F.A.No.408 OF 2010 AGAINST C.C.NO.81  OF 2009 DISTRICT FORUM ONGOLE

Between:

Bajaj Allianz LIC Ltd.,
rep. by its Branch Manager,
Near LIC Office, Ongole
Prakasam District

                                                        Appellant/opposite party

                A N D

Sri Puvvada Ramachandra Rao
S/o Hanumantha Rao
R/o Ratnam Diamond Towers
37-1-169 (58A), Kurnool Road
Ongole, Prakasam District

                                                        Respondent/complainant

Counsel for the Appellants                    Sri Srinivas Karra

Counsel for the Respondent                  Sri MAS Narasimha Rao

        QUORUM:   SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER
               

                                                AND

SRI THOTA ASHOK KUMAR, HON’BLE MEMBER

THURSDAY THE TENTH DAY OF NOVEMBER

                                TWO THOUSAND ELEVEN

Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)

                                        ***

1.     The opposite party has filed the appeal challenging the order of the District Forum and contended that the policy holder was suffering from Type 2 diabetes mellitus, hypertension and nephropathy and took treatment with Dr.K.Seetha Ramaian of Venkata Ramana Diabetic and Endocrine Hospital, Ongole from 2004 to 2007 and that after conducting investigation the claim was repudiated by the opposite party.

2.     The factual matrix of the case is that the respondent had obtained two insurance policies bearing Nos.32751751 and 32739973 for  period of 10 years for the sum assured `1,00,000/- under each policy and the date of maturity of the policies is 20.12.2016.  The respondent had paid `20,000/- each towards premium amount.  The respondent is the nominee of the policies.  On 6.2.2007 the mother of the respondent died due to heart attack.  After her death the respondent submitted claim form with all required documents and the same was repudiated by the opposite party on 18.4.2007 on the ground of non-disclosure of material facts at the time of taking policy.  On 21.5.2007 the respondent submitted representation to the review committee of the opposite party at Pune.  The complainant did not receive any intimation from the review committee.

3.     The opposite party was set exparte.

4.     The respondent filed his affidavit and documents Exs.A1 to A8.

5.     The point for consideration is whether the order of the District Forum is liable to be set aside?

6.     The appellant company had issued two insurance policies w.e.f. 20.12.2006 for a period of 10 years for the sum assured of `1,00,000/- under each policy and the date of maturity of the policy is 20.12.2016.  The respondent had paid `40,000/- towards premium for both the policies and the respondent’s mother died on 6.2.2007.  The appellant insurance company has repudiated the claim of the respondent on the ground that his mother had suppressed material facts in regard to her health at the time of taking the insurance policy.

7.     The District Forum has allowed the complaint holding the appellant company liable to pay `2,00,000/- under two insurance policies with interest and compensation for mental agony besides costs.

8.     The District Forum had come to the conclusion that the repudiation of the claim by the appellant company is not tenable basing on the evidence Exs.A1 to A8 placed on record.  The appellant company was set exparte before the District Forum and filed the instant appeal contending that the respondent’s mother had suppressed the fact relating to her health and that she was suffering from Type 2 diabetes with hypertension and nephropathy and she was under the treatment of Dr.K.Seetha Ramaiah of Venkata Ramana Diabetic and Endocrine Hospital, Ongole for a period of 3 years from 2004 to 2007.  The appellant company had filed the documents, proposals, policies, investigation report and certificate of medical treatment issued by Dr.K.Seetha Ramaiah as also repudiation letter dated 18.4.2007.  The documents have been filed along with petition to receive them as additional evidence in the appeal.

9.     The respondent has resisted the receipt of documents as additional evidence.  The documents sought to be received as an additional evidence before this Commission are contended to be essential for the case of the appellant company.  If the documents are received at this stage the respondent would lose an opportunity to challenge them.  Taking into consideration of the nature of the documents and their relevance to the contention of the appellant company, we deem it fit to remand the matter to the District Forum giving opportunity to both parties to adduce evidence oral, documentary besides the opportunity to the appellant company to file its written version.

10.    In the result the appeal is allowed.  The order of the District Forum is  set aside.    The complaint is remanded to the District Forum.  Both the parties shall appear on 17.12.2011 before the District Forum and adduce evidence.  The District Forum is directed to dispose of the matter within three months.  There shall be no order as to costs.

                                                                                   Sd/-

                                                                        MEMBER

                                                                           Sd/-

                                                                        MEMBER

                                                                      Dt.10.11.2011

KMK*