PER SHRI N.ARUMUGAM, HON’BLE MEMBER
This is an appeal against the judgment and order dated 14/7/2010 passed by District Consumer Forum, Nagpur in CC No.113/10.
Facts of the case in brief are as under…
The Respondent/complainant’s husband Naresh Puri had insured his life for Rs.50,000/- on 28/2/2002 from the O.P. LIC vide policy No.971453974. This policy was assigned to the Gandhibag Co.Op.Bank against the loan. This policy was lapsed in the year 2002 and later was revived in the year 2005. After revival of the policy, on 13/1/2006, as the insured was not feeling well, he was hospitalized in Government Medical College & Hospital, Nagpur, but on the next day, he died. Since the complainant was the nominee, she filed claim with the appellant LIC. However, as she was not getting the claim amount, she filed consumer complaint bearing No.181/08 before the Distt.Consumer Forum, Nagpur.
While hearing the case, the LIC informed the Distt. Consumer Forum that Rs.60,100/- has been sanctioned and the same being sent to Gandhibag Sahkari Bank i.e. the assignee of the policy, but the LIC sent only Rs.11,275/- to the said Bank. Since the complainant could not get the assured amount of Rs.60,100/- she filed another complaint for claiming this amount vide complaint No.113/2010.
On hearing both the parties and perusing the record, the District Forum referred to the provision of Sec.45 of the Insurance Act wherein it is provided that, after the laps of two years from taking the policy, the insurance Company can not repudiate the claim under the garb of wrong information provided by the Insured while taking the policy. Accordingly, the District Forum partly allowed the complaint and directed the appellant LIC to pay the remaining amount of claim after deducting the amount already paid to the Gandhibag Co.Op.Bank alongwith interest @9% p.a.till payment of the amount besides Rs.1000/- as compensation and Rs.1000/- as costs. Against this order, the Appellant LIC has come up in appeal.
We heard Adv.Quazi for the appellant LIC and Adv.Vakil for the Respondent/complainant. Counsel for the Appellant/Opponent argued that After the revival of the policy, the insured died within a month, however, at the time of revival of the policy, the insured did not give correct information about status of his health and the treatment taken at the hospital. As the deceased policy holder suppressed material facts, the claim was not payable under the policy. He argued that the District Forum misinterpreted Sec.45 of the Insurance Act and submitted that this provision is applicable also to the revival of the policy, and in the present case, the insured died within 1 month from revival of the policy.
He further argued that present appellant wrongly informed the consumer Forum that the claim of Rs.60,100/- has been sanctioned and the money has been sent to Gandhibag Co.Op. Bank, but it was a bonafide mistake. He argued that since the deceased policy holder had concealed material information at the time of revival of the policy, only paid up value i.e. Rs.11,275/- was sanctioned and has been sent to the Gandhibagh Co.Op.Bank. He prayed for setting aside the order of the forum.
Adv.Vakil for the Respondent argued that the LIC had clearly stated before the District Forum that the claim of Rs.60,100/- has been sanctioned and the money is being sent to Gandhibag Co.Op. Bank but, in fact, only paid up value i.e. Rs.11,275/- was sanctioned and has been sent to the Gandhibagh Co.Op.Bank. However, this information was not revealed by the LIC either to the Respondent or to the District Forum, Nagpur.
We find that, in the repudiation letter, the Appellant LIC has not given any reason for repudiating the claim and simply stated therein that due to non disclosure of the material information, the claim has been repudiated. This is not acceptable. Once the appellant LIC had informed the District Consumer Forum that the claim of Rs.60,100/- has been sanctioned, they can not now change their stand. Hence the appellant is duty bound to pay the claim amount of Rs.60,100/- to the Respondent/complainant. However, the appellant LIC sanctioned only Rs.11,275/- under the policy and sent this amount to the Gandhibag Co.Op. Bank. However, it did not communicate this fact either to the complainant or to the District Forum. In these circumstances, the Respondent/complainant is entitled to get the remaining amount as rightly held by the District Consumer Forum. District Consumer Forum has rightly considered all these facts and passed a correct order which needs no interference. Hence we pass the following order…
ORDER
1) Appeal is dismissed.
2) No order as to cost.
3) Inform the parties accordingly.
Delivered on 18/10/2011.
