cOsts of Rs.2,500/- to the Complainant within one month, by dismissing the complaint insofar as Opposite party No.1 is concerned. Por the sake of convenience, the parties are referred to as arrayed in the complaint.

2)

3 It is the case of Complainant that she is wife of one Katkam Bhumaiah, who availed home loan from Opposite party No.l vide account bearing No.62182722540 in a sum of Rs.6,00,000/-

on 12.03.2011, at which time, Opposite party No.1 obtained SBI Lile Insurance policy in favour of the borrower. In turn, Opposite party No.2 issued SBI Life Dhanaraksha Plus LPPT policy bearing No.93000001610 and Membership

form No.933046208 on 26.03.2011 by collecting the premium of Rs.7,758/- covering the loan amount of Rs.6,00,000/- from 26.03.2011 onwards till 72 months. As per the terms of said policy, in the event of death of the borrower, the entire outstanding loan amount will be waived of.

4) To the misfortune of Complainant, her husband died on 21.06.2013 while the policy was in force. She being the wife made claim with the Opposite parties, which in turn repudiated the claim on the ground of suppression of material information. Hence, complaining deficiency^of service on^the part of the Opposite parties, the present complaint was filed with a prayer to direct the Opposite parties to waive of the entire outstanding loan amount of Rs.5,60,524/- together with interest thereon and to pay compensation of Rs. 1,00,000/- and costs of the complaint.

5) Opposite party No.1 filed its written version admitting that Katkam Bhumaiah obtained home loan vide account No.62182722540 and availed the amount of Rs.6,00,000/- on 12.03.2011. As a security measure, the borrower took policy from Opposite party No.2 by paying the premium of Rs.7,758/- covering the loan amount. However, the borrower expired on 21.06.2013 and as on 09.03.2015, the outstanding There is no amount due towards loan account is Rs.3,84,000/-. deficiency of service on their part and accordingly prayed to dismiss the claim of Complainant insofar as they are concerned.

2

Oppoalte arty No.2 iled itN Wrillen vernion contending thut the COiliit not maintuinable lor wanl ol terrilorial juriscliction, however, udnitted to have inued the oliey in quention. The cloceaned te ANIed uppreueel he muteriat fuet uat he was suffering Irom heurt dineaNe prior to obtaining the insurunce covcr In the event of leatlh of tlie nenmler, the mum as8Lred will be payuble. The sum asurcd IN the loun anount outstanding for the onth during which the death 0CCurs, aN Npeeilicd in the Certificute of Iusurnnec. In the instant case, he outnding loun mount as on the dute of death of member is Rs.4,13,825/. Their investigation revealed thal the borrower was treated nt Star Hospitals, Ilyclerubned prior to obtaining the policy. Hence, pruyed to dismiss the complaint

During the course of enquiry before the District Porum, in orderto prove their casc, the Complainant filed her aflidavit cvidence as PW1 and

7)

gol marked the documents Ex.AI to A3. On behalf of Opposite party No. I, one P.Abhishek, its Assistant Manager filed his affidavit evidence as RWI and on behall of Opposite party No.2, one K.P. Dhanya, authorised representative liled his allidavit evidence as RW2 and got marked the documents Ex. B1 to B8.

8) The District Porum after consicdering the material available on record, allowed the complaint bearing CC No. 104 of 2014, by orders dated 27.05.2015, as stated, at paragraph No. 1, supra.

9) Aggrieved by the said orders, the Appcllant preferred the present appeal contending that the forum below failed to consider the fact that the policy in question was obtained by suppressing the material fact of hcalth condition. It failed to understand that the contract of insurance is based on the principles of "utmost good faith". Hence, prayed to allow the appeal by setting aside the orders impugned.

10)

Immediately after filing the above appeal, the Appellant herein filed WP No.26000/2015 before the Hon'ble High Court of Judicature at Hyderabad for the State of Telangana

and the State of Andhra Pradesh, wherein, by orders dated 18.08.2015, Hon'ble High Court granted interim stay of the orders impugned. However, on 05.07.2018, due to non-pursuing

the case, the writ petition came to be dismissed.

3

4

11)^ne point that arises for consideration is whether

the impugned

Oraer as passed by the District Forum suffers from any

error Or

rregularity or whether it is liable to be set aside, modified or interiered

with, in any manner? To what relief?

12) Having heard the submissions of the learned counsel appearing

1or

Lhe Appellant and thoroughly perusing the oral and documentaiy

evidence^on record, without fear of contradiction, it can be said that^tne

lacts which are not in controversy or disputed out-weigh the contenuous aspect. Firstly, we would like to place on record the facts which^arc

Katkam admitted or established from the documents on record. Bhumaiah was the husband of the Complainant. He took housing loan of about Rs.6,07,758/- from the Respondent/Opposite party No.l on 26.03.2011. As per the scheme available at that time, the Appellant/ Opposite party No.2 has offered SBI Life Dhanaraksha Plus LPPT insurance coverage for the borrowers of the housing loan by accepting a premia of Rs.7,758/-. The policy came into effect from 26.03.2011. As per the terms of the policy, in the event of unfortunate event taking place, the insurance company will pay the diminishing balance which was payable by the borrower to the lending bank on the date of the death of the borrower. As per the diminishing balance statement that is furnished, with which there is no dispute, on the date when the borrower died i.e., 21.06.2013, the outstanding loan was Rs.4,43,825/. As per the terms of the contract of insurance, this amount was payable by the Appellant insurance company to the Respondent/Opposite party No.1 lending bank in full and final settlement of the outstanding loan taken by the said deceased Katkam Bhumaiah. When the claim was made, the same was repudiated on the ground that the deceased has suppressed the existing ailment and therefore the claim was repudiated. Aggrieved thereby, the present complaint is filed.

13) As already stated, the only ground on which the claim is repudiated is that the deceased has suppressed the fact that he underwent the treatment for CAD (coronary Artery Disease) - Acute Anterolateral Wall MI (Myocardial Infraction), Post STK, Mild LV Dysfunction, CAG-Two vessel disease during the year 2009 but whereas he has died in 2013 due to cardiac problem while he was sleeping and in the proposal form, this fact is suppressed. In other words, the

Ontentuon is that when the proposal is submitted

at the time when the pollcy was taken, the life assured has not revcaled that he was admitted in hospital during April 2009 and had undergone certain procedure whereby Zeta Stent was done on 02.05.2009 and he was discharged from the hospital on 04.05.2009. This fact having been suppressed by the lile assured, according to the Appellant/ Opposite party No.2 gives rise lor repudiation of the claim on the ground that the material facts have been suppressed by the life assured.

14) f this factum of the deceased having undergone the treatment and the procedure during 2009 is established, certainly the 1t Respondent/ Complainant cannot be granted the relief since it clearly amounts to Suppressing a material fact which was well within the cxclusive knowledge of the life assured Katakam Bhumaiah.

15) Reliance is placed heavily by the insurance company on Ex.B4 and Ex.B5. Ex.B4 is the registration data of Star Hospital, Hyderabad dated 29.04.2009. It shows that one Bhumanna, aged about 45 years, a resident of Luxettipet, Adilabad was admitted in the hospital and Ex.B6 is the Discharge Summary dated 04.05.2009. The discharge summary records as under:

45 years old Mr.Bhoomanna, is a known case of CAD recent anterolateral wall MI,

(26.04.2009). He is not a diabetic (or) hypertensive. He was admitted for stabilization followed by CAD. CAG was done on 02.05.2009. It revealed Two Vessel Disease (LMCA 30- 40%, LAD proximal 90%, distaB LCx 70%).

Stenting to LAD with 3 x 23 mm Zeta Stent was done with any complications. He is asymptomatic^at discharge.

"

thrombolysed with STK Successful PTCA+

16) Ex.B7 is the entire case sheet of the Star Hospitals. If we peruse Ex.B5 and Ex.B6, there is no doubt, whatsoever, that the said Bhumanna has undergone major surgeries during April/May 2009 and if the policy is taken in March 2011 without revealing the said facts, it clearly amounts to suppressio-veri thereby giving scope to the insurance company to repudiate the claim on the ground that the life assured has suppressed the material facts thereby affecting the policy.

17) The District Forum has discussed Ex.B5 and B6 but rejected it solely on the ground that Ex.B5 and Ex.B6 are in respect of Bhoomanna

5

whose detailed description is not made but whercas the life assured/

nusband of the Complainant is one Katkam Bhumaiah. On that ground the District Forum has refused to take cognizance of Ex.B5 and Ex.B6

which if accepted will certainly disentitle the Complainant from claiming any reliefs.

18) We are of the opinion that unfortunately the Appellant insurance company could not establish nexus in between the person who has undergone the treatment during April/May 2009 and the person who has obtained the insurance policy namely Katkam Bhumanna.

19) When the insurance company seeks to repudiate the claim on the ground of suppression of material fact, onus lies upon them to convincingly and cogently establish that the life assured has suppressed the existing ailment. The burden is upon them to prove but in the instant case, though an attempt has been made but the insurance company could not succeed in establishing that the Bhoomanna who has undergone treatment during April/May 2009 is the same Katkam Bhumaiah who has obtained the housing loan and the insurance from the Appellant insurance company.

20) The learned counsel appearing for the Appellant insurance company argues with full command at his disposal that having received the repudiation letter alleging that the deceased life assured has suppressed the existing ailment, it was obligatory on the part of the Complainant being the claimant to refute the said aspersions made by the insurance company in the repudiation letter and that not having been done, it can straight-away be believed that whatever is stated in the repudiation letter is gospel truth.

21) In spite of the best efforts made by the learned counsel, we find ourselves to be not in agreement with the strenuous submissions made by him. Having received the letter of repudiation on the said ground, the Complainant has filed the complaint which itself amounts to refuting the allegations as contained in the repudiation letter. There need not be any specific reply or notice refusing the aspersions that are cast upon the deceased person in the repudiation letter. Therefore, this submission is placed on record only to be rejected.

6

Therefore,^we do not find any error in the appreciation of^the material by the District Forum and the findings recorded therein^are proper appreciation which do not warrant any interference, There are no merits in the appeal and the same is liable to be dismissed.

22)

23) In the result, the appcal fails and is accordingly dismissed, n COsts.

7