Karnataka

StateCommission

A/1591/2018

Shankar - Complainant(s)

Versus

The Chief Manager - Opp.Party(s)

Mohan Malge

27 Dec 2023

ORDER

                                                                     Date of Filing :10.10.2018

                                                               Date of Disposal : 27.12.2023

 

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

 

DATED:27.12.2023

 

PRESENT

 

HON’BLE Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

Mrs DIVYASHREE M : LADY MEMBER

 

 

APPEAL No.1591/2018

 

Sri Shankar

S/o Late Lakkappa Chande

Aged 60 years

Occupation : Agriculture

Resident of Islampur

Taluk Basava Kalyan,

Bidar District

(By Mr Mohan Malge, Advocate)                                         Appellant

 

 

                                                             

                 - Versus -

1. The Chief Manager

    LIC of India

    Basavkalyan

 

2. The Senior Divisional Manager

    L & H P F Department

    Divisional Office

    Raichur                                                                           Respondent

    (By Mr H N Kasal, Advocate

     For R1 and R2)

                                                                                                        

   : ORDER :

 

Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

1.       This Appeal is filed under Section 15 of Consumer Protection Act 1986 by the Complainant, aggrieved by the Order dated 31.07.2018 passed in Consumer Complaint No.85/2017 on the file of District Consumer Disputes Redressal Forum, Bidar (hereinafter referred to as the District Forum).

2.       Heard the arguments of the learned Counsels on record. Perused the Impugned Order and grounds of Appeal.

3.       The District Forum after enquiring into the matter, Dismissed the Complainant with no order as to costs. Being not satisfied with the Order, the Complainant is in Appeal.

4.       Admittedly, Late Avinash, son of the Complainant, during his life time had obtained Jeevan Anand Policy in his name bearing No.661779186 with the Sum Assured being Rs.2 Lakhs from OP on 22.06.2016. On 28.07.2016 the Insured died due to heart attack and the Complainant being the Nominee to the said Policy, submitted his Claim to the OP.  On receipt of the Claim, OP repudiated the Claim under Section 45 of the Insurance Act, on the ground of misleading by suppressing of the fact of pre-existing disease and answered in negative to the entire questionnaire in Col. No.11 of the Proposal Form.

5.       According to Complainant, the deceased Insured namely Avinash was a Government School Teacher on permanent basis, he was hale & healthy and obtained the Policy through the agent and Development Officer, Basavakalyan Branch.   The complainant averred that death of the insured was due to stomach pain and chest pain and the patient died on the way of to Hospital. The allegation of the complainant that it is the duty of the OP to get Medical Examination of the Proposer and OP has not followed such essential initial process at the time of accepting the Proposal Form for the issue of Insurance Policy to the insured. The OP1’s Agent and Development Officer had taken signature of the deceased Avinash, without informing him the contents of the Proposal Form, though the Proposer had appended his signature on the Proposal Form.  In the Declaration portion, the Proposer had given liberty and No Objection to conduct his Medical Examination by the OP. 

6.  The stand taken by the OP for the repudiation of the claim is that the death of the Insured was not due to the simple reason of Chest Pain or Stomach pain, but, the Life Assured was a chronic patient of CROHNS disease and was under treatment at Diggikere Hospital, Omerga and also had undergone treatments from time to time.

7.       The District Forum had Dismissed the Complaint by considering the documents produced by the OPs Ex-R1 to R7 and R13, which discloses that the Insured took treatment and underwent diagnosis for liver G1 dis-orders and health hazard crohns disease is serious inflammation of the ileum of obstructive type and at the time of proposing the policy on 22.06.2016, he has never disclosed about the pre-existing disease and all the queries in Column No.11 of the Proposal Form was answered in negative.  Further, at the time of proposing for the Policy on 22.06.2016, the Insured never disclosed about the pre-existing disease and all the queries in column No.11 of proposal form was answered in negative. Therefore, the Claim repudiation by the OP was justified under Section 45 of Insurance Act.

8.       During the course of arguments, the learned Counsel for Appellant filed a Memo with physical Fitness Certificate issued by Medical Superintendent, SR1MS Teaching Hospital, Bidar and contended that deceased insured was physically fit while obtaining the policy from OP1.

9.       Above all, it is seen that, the documents produced by the OPs before the District Forum is only after thought.  OP1 had not followed the initial process of Medical Examination of the Insured while issuing the Policy.  No doubt, as per the advice of Agent of OP1, the Insured had answered the queries in Col.No.11 of the Proposal Form in Negative and it cannot be said that the Insured never disclosed about the pre-existing disease while taking Policy from Insurer.

10.     Thus, the OP Insurance Company has failed to prove that in the Proposal Form the Insured had suppressed the material facts, more so, non-examination by the said Agent, with regard to such declaration and filling up of the Form as per oral instructions of the Proposer.  The reason assigned by the OPs insurance company that insured had suppressed the material fact of pre-existing disease has not been convincingly established by the Insurance Company.  Of course, we are in agreement with the concept of the Insured has to disclose all the material facts with regard to the previous ailments, if any and his general health condition as per section 45 of Insurance Act.  But, we are at a loss to understand as to what prevents the Insurance Company to get the new Proposer got medically examined by any of his Panel Doctor and having failed to perform so and trying to take advantage of his own mistake, as his reason for repudiating the Claim,  when the innocent successors of the deceased/insured for getting a paltry sum and many a times, the deceased would have been the sole bread winner of his family.  Unless it is certified that the contents of the said Proposal Form has been read over and explained to the executants/proposer, it cannot be said that the Insured was aware of the facts and misled the Insurer by concealing any information in the Proposal Form. Hence, it cannot be said that he played any fraud in submitting the said Proposal Form and whatever documents produced before the District Forum by OPs is after issuance of the Insurance Policy. On perusal of the Physical Fitness Certificate issued by Medical Superintendent, SR1MS Teaching Hospital, Bidar it is observed that, it discloses that the deceased Insured was hale & healthy at the time of his employment in the office of DDPI, Bidar. Even if this policy was not taken, the deceased Insured is bound to get all the necessary service benefits and in such circumstances, the Impugned Order requires to be interfered with the observation that the document in respect of physical Fitness Certificate is not considered by the District Forum and on this ground alone, the Claim of the Complainant cannot be repudiated by the Insurance Company.  In the result, we proceed to pass the following

O R D E R

Appeal is allowed in part.  Consequently, Impugned Order dated 31.07.2018 passed in Consumer Complaint No.85/2017 on the file of District Consumer Disputes Redressal Forum, Bidar is set aside and OP is directed to pay the sum of Rs.2 Lakhs, being the Sum Assured to the Complainant, within three months from the date of this Order.

Send a copy of this Order to the District Commission, as well as to the parties concerned, immediately.

 

 

 

                    Lady Member                                      President

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