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State Consumer Disputes Redressal Commission

Icici Prudential Life Insurance Com. ... vs Mahankalamma on 15 July, 2022

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                                                    APPEAL No.1573/2017



                                              Date of Filing : 25.7.2017
                                          Date of Disposal : 15.07.2022

      BEFORE THE KARNATAKA STATE CONSUMER DISPUTES
     REDRESSAL COMMISSION, BENGALURU (PRINCIPAL BENCH)
                        DATED: 15.07.2022
                              PRESENT

          Mr K B. SANGANNANAVAR: JUDICIAL MEMBER

Mrs DIVYASHREE M: LADY MEMBER APPEAL NO.1573/2017 ICICI Prudential Life Insurance co. Ltd., Through Associate VP-Claims.

Unit No.1A & 2A. Raheja Tipco Plaza.

Rani Sati Marg, Malad (E) Mumbai-400097 Maharashtra.

(By Mr H.K.Revanna Siddappa, Advocate) Appellant

-Versus-

Mr Mahankalamma W/o Sannamallappa Ayyappa.

R/at Sasalmari Village.

Post Sasalmari Camp-584128 Sindhanur Tq.. Raichur Dist.

(By Mr T M Swamy Advocate)                                 Respondent

                              -:ORDER:-

Mr K B. SANGANNANAVAR: JUDICIAL MEMBER

1. This is an Appeal filed under Section 15 of Consumer Protection Act 1986 by OP aggrieved by the Order dated 30.05.2017 passed in Consumer Complaint No.97/2015 on the file of District Consumer Disputes Redressal Forum, Raichur (for short, the District Forum).

2. Commission examined the impugned order, grounds of Appeal and heard learned counsels.

3. It is found from the impugned order that husband of complainant obtained a policy from the OP on 12.11.2014 with sum assured of Rs.2 lakhs; had paid Rs.20,618/- and he died on 28.12.2014 within 1 + month after obtaining the policy. The claim of the complainant came to be repudiated by OP for suppression of pre-existing disease contending had life assured disclosed his medical history at the time of proposal, OP would have declined to issue policy in favour of diseased insured. In this regard, learned counsel for Appellant would submit that District Forum lost sight of date of visit of insured found in Ex-R5 on 25.05.2010 to ART Centre namely Antiretroviral Treatment Records, namely he followed treatment wherein could see insured who was aged about 44 years first visited ATR on 25.05.2010 and he had proposed to obtain the policy from OP and submitting proposal with personal details in particular clause 5 (g) which provides 'were you or your spouse ever diagnosed to have hepatitis B or C, HIV/AIDS or any other sexually transmitted disease' and his answer was 'No' was not at all considered by the District Forum and in Para 30 of the impugned order the District Forum on perusal of Ex-R5 to R7 the medical records of the policy holder stated the test for his alleged diseases have been conducted on 04.12.2014 and on 26.12.2014 as per Ex- R5 and as per Ex-R6, examined on 25.12.2014 and as per Ex-R7, on 05.12.2014 and 26.12.2014 but, opined as insured proposed to take policy from OP on 12.11.2014 is prior to the date of his clinical examination, but failed to appreciate Ex-R5 ATR wherein his first visit was on 25.05.2010 was not at all mentioned in the impugned order. In other words, failed to perceive this vital medical record before arriving at a conclusion to record on the alleged deficiency in service on the part of Ops, since life assured died on 28.12.2014, it is found from impugned order that he died due to Bronchial Asthama and Myocardial Infarction within two months from the date of 2 3 APPEAL No.1573/2017 obtaining insurance policy, yet direct OPs to settle the claim and awarded compensation.

4. The District Commission relied on a decision in Para 38 of the Hon'ble National Commission in the case of Additional Director General, APS (PLI CELL) and another Vs Jyoni Devi reported in I (2014- CPJ 41 (NC), wherein held that "insured suffering from HIV positive-non-disclosure in proposal form- claim repudiated - deficiency in service - District Forum allowed complaint - State Commission dismissed Appeal - Hence, Revision, Petitioner failed to establish that insured was aware that he has been detected HIV positive - Insured had not indulged in fraud, misrepresentation or concealment of material fact while obtaining insurance policy - repudiation not justified''.

5. In our view, on facts the above ratio could not be applied to the facts of the case, since in Ex-R5 ATR, his first visit was on 25.05.2010 and he obtained policy on 12.11.2014. In such circumstances, insured suffering from HIV positive was within his knowledge in other words had notice of HIV positive, yet suppressed such disease, submitted proposal and the District Forum lost sight of vital documents as stated. In such circumstances, impugned order does call for an interference hence proceed to allow the Appeal. Consequently, set aside the impugned order dated 30.05.2017 passed in Consumer Complaint No.97/2015 on the file of District Consumer Disputes Redressal Forum, Raichur and in the result, dismissed the complaint No.97/2015 with no order as to costs.

6. Amount in Deposit is directed to be transfer to the District Commission for the needful.

7. Return the LCR forthwith to the District Commission.

8. Send a copy of this Order to the District Commission and the parties concerned, immediately.

              Lady Member                Judicial Member

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