DATED THE 31st MARCH, 2017
O R D E R
SMT.SMARITA MOHANTY, MEMBER
This appeal has been preferred against the order dated 12.5.2014 passed by District Forum, Angul in C.C.no. 10 of 2011.
The brief facts of case are that complainant’s wife was insured under opposite party – Insurance Company during her life time. She was insured under Jeevan Anand policy bearing no., 586508156 with profit and accidental benefit for an assured sum of Rs.1,00,000/-. The policy period was valid from 28.5.2006 to 28.5.2027. The mode of premium was half yearly of Rs.2,896/-. Complainant was the nominee under the said policy. Unfortunately, the insured died on 25.1.2009 due to sudden illness. Complainant being the nominee claimed for the benefit under the said policy but in vain. Complaint therefore filed a complaint case before the Forum below and prayed to direct opposite party to pay the benefit under the policy and compensation and cost.
Opposite party in his written version contended that the case is not maintainable. Admitting the fact of policy it was contended that after paying the second premium, the policy had lapsed and the same was revived by the deceased life assured just six months and 23 days after her death. The actual revival of the policy was on 1.7.2008. It was contended that the insured had suppressed the material fact of her treatment at SCB Medical College and Hospital, Cuttack during the revival of policy in question. It was contended that the policy holder was treated for scleroderma disease since 21.8.2007 by Dr.Deepak Garnaik of Angul and form 19.12.2008 in S.C.B.Medical College and Hospital, Cuttack. Further, it was contended that the said policy lapsed on 1.12.2007 due to non-payment of premium within stipulated period or grace period. Later policy holder revived her policy on 1.7.2008 by submitting relevant medical certificate. It was contended that after the death of the policy assured, complainant the nominee claimed against the said policy which was repudiated on the ground of suppression of material fact by deceased insured. During the initial stage of proposal of the policy and revival of lapsed policy which was revived on 1.7.2008. Opposite party, therefore, prayed for dismissal of the case.
After hearing the counsel of both parties and going through the record learned District Forum directed opposite party to pay a sum of Rs.2,00,000/- as per the scheme of insurance policy in question as benefits with interest @9% per annum from the date of filing of the case i.e., from 17.1.2011 till its realisation to the complainant.
It was further directed to pay a sum of Rs.20,000/- as compensation for deficiency of service causing mental agony and harassment along with a sum of Rs.2,000/- towards cost of litigation to complainant. The above order was to be carried out within four weeks from the issuance of the order.
Being aggrieved of the aforesaid order, opposite party in the Forum below filed the present appeal before this Commission on the ground that respondent deliberately suppressed the material fact which has vitiated the deceased life assured’s insurance and appellant has rightly repudiated the claim as per the provision of Section 45 of Insurance Act. When the policy is valid for the deliberates suppression of material fact, the same cannot be enforced at the instance of the nominee. Hence, the impugned order is liable to be set aside.
