties.
4. On going through the memorandum of appeal, certified copy of the Order and documents produced before the District Commission, it is an admitted fact that the husband of the complainant had obtained Jeevan Anand – Risk policy bearing No.725659219 from Opposite Parties for an assured sum of Rs.5,00,000/- on 28.07.2012 and paid premium of Rs.11,137/- which is half yearly premium commences from 28.07.2012 and the maturity date is 28.01.2037. After issuance of the policy, the husband of the complainant died at his home and whereas after receipt of the claim, the Opposite Parties have repudiated the claim for the reason that the husband of the complainant was suffering from Kidney disease since last two years and at the time of proposal, the husband of the complainant had not disclosed the said ailment. Hence, for suppression of material facts, they have repudiated the claim and submits to set aside the Order passed by the District Commission.
5. We noticed that the Opposite Parties have produced the medical records to show that the husband of the complainant was suffering from Kidney disease. The District Commission in its Order had categorically noticed that the husband of the complainant had taken a treatment at the first time on 04.10.2013 with respect to the Kidney disease whereas the policy was issued on 28.07.2012 itself. The husband of the complainant had taken a treatment towards Kidney disease after obtaining the policy, hence, awarded a claim to be payable to the complainant. Ofcourse we noticed that the appellant had not placed any material before the District Commission to show that he was taken treatment prior to 04.10.2013. The husband of the complainant also came to know with respect to the disease subsequent to issuance of policy and also after disclosed by the doctors. Hence, the grounds for repudiation of the complaint are not in accordance with law. We are of the opinion that the husband of the complainant had not suppressed any illness or disease at the time of taking the policy. We also noticed that the cause of death is not due to kidney disease. Hence, the repudiation definitely amounts to deficiency in service. The District Commission rightly appreciated the facts of the case and allowed the complaint. We do not found any irregularity or illegality in the Order passed by the District Commission. 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*
