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G. Maruthi Vs. Met Life India Insurance Company Pvt. Ltd., (Met Life), Brigae Shesha Mahal - Court Judgment

LegalCrystal Citation
CourtKarnataka State Consumer Disputes Redressal Commission SCDRC
Decided On
Case NumberAppeal No. 708 of 2012
Judge
AppellantG. Maruthi
RespondentMet Life India Insurance Company Pvt. Ltd., (Met Life), Brigae Shesha Mahal
Excerpt:
.....received by any information or reply from the opposite party or from that authority. therefore, filed a complaint for declaration that the cancellation of the policy made by the opposite party is illegal and for a direction to the opposite party to make payment as per the directions of the dfs in complaint nos. 943/2007 and 2674/2008. 7. no doubt that the respondent who appeared through counsel filed its version contending that, the medical report relating to policy no. 1200600182398 was submitted on 21.01.2006 and thereafter policy in question was issued on 09.04.2006 with the date of commencement of risk from 19.12.2005. therefore, the appellant preferred a claim on 24.11.2006 and filed a complaint no. 943/2007 before the 4th addl., df, bangalore which was allowed and the opposite.....
Judgment:

K. Ramanna, President

1. This appeal is filed under Section 15 of the C.P Act, 1986 by the unsuccessful complainant to set aside the order dated 08.12.2011 passed by the III Addl., DF, Bangalore Complaint No.866/2011 whereby the complaint filed by the appellant/complainant came to be dismissed. Therefore, he has come up with this appeal on various grounds.

2. The appellant also filed an application under Section 5 of the Limitation Act to condone the delay of 96 days caused in preferring this appeal supported by his affidavit explaining the delay.

3. In this appeal, we have heard the arguments of the LC for the appellants on admission and perused the records.

4. The point that arises for our consideration is:

1. Whether the appellant has shown sufficient and reasonable grounds to condone the delay of 96 days caused in preferring this appeal?

2. Whether there is any prima-facie case to entertain this appeal and to issue notice to respondent?

3. If so, what order?

5. Point No.1 and 2:- According to the appellant, he had taken two insurance policies from the respondent relating to the claims. Therefore, initially he had filed two complaint Nos. 943/2007 before the 4th Addl., DF, Bangalore which came to be allowed and in respect of another policy in Complaint No. 2674/2008 before the III Addl., DF, Bangalore which also came to be allowed. Against the said order, the respondent/Opposite Party preferred the appeals before this Commission and those appeals were dismissed.

6. Under the policy, appellant claims that, he is entitled to claim insurance amount but, on 29.01.2010 the respondent/Opposite Party sent a letter stating that, they have cancelled one of the policy for the reasons best known to them and they have also returned the premium paid relating to that policy. When he approached the Government Body of the Insurance Council with all his grievances but, his complaint has not been received by any information or reply from the Opposite Party or from that authority. Therefore, filed a complaint for declaration that the cancellation of the policy made by the Opposite Party is illegal and for a direction to the Opposite Party to make payment as per the directions of the DFs in Complaint Nos. 943/2007 and 2674/2008.

7. No doubt that the respondent who appeared through counsel filed its version contending that, the medical report relating to Policy No. 1200600182398 was submitted on 21.01.2006 and thereafter policy in question was issued on 09.04.2006 with the date of commencement of risk from 19.12.2005. Therefore, the appellant preferred a claim on 24.11.2006 and filed a complaint No. 943/2007 before the 4th Addl., DF, Bangalore which was allowed and the Opposite Party has settled the claim for Rs. 2 lakhs. The complaint filed another complaint No. 2674/2008 before the III Addl., DF, Bangalore and the said complaint allowed holding that, the complainant shall claim and the Opposite Party shall decide the said claim. Against the said order, the Opposite Party preferred an appeal and this Commission has directed the Opposite Party to settle the claim within two months from the date of order and the Opposite Party settled the same.

8. In the earlier appeals filed by the Insurance Company which came to be dismissed since in those cases the insurer had informed the ailment to the Insurance Company but, in the present case on hand the complainant has suppressed the ailment.

9. The complainant made a claim on 24.11.2006 seeking several clarifications including the details regarding the treatment taken by him at St. Johns Hospital and KIMS Hospital, Bangalore. The documents produced by the appellant/complainant himself noticed that, he had consulted Dr. Rama Prasad of Bangalore Hospital on 23.11.2005 who identified the problem as renal failure. So the policy was taken by suppressing the pre-existing disease.

10. As per the terms in the proposal form, after submission of the proposal before issuance of the policy, if there is any change in the general health and other conditions, he shall intimate the same in writing to the insurance company. Since the complainant has diagnosed that he was suffering from Bilateral Grade III Neuropathy and Ecotopic Right Kidney and the same is evident that, the complainant was aware that he was suffering from the above said ailment and the fact of said ailment has not been intimated to the insurance company.

11. After considering the evidence, the DF rightly dismissed the complaint mainly on the ground that the policy has taken by suppressing pre-existing disease. The documents produced by the appellant/complainant himself clearly indicates that, he was suffering from Bilateral Grade III Neuropathy and Ecotopic Right Kidney. Therefore, we dont notice any prima-facie case to admit this appeal. Since we are dismissing the appeal on merits, the question of consideration of I.A to condone the delay does not arise. Hence, appeal is liable to be dismissed. Since we are dismissing this appeal on merits, question of considering I.A for condonation of delay does not arise. Accordingly, we pass the following:

ORDER

Appeal is dismissed at the stage of admission. No order as to costs.


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