Orissa

StateCommission

A/58/2015

The Branch Manager, LIC of India - Complainant(s)

Versus

Bharati Naik - Opp.Party(s)

Mr. U.K. Mishra

24 Jun 2022

ORDER

IN THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION
ODISHA, CUTTACK
 
First Appeal No. A/58/2015
( Date of Filing : 27 Jan 2015 )
(Arisen out of Order Dated 21/11/2014 in Case No. Complaint Case No. CC/07/2014 of District Sundargarh)
 
1. The Branch Manager, LIC of India
Sundargarh Branch, At/Po/Ps/Dist-Sundargarh.
2. The Divisional Manager, LIC of India
At/Po/Ps/Dist-Sambalpur.
3. The Zonal Manager, LIC of India
East Central Zone Office, Jeevan Deep, 6th Floor, Exhibition Road, Patna.
...........Appellant(s)
Versus
1. Bharati Naik
W/o- Late Bikramaditya Naik, R/o- Vill-Sanpatrapali Sadar, Sundargarh, Dist- Sundargarh.
2. The Bajaj Allianz General Insurance Co. Ltd.
Branch Manager, Cuttack, Surya Vihar, Ground Floor, Link Road, Sramika Bhawan, Cuttack.
...........Respondent(s)
 
BEFORE: 
 HON'BLE MR. JUSTICE Dr. D.P. Choudhury PRESIDENT
 HON'BLE MR. Pramode Kumar Prusty. MEMBER
 HON'BLE MS. Sudihralaxmi Pattnaik MEMBER
 
PRESENT:Mr. U.K. Mishra, Advocate for the Appellant 1
 M/s. P. Chaudhury & Assoc., Advocate for the Respondent 1
Dated : 24 Jun 2022
Final Order / Judgement

                     

            Heard Learned Counsel for the appellant. None appears for the respondent.

           2.The  case of the Complainant innutshell is that the husband of the Complainant had purchased  two life insurance policies bearing nos.592067283    & 592068617 for sum assured of Rs. 150,000/- and  Rs. 1,00,000/- respectively from  the O.P on 28-07-2010  . The policy holder died on 29-02-2012. Thereafter, the Complainant nominee applied for the sum assured but the O.P on the other ground repudiated claim aspolicy holder has suppressed thepre-existingdisease while filing up of the proposal form.Alleging about deficiency in service of O.P complaint was filed.

3.The O.P filed written version stating that two policies have been  purchased by the deceased police holder butsuppressed the pre-existingdisease while filling up of the proposal form .It is averred that  questions alleged in clause 11 was rendered  in negative by the policyholder in proposal  form although he has suffered from pre-existingdisease. For that they have repudiated claim.

4. After hearing the both parties, Learned District forum allowed on complaint.

5. Learned Counsel for the appellant submitted that the LearnedDistrict forum has not gone through the written version filed by the O.P.According to him  the  police holder has  suffered from  previous disease but he has not disclosed such fact in his proposal form. He further submitted that Insurance contract is based on the principles of “Uberrima fide” i.e Utmost Good Faith”Sincethe policy holder has violated the insurance contract by suppressing  material fact ,O.P has called thepolicy in question  U/s 45 ofInsurance Act. So complainant is not liable to get the sum assured. He submitted to set aside the impugned order by allowing the appeal.

6. Considered the submission of learned counsel for appellant and perused the DFR and impugned order. It is admitted fact that the policy holder has purchased two policiesfor sum assured of Rs.1,50,000/- & 1,00,000/-.No doubt onus lies on  the  complainant to prove the case but as per settled principle of law the O.P has to provepre-existingdisease, suppression  of material fact of his pre- existing disease the policy holder  while filled up of proposal form.In the instant case, written version filed by the O.P clearly it is averred  that the policy holder had under -taken kidneytransplant in the year2004 as perrecord but not a singledocument is filed to substantiate his claim .In absence of any document, we are in view that the O.P has not discharged onus of proving the suppression of material fact. When policy holder has answered clause 11 of proposal form correctly, the repudiation of claim by O.P is deficiency in service .Complainant has been proved deficiency in service on the part of O.P. We, therefore confirmed the impugned order. Thus, appeal being devoid of merit   stands dismissed. No. Cost.

 
 
[HON'BLE MR. JUSTICE Dr. D.P. Choudhury]
PRESIDENT
 
 
[HON'BLE MR. Pramode Kumar Prusty.]
MEMBER
 
 
[HON'BLE MS. Sudihralaxmi Pattnaik]
MEMBER
 

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