Per – Hon’ble Mr. S. R. Khanzode, Presiding Judicial Member
Heard Adv. Nandkishore Hiralal Lahoti on behalf of the Appellant/original Complainant, namely – Mr. Murari Shankarlal Jajoo (hereinafter referred to as ‘the Complainant’ for the sake of brevity) and Adv. R. P. Bafna on behalf of the Respondent/original Opponent, namely – The New India Assurance Company Ltd. (hereinafter referred to as ‘the Insurance Company’ for the sake of brevity).
[2] This appeal takes an exception to an order dated 26/8/2003 passed by the District Forum, Nasik (hereinafter referred to as ‘the District Forum’ for the sake of brevity) in Consumer Complaint No.73 of 2000, Mr. Murari Shankarlal Jajoo Vs. The New India Assurance Company Ltd. It is the case of arbitrarily repudiating the mediclaim which was made by the Complainant after he had undergone surgery for piles on 16/9/1999 and for which he was admitted in a hospital for couple of days during the period 16/9/1999 to 25/9/1999. The Complainant preferred an insurance claim for an amount of `27,916/-. Same was repudiated on the ground that at the time of purchasing the insurance policy, the Complainant concealed the information regarding suffering from piles and thus, there is breach of utmost good faith on the part of the Complainant. The District Forum upholding the case of the Insurance Company dismissed the consumer complaint and feeling aggrieved thereby, the Complainant preferred this appeal.
[3] At the outset it may be mentioned that the Commission directed the Insurance Company to produce on the record proposal form i.e. document on the basis of which it can be inferred that the Complainant concealed material fact about the illness regarding piles. Learned Advocate for the Insurance Company submitted that document is not traceable and as such, Insurance Company cannot produce the same on the record.
[4] In the instant case what we find is that after the written version was filed by the Insurance Company, the Complainant filed his affidavit i.e. ‘rejoinder affidavit’, wherein on oath, as revealed from the record, it was disclosed that he had some trouble of piles in the past say about 10-15 years back for which he had undergone operation also but, thereafter he had no problem at all particularly when the insurance policy was taken in the year 1993 and which was subsequently renewed from time to time. The Complainant has specifically stated that since he was not suffering from any problem related to piles, there arose no question to disclose such information when the mediclaim policy was taken.
[5] Crucial issue about the information sought by the insurance company while issuing the insurance policy i.e. information shared by the Complainant in the proposal form is not forthcoming before us. Material to show that the Complainant suppressed material information is not available. Once said parameter is not available it cannot be inferred that that the Complainant has concealed material information. In case of repudiation it is for the insurance company to justify the repudiation. We find that insurance company failed to discharge such onus on them in the instant case and particularly to discard the statement on an oath given by the Complainant. Thus, we find the District Forum committed error in appreciating mater placed before it and arrived at a wrong conclusion. We hold accordingly and pass the following order:-
ORDER
Appeal is partly allowed.
Impugned order dated 26/Aug/2003 passed by the District Forum, Nasik in Consumer Complaint No.73 of 2000 is set aside.
Respondent Insurance Company is hereby directed to pay to the Appellant an amount of `27,916/- together with interest thereon @ 9% p.a., as from the date of complaint viz. 16/March/2000 till realization of the amount.
In the given circumstances, parties to bear their own costs.
Pronounced and dictated on 30th August, 2012
