Heard learned counsel for the parties.

2.        Captioned appeal is filed u/s 15 of the erstwhile Consumer Protection Act, 1986 (hereinafter called the ‘Act’). Parties to this appeal shall be referred to with reference to their respective status before the District Forum.

3.        It is submitted by the learned counsel for the appellant that complainant’s daughter Sasmita Dora had taken a New Bima Gold Policy from the opposite party and paid the annual premium amounting Rs. 10,660/- on 17.4.2019. The sum assured under the said policy is Rs. 1,85,000/-. During the currency of the policy, the policy holder died on 10.1.2008. After the death of the policy holder, the complainant  submitted the claim, but the same was repudiated on the ground that policy holder suppressed the material facts of pre-existing disease.

4.        The opposite party filed written submission stating that they have already gone  through the matter and found the claim has no merit because the policy holder was suffering from Rheumatoid heart disease and had undergone neutral valve replacement prior to the date of filing proposal form. It is therefore submitted to set aside the impugned order.

5.        After hearing both the parties, learned District Forum passed the following order:-

              “xxx  xxxxxx

                 The O.Ps are directed to pay the assured amount of Rs. 1,85,000/- (Rupees One Lakh Eighty five thousand) to the complainant with an interest @10% per annum from the date of repudiation of the claim i.e. from 22.10.2010 till payment within one month from the date of receipt of this order.

                 The O.Ps are further directed to pay Rs. 2000/- (Rupees Two Thousand) towards cost to the complainant within the aforesaid time.

                 Accordingly the case is allowed.”

6.        Learned counsel for the appellant submitted that learned District Forum without understanding the law passed the impugned order, but actually it is barred by time and learned District Forum has not considered all the issues. Therefore, he submitted to set aside the impugned order by allowing the  appeal. On the other hand, learned counsel for the opposite party submitted that after the death of the policy holder, there was no one to look after the complainant and his wife. He also supports the impugned order.

7.        Considered the submissions, perused the DFR including the impugned order.

8.        Since it is a case filed against the opposite party by the father of the deceased policy holder and the Hon’ble Supreme Court of India in Mithoolal Nayak Vrs. Life Insurance Corporation of India, reported in AIR 1962 SC 814  held that it is for the insurer to prove the pre-existing disease is there with insured or not.

9.        We have gone through the impugned order and found that the opposite party only relied on the report of the attendant register after the death of the policy holder but there is no documents placed by the learned counsel for the opposite party to prove that the complainant was suffering from pre-existing disease and medical attendant’s document being passed after the death of the insured and in absence of any other document, we are of the view that  O.P. failed to prove that policy holder has suppressed the material fact i.e. pre-existing disease at the time of filing proposal form.

10.      In view of the aforesaid fact, we confirmed the impugned order and the appeal stands dismissed. While confirming the impugned order, we hereby modify the impugned order by directing the opposite party to pay the sum assured to the complainant with interest as ordered, within 45 days from today till the date of payment made.

11.      The appeal is accordingly dismissed.

DFR be sent back forthwith.

           Supply free copy of this order to the respective parties or the copy of this order be downloaded from Confonet or Website of this Commission to treat same as copy supplied from this Commission.