State Consumer Disputes Redressal Commission
India First Life Insurance Co. Ltd., vs 1.Botla Yakantha Alias Srikala on 14 July, 2022
Before the State Consumer Disputes Redressal Commission
(constituted under the Consumer Protection Act, 2019)
of Telangana, Eruvaka Building, Khairathabad at Hyderabad
FA NO.13 OF 2019 AGAINST CCNO.86 OF2016
ON THE FILE OF DISTRICT COMMISSION, WARANGAL
Between:
IndiaFirst Life Insurance Company Limited,
through its Head-Governance & Company Secretary,
having its Registered and Corporate officeat
301, (B)-Wing, the Qube, Infinity Park,
Dindoshi, Film City Road,
Malad (E), Mumbai - 400 097.
Appellant/Opposite party No.1
And
1) Botla Yakantha @ Srikala
S/o late Botla Venkateshwarlu,
H.No.1-9-581, Julywada,
Police Headquarters,
Subedari, Warangal district.
..Respondent/Complainant
2) The Manager,
Andhra Bank,
Nakkalagutta branch,
Warangal district.
Respondent/Opposite party No.2
Counsel for the Appellant Sri G.Nagesh
Counsel for the Respondent Sri K.Rajeshwar Rao-R1
M/s P.Balaji-R2
cORAM:
*****
Hon'ble Sri Justice MSK Jaiswal President
and
Smt Meena Ramanathan Member
Thursday, the Fourteenth day of July Two Thousand Twentty Two Oral Order: *** This is an appeal preferred by the Opposite party No.1 aggrieved by the orders dated 18.01.2018 passed by the District Consumer Forum, Warangal in CC No.86/2016 in allowing the complaint and directing the Opposite party No.1 therein to pay Rs.2,00,000/- towards the sum assured with interest 7.5% per annum from the date of filing the Complaint i.e., 19.05.2016 till date of realisation and to pay Rs.10,000/.
tOwards legal expenditure including costs within one month. By dismissing the complaint against Opposite party No.2
2) For the sake of referred to convenience, the parties are as arrayed in the complaint.
3) tis the case of
Complainant that she is the wife of Botla
venkateswarlu who worked in Police Department and during his lifetime,
ne
obtained
insurance policy "IndiaFirst Money Balance Plan"
bearing8 No.70129406 from the Opposite party No.1 for an assured sum or RS.2,00,O00/- by paying the premium of from Rs.15,000/-, which commenced 06.03.2014 onwards. While the policy was in force, the life assured died on 28.05.2015 leaving behind him the Complainant, his wife and two children Swetha and Vishal. the above said Complainant was shown as nominee to policy.
4) When the claim was made, the Opposite party No.1 repudiated the claim on the ground that the deceased life assured had suppressed the material fact i.e., admission in Jaya Hospital in the year 2010 with regard to treatment he underwent for liver problem. Hence, complaining deficiency of service, filed the present complaint with a prayer to direct the Opposite parties to pay the amount covered by policy in a sum of question for Rs.2,00,000/- together with interest, Rs.20,000/- as damages and costs of Rs.10,000/-
5) Opposite party No.1 filed its written version admitting the issuance of policy in question contending that the proposal for the policy was signed 02.03.2014 suppressing the factum of on taking treatment from Jaya Hospital, Hanamkonda from 04.01.2010 to 07.01.2010 vide IP No.6935/2010 in Grastoenterology Department having diagnosed for Reflux Esophagitis Grade-l. Again, he treated on 28.05.2015 at was Jaya Hospitals for Hematemesis with history of alcoholism and hence there is no deficiency of service on its part. Hence, prayed to dismiss the complaint with costs.
6) Opposite party No.2 filed its written version contending that they are not party to the agreemnent in between Opposite party No.1 and the Complainant and hence it has nothing to do with the policy in question.3
norder to evade payment of housing loan instalments, the presen Complaint is initiated. Hence, prayed to dismiss the complaint against l to
7) During the course of enquiry before the District Forum, in order prove his case, the Complainant filed his affidavit evidence as PWI and got marked the documents Ex.Al to A8. On behalf of Opposite party NO., one K.R.Viswanarayan, their Head-Governance & Company marked the affidavit evidence RW1 and got Secretary filed his as documents Ex.B1 to B7.
material available on
8) The District Forum after considering the
2016, by orders dated
allowed the complaint bearing CC No.86 of
record,
18.01.2018, as stated, at paragraph No.1, supra.
preferred the present
9) Aggrieved by the said orders, the Appellant
the documents
forum below failed to consider
appeal contending that the
on record in proper perspective and thereby allowed the
brought
assured
the fact that the deceased life
was
complaint without considering
hematemesis with Reflux Esophagitis (Grade-I) with
diagnosed with
of Liver) with portal
bleed and had previous history of COL (Cirrhosis EVL (Esophageal Varices ligation) hypertension with decompensation, done twice last in January 2009 with ADL (Alcoholic Liver Disease).
to allow the appeal by setting aside the orders impugned. Hence, prayed The point that arises for consideration is whether the impugned
10) Forum suffers from any error or order as passed by the District interfered irregularity or whether it is liable to be set aside, modified or with, in any manner? To what relief?
A careful perusal of the voluminous evidence on record in support
11) of the impugned order, without fear of contradiction, we can place on record certain facts which are either admitted, not controverted or proved.
Botla Venkateshwarlu was a group member and he has taken the
12) ife insurance policy from the Appellants/Opposite party vide Ex.B3 which came into force w.e.f. 02.03.2014 having paid the annual premia of Rs.15,000/- vide Ex.A6. The sum assured was Rs.2,00,000/-. The life of the policy was 10 years. The date of birth of life assured was 4 OO19. He has taken a policy and nominated his minor son Botla S a l as a nominee who was to be represented by the Respondent/ Complainant being the natural mother.
13) While the matter stood thus, on 28.05.2015, the life assured had Sun stroke due to which he was hospitalised in Jaya Hospital, Warangal and untortunately on the same day at about 7.30 pm succumbed to une sun stroke. When the claim was made to the Appellant insurance onpany, the same was repudiated vide Ex.A5 on 17.05.2015 on the ground that the life assured is guilty of having suppressed the materia information from the Appellant which the effect that was to though even the life assured had undergone inpatient treatment in Jaya Hospitals from 04.01.2010 to 07.01.2010, the same was not disclosed in tne proposal form in spite of there being a pointed question to the effect as to whether the life assured was hospitalised or underwent treatment for the period of five years prior to the submission of the proposal. Since the hospitalisation was well before proposal and the policy was taken in 2014, which was within fiveyears, the non-disclosure of the hospitalisation according to insurance company amounts to of material fact which affects suppression the very contract in between the insurance company and the life assured. On the said ground, the claim was repudiated.
14) Aggrieved thereby, the Respondent/Complainant being the mother of the nominee, filed CC
No.86/2016 which came to be allowed vide the impugned order.
15) The learned counsel
appearing
for the insurance
company submits
that even though the record clearly shows that the life
assured has
suppressed the material fact,
the District Forum has
erroneously granted
the relief which cannot be sustained.
16) On the other hand, the learned counsel appearing for the Respondent/ Complainant submits that no doubt, the record shows that the life assured was admitted in hospital for three days in January 2010 but that was more than four years prior to the unfortunate death which was purely accidental due to sun stroke and that the ailment with which he was admitted in January 2010 has absolutely no nexus whatsoever with the cause of death which is purely accidental. Therefore, the 5 earned counsel appearing for the Respondent/Complalnan ga .
O u i c t Forum has properly appreciated the material on recora and granted the reliefs.
find ourselves
17) pon carefully perusing the material on record, we
to n agreement with the submissions made by the learned counsel
absence of there
appearing for the Respondent/Complainant that in the c a u s e of death and the Deng any nexus or close proximity in between the cannot repudiate the claim 1acts suppressed, the insurance company other grounds on which the sOlely on that ground. May be if there are weighed but in Tepudiation is made, this may be one of the factors to be the ground that the instant case, the entire claim is repudiated solely on admitted in hospital the life assured has suppressed the fact that he was in 2010 when he taken the policy in March 2014 and died on January is produced to show about any 28.05.2015. Absolutely, no evidence between 2010 and 2015. The Forum treatment or hospitalization in material record in correct perspective and below has appreciated the on We no reason to interfere with the said findings granted the relief. see by dismissing the and the impugned order is liable to be confirmed appeal.
that the Appellant insurance 18) However, we would like to state
and pay the proceeds of the policy in company is liable to settle the claim favour of Botla Vishal who is the nominee and who is competent to give valid legal discharge to the insurance company. As per the policy bond, Ex.B1, the said nominee is shown as a minor whose date of birth waas 20.03.2004 and appointee as per the policy is the Complainant, being the natural mother. When the life assured died on 28.05.2015, the nominee was aged about 11 years and when the consumer complaint was filed on 19.05.2016, the nominee was aged about 12 years. The Complainant being the natural mother of the nominee and the appointee, has filed the complaint. During the pendency of the proceedings i.e., in March 2022, the nominee Botla Vishal has attained majority and therefore the proceeds of the policy are liable to be paid to him directly but not to the Complainant.
19) In view of the foregoing discussion, the appeal is dismissed with a direction to the Appellant insurance company to pay the proceeds of the 6 POHey together with interest thereon @ 7.5% per annum from 19.05.2016 till the date of payment to Botla Vishal, son of late Botla Venkateswarlu, ogether with costs of the litigation at Rs. 10,000/- which have been quantified by the District Forum.