IMPORTANT POINT
Date of – The approximate period reported by the life assured or any other source is not mentioned to determine as to for how long the life assured was alcoholic and this ambiguous situation is not sufficient to hold that the life assured was alcoholic prior to the date of proposal.

JUDGMENT

Gautam Chourdiya, President—This appeal, filed under Section 15 of the Consumer Protection Act 1986 (hereinafter called “the Act” for short) is directed against order dated 13/12/2019 passed by District Consumer Disputes Redressal Forum, Janjgir-Champa (C.G.) (hereinafter referred to as “District Forum” for short), in Complaint Case No.CC/11/2019, whereby the complaint filed by the respondent herein alleging deficiency in service against the appellants herein in repudiating her insurance claim was partly allowed and the appellants were directed to pay within a month the sum assured of Rs.5,00,000/- (Five Lacs) along with interest @ 6% p.a. from the date of compliant i.e. 30.01.2019, compensation for mental agony Rs.10,000/- (Ten Thousand) and cost of litigation Rs.2,000/- (Two Thousand). Feeling aggrieved, the opposite party insurance company has preferred this appeal.

2. In nutshell the facts of the case are that indisputably the husband of the complainant Late Rajababu obtained a life insurance policy from the appellant/ opposite party on 14.03.2015 for sum assured of Rs.5,00,000/- (Five Lacs). During subsistence of the policy on 07.01.2017 the insured husband of the respondent / complainant died. As per case of the respondent/ complainant she preferred claim before the appellant / insurance company in the month of April 2017, which was repudiated. Legal notice was also sent but the same was not replied nor the amount of insurance claim was paid hence alleging deficiency in service on the part of the appellant/ opposite party insurance company, complaint was filed seeking direction for payment of sum assured of Rs.5,00,000/- (Five Lacs), compensation for mental agony Rs.1,00,000/- (One Lac) along with cost of litigation and any other relief.

3. The appellant / opposite party insurance company filed its written version before the District Forum mainly to the effect that the life assured was chronic alcoholic and suffering from ascites with cirrhosis of liver disease, he was taking treatment for the same. He was first diagnosed for ascites and positive cirrhosis of liver on 03.10.2011, which was prior to the issuance of insurance policy but this material information was suppressed at the time of filling proposal form for insurance which amounts to breach of principle of uberrima fides hence the insurance claim was repudiated, in which the insurance company has not committed any deficiency in service.

4. Learned District Forum on consideration of rival contentions of both parties partly allowed the complaint and directed the appellant/ opposite party to pay the sum assured, compensation for mental agony and cost of litigation as aforesaid in paragraph No.1.

5. We have heard final arguments of both parties, perused the record and the written arguments submitted by learned counsel for the respondent / complainant.

6. Learned counsel for the appellant / opposite party has filed certain document as per list along with an application under order 41 rule 27 of CPC, marked as I.A. No.01/2023, which has already been allowed and documents are taken on record. Along with the application the documents filed are photocopy of Liver Function Test of the deceased dated 31.10.2011, his treatment records of 2016 and 2017, letter of repudiation and investigation report, death certificate etc. whereas most of them were already filed before the District Forum and were considered.

7. Before us the appellant/ opposite party has reiterated the facts stated and grounds taken in the written version and argued that the learned District Forum has erred in appreciating the terms of the policy, information filled in the proposal form by the deceased life assured and his treatment records in the light of Section 45 of the Insurance Act, 1938 and has passed an erroneous order, hence this appeal needs to be allowed setting aside the impugned order. Whereas the learned counsel for the respondent/ complainant has supported the impugned order and argued