Karnataka

StateCommission

A/1943/2017

Smt.Laveena L.I.Pinto - Complainant(s)

Versus

The Senior Divisional Manager - Opp.Party(s)

Krishnamoorthy.D

25 Jan 2024

ORDER

                                                                     Date of Filing : 22.09.2017

                                                                  Date of Disposal:25.01.2024

 

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

 

DATED:25.01.2024

 

 

PRESENT

 

 

HON’BLE Mr JUSTICE HULUVADI G RAMESH : PRESIDENT

 

Mr K B SANGANNANAVAR : JUDICIAL MEMBER

 

Mrs DIVYASHREE M : LADY MEMBER

 

 

 

 

APPEAL No.1943/2017

 

 

Smt Laveena L I Pinto

Aged about 49 years

R/at 1-37/1

Karnoji Road

Berike House

No.34, Nekkilady Village & Post

Puttur Taluk

Dakshina Kannada District - 574 201                             Appellant

 

(By Mr Krishnamoorthy D Advocate)

 

 

                 -Versus-

 

1. The Senior Divisional Manager

    LIC of India

    Divisional Office

    Ajjarkad, Udupi - 576 101

 

   

2. The Manager

    LIC of India

    Near Bhavani Shankar Temple

    Puttur, D K - 574 201                                                  Respondents 

                                                 

    (By Mr S Guru Prasanna, Advocate

     For R1 & 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 06.09.2017 passed in Consumer Complaint No.81/2016 on the file of District Consumer Disputes Redressal Forum, Mangaluru, Dakshina Kannada (hereinafter referred to as the District Forum).

 

2.       Heard the arguments of the learned Counsels on record.

3.       The District Forum after enquiring into the matter and by considering the documents produced by the parties, Dismiss the Complaint.   Being not satisfied with the Order, Complainant is in Appeal interalia contending amongst other grounds that the deceased Edwin Crasta died due to heart attack and the policy was in force as on the date of death of her husband.  The District Forum ought to have looked into the fact that the insurance scheme of the OP introduced with social responsibility for the benefit of the legal representatives surviving the deceased; it is a benevolent insurance scheme; in reasonable cases the consumer should be given full benefit without any bias and the District Forum did not considered the documents produced by the Complainant.

4.       The Complainant in the complaint averred that the insured admitted to the KMC Hospital, Mangalore on 22.06.2016 for Acute Upper GI Bleeding/Renal Failure/Ischemic Heart Disease and he died due to Heart Attack on 02.07.2015 at KMC Hospital. Repudiation of the claim by OP is without any basis and bad under law.

5.       In his Version, OP had taken the stand that the deceased insured suppressed the material fact of his knowledge of his illness and having taken treatment for Hypertension, Benign Paroxysmal Positional Vertigo at Father Muller’s Hospital, Mangalore from 05.10.2012 to 06.10.2012 Further, OP had issued Cheque for Rs.4,544/- on 15.07.2015 and 17.08.2015, being the Premiums paid, subsequent to the death of the Insured but, the Complainant declined to receive the same.

6.       It is not in dispute that the Late husband of the Complainant obtained Jeevan Surabhi Policy bearing No.626774509 on 13.11.2013 by paying monthly premium of Rs.2,272/- with sum assured being Rs.2 Lakh and the Policy had maturity on 13.11.2028.   The husband of the Complainant got admitted to the KMC Hospital, Mangaluru on 22.06.2015 for Acute Upper GL Bleeding/Renal Failure/Ischemic Heart Disease and he died due to heart attack on 02.07.2015.  Thereafter, the Complainant being his Nominee to the said Policy, submitted her Claim to the OP which was repudiated on the ground that deceased insured withheld information regarding his health at the time of obtaining the policy. The deceased insured had obtained the Policy from the OPs in the year 2013 agreeing to pay monthly premium of Rs.2,272/-, if at all the deceased insured had suppressed the materials facts of his illness, the OPs ought not to have received the subsequent premiums and  withdraw the proposal and now taking the defense of non-disclosure of materials facts as to the health in the Proposal Form by the deceased insured, repudiated the claim on the basis of Discharge summary, Death summary and Medical Examiner’s Confidential Report. Repudiation of the Claim is only after thought and at the cause of Death being due to Acute Upper GL Bleeding/Renal Failure/Ischemic Heart Disease being sudden onset, these diseases are common diseases today and OP finding reason for repudiating the claim referring the disease underwent and treated well after availing treatment is definitely not convincing. The latest set of causes for deterioration of health of the deceased insured is sudden and cannot be linked to treatment availed by him during 2012.  The Insurance Company after receiving the monthly Premium under the Policy and to repudiate the claim for paying the Sum Assured, and taking a decision for returning of the premiums amount received to the nominee of the Policy Holder amounts to deficiency in service.   Further, OPs cannot escape from their committed liability and is bound to honour the Claim of the Complainant. Therefore, the Impugned Order requires to be set aside by allowing the Complaint.  In the result, we proceed to pass the following  

ORDER

Appeal is partly allowed.  Consequently, Impugned Order dated 06.09.2017 passed in Consumer Complaint No.81/2016 on the file of District Consumer Disputes Redressal Forum, Mangaluru, Dakshina Kannada is set aside and OPs are jointly and severally held liable to pay the Assured Sum of Rs.2 Lakhs under the Policy No.626774509 with cost of Rs.5,000/- to the Nominee/Complainant, within three months from the date of this Order,  failing which,  the amounts due & payable as on the Date of this Order, shall carry interest at the rate of 6% pa.

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

 

 

Lady Member                   Judicial Member                       President

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