ORDER

 20.03.2018

Smt. Renu Sinha, Member (F).

                                     The present appeal is directed against dt. 18-12-15, passed by the District Forum East Champaran Motihari, in complaint case no. 125/14 wherein it was directed to op no. 1 Insurance co. to pay complainant and other complainants assured amount Rs. 3,12,000/- with a month, failing which shall be liable to pay the amount with interest @9% p.a from the date of order till date of final payment.

2.                 The complaint case filed by complainant in District Forum alleging deficiency in service against the ops insurance co. for nonpayment of assured amount under the policy claimed after death of her assured husband who died on 22-11-12 due to heart failure and the claim repudiated taking ground of suppression of material facts regarding health found to be suffering from cancer not disclosed in proposal form as wrong as the complainant has already received the sum assured amount against the policies issued by Bajaj Alliance and Reliance Life Insurance co. hence non payment by ICICI Prudential Life Insurance co. on aforesaid grounds not legal and proper. The District Forum after hearing both parties and on consideration of materials produced in case, having found the objections raised for nonpayment of amount not supported by evidence and in view of death certificate not in dispute, the documents issued my Mahavir cancer Sansthan- Patna shows only regarding conducting tests of deceased assured Shailendra Pd. There and not suggest to cancer, and in view of the death claim already paid by other insurance co. after investigation, held deficiency in service on part of insurance co for repudiation claim and accordingly allowed the claim of complainant.

3.                          Being aggrieved with the order of District Forum, the appellant Insurance co. have come in appeal stating the same grounds which were already taken in District Forum with respect to suppression of material facts regarding health/illness by assured who upon investigation found to be suffering from cancer disease prior to taking policy with appellant and was treated at Mahavir cancer sansthan- Patna supported by examination note related to cancer disease issued in name of deceased assured Shailendra Pd. By the said hospital dt. 08-12-11 as evidence whereas the risk of the policy issued by appellants commenced from 13-07-12 was not disclosed by assured intentionally who died due to cancer of penis followed by heart failure.

4.                                              Heard the counsel for the appellants insurance co. nobody appeared for the respondents however have filed their notes of arguments earlier available on record. Perused the entire materials on record as well as the impugned order in detail.

5.                          Admittedly, the deceased Shailendra Pd. Had obtained a life insurance policy issued by present appellants on deposit of first yearly premium covering the risk from 13-07-12 and the policy holder died on 22-11-12 due to heart failure and after death of policy holder the complainant as wife/nominee made claim under the policy of her assured husband repudiated on grounds of concealment of materials facts regarding health who found to be suffering from cancer prior taking the present policy. Now the issues for consideration is whether the deceased policy holder was suffering from cancer disease or not and if was then non disclosing of above fact of health at time of taking present policy was material or not.

6.                         Since the documents as evidence produced by appellants insurance co. in support of their objections as annexure-A-5 issued by Mahavir Cancer Sansthan Patna which is the examination note dt. 08-12-11 mentioned as K/C/O Ca penis in name of deceased policy holder, clearly suggests that the policy holder was suffering from cancer of Penis and was under treatment at Mahavir Cancer Sansthan- Patna and the said documents not been challenged as forged one and in view of admission of complainant of having paid claim for some more insurance policies issued by other insurance co. were also not disclosed in proposal form, establish the facts that deceased policy holder gone through cancer treatment prior to date of proposal, having serious nexus with health of insured who died within four and half month from the date of taking the policy, proves direct nexus between cause of action and prior illness. Therefore, the suppression of facts which was material to disclosed was not done by the policy holder and made false statement while taking present one. For the reason as stated above, the grounds taken for the repudiation of claim by appellants insurance co. appears justified. The District Forum failed to appreciate the above facts in correct perspective and passed the impugned order which is not sustainable and same is set aside.

7.             In result, the order of District Forum is set aside. The appeal stands allowed.

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S.K. Sinha                             Upendra Jha                       Renu Sinha

President                              Member(M)                         Member(F)

        Mukund