State Consumer Disputes Redressal Commission
Divisional Manager,Life Insurance ... vs Akhatarbi Sayyed Imam Ali, on 12 March, 2009
1 F.A.317-08
STATE CONSUMER DISPUTE REDRESSAL COMMISSION,
MUMBAI, CIRCUIT BENCH AT AURANGABAD.
Date of filing : 19.03.2008
Date of Order : 12.03.2009
FIRST APPEAL NO. 317 OF 2008
IN COMPLAINT CASE NO. 253 OF 2007
DISTRICT CONSUMER FORUM: OSMANABAD.
1. Divisional Manager,
Life Insurance Corporation Auragnabad
Divisional Office, Jeevan Prakash,
Adalat Road, Aurangabad.
2. Branch Manager,
Life Insurance Corporation,
Branch at Osmanabad. ...Appellant
VERSUS
1. Akhatarbi Sayyed Imam Ali,
R/o. Parshuram Housing Society,
Opp. M.S.E.B. Sub Station,
Sanja Road, Osmanabad.
2. Hajara Sayyed Imam Ali
3. Salma Sayuyed Imam Ali
4. Saji Sayyed Imam Ali
u/g of respondent no.1
All r/o. As above. ... Respondents.
Coram : 1) Shri. M.N. Ahmed, Hon'ble Judicial Member
2) Mrs. Uma S. Bora, Hon`ble Member.
Present: Adv. Murar V. Deshpande, for appellant.
Adv. Vikas Tanwade, for respondent.
:: ORAL ORDER ::
Per Mrs. Uma S. Bora,, Hon'ble Member
1. Divisional Manager, LIC Aurangabd and Branch Manager LIC Osmanabad challenges in this appeal judgment and order passed by 2 F.A.317-08 Dist. Forum Osmanabad in complaint case No. 250/07 decided on 11.02.08.
2. Complainant Akhtarbee Sayyad Imam Ali is wife of deceased Imam Ali Sayyad Ahmed Ali and complainant No. 2 to 4 are children's of deceased Imam Ali. Deceased Imam Ali obtained policy No.984310839 for sum assured of Rs.55,000/- in the year 2005. He also obtained policy No. 984313557 for Rs.1,00,000/- On 15.09.2005. Imam Ali went for nature call and thereafter on well to clean the hands. At that time he fell in well and died by drowning. Complainant preferred the claim with opponent LIC which was repudiated on the ground that deceased had suppressed the material facts about his health, while obtaining the policy. Therefore, complainant approached to Dist. Forum by demanding total Rs.3,25,000/- .
3. Notices were issued to the opponents. They appeared before Dist. Forum and resisted the claim. It is submitted that immediate after obtaining the policy, life assured died therefore, it reveals that the deceased had suppressed material facts about his health. Life assured was suffering from chronic deceased which was not mentioned in the proposal. Therefore, his claim was repudiated rightly.
4. After hearing both the parties Dist. Forum directed opponent to pay assured amount with all its benefit within 30 days.
5. Notices of final hearing were issued to both the parties. Adv. Murar V. Deshpande, appeared for appellant. Adv. Vikas Tanwade, appeared for respondent. Appellant submitted that claim of life assured was repudiated as he suppressed the material information at the time of taking the policy. Prior illness suffering by policy holder was suppressed while obtaining the policy. Therefore, the claim made on the basis of 3 F.A.317-08 accidental death was rightly repudiated. Life assured was very much aware of the disease of arthritis and even then it appears that he has gone to the well. It appears that he can not to well in case of such an injury of back and arithirities of joints, paralysis a person, when falls in water and causes death.
Dist. Forum committed error while appreciating the evidence brought by appellant.
6. Adv. Tanwade submitted that, life assured was died due to drowning in the well; there is no nexus between his illness and cause of death. Dist. Forum rightly considered all the facts and material on record and rightly directed LIC to pay the policy amount with benefit. In support of his argument he filed one authority of National Commission reported in 2008 (4) CPR 399 (NC) in Sukumar Bag vs. Oriental Insurance Co. It is held by National Commission " If a party wished to rely upon evidence of any expert then that opinion was to come to form of affidavit " He submitted that no affidavit of any expert doctor was produced on record by LIC. The suppression of material fact was not proved beyond doubt. Therefore, appeal be dismissed and complaint be allowed.
7. We heard the arguments of both the advocates and perused the record.
8. Whether the fact is material or not has to be decided in the light of and in the context of cause of death. If the fact has bearing on the cause of death it would become material be said to be material, otherwise it could not said to be mere incorrect or wrong answer to questions which ultimately do not have any bearing or connection with the death of the insured would not absolve the Corporation from its liability under the policy.
4 F.A.317-08 Onus in cases of fraudulent suppression of material facts rests heavily on the party alleging fraud, namely the insurer therefore, that burden has to be discharged by the LIC and in the present case the respondents LIC had failed to discharge that burden and, therefore the stand taken by the respondent LIC in repudiating the claim of the complainant could not be acceptable.
9. National Commission in LIC Vs. Smt. Tejalben Kananbhai Patel held that, the illness which was suppressed by the policy holder and actual cause of death when total different there can not be suppression of fact the expert opinion should be produced in the form of affidavit so that other party could challenge the said evidence by cross examination or otherwise. In the light of above discussion, we are of the view that there is no nexus between the suppression of ill health of policy holder and cause of death of policy holder. We are therefore do not inclined to interfere the order of Dist. Forum. Hence the order.
// O R D E R //
1. Appeal is dismissed.
2. Appellant to pay the cost of Rs.1,000/- to the respondent in appeal.
3. Copy of order be furnished to the parties.
Mrs. Uma S. Bora M.N. Ahmed
Member Presiding Judicial Member
Kalyankar