The main legal point established in the judgment is the application of Section 45 of the Insurance Act in cases of repudiation of claims, emphasizing the need for the insurance company to prove intentional misrepresentation or suppression of material facts by the insured.

JUDGMENT :

1. The appeal is challenge to the order of the District Forum which allowed the claim of the respondent in respect the insurance policy.

2. FACTS OF THE CASE

The respondent's husband namely Midde Chinna Rao during his life time obtained two insurance policies bearing numbers 681327665 and 686664478 for a sum assured of Rs.34,000/- and Rs.10,00,000 on 31.3.1997 and 12.2.2003 respectively from the Life Insurance Corporation of India represented by the appellants No.1 and 2. The respondent was appointed as the nominee by her husband. The respondent's husband died on 16.3.2003. After the death of her husband, the respondent submitted claim along with relevant documents. The second appellant partly settled the claim that arose under the insurance policy number 681327665 and repudiated the claim under the insurance policy number 686664478 on 29.11.2003. The respondent had sent a letter to the appellant no.2 as to now the repudiation of the claim was bad and the facts and circumstances in support there for.

3. CLAIM OF THE RESPONDENT

The respondent's case is that immediately after the death of her husband, she had informed the appellants about the incident. The appellants had sent cheque for Rs.17,000/- instead of Rs.34,000/-. She had explained in her letter dated 4.2.2004 the facts that support her claim such as her husband's death in the accident, and these facts which falsify the grounds of repudiation of her claim, to the zonal office of the appellants and thereafter she addressed letters on 22.12.2004, 31.1.2005 and on 11.2.2005 and the letters had not evoked any response from the appellants.

4. The respondent had approached the Insurance Ombudsman who in turn directed her to approach the Claims Review Committee owing to the amount of Rs.2,00,000/- sought under the claim exceeding his pecuniary jurisdiction. It is contended on her behalf that a criminal case was registered against the driver of the Auto and that the United India Insurance Company settled her claim under Janatha personal accident policy as also satisfied the award passed in her favour in M.V.O.P. No. 1005 of 2003 passed by the M.C.A.T. Khammam, It is contended that arbitrary repudiation of the claim amounts to deficiency in service on the part of the respondents and .as repudiated in order to avoid payment of the amount due under the insurance policies obtained by her husband.

5. DEFENCE OF THE APPELLANTS

The Appellants resisted the claim by filing written version. The issuance of the insurance policies, the death of the respondent's husband and repudiation of the claim of the respondent are admitted. In the claim form submitted on 24.6.2003 the respondent mentioned that her husband died of cancer. Therefore, the accident benefit will not be payable. The accident benefit is payable when the insured died in an accident as described in clause 10(b) of the policy conditions. Hence, basic sum with bonus was paid to the respondent. It is submitted that the insured suppressed that he was treated for throat cancer during the year, 2002 in MNJ Cancer Hospital, Hyderabad and the respondent submitted a disclaimer on 9.5.2003. It is contended that the claims review committee of the appellant corporation confirmed the repudiation which was communicated to the respondent on 11.8.2005.

6. EVIDENCE ON RECORD

The respondent has filed her affidavit. Photo copies of the two insurance policies, repudiation letters, Copies of FIR, Charge Sheet, Report of Post Mortem Examination, Death Certificate of the respondent's husband, Award passed by the Lok Adalat, letters addressed to the appellants and the zonal committee, Claims Review Committee, communication from the Insurance Ombudsman, are marked as ExAl to A29.

7. On behalf of the appellants, their legal assistant has filed his affidavit. The proposal form submitted by the respondent's husband, copy of cash sheet issued by MNJ Hospital, Hyderabad, claim form, policy band copy of repudiation letter and the letter from the respondent i