AVIVA LIFE INSURANCE CO. INDIA LTD. Vs. KARIYAPPA

JUDGEMENT

(1.) Appellant Insurance Company has filed this Appeal challenging the order dtd. 19/7/2016 of the State Consumer Disputes Redressal Commission, Karnataka at Bangalore (for short 'the State Commission') in Complaint NO.10 of 2014 filed by the Respondent. By the impugned order, the State Commission allowed the Complaint with costs of Rs. 5,000/- and directed the Appellant to pay to the Complainant/Respondent Rs. 30,00,000/- along with interest @ 8% p.a. from the date of complaint till actual realization. Appellant was directed to comply with the order within sixty days from the date of receipt of the order.

(2.) In brief, the facts of the case are that on 13/9/2012, Complainant's son namely Pampapathy had taken life insurance policy No.ALA 3115653 for sum assured of Rs.30,00,000/- with yearly premium of Rs. 12,566/- for a period of 30 years. The policy was to expire on 13/9/2042. On 29/10/2012, THE Life Assured died due to heart attack. The Complainant informed the death of his son to Appellant Insurance Company along with necessary records. However, the claim was repudiated by the Appellant vide their letter dtd. 28/8/2013 stating that the Deceased Life Assured (DLA) was suffering from pre-existing Chronic Kidney Disease. Against the said repudiation, the Complainant filed the Complaint before the State Commission seeking direction to the Appellant Insurance Company to pay the policy amount of Rs. 30,00,000/- along with compensation for mental agony and deficiency in service, amounting to Rs. 34,10,000/- along with interest @ 12% p.a.

(3.) Complaint was resisted by the Appellant by filing written version. The Appellant submitted that the Deceased Life Assured had obtained the policy from them by suppressing the material facts. It was submitted that the DLA was admitted as inpatient at Vijayanagar Institute of Medical Science, Bellary on 6/9/2012 with a history of breathlessness since two months and discharged on 7/9/2012. It was also submitted that as depicted from the progress notes of the hospital, the DLA was a known case of Chronic Kidney Disease and was on maintenance hemodialysis. Appellant stated that the Insurance Company had accepted the proposal in good faith and therefore, requested that the Complaint be dismissed.