THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 15th DAY OF MAY, 2023
APPEAL NO.360/2015
PRESENT
SRI RAVI SHANKAR, JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI, MEMBER
Sri.Nagappa Gurusiddappa Hegadal,
Aged about 59 years,
Occ: Business, … Appellant/s
R/o. Subhash Nagar,
Devaragudihal Road,
Hubli, District Dharwad – 580 024
(By Sri.K.A.Patil, Advocate)
V/s
1. The Zonal Manager,
Life Insurance Corporation of India … Respondent/s
South Central Zonal Office,
Saifabad, Hyderabad-560 063
2. The Senior Divisional Manager,
Life Insurance Corporation of India
Divisional Officer,
Karnataka College Road,
Dharwad-580 001
3. The Branch Manager,
City Branch -2, … Respondent/s
Life Insurance Corporation of India,
Jeevan Jyoti Building,
Club Road, Desai Cross,
Hubli-580 029
(Respondents-By Sri.Ramachandra G.Bhat, Advocate)
O R D E R
BY SRI.RAVISHANKAR, JUDICIAL MEMBER
The complainant in complaint No.75/2014 has preferred this appeal against the dismissal order made by the District Consumer Commission, Dharwad and submits that he is husband of the deceased life assured one Smt.Prema Nagappa Hegadal who took the policy from the Opposite Party/Respondent Insurance Company. Being to the nominee to the said policy, he claimed for compensation by virtue of the policy, the Opposite Parties have settled all the claims raised by this complainant and have not paid compensation under Jeevan Saral policy and Bima Bachat policy, for which the complainant alleged deficiency of service and filed a complaint before the District Consumer Commission. After trial, the District Consumer Commission dismissed the complaint as the deceased life assured has not disclosed the health condition at the time of taking the proposal of the said Jeevan Saral Policy and Bima Bachat Policy. In fact the life assured not suffered any pre-existing diseases and she was hale and health at the time death. In spite of that merely basing on the opinion of DMR/ZMR have repudiated the claim, but the District Consumer Commission not appreciated the claim and dismissed the complaint. Hence prays for set aside the order passed by the District Consumer Commission and direction be given to the respondent to settle the claim under above said two policies.
2. Heard the arguments.
3. On going through the certified copy of the order, memorandum of appeal and other documents produced before the District Consumer Commission, we noticed that the wife of the complainant during her life time had obtained several life insurance policies from respondent company. After her death the complainant had received compensation from the Opposite Party Company by virtue of the policy obtained by deceased life assured, but the Opposite Party has not settled the claim under Jeevan Saral policy bearing No.638187787 and other Bima Bachat policy bearing No.638460718. The reason for not settling the claim is that she had not disclosed her hypertension at the time of taking proposal and they noticed that she had taken treatment at hospital prior to taking the policy with respect to the ailment of hypertension hence, they have repudiated the claim. The District Consumer Commission after trial had dismissed the complaint for the reasons that the life assured at the time of obtaining the policy ought to disclose her ailments when she failed to disclose, the claim is not payable and concluded that there is no deficiency of service on the part of the respondent.
4. We are of the opinion that merely any persons suffering from hypertension is not amounts that the life assured was suffering any diseases. The hypertension is only a disorder which can be regularized by changing the life style it is not a disease in this regard it is well established by the Apex Courts in so many decisions. Further, we are of the opinion that, it is not required to disclose the hypertension at the time taking proposal policy as because it is not any disease and non disclosure of such disorders not amounts to suppression of material facts. As such the Opposite Party/Respondent cannot be repudiate the claim basing on the suppression of material facts. It is clear case of deficiency of service on the part of the Opposite Party in not settling the claim of the complainant towards the above said two policies. The District Consumer Commission made an error in dismissing the complaint holding that there is no deficiency of service. The claim made by the complainant is genuine and the Opposite Parties are liable to pay the claim by virtue of the policies to the complainant. As such the order passed by the District Consumer Commission is hereby set aside and the below direction given to the respondent to settle the claim. As such the appeal is allowed and accordingly, we proceed to pass the following:-
O R D E R
The appeal filed by the appellant is hereby allowed.
The Opposite Party/Respondent is directed to pay the assured amount under Jeevan Saral policy bearing No.638187787 and another Bima Bachat policy bearing No.638460718 with bonus if any within 30 days from the date of this order to the complainant, failing which 9% interest will be charged on the above said assured amount from the date of default till realization.
Further the Opposite Party is directed to pay compensation of Rs.25,000/- for repudiating the genuine claim of the complainant along with litigation expenses of Rs.10,000/
Send a copy of this order to both parties as well as concerned District Consumer Commission.
Member Judicial Member
