BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD.

F.A.No. 455 OF 2023 AGAINST ORDERS IN C.C.454/2022 DISTRICT CONSUMER COMMISSION-III, HYDERABAD Between:

The Manager, Bharti AXA Life Insurance Company Limited, Spectrum Towers, 3^rd Floor, Malad Link Road, Malad (West) Mumbai- 400 064, Maharastra, As per Cause Title in CC 454/2022 Bharti AXA Life Insurance Company Limited, Having its registered office at “Unit No.1902, 19th Floor, Parinee Crescenzo, G Block, Bandra Kurla Complex, BKC Road, Opposite MCA Ground, Bandra (East), Mumbai, Maharastra- 400 051.

Represented through its Authorized Representative Ms.Snehal Sawant, D/o S.Sawant, Aged about 33, Occ.: Senior Manager-Legal, O/o Bharti AXA Life Insurance Co., Ltd., ………..Appellant/ Opposite Party And:

Sri Ankam Yadagiri, S/o Ramulu, Aged about 73, Occ.: Nil, R/o Flat No.202C, Gowtham Towers, Bapunagar, Chikkadpally, Hyderabad-500 020.

……..Respondent/Complainant Counsel for the Appellant/Opposite Party : M/s.Manav Gecil Thomas Counsel for the Respondent/Complainant : M/s. K. Srinivas QUORUM:

HON’BLE SMT. JUSTICE DR.G.RADHA RANI, PRESIDENT HON’BLE SMT. MEENA RAMANATHAN, MEMBER (NJ)

WEDNESDAY, THE 25^th DAY OF FEBRUARY TWO THOUSAND TWENTY SIX ******

Order:

PER HON’BLE SMT. JUSTICE DR.G.RADHA RANI, PRESIDENT

1. The appeal is filed by the opposite party Insurance Company, aggrieved by the order dated 01.05.2023 in CC 454/2022 on the file of District Consumer Disputes Redressal Commission-III, Hyderabad, wherein the complaint filed by the Respondent/complainant was allowed in part, directing the opposite party to pay Rs.15,72,034/- along with interest at 6% p.a. from the date of repudiation letter till the date of realization and to pay costs of Rs.5,000/-.

2. The parties are herein after referred as arrayed before the District Consumer Commission as complainant and the opposite party.

3. (a) The case of the complainant in brief was that the complainant was the husband and nominee of the deceased by name Ankam Nagamani. On 19.06.2019, the deceased Ankam Nagamani had taken Life Insurance policy from opposite party vide policy No.501-9265916. The deceased Nagamani paid 1^st premium of Rs.1,54,480/- on 19.06.2019 and 2^nd premium of Rs.1,51,318.71ps. on 30.07.2020 (wrongly mentioned as 20.06.2021). The opposite party assured a sum of Rs.15,72,034/- towards death benefit and 40 days hospital cash benefit rider. On 22.10.2020 the deceased Ankam Nagamani suffered with Covid-19, due to which she was admitted in ICU Ward of Continental Hospital, Hyderabad as in-patient. While undergoing treatment in the said hospital, the deceased Nagamani succumbed due to cardiac arrest on 07.11.2020. The complainant spent an amount of Rs.9,77,111.34 ps towards medical treatment of the deceased in the said hospital. After the death of the deceased life assured, Ankam Nagarmani, the complainant submitted claim intimation to the opposite party on 15.12.2020 claiming death benefit and hospital treatment expenses of Nagamani. After a gap of 15 days, on 31.12.2020, the opposite party sent claim repudiation letter on the ground of “non-disclosure of material information at the time of making proposal”. On 25.02.2021 the complainant sent his complaint to opposite party Grievance Redressal Cell, Mumbai . But the said Greivance Redressal Cell not replied and dodged the matter. Vexed, the complainant approached the office of Insurance Ombudsman, Hyderabad and filed a complaint. However, the Insurance Ombudsman dismissed the complaint on 09.06.2021. As such, the complainant was forced to approach the District Commission for legal remedy against the opposite party.

(b) The complainant further submitted that the proposal form was not signed by deceased life assured Nagamani, the agent of the opposite party did not choose to take the same from her, for the reasons known to him. The opposite party did not refund premium amount paid. As per the policy condition 7, in case of repudiation, on ground of mis-stat