THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH).
DATED THIS THE 28th DAY OF JULY 2021
PRESENT
SRI RAVI SHANKAR – JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI - MEMBER
APPEAL NO. 1564/2019
1. PNB Metlife India Insurance Co., Ltd., & Anr.,
Through Branch Manager,
Shweta Complex, 1st Floor,
Opp. Sub Urban Police Station,
Lamington Road, Hubballi-580 020.
2. The PNB MetLife India Insurance Co., Ltd.,
The General Manager,
Unit No.701, 702 and 203, 7th Floor,
West Wing, Raheja Towers, 26/27
M.G.Road, Bengaluru-560 001.
……….Appellants.
(By Shri/Smt. I.Gopalakrishna, Adv.,)
-Versus-
Smt. Manjula W/o Raju Malladihalli,
Aged about 35 years,
Occ:Houswife,
R/at No.53, KHDC, Nekar Colony,
Ranebennur-581115,
Haveri District.
(By Nagesh M.Badiger, Adv.,)
:ORDERS:
BY SRI.RAVI SHANKAR - JUDICIAL MEMBER
The Opposite Party in complaint No.12/2019 preferred this appeal against the order dated:16/10/2019 passed by the District Commission, wherein the District Commission directed the Opposite Parties to pay Rs.12,00,000/- with interest @ 7% p.a. from the date of legal notice till realization towards insurance claim made by the nominee of the deceased /insured along with Rs.5,000/- towards mental agony and Rs.4,000/- towards cost
2. The parties to the appeal shall be referred to as complainant and Opposite Parties respectively as per their rankings before the District Commission.
3. The brief facts of the complaint is that:-
The complainant’s husband by name Raju Malladihalli had obtained Met Family Income Protect Plus Policy on 09.02.2015 for a sum assured of Rs.12,00,000/- and he paid one premium and policy came into force. Such being the case, on 08.03.2016 the husband of the complainant died at his residence. Thereafter, the complainant being the nominee to the insurance, had claimed for compensation by virtue of the policy obtained by the husband of the complainant on 20.06.2016. But the Opposite Party instead of settling the claim has repudiated the claim for the reason that the insured at the time of submitting his proposal had suppressed that he was suffering from some diseases and violated the terms and conditions. Hence, they have shown their inability to settle the claim made by the complainant.
4. Being aggrieved by the said repudiation, the complainant preferred a complaint before the District Commission and allowed the complaint by considering the documents produced by both the parties directing the Opposite Party as stated above.
5. Being aggrieved by the said order, the appellant before this Commission.
6. On going through the memorandum of appeal and certified copy of the order with required documents produced before the District Commission, the husband of the complainant one Raju Malladihalli during his life time had obtained Met Family Income Protect Plus Policy on 09.02.2015 by paying yearly premium amount of Rs.15,864/-. Such being the case, after issuance of the policy, the complainant’s husband died at his residence and by virtue of the policy, complainant claimed for assured amount to the tune of Rs.12,00,000/-. After receipt of the claim from the complainant they have investigated the matter and traced out that the complainant at the time of taking proposal/policy, was suffering from Delirium Tremens (alcohol withdrawal seizures) and the same was not disclosed by the deceased at the time of obtaining the policy. The same was traced out when the Investigator has investigated and tendered a discharge summary to show that he was suffering from Delirium Tremens (alcohol withdrawal seizures) and taking treatment towards that. For that reason, under the terms and conditions of the policy, they have repudiated the claim.
7. We are of the opinion that the insurance policy has to be obtained at-most good faith and the parties who makes proposal should express their health condition at the time of taking the proposal. We noticed here, that the complainant’s husband was suffering from Delirium Tremens (alcohol withdrawal seizures) which is a serious disease which causes after immediate quitting of the alcohol. The said type of disease is a fatal in nature. These type of diseases has to be informed at the time of taking any policy. In this case, we noticed that, in the proposal the husband of the complainant has not mentioned anything about his illness and health condition. Further, merely not informing the Hypertension and Diabetes will not amounts to a suppression of material facts, whereas the severe disease like Delirium Tremens (alcohol withdrawal seizures) has to be informed at the time of taking the policy. Here, we are of the opinion that the deceased husband of the complainant has not obtained the policy in good faith. As such the complainant though she is a nominee to the policy is not entitled get any claim as the insured has violated the terms and conditions of the policy. We found the repudiation made by the Opposite Party not amounts to any deficiency in service. But the District Commission made an error in not appreciating the suppression of insured ailment and health condition at the time of taking proposal. Hence, the order passed by the District Commission is liable to be set-aside and complaint has to be dismissed. Accordingly, we proceed to pass the following:-
:ORDER:
The appeal filed by the appellant/Opposite Party is allowed. No costs.
The impugned order dated:16/10/2019 passed by the Dharwad District Consumer Commission in C.C.No.12/2019 is hereby set-aside. Consequently, the complaint filed by the complainant is dismissed.
The amount in deposit shall be transmitted to the concerned District Commission to pay the same to the appellants/Opposite Parties.
Send a copy of this order to both parties as well as Concerned District Commission.
Sd/- Sd/-
Member. Judicial Member.
Tss
