Date of filing:26.09.2019

                                                                                                Date of Disposal:19.10.2023

BEFORE THE KARNATAKA STATE CONSUMR DISPUTES REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)

DATED: 19^th Day of OCTOBER 2023

PRESENT

Mr. K B SANGANNANAVAR: JUDICIAL MEMBER

Mrs.M.DIVYASHREE : LADY MEMBER

APPEAL NO. 1391/2019

1. K.Lokesh Kumar

S/o Late M.H.Krishnegowda,

Major,

Mandya Koppalu,

Arakere Hobli,

Srirangapatna Tq.,

Mandya Dist.

2. Smt.Mahadevamma

W/o Late M.H.Krishnegowda,

Major,

Mandya Koppalu Village,

Gandehosahalli Post,

Srirangapatna Tq.,

Mandya Dist.

3. Smt.M.K.Mahalakshmi

D/o Late M.H.Krishnegowda,

W/o M.N.Prakasha,

Major,

Nidaghatta Village,

Kasaba Hobli,

Mandya Tq. & Dist.

4. Smt.M.K.Shobha

D/o Late M.H.Krishnegowda,

W/o C.Thimmegowda,

Major,

Hallikere Hundi Village,

Varuna Hobli,

Mysuru Tq. & Dist.…….. Appellant

(By Mr.N Suryanarayana, Adv.)

-Versus-

1. Sr.Divisional Officer

Life Insurance Corporation of India,

Divisional Office Post,

Box No.37,

Bannimantapa,

2. The Branch Manager

Life Insurance Corporation of India,

Srirangapatna Branch,

Mandya Dist.

1. …….. Respondents

(By Mr.H.N.Kasal, Adv.)

ORDER

BY Mr. K. B. SANGANNANAVAR: Pri. Dist. & Session Judge (R)- JUDICIAL MEMBER:

1. This is an appeal filed by complainant in CC/1523/2016 on the file of District Consumer Disputes Redressal Forum, Mysuru aggrieved by the order dated 05.10.2018. (The parties to this appeal will be referred as to their rank assigned by the Forum below).

2. The brief facts of the case of the complainant Nos.1 to 4 before the Forum below is stated as below:   

One Mr.M.H.Krishnegowda had obtained insurance policy for sum assured at Rs.1,00,000/- from OPs. He was promptly paying premium amount.He failed to pay premium between March 2012 to March 2013, as a result policy got lapsed and subsequently the said policy was revived on submission of medical reports, on due approval by medical officer of OPs and on payment of penalty with premium amount on 27.09.2013. While the said policy was in force Mr.M.H.Krishnegowda died on 03.01.2014 at JSS Hospital, Mysuru.The complainant No.1 is son of insured, complainant No.2 is his wife, while complainant No.3 and 4 are his daughters and they are the LRs of insured. In their complaint have claimed Rs.1,37,600/- covered under the policy.However, OPs deducted Rs.68,015/- and paid Rs.30,429/- and they refused to pay the remaining amount on the grounds of suppression of facts.

In the above background, complainants raised Consumer Complaint before the Forum below.The OPs have contested the complaint, contending that on revival of the policy, fresh contract of insurance begins as per policy terms and conditions.Since the claim was filed early on revival of the policy, OPs found there was concealment of information relating to life assureds’ health status prior to revival of the policy and the policy was treated as null and void.

In view of rival contentions of the parties to the complaint, Forum below held an enquiry, thereby dismissed the complaint with no order as to cost. The Forum below dismissed the complaint on the ground of suppression of material facts related to health conditions, ailments, treatment availed and it is this order being assailed in this appeal contending that the Forum below failed to appreciate materials on record placed by parties during the course of enquiry in right perception and the impugned order suffers from infirmities, is liable to be set aside. Now we have to decide whether appellants have made out grounds to interfere in the impugned order passed by the Forum below?

3. It is not in dispute that Mr.M.H.Krishnegowda had obtained the   policy only after due medical examination on 28.09.2005.  The complainants have stated Mr.M.H.Krishnegowda, was very conscious of   his health, had obtained Yashaswini Health Policy for the period from January 2012 to 2014 from Oriental Insurance Company. During his life time never admitted as inpatient in any of the hospitals, as he was hail   and healthy/ He had taken treatment once in the month of May 2012 at JSS Hospital as an outpatient.  He died on 03.01.2014. It is not in dispute his lapsed policy was revived on 27.09.2013 prior to his death. It is to be noted herein he had obtained policy on 28.09.2005 and it was revived on 27.09.2013 on submission of medical reports only on due approval of report by   OPs medical officer and it was on payment of penalty with premium amount.  Learned Counsel for the appellants  would submitted the Forum below failed to consider all these vital facts in right, perception has some considerable force.

4. On the contrary, learned counsel for Ops would submit insured died within short span from the date of revival of the lapsed policy, but in our view facts remained Mr.M.H.Krishnegowda had obtained life insurance policy during 2005. It is not that the said policy was a Non-Medical policy but was obtained only after due medical examinations supported by  reports thereon  was also revived on payment of penalty with premium amount along with medical reports approved from medical officer of OPs. In such factual matrix found from the enquiry, in our view, recording negative finding on  point No.1 for the reasons recorded in Para-13 of the impugned order has to be held contrary to facts and such reasons suffers from infirmities are to be corrected in the appeal.

5. According to complainants, as per policy, they are entitle for Rs.1,37,600/-, since Mr.M.H.Krishnegowda availed loan of Rs.34,000/-.  OPs have deducted Rs.68,015/- and paid Rs.30,429/-.  In such circumstances, they have sought for direction to OPs to pay Rs.68,015/-.  In other words, in their complaint they have sought for payment of Rs.68,015/- arising out of the policy obtained by Mr.M.H.Krishnegowda and sought for compensation of Rs.1,50,000/- towards mental agony and physical inconvenience.  If we examine the impugned order in para-03, the Forum below recorded that LRs of life assured have claimed Rs.1,37,600/- under the policy.  The OPs after deducting Rs.68,015/-, have already paid the balance amount of Rs.30,429/- and refused to pay the remaining amount on the grounds of suppression of facts.  In this regard in our view, such finding recorded by the Forum below is nothing but perverse or suffers from infirmities and it would be said contrary to the findings recorded in para-13. In such view we are of the view the Forum below failed to examine all the materials placed on record by the parties to the complaint.

6.  Admittedly, Mr.M.H.Krishnegowda- the insured had availed loan of Rs.34,000/- which has to be deducted along with interest if any which was prevailing at the relevant time and further the forum below failed to record   finding as to payment of Rs.4,250/-.  The complainants, have raised a question, when Rs.4,250/- was paid before the revival of the policy in question, as such in our view question of deducting an amount of Rs.4,250/- does not arise at all.  The Forum below has also failed to appreciate as to how the amount paid at Rs.30,429/- would satisfy the claim submitted by the complainant as against their prayer at Rs.1,37,600/-.  According to complainants they are still entitle for Rs.68,015/-.  On the contrary, according to OPs,   have deducted  total sum of Rs.99,171/- towards the loan amount, interest, premium amount and other deductions and paid a sum of Rs.30,429/-.  In our view   on these figures the Forum below failed to record proper findings whether OPs are entitle to deduct Rs.39,171/- or whether they are still entitle to deduct Rs.34,000/- along with interest and  to explain as to the deduction of Rs.4,250/- towards premium.  It is therefore, in this appeal, in our view, it would be just and proper for the Commission to remand back the matter to Forum below with a direction to examine whether complainants are entitle for Rs.68,015/- or whether OPs are entitle to deduct Rs.99,171/- towards loan amount, interest, premium amount and other deductions and decide on the complaint in accordance with law.  Accordingly, we proceed to allow the appeal.  Consequently, set aside the impugned order dated 05.10.2018 passed in CC/1523/2016 on the file of District Consumer Disputes Redressal Forum, Mysuru with a direction to Forum below to re-admit the complaint and decide the case as observed in the order and affording opportunity to both parties keeping in mind the object of the Consumer Laws as early as possible not later than 03 months from the date of receipt of this order.

7. Remit back the LCR to the District Commission.

8. Send a copy of this Order to the District Commission and parties to the appeal.

        Lady Member                                 Judicial Member               

*GGH*