Learned counsel for the appellant is present.

2.             Learned counsel for the respondent is present.

  3.           Heard learned counsel for the respective parties.

  4.       This is an appeal U/S-15 of erstwhile  Consumer Protection Act,1986(herein-after called the Act). The appellant was the OP whereas the respondent was the complainant before the learned District Forum. Hereinafter, the parties to this appeal shall be referred to  with reference to their respective status before the learned District Forum.

5.            Learned counsel for the  appellant submitted that the complainant has purchased two policies bearing No.598556163 for Rs.5,00,000.00 and 598559258 for Rs.1,00,000.00 from OP respectively. It is alleged inter-alia that these policies commenced on 28.05.2012 and 12.12.2012 respectively. The policy holder suddenly became ill and was treated at SCB Medical, Cuttack. After that he shifted to another hospital where he expired on 03.03.2013. According to him after death of assured the complainant filed this case.

 6.          Learned counsel for the appellant submitted that the OP filed written version stating that the deceased assured has purchased two policies just before three months of his death. It is further submitted that the proposal form of the deceased assured is silent  about suffering from any disease.  As the deceased was suffering from pre-existing diseases, the OP found that the  deceased assured is  not entitled to any compensation. So, OP repudiated the claim.

7.     Learned counsel for the appellant submits that learned District Forum, after hearing both the parties,illegally allowed the complaint.

8.           Learned counsel for the appellant submitted that the impugned order being illegal and improper should be intervened by this Commission.  According to him learned District Forum, without appreciating the report of the DMR allowed the complaint. Learned District Forum ought to have dismissed the complaint because no sufficient materials have been produced to allow the complaint.

9.            Learned counsel for the appellant  submitted that as the deceased assured has  pre- existing diseases and same  have been proved by the Op through an expert, learned District Forum committed error in law by not rejecting claim.  In toto he submitted to set-aside the impugned order by allowing the appeal.

10.           Learned counsel for the respondent submitted that medical report is clear to show  that the complainant’s father was suffering from Polycystic Liver disease and pneumonia  for which he  died and he has not suppressed any material fact about suffering from any pre-existing diseases. Learned District Forum have not committed any error and after going  through the materials on record alleged compensation. So, he submitted to dismiss the appeal.

11.         Considered the submission of respective parties, perused the DFR including impugned order.

12.          It is admitted fact that the deceased assured has purchased two policies from the OP. It is also not in dispute that the deceased expired three months after commencement of two policies. Section-45 of the Insurance Act is clear shows that the insured can  call the policies in question within a period of two years if there is suppression of material fact or making …. statement or any fraudulent statement while proposing to  purchase policies. It is well settled in law that onus lies on the insurer to prove those facts to call the policies in question. OP depends upon report of DMR(Divisional Medical report)  but such DMR has not been examined by the OP to support this case.  

13.     In view of the above discussion this Commission is of the view that OP has failed to discharge his onus by proving that the complainant was suffering from any pre- existing diseases and as such suppressed the material facts while purchasing the two policies. On the otherhand complainant has clearly proved medical documents of SCB medical college and hospital when he was treated by Dr.U.C.Patra the Professor of Hepatology. His official record and …. with report is clear to prove assured death.  Therefore, learned District Forum, after analyzing the facts  and figures has also observed that the repudiation of the claim is illegal and as such there is deficiency of service on the part of the OP. So, this Commission fully agree with the view of the impugned order of the learned District Forum.

14.     In the result, the impugned order of the learned District Forum is hereby confirmed and appeal stands merit. No cost.

           Free copy of the order be supplied to the respective  parties.

           DFR be sent back forthwith.