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GAUTAM CHOURDIYA, PRAMOD KUMAR VARMA
In the matter of the Branch Manager, India First Life Insurance Company Limited – Appellant
Versus
Rohini Bai W/o. Late Rajababu – Respondent
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 res
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 s....
Insurance—Repudiation of death claim on the ground of concealment of disease must be supported with reliable and cogent evidence.
Life Insurance Policy – Repudiation of death claim on the ground of suppression of material facts – Mere existence of past medical records is insufficient unless knowledge on part of insured is prove....
(1) Full Knowledge – DLA had the full knowledge of pre-existing ailments at the time of filling the proposal form and there was a nexus with preexisting disease and the cause(s) of death.(2) Proposal....
(1) The Principle of Uberrima Fides (Utmost Good Faith) – The Commission reiterated that the relationship between an insurer and the insured is founded on mutual trust. The insured is under a “solemn....
Pre-existing disease – life assured has deliberately concealed the true facts about his state of health and suppressed his pre-existing disease.
Insurers cannot repudiate a claim without establishing a direct causal link between disclosed ailments and the cause of death.
Medical Examination – Insurance company is responsible for conducting a medical examination of the policyholder in advance.
Repudiation of death claim on the ground of concealment of pre-existing ailment – Onus lies upon Insurance company to prove factum that at the time of taking insurance policy in question, deceased li....
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