State Consumer Disputes Redressal Commission
Lic Of India vs Smt.Devaki on 30 October, 2023
Cause Title/Judgement-Entry KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION BASAVA BHAVAN, BANGALORE. First Appeal No. A/194/2021 ( Date of Filing : 25 Feb 2021 ) (Arisen out of Order Dated 11/01/2021 in Case No. Complaint Case No. CC/61/2019 of District Udupi) 1. LIC of India Rep. by its Sr.Divisional Manager, Divisional Office, Jeevan Krishna, Ajjarkadi, Udupi-576101 Rep. by K.Bheemsen Rao, Secretary(Legal Cell), LIC of India, Legal Cell, ZO Unit, Bengaluru-560025 Karnataka ...........Appellant(s) Versus 1. Smt.Devaki M/o Late Ashoka R.Kulal, Aged about 70 years, R/a Devaki Nivasa, Uggedabettu, Sankalakariya, Mundkur Post, Karkala Tq., PIN-574121 Udupi Karnataka 2. Dinesh Pai.M R/a Jain pette, Mundkur village & post, Karkala Tq, Udupi Dist. Karnataka ...........Respondent(s) BEFORE: HON'BLE MR. Ravishankar PRESIDING MEMBER HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi MEMBER PRESENT: Dated : 30 Oct 2023 Final Order / Judgement THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH) DATED THIS THE 30th DAY OF OCTOBER, 2023 APPEAL NO.194/2021 PRESENT SRI RAVI SHANKAR, JUDICIAL MEMBER SMT. SUNITA C.BAGEWADI, MEMBER Senior Divisional Manager LIC of India, Division office, ...Appellant/s "Jeevan Krishna" Ajjarkadi, Udupi-01 Represented by its Sri.K.Bheemsen Rao, Secretary (Legal Cell) LIC of India, Legal Cell, ZO Unit, Bengaluru - 25 (By Sri.Shivayogi B.Hallur, Advocate) -Versus- 1. Smt.Devaki M/o late Ashoka R.Kulal Aged about 70 years, ... Respondent/s R/o Devaki Nivasa Uggedabettu, Sankalakariya, Mundkur post, Karkala Taluk Udupi-574 121 2. Sri.Dinesh Pai.M. R/at Jainpette, Mundkur village & Post, Karkala Taluk, Udupi (Respondent No.2-By Sri.K.Chandranath Ariga, Advocate) (Respondent No.1- By Raveendran, Advocate) ORDER
BY SRI RAVI SHANKAR, JUDICIAL MEMBER The Appellant/Opposite Party No.1 in complaint No.61/2016 has preferred this appeal against the order passed by the District Consumer Commission, Udupi which directed this appellant to pay an amount of Rs.9,00,000/- with interest @10% per annum from 14-6-2017 till realization and further directed to pay Rs.1,00,000/- as compensation and Rs.25,000/- litigation expenses and submits that the complainant had filed a complaint before the District Commission alleging deficiency in service in not settling the claim made by her towards death of her son one Mr.Ashoka R.Kulal who died during the accident. The said Mr.Ashoka R.Kulal had obtained five policies from this appellant/ 1st Opposite Party as shown below;
Sl.
No. Date Policy number Sum Assured 1 28/3/2014 628290302 1,00,000/-
228/12/2015 628507681 2,00,000/-
328/12/2015 628507682 4,00,000/-
411/01/2016 628508071 1,00,000/-
57/6/2016 628593126 1,00,000/-
Such being the case, when the policies in force, it was reported that the life assured/ Mr.Ashoka R.Kulal son of complainant died on 28-1-2017 due to road traffic accident. The claim made by the complainant was repudiated for the reason that, the life assured at the time of taking policies had suppressed the material facts and he was suffering from Spelnomegaly, right renal concretions and left non obstructive calculi, dyspeptic megakaryocytic, hyperplasia, pancyteopenia and availed treatment for the same. Even the cause of death was due to the uncontrolled sever chronic ITP, hence they have declined to settle the claim made by the complainant.
2. Being aggrieved by the said repudiation, the complainant approached the District Commission alleging deficiency in service. The District Commission after trail allowed the complaint and directed this appellant to pay the assured amount to the tune of Rs.9.00 lakhs from all five policies and also directed to pay interest on the said amount @10% per annum along with compensation of Rs.1.00 lakhs and litigation expenses of Rs.25,000/-. In fact they are not liable to pay the assured amount to the complainant as the life assured had suppressed the previous diseases at the time of taking the policies, the complainant is not entitled to get any claim. The District Commission without considering the said defence has allowed the complaint and directed this appellant to pay the above said amount. Hence, prays for set aside the order passed by the District Commission and dismiss the complaint, in the interest of justice and equity.
3. Heard from the appellant.
4. On perusal of the certified copy of the order, memorandum of appeal, there is no dispute that, the life assured one Ashoka R.Kulal had obtained five policies as described above and assured amount from all these policies for Rs.9.00 lakhs, when the policies were in force. It is alleged that the life assured died on 28-1-2017 due to road accident. The said accident is self accident where he suffered from injuries, immediately he was shifted to hospital where the doctors noticed no such grievous injuries and discharged after First-Aid. Subsequently, the complainant again on 23-1-2017 he found some variations and immediately he admitted to Nitte Gajariya Speciality Hospital at Karkala as inpatient for two days. As per the advice of the doctors at Nitte Gajariya Speciality Hospital he was taken to KMC, Mangalore on 25-1-2017 for further treatment at that time it was noticed in the hospital that the patient had suffered head injuries and due to hemorrhage, he died on 28-1-2017. In this regard, the doctor who had treated him had given evidence before the District Commission stating that, the said Ashoka R.Kulal died due to injuries suffered in the accident. But the appellant had produced certain documents before the District Commission to show that, he has taken treatment to the ailment suffered by the son of the complainant such as Spelnomegaly, right renal concretions and left non obstructive calculi, dyspeptic megakaryocytic, hyperplasia, pancyteopenia. We are of the opinion that though the life assured had taken treatment prior to the proposal and died subsequently due to accident. The suppression of the said ailments are irrelevant when the life assured died due to accident. Further we are of the opinion that, the said ailments are not serious diseases which requires to be disclosed at time of taking the policies. The said ailments are only disorders which can be rectified during the course of daily routine. The OPs have repudiated basing on the suppression of the material facts which are irrelevant subject matter at time of settling the claim, when the death caused due to accidental injuries. It is clear by looking at the testimony given by doctors who had treated at KMC hospital who spoken that the life assured died due to injuries suffered in the self road traffic accident. The testimony cannot be ruled out. This appellant/1st Opposite Party could have settled the claim by observing the testimony given by the doctor himself. Instead of that, this appellant had repudiated the genuine claim made by the complainant. The complainant being nominee/LRs is legally entitled to get the assured amount as per the policies terms and condition. The District Commission after considering the materials produced before them had rightly arrived for payment of the assured amount to the complainant. We do not find any irregularity in the order passed by the District Commission and the same time we do not find valid grounds urged to set aside the order passed by the District Commission. As such the appeal is dismissed. Hence, we proceed to pass the following:-
O R D E R The appeal is dismissed. No order as to cost.
The impugned order 11.1.2021 passed by District Consumer Disputes Redressal Commission, Udupi in CC.No.61/2019 is confirmed.
The statutory amount deposited before this Commission along with accrued interest if any shall be transmitted to the concerned District Commission to pay the same to the complainant.
Send a copy of this order to both parties as well as Concerned District Commission.
Member Judicial Member [HON'BLE MR. Ravishankar] PRESIDING MEMBER [HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi] MEMBER