1. THIS is an appeal against the judgment and order dated 8.5.1995 passed by the District Forum, Jeypore in Complaint Case No. 21 of 1995.
2. THE brief fact of the case is that Smt. Miniyaka Parbati w/o Late Miniyaka Salabu is a nominee of the insurance policy for Rs. 15,000/- under Policy No. 581206633 taken by her late husband for a period of 10 years. Her husband died on 11.11.1993 while in service. THE Insurance Company repudiated the claim on the ground of suppression of material facts. Complaint claims that all the documents including the claim forms were submitted by the complainant in time.
The District Forum after considering the case of the parties held that the Insurance Company repudiated the claim without any valid reason. It recorded a finding that there was deficiency in service on the part of the Insurance Company. Hence it decreed the claim for payment of the assured amount with bonus.
Aggrieved against the order of the learned District Forum, the Insurance Company have come in appeal through his Advocate Mr. Samantray and have challenged the correctness of the order of the District Forum and contested the case as under : The deceased was undergoing treatment for burnt injury and for Acid Peptic disease as an OPD patient during the period from 2.12.1990 to 4.1.1991 and 2.9.1991 to 18.9.1991 i.e., within 5 years prior to the policy. Hence the cause of death could be due to his previous ailments. So, the life assured concealed material facts. Hence, the claim is not maintainable.
3. WE have heard the learned Counsel for the parties and have perused the evidence on record. Question arises as to whether the petitioner is a consumer and the repudiation is justified. In this connection, the Hon''ble National Commission in United India Insurance Co. Ltd. v. P.S. Mani, reported in II (1992) CPJ 354 (NC)=1992 (2) CPR at Page 91, took the view that "if the repudiation of the liability under the policy is arbitrary and is not based of an enquiry, the claim can be entertained by the Forums constituted under the provisions of the C.P. Act, 1986 and appropriate relief can be granted". In view of this decision, the Forum below had jurisdiction to treat the petitioner as a beneficiary, and thus a consumer. Insurance business is based on contract and is also a service to the policy holder. But a lay man is not in a position to evaluate critical terms and conditions incorporated in the insurance policies. Mr. Samantray, the learned Counsel for the Insurance Company strenuously argued relying on a decision of the Hon''ble National Commission reported in 1994 (1) CPR at page 31 that there is no deficiency of service on the part of the Insurance Company. This is not accepted by us because the deceased died on 11.11.1993 on account of burnt injury and Acid Peptic. No material has been filed by the L.I.C. to show the cause of the death of the deceased. It has been alleged by the complaint that the death of the deceased took place suddenly and had no serious disease from before. The medical report on his physical condition is sufficient proof of this fact. The Insurance Company also failed to show that the deceased was suffering from any serious or fatal disease which he had suppressed at the time of filling up of the proposal form. Thus, the Insurance Company has failed to prove that any fact which was material to be disclosed at the time of taking policy was suppressed by the insured. The Forum below after taking into consideration, the relevant materials placed on record and after hearing the projection of hues of the respective parties through their respective learned Counsel ultimately rendered a finding that there was deficiency in service on the part of the Insurance Company. WE entirely agree with the above finding of the Forum below which needs no interference. So, both on facts and law, the L.I.C. stands nowhere. Thus we come to the conclusion that the appeal is to be dismissed being devoid of merit with modification that the Insurance Company to make payment of the assured amount of Rs. 15,000/- plus Rs. 500/- as cost to the petitioner within two months from the date of receipt of this order failing which the Insurance Company will be liable to pay interest @ 12% on the awarded amount from the date of this order till payment. Appeal dismissed.
