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

For the sake of convenience, the parties are referred to as arrayed in the complaint.

2)

tis the case of Complainant that she is the wife of Botla venkateswarlu who worked in Police Department and during his lifetime,

3)

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 Rs.15,000/-, which commenced from 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. Complainant was shown as nominee to the above said 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 question for

a sum of 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^on 02.03.2014 suppressing the factum of 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 was treated on 28.05.2015 at 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.

2

3

norder to evade payment of housing loan instalments, the presen Complaint is initiated. Hence, prayed to dismiss the complaint against l

7) During the course of enquiry before the District Forum, in order to

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 Secretary filed his affidavit evidence as RW1 and^got marked the

documents Ex.B1 to B7.

8) The District Forum after considering^the material available^on

record, allowed the complaint bearing CC No.86 of 2016, by orders dated

18.01.2018,^as stated,^at paragraph No.1, supra.

9) Aggrieved^by the said orders,^the Appellant preferred the present

appeal contending that the forum below failed to consider the documents

brought on record in proper perspective and thereby allowed the

complaint without considering the fact that the deceased life assured^was

diagnosed with hematemesis with Reflux Esophagitis (Grade-I) with

bleed and had previous history of COL (Cirrhosis of Liver) with portal

hypertension with decompensation,^EVL (Esophageal Varices ligation)

done twice last in January 2009 with ADL (Alcoholic Liver Disease). Hence, prayed to allow the appeal by setting aside the orders impugned.

10)

The point that arises for consideration is whether the impugned order^as passed by the District Forum suffers from any error or

irregularity or whether it is liable to be set aside, modified^or interfered

with,ⁱⁿ any manner? To what relief?

11) A careful perusal of the voluminous evidence on record in support of the impugned order, without fear of contradiction, we can place on record certain facts which are either admitted, not controverted or proved.

12) Botla Venkateshwarlu was a group member and he has taken the 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 Sal 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 was to the effect that even though 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 five years, the non-disclosure of the hospitalisation according to insurance company amounts to suppression of material fact which affects 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.

On the other hand, the learned counsel appearing for the 16) 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 . Ouict Forum has properly appreciated the material on recora and granted the reliefs.

17)

to n agreement with the submissions made by the learned counsel pon carefully perusing the material on record,^we find ourselves

appearing for the Respondent/Complainant that in the absence of there

Deng any nexus or close proximity in between the cause of death and^the

1acts suppressed, the insurance company cannot repudiate the claim

sOlely^on that ground. May be if there are other grounds on which the

Tepudiation is made, this may be one of the factors to be weighed butⁱⁿ

the instant case, the entire claim is repudiated solely on the ground that

the life assured has suppressed the fact that he^was admitted in hospital

in January 2010 when he taken the policy in March 2014 and died^on

28.05.2015. Absolutely, no evidence is produced^to show about any

The Forum

treatment or hospitalization in between 2010 and

2015.

below has appreciated the material on record in correct perspective and

granted the relief.^We see no reason to interfere with the said findings and the impugned order is liable to be confirmed by dismissing the

appeal.

18) However, we would like^to state that^the Appellant insurance

company is liable to settle the claim and pay the proceeds of the policy in

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

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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.