Heard the learned counsels for both the parties.
2. This appeal is filed U/S-15 of erstwhile Consumer Protection Act,1986(herein-after called the Act). Parties to this appeal shall be referred to with reference to their respective status before the learned District Forum.
3. The factual matrix leading to the case of the complainant, is that the complainant/appellant is that the complainant’s father late Adhibas Raut has purchased a insurance policy under the product Sahara Kavach Pure Term Policy. It is alleged inter-alia that the policy holder was examined by the doctor of O.P. and after health condition being recommended, the policy holder was issued the policy commencing from 27.11.2013 for sum assured of Rs.7,00,000/-. But the complainant alleged that on 12.02.2014 the policy holder died and thereafter the matter was informed to the OP for settling the claim. But the OP repudiated the same stating that the policy holder has suppressed the material of fact of pre-existing disease suffered by him. Finding the deficiency of service on the part of the OP, the complaint was filed.
4. The OP filed written version stating that the policy was purchased by the policy holder Adhibas Raut for sum assured of Rs.7,00,000/- on 27.11.2013. But the policy holder of Adhibas Raut has suppressed the material fact of his pre-existing disease because he has been diagonised caner on his person by Tata Memorial Hospital which he has not disclosed while filling up the proposal form. As the policy holder has suppressed material fact, the OP repudiated the claim. So, there is no deficiency in service on the part of the OP.
5. After hearing both the parties, learned
District Forum passed the following order:-
Xxxxx xxxxxxxx xxxxxx
“ In the result, the case of complainant is partially allowed against the Ops. We direct the Ops who are jointly and severally liable to refund the premium amount of Rs.10,223.64 paise together with litigation cost of Rs.2,000/- to the complainant within 45 days from the date of receipt of this order failing which the complainant is at liberty to recover the same under Section 25/27 of the Consumer Protection Act,1986. The case of the complainant is disposed of accordingly. No order as to compensation.”
6. Learned counsel for the appellant /complainant submitted that learned District Forum has committed error in law by not understanding the case of the complainant. According to him the complainant had been to Tata Memorial Hospital for check up and he was never treated there. Learned District Forum ought to have considered the matter keeping in view the development of the law. It is also contended that learned District Forum erred in law by not applying the judicial mind to the Section-45 of the Insurance Act which envisages that suppression of material fact not only violating good faith but also exploits public exchequer. Since, the policy holder has died, he is entitled to get entire sum assured because death occurred before money encashed. So, he submitted to set-aside the impugned order by allowing the appeal.
7. Learned counsel for the respondent submitted that due to suppression of pre-existing disease they have repudiated the claim and same has been accepted by the learned District Forum. They have obtained that the order of the learned District Forum and there is nothing remained to decide in this appeal. He has already been paid the dues as ordered by learned District Forum.
8. Considered the submission of learned counsels for the parties, perused the DFR and impugned order.
9. It is admitted fact that the complainant has purchased the policy from Op commencing from 27.11.2013 for 15 years. It is also not in dispute that the claim has been repudiated U/S-45 of the Insurance Act. But in the instant case the Hon’ble Supreme Court of India passed judgment in Moothlal Nayak-vrs- LIC of India reported in AIR 1962 SC-814 which is relied on. With due regard to aforesaid decision, it is held that the suppression of material fact or mis-statement or any fraudulent conduct of insured would be seriously viewed. According to the decision, the onus lies on the OP to prove the suppression of pre-existing disease of the policy holder. It appears from the copy of the medical report of Tata Memorial Hospital that on 10.04.2013 insured was treated there for the terminal disease but the proposal form shows that he has filled up the form showing all negative answer to the queries made. Since, the insurance contract is based on the good faith. So, the complainant is found to have suppressed the material fact while filling up the proposal form. In this regard, the view of the learned District Forum is accepted and there is no any illegality in scrutinizing the case.
10. The plea of the learned counsel for the appellant is that the policy holder has no knowledge about the contacts and it is only Sitaram Das who is a LIC agent filled up the form but the facts remain that the policy holder has suppressed the material fact.
11. In view of aforesaid discussion, this Commission is in fully agreement with the order of the learned District Forum. However, learned District Forum has directed to return the premium paid to the complainant but in the meantime learned counsel for the appellant submitted that he has already filed necessary money receipts showing payment.
12. From the foregoing discussion, this Commission hereby affirm the impugned order and appeal stands dismissed as no further relief can be granted to the appellant/ complainant. No cost.
Free copy of the order be supplied to the respective parties or they may download same from the confonet or webtsite of this Commission to treat same as copy of order received from this Commission.
DFR be sent back forthwith.
